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Alaska can do better than Medicaid expansion

Posted: December 2, 2013 - 1:03am

Medicaid expansion might solve your medical care problems today but if you are 55 or older, signing up could cost your family their inheritance.

When a Medicaid enrollee dies, the federal government encourages states to bill the estate for all costs incurred over age 55, including routine care. Already, 26 states do this. Even if you never need nursing care, routine costs, like $12,000 for a pacemaker, $15,000 for a broken leg, or $30,000 for a short hospital stay, could mean leaving nothing for your family. No ancestral land. No family home. Not even a parent’s wedding ring. Under Medicaid estate recovery there are no permanently exempt assets.

Medicaid requires states to at least bill estates for nursing care, hospital care, and home care costs of the over 55 crowd. Even that harms families. Just six months in Wildflower Court, our local nursing home, can run over $100,000. Medicaid doesn’t magically make that vanish. It turns it into a bill payable on death, which means your family may lose everything.

If Alaska expands Medicaid, will we continue to bill estates the minimum? The expanded benefits do cost money. We don’t have an income tax. And we’re told that the oil companies really did need that tax cut. That leaves but one source: the estates of the income poor. It’s entirely foreseeable that if Alaska expands Medicaid we will have to start billing enrollee estates for all costs incurred after age 55.

This isn’t equitable. Under the Affordable Care Act (Obamacare), if you’re 55, own a $125,000 home free and clear but have only $11,000 of annual income, you will be dumped into Medicaid and potentially face a 100 percent death tax. Your family probably won’t get to keep the house. But if you have $12,000 of annual income, they’ll buy you insurance and you’ll never have to repay a penny. How can such unequal treatment even be constitutional?

It’s disappointing to hear really smart people blindly push for Medicaid expansion without considering the extremely harmful side effects. Medicaid is effectively an abusive loan shark program right out of Charles Dickens’ England. It’s designed to make sure that poverty is handed down to the next generation. Surely Alaska can do better than that for its people. Uncle Sam is desperate to make health care reform work. Our leaders could negotiate for that money but deliver it some other way.

• Walter Gregg lives in Juneau and is the primary caregiver for his father.

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