My partner Michael and I have assumed the primary responsibility for Mary, the 96 year old mother of his late partner Louis, who died in 1989. Michael and Louis were together for 14 years and, after Louis died, Michael continued to visit her and take her shopping nearly every weekend. After I came on the scene in 1992, I learned immediately that I would be gaining two de facto mothers-in-law, one off in Texas and one right here in New York City. Mary was quite self-sufficient until last November, but then she effectively lost the use of her right arm. In our efforts to make sure that she has the help she needs, we have discovered how the administration of Medicaid seems intended to foster resentment against the poor and immigrants.
With Mary unable to dress, get meals or bathe herself like she used to, we needed to get a home health aide. At first, we sought help under Medicare and found out that Mary could only get 4 hours a day, 5 days a week. The aide who was assigned was a wonderful woman originally from Liberia. We made private arrangements with her for an extra 4 hours each day and started sleeping at Mary's and spending the weekends there. But then she fell and broke several vertebrae in February and needed to have full 24 hour care. The home health aide had a daughter who could take the night shift and found someone else to fill the remaining holes in the schedule. Since Mary has no savings and we didn't have the resources to cover the expense, the additional cost came out of a home equity line of credit that Mary had gotten to take care of basic electrical and plumbing work needed on the 80 year old house. By the summer it was clear that the line of credit would be exhausted by September, so we talked to an elder care lawyer who said we had to transfer title to the house and apply for Medicaid.
In order to qualify Mary for Medicaid, it is necessary to show that she has no assets and almost no income. It is also necessary to show that she has just the right kind of impairments. After the application was submitted, the case worker came out and the main home health aide recognized her from one of her previous assignments. She had told the daughter of another very elderly woman, one with Alzheimers, that "as long as I'm working here your mother will NEVER get 24 hour care." Again and again, health care workers, friends and relatives tell us about their own experiences with Medicaid - that the system is set up to reward the employees who manage to deny coverage. And over and over again, the refrain is one of resentment against poor people who allegedly come to the country and get right on Medicaid, while people who have paid taxes their whole lives are frozen out. Even the home health aides, who are themselves often underpaid immigrants, say the same thing. Regardless of the reality, this is the widespread perception.
And sure enough, the first application was denied. The only grounds given were that Mary needed "too much assistance." When we followed up, it turned out that the reason was that the initial report indicated that there were 30 steps down to the street, which got misinterpreted as 30 steps to get out of the house, which would have made it impossible for a single aide to get her out in an emergency. Then we got a second notice of denial, saying that Mary's income (i.e. her monthly social security payment) was too high, even though it is not enough to pay for even one week of the home health aides.
Our advisor said this is the typical response and that, even though we had presumably cleared up the misunderstanding about the steps, we had to start the process all over again. We submitted a new application this week and are now hoping that it will be possible for her to qualify before the money is gone. We are fortunate in that I had a lot of paid work over the summer, so we can manage for a while before having to borrow money, and we are in a position to borrow money if we have to. But having gotten this crash course in the economics of elder care, it is clear that the Republicans have maneuvered our economy to the point where they can demand that Medicaid spending be reduced, at which point Democrats either struggle to protect the benefits and thereby stoke the anti-poor anti-immigrant resentment of the unentitled middle class, or play "new Democratic" game and go along with the cuts to show how pragmatic they are. But what about taking another course? How about demanding that the benefits of Medicaid be extended beyond the very poor, as a step toward real national health insurance, and paying for it by reinstating the estate tax and perhaps adding a wealth tax to get at all the assets that the Republicans have plundered in the last six years? By now, most people understand that the tax cuts were only good for the super rich. How about giving the middle-aged middle class a reason to make common cause with their poorer neighbors instead of letting the Republicans continue to divide and conquer the majority?