Legislation enacted in December will be phasing out that money over the next year and calls for states to resume cutting off from Medicaid people who no longer qualify.
States are preparing to remove millions of people from Medicaid as protections put in place early in the covid-19 pandemic expire.
The upheaval, which begins in April, will put millions of low-income Americans at risk of losing health coverage, threatening their access to care and potentially exposing them to large medical bills.
It will also put pressure on the finances of hospitals, doctors, and others relying on payments from Medicaid, a state-federal program that covers lower-income people and people with disabilities.
Almost three years ago, as covid sent the economy into free fall, the federal government agreed to send billions of dollars in extra Medicaid funding to states on the condition that they stop dropping people from their rolls.
But legislation enacted in December will be phasing out that money over the next year and calls for states to resume cutting off from Medicaid people who no longer qualify.
Now, states face steep challenges: making sure they don’t disenroll people who are still entitled to Medicaid and connecting the rest to other sources of coverage.
Even before the pandemic, states struggled to stay in contact with Medicaid recipients, who in some cases lack a stable address or internet service, do not speak English, or don’t prioritize health insurance over more pressing needs.
“We have no illusion that this will be beautiful or graceful, but we will be doing everything we can not to lose anyone in the process,” Dana Hittle, Oregon’s interim Medicaid director, said of the so-called Medicaid unwinding.
With the rate of uninsured Americans at an all-time low, 8%, the course reversal will be painful.
The Biden administration has predicted that 15 million people — 17% of enrollees — will lose coverage through Medicaid or CHIP, the closely related Children’s Health Insurance Program, as the programs return to normal operations. While many of the 15 million will fall off because they no longer qualify, nearly half will be dropped for procedural reasons, such as failing to respond to requests for updated personal information, a federal report said.
Certain states may be hit particularly hard: Nevada’s enrollment in Medicaid and CHIP has risen 47% since February 2020. Many signed up toward the start of the pandemic, when the state’s unemployment rate spiked to nearly 30%.
Ordinarily, people move in and out of Medicaid all the time. States, which have significant flexibility in how they run their Medicaid programs, typically experience significant “churn” as people’s incomes change and they gain or lose eligibility.
The unwinding will play out over more than a year.
We acknowledge that this is going to be a bumpy road
People who lose Medicaid coverage — in the more than 30 states covered by the federal marketplace — will have until July 31, 2024, to sign up for ACA coverage, CMS announced on Jan. 27. It’s unclear whether the state-based marketplaces will offer the same extended open-enrollment period.
Even states that are taking far-reaching action to make sure people don’t end up uninsured worry the transition will be rough.
In California alone, the state government forecasts that at least 2 million people out of 15 million in the program today will lose Medicaid coverage because of loss of eligibility or failure to reenroll.
“We acknowledge that this is going to be a bumpy road,” California Health and Human Services Secretary Mark Ghaly said. “We’re doing all we can to be prepared.”
In an all-hands-on-deck effort, states are enlisting Medicaid health plans, doctors, hospitals, state insurance marketplaces, and an assortment of nonprofit groups, including schools and churches, to reach out to people at risk of losing coverage.
States will also use social media, television, radio, and billboards, as well as websites and mobile phone apps, to connect with enrollees. That’s in addition to letters and emails.
Nevada has developed a mobile app to communicate with members, but only 15,000 of its 900,000 Medicaid enrollees have signed up so far.
“[T]he transient nature of Nevada’s population means that maintaining proper contact information has been difficult,” a state report said in November. At least 1 in 4 letters sent to enrollees were returned on account of a wrong address.
The law that allows states to begin disenrolling ineligible Medicaid recipients on April 1 bars states from disenrolling anyone because mail was returned as undeliverable until the state has made a “good faith effort” to contact the person at least one other way, such as by phone or email.
To further reduce disruption, the law requires states to cover children in Medicaid and CHIP for 12 months regardless of changes in circumstances, but that provision doesn’t take effect for almost a year.
States will give Medicaid recipients at least 60 days to respond to requests for information before dropping them, said Jack Rollins, director of federal policy at the National Association of Medicaid Directors.
States will use government databases such as those from the IRS and Social Security Administration to check enrollees’ income eligibility so they can renew some people’s coverage automatically without having to contact them. But some states aren’t taking full advantage of the databases.
States have until February to submit their unwinding plans to the federal Centers for Medicare & Medicaid Services, which will monitor the process.
We want to make it easier to say yes to coverage
But it is already clear that some states are doing much more than others to keep people insured.
Oregon plans to allow children to stay on Medicaid until age 6 and allow everyone else up to two years of eligibility regardless of changes in income and without having to reapply. No other state provides more than one year of guaranteed eligibility.
Oregon is also creating a subsidized health plan that would cover anyone who no longer qualifies for Medicaid but has an annual income below 200% of the federal poverty level, which amounts to about $29,000 for an individual, state officials said. The program will have benefits similar to Medicaid’s at little or no cost to enrollees.
