The Senate vote on the health care bill has been pushed back, but it still has a lot of people in the nursing home industry worried. About two-thirds of nursing home residents are paid for by Medicaid. And the Congressional Budget Office found that the Senate health care bill would cut Medicaid by more than $770 billion over the next decade.
That could mean trouble for people like 88-year-old Betty Redlin. She's lived at the Victoria Care Center in Ventura, Calif. for about 2 1/2 years.
She explains that she fell and broke her hip and never regained her ability to walk. "I was living with my granddaughter," she says, "and my doctor won't [allow] going back to her place."
Betty had a career as a bookkeeper. She also raised three children. Now she's spent everything she had. There's no way she could afford the roughly $80,000 a year this nursing home costs. (That fee is pretty standard for nursing homes.) So it's Medicaid that enables her to stay here.
"There's nothing I can do about it," she says. "It's gotta be [Medicaid] or [I'm] out on the street. One or the other."
John Gardner, executive director of the Victoria Care Center, says that most of the long-term care residents like Redlin are on Medicaid or, as it's called in California, Medi-Cal.
"If you look at what it costs to provide that service and what we get from Medi-Cal, we're actually losing a little bit of money every day on that." He says they make up the difference with short-term residents who have Medicare, which pays more than Medicaid does. Private pay patients also pay more than Medicaid.
Gardner says he's an optimist. Whatever Congress does, he doesn't think that Victoria Care Center would close down, though there might have to be cuts in staff and in the costs of food and supplies. Also, Gardner says that Victoria Care Center is part of a chain of 200 facilities, which could cushion the blow.
But not everyone is as optimistic as he is. According to the American Health Care Association (AHCA), a national trade group for nursing homes, the current Senate bill's cuts to Medicaid could mean that a typical nursing home would eventually run deficits of hundreds of thousands of dollars a year. James Gomez is the CEO of The California Association of Health Facilities, the AHCA's California chapter.
"If you can't break even or make a few dollars, you're not going to keep running your business," says Gomez. And that could lead to closures. "So access [to nursing home beds] will become a huge issue."
The repercussions of cuts and closures would be felt across the nation's health care system, says Katie Smith Sloan, the president of Leading Age, which represents non-profit nursing homes and other services for older adults.
"People who are in nursing homes are there because they need the kind of services that a nursing home provides" says Sloan. "Without those services, they'll be forced to get that kind of care in a hospital, which will simply increase costs to Medicare."
Reining in Medicaid has been on conservatives' to-do list for a long time. House Speaker Paul Ryan has said he's dreamed of it since his college days. Robert Moffit, a senior fellow in health policy studies at the conservative Heritage Foundation, argues that the program isn't being used as intended.
"Do we want Medicaid, which was a program designed for the poor and the indigent, to become a kind of backdoor mechanism to establish a middle class entitlement for long-term care? Medicaid was never really intended to do that," says Moffit.
The Senate bill is likely to change. But leader Mitch McConnell has indicated that Medicaid cuts will still be part of it.