Dorschima Jones has worked at nursing homes in Doylestown for 33 years. She loves it.
“I love the residents. I love going to work. I love seeing the residents smile when I go in the room because some of the residents don’t have family,” said Jones, then pausing for a moment. “So, I feel like I’m their family. I’m who they look forward to and I just enjoy my job.”
While no one has a crystal ball, if the U.S. Congress passes the Republican budget, Jones and her residents may have to part ways. Coming up for a vote – at least according to some economists – is hundreds of billions of dollars in cuts to Medicaid. This is bad news for seniors who rely on nursing homes and home care – not to mention their families who want them cared for.
“By and large, over 60% nursing home and home care services are paid for from Medicaid directly,” said SEIU Healthcare Pennsylvania’s President Matthew Yarnell. And, in Bucks County the vast majority of nursing homes rely on Medicaid – 26 out of 31.
Understanding the Republicans’ plans to extend and/or expand the tax cuts that are set to expire later this year, requires one to understand the complexity of federal funding mechanisms. Lawmakers must find $4.5 trillion to fund it. And while there’s no language calling for that explicitly, the math makes it impossible to achieve without gutting Medicaid.
Economists have estimated that allocating that kind of money will require cuts from all federal agencies – and economists have estimated that this will likely necessitate Medicaid’s portion of those cuts be a cool $880 billion. Pennsylvania spends nearly $45 billion on Medicaid each year, with just shy of 60 percent of that reimbursed by the federal government.
If you’re doing the math at home, $880 billion is 19.56 percent of the tax cuts coming from health care for the nation’s most economically disadvantaged children, families and elders.
“What I think is happening is basically a distribution [of wealth] away from low income to high income individuals,”explained Ebru Kongar, Professor of Economics at Dickinson College.
From Richlandtown to Bristol, Bucks County nursing home patients, home care patients, and the staff who care for them will be directly impacted.
SEIU’s Yarnell notes that for many people, keeping a loved one in their home isn’t just preferable, it’s essential for everyone involved.
“As a union we fight really hard for improvements to the home care system so people can stay at home or have the choice to get the care in the setting where they want,” he said. “We know that it’s really important that there are actual skilled nursing facilities that can take care of people who are requiring 24-hour care who maybe can’t receive that any longer in their homes.” And, Yarnell added, “Medicaid is the largest payer for both those programs.”
Locally, Jones isn’t just a CNA who loves her job and provides excellent care to the people at the facility where she works. Jones is the mom of a special needs child who receives 85 hours of skilled home care, weekly – care that’s not only essential for his well being, but that allows Jones to work outside the home and provide for their entire family.
READ: More Than 5 Million Americans Could Lose Medicaid Coverage if Feds Impose Work Requirements
Jones worries what will happen if Congress, with the help of Fitzpatrick, makes the predicted cuts to Medicaid. If the long-term care facility where she works loses funding, she may lose her job – even with 33 years of experience and SEIU fighting on her behalf.
Of course, if her son loses his Medicaid, she won’t be able to work anyway.
But when asked what she’s really afraid of, Jones fears for her patients. “I’m afraid for them because a lot of residents gave up their homes. They didn’t have a choice to come into the facility,” said Jones. “What would happen [if they can’t pay]? Where will they go after this, if there’s no Medicaid? We have some residents that may have mental health issues. I’m scared for them.”
Dr. Val Arkoosh, Secretary of the Pennsylvania Department of Human Services, echoed the potentially grim forecast for Medicaid-funded health care in the commonwealth, should Congress pass their proposed budget. “It would be devastating.”
Arkoosh harkened back to the time before Medicaid expanded in 2015. Increased eligibility for Medicaid brought 750,000 Pennsylvanians into the system. Arkoosh predicts that the proposed cuts will mean that there will be, “Many uninsured individuals and many still with Medicaid but with far less benefits.”