Rhode Island will automatically move people who are no longer eligible for Medicaid — and with annual incomes below 200% of the poverty rate — into an Affordable Care Act plan and pay their first two months of premiums. State officials hope the shift will be seamless for many enrollees because they’ll be moving between health plans run by the same company.
California will move some people to a subsidized private plan on the state’s marketplace, Covered California. Enrollees will have to agree and pay a premium if they don’t qualify for a free plan. However, the premium could be as low as $10 a month, said Jessica Altman, executive director of Covered California. (Altman’s father, Drew Altman, is president and CEO of KFF. KHN is an editorially independent program of KFF.)
“We want to make it easier to say yes to coverage,” Altman said.
But experts worry about what will become of Florida Medicaid enrollees.
Florida doesn’t have its own ACA marketplace. As in most states, its residents use the federal exchange to shop for ACA plans. As a result, the handoff of people from Medicaid to marketplace may not be as efficient as it would be if it involved two state agencies that regularly work together, said Jodi Ray, director of Florida Covering Kids and Families, a nonprofit that helps people find coverage.
Another concern for advocates is that Florida makes less use of government databases than other states to check enrollees’ incomes. “We make everyone jump through hoops to get reenrolled instead of utilizing all the acceptable data,” Ray said.
Florida typically takes weeks to process Medicaid applications, while some states do it in a day, she said.
Florida’s unwinding plan illustrates the difficulty of reaching enrollees. The plan said that, since 2020, the state has identified 850,000 cases in which Medicaid recipients did not respond to requests for information.
Florida Medicaid officials did not return calls for comment.
While state officials struggle to manage the unwinding, health care providers are bracing for the fallout.
Dennis Sulser, chief executive of Billings, Montana-based Youth Dynamics, which provides mental health services to many children on Medicaid, expects some will lose coverage because they get lost in the process.
That could leave patients unable to pay and the nonprofit financially stretching to try to avoid children facing an interruption in treatment.
“If we had to discharge a child who is in our group home care, and they're only halfway through it and don't have all of the fundamentals of the care support needed, that could be tragic,” Sulser said.
KHN correspondents Daniel Chang in Hollywood, Florida; Angela Hart in Sacramento, California; Katheryn Houghton in Missoula, Montana; Bram Sable-Smith in St. Louis; and Sam Whitehead in Atlanta contributed to this report.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
If the federal match rate drops, Illinois would have two options: come up with more than $40 billion to cover expansion costs or drop it altogether.
Photo: Freestocks.org/StockSnap
by Judith Ruiz-Branch Illinois News Connection
CHICAGO -
As Congress continues to threaten deep cuts to the Medicaid program, a new KFF report shows how some of the proposed changes could end coverage for an estimated 20 million people nationwide, more than 800,000 in Illinois. One idea targets the Medicaid expansion federal match rate. The federal government currently pays 90% of the costs for people covered under what's known as the Medicaid expansion, that extended coverage to nearly all low-income adults.
Liz Williams, senior policy analyst with KFF, explained that if the federal match rate drops, Illinois would have two options: come up with more than $40 billion to cover expansion costs or drop it altogether.
"Illinois has a law where the state is required to automatically end expansion coverage if the match rate drops, so in those trigger law states, there's 12 of them, enrollees are at greater risk of losing coverage," she explained.
Nearly 30% of Medicaid enrollees in Illinois have health-care coverage because of the Medicaid expansion and would be at risk of losing it should these changes go through.
The Medicaid expansion under the Affordable Care Act was enacted to reduce the number of uninsured people nationwide. It provided states with an increased federal match rate to help pay for their health-care costs. Williams added that if states can't afford to pick up the added costs from decreased federal support, the number of uninsured people will dramatically increase, and any gains in financial security and health outcomes associated with the expansion would be reversed.
"Medicaid is jointly funded by states and the federal government, so any restrictions in federal Medicaid spending really leaves states with tough choices about how to offset reductions," she continued.
She said states have a few options, including increasing state tax revenues, decreasing spending on non-Medicaid services such as education, or decreasing coverage for other groups. Governor J.B. Pritzker has already proposed eliminating Medicaid coverage for non-citizen adults aged 42 to 65 as a way to make up for the state's $1.7 billion-budget gap.
Medicaid re-determination will happen on a rolling basis through mid-2024, meaning not everyone will lose eligibility at once.
CHICAGO - Millions of Medicaid recipients are losing coverage as the program's pandemic-era Continuous Enrollment Provision unwinds. In Illinois, the number could reach close to three-quarters of a million, even if many are still eligible for benefits.
In just the first month since states started to whittle down their Medicaid rolls, more than 47,000 people in Illinois have lost coverage. They may still qualify, but simply failed to re-enroll in time to avoid a coverage lapse or didn't respond to the government's request for information.