According to Arkoosh, it won’t just hurt the patient – cutting Medicaid will be disastrous for hospitals that are duty bound to provide emergent care. Speaking about hospitals in the more economically distressed regions of Pennsylvania, Arkoosh stated, “These hospitals can’t tolerate any increase in uncompensated care.”
As for wealthy Bucks County, where median household incomes are some of the highest in Pennsylvania, 14% of the residents – 91,023 people – rely on Medicaid for their health insurance plan. Eliminating or restricting services to these individuals, especially those receiving long term care, will wreak havoc in the 26 nursing care facilities in Bucks County that accept Medicaid and provide for the needs of these patients. Of Bucks County’s 31 long-term care facilities, just five do not accept Medicaid.
Asked why it’s all happening and what can be done, Yarnell asked that people look to the government – to the people in charge. “This administration has made a point, you know, they have an approach that seems to be deeply vindictive.”
Like Kongar, Yarnell sees a massive transfer of wealth and priorities. “They have essentially tossed the keys of the car in our economy to billionaires. Billionaires didn’t become billionaires because they like to share,” said Yarnell. “All of them are pretty far from what it’s like to be living in complete poverty and then being faced with the cost of everything just completely jumping out of people’s ability to participate. I think we’re in a real danger zone.”
As for whether or not SEIU can exert enough pressure to stop those billionaires from hurting Jones, her patients and her son, Yarnell answered, “We are working really hard. We think there are a couple of key house districts where we’re working really hard to both build relationships and hold [law makers] accountable. You know, Republicans that are in what are significant swing districts. Several of them here in Pennsylvania.”
READ: State-by-state Report by Democrats Projects Millions of People Could Lose Medicaid Coverage
When asked to name those swing district Republicans that SEIU is demanding make good on their claims – Yarnell included Bucks County’s own Congressman Brian Fitzpatrick. “Fitzpatrick is one. He’s been public and saying that he will not vote for a budget to cut Medicaid.” But he nevertheless continues to support the GOP budget which makes not cutting and gutting Medicaid impossible.
“We have been in public conversation, private conversation and really staying on him and you know he continues to say he will not vote for a bill that cuts Medicaid. So, we are doing everything we can to keep him at his word,” Yarnell added.
Sure enough, on Fitzpatrick’s own website he states boldly, “I will continue to protect Medicaid and the Children’s Health Insurance Program.” Still, with no town halls and an unwillingness to speak publicly to constituents, or go on the record with local media, Fitzpatrick’s true intentions are impossible to gauge. Should Fitzpatrick go back on his word, the Center for American Progress estimates that PA District One – Fitzpatrick’s own district – will lose $2 billion in Medicaid and Children’s Health Insurance Program Funding over the next 9 years.
Fitzpatrick’s April 11 press release excused his vote for the Republicans’ spartan budget, claiming his vote was necessary to insure that tax cuts for the wealthy don’t expire. And, he renewed his promise to protect the district’s residents. “As deliberations move forward, I remain firmly committed to protecting the benefits that our seniors, individuals with disabilities, and most vulnerable neighbors rely on through Medicare, Medicaid, and Social Security.”
Because the House is still wrangling with the Senate over a budget where the two bodies remain trillions of dollars apart – and because Fitzpatrick has already voted with his Republican colleagues – Yarnell thinks Bucks County voters need to reach out and add their comments to those of the union leaders.
“Fitzpatrick, I mean he’s gonna [need to] be standing up to Donald Trump who’s gonna call and say, ‘You have to vote for my budget or I’m gonna primary you.’ And then there will be a second phone call that comes from Elon Musk that says, ‘I’m gonna spend $100 million in your district to defeat you.’ This is what these folks are gonna be up against when they decide.”
That’s where the voters come in, “We’re gonna have to make sure that they understand that there is a human cost to the decisions they’re gonna make.”
Yarnell added more broadly, “We’re trying to do everything we can in those key districts to help those Republicans understand that there will be real consequences.”