Marcus Robinson, UnitedHealthcare's president of markets for the indivicual and family plan business, said suddenly losing coverage can be frightening, but it also disrupts the doctor-patient relationship.
"And keeping access to that relationship for your overall well-being is really important," he said. "Regular doctor's visits for yourself or your family, of course - you can continue to obtain your preventive care, critical screenings."
Robinson said disrupting that relationship means at-risk patients could fail to manage chronic conditions or miss emerging illnesses. He added that UnitedHealthCare has online tools to help people determine if they are still Medicaid-eligible, and offers options if they're not.
People were not required to prove Medicaid eligibility during the pandemic, but now that is changing. Illinois Gov. J.B. Pritzker has said to avoid a "coverage cliff," Medicaid re-determination will happen on a rolling basis through mid-2024, meaning not everyone will lose eligibility at once. But UnitedHealthCare's Robinson said people who do lose coverage can still access health insurance, because losing Medicaid allows them coverage options outside of a normal enrollment period.
"It's determined you are not longer eligible for Medicaid - well, that's a loss of coverage," he said, "and that allows you a qualifying event to enroll in the individual exchange marketplace. "
The individual exchange marketplace is online at healthcare.gov.
The financial and emotional toll of providing and paying for long-term care is wreaking havoc on the lives of millions of Americans.
by Reed Abelson, The New York Times Jordan Rau, KFF Health New
Kaiser Health News - Margaret Newcomb, 69, a retired French teacher, is desperately trying to protect her retirement savings by caring for her 82-year-old husband, who has severe dementia, at home in Seattle. She used to fear his disease-induced paranoia, but now he’s so frail and confused that he wanders away with no idea of how to find his way home. He gets lost so often that she attaches a tag to his shoelace with her phone number.
The financial and emotional toll of providing and paying for long-term care is wreaking havoc on the lives of millions of Americans. Read about how a few families are navigating the challenges, in their own words. (Read More)
Feylyn Lewis, 35, sacrificed a promising career as a research director in England to return home to Nashville after her mother had a debilitating stroke. They ran up $15,000 in medical and credit card debt while she took on the role of caretaker.
Sheila Littleton, 30, brought her grandfather with dementia to her family home in Houston, then spent months fruitlessly trying to place him in a nursing home with Medicaid coverage. She eventually abandoned him at a psychiatric hospital to force the system to act.
“That was terrible,” she said. “I had to do it.”
Millions of families are facing such daunting life choices — and potential financial ruin — as the escalating costs of in-home care, assisted living facilities, and nursing homes devour the savings and incomes of older Americans and their relatives.
“People are exposed to the possibility of depleting almost all their wealth,” said Richard Johnson, director of the program on retirement policy at the Urban Institute.
The prospect of dying broke looms as an imminent threat for the boomer generation, which vastly expanded the middle class and looked hopefully toward a comfortable retirement on the backbone of 401(k)s and pensions. Roughly 10,000 of them will turn 65 every day until 2030, expecting to live into their 80s and 90s as the price tag for long-term care explodes, outpacing inflation and reaching a half-trillion dollars a year, according to federal researchers.
By 2050, there will be more than 86 million Americans over the age of 65. The U.S. does not dedicate enough funds for long-term care of the aging population. For the most, the financial burden is left on the shoulders of the senior and their financial resources or that of the family.
Photo: Spolyakov/PEXELS
The challenges will only grow. By 2050, the population of Americans 65 and older is projected to increase by more than 50%, to 86 million, according to census estimates. The number of people 85 or older will nearly triple to 19 million.
The United States has no coherent system of long-term care, mostly a patchwork. The private market, where a minuscule portion of families buy long-term care insurance, has shriveled, reduced over years of giant rate hikes by insurers that had underestimated how much care people would actually use. Labor shortages have left families searching for workers willing to care for their elders in the home. And the cost of a spot in an assisted living facility has soared to an unaffordable level for most middle-class Americans. They have to run out of money to qualify for nursing home care paid for by the government.
For an examination of the crisis in long-term care, The New York Times and KFF Health News interviewed families across the nation as they struggled to obtain care; examined companies that provide it; and analyzed data from the federally funded Health and Retirement Study, the most authoritative national survey of older people about their long-term care needs and financial resources.
About 8 million people 65 and older reported that they had dementia or difficulty with basic daily tasks like bathing and feeding themselves — and nearly 3 million of them had no assistance at all, according to an analysis of the survey data. Most people relied on spouses, children, grandchildren, or friends.
The United States devotes a smaller share of its gross domestic product to long-term care than do most other wealthy countries, including Britain, France, Canada, Germany, Sweden, and Japan, according to the Organization for Economic Cooperation and Development. The United States lags its international peers in another way: It dedicates far less of its overall health spending toward long-term care.
“We just don’t value elders the way that other countries and other cultures do,” said Rachel Werner, executive director of the Leonard Davis Institute of Health Economics at the University of Pennsylvania. “We don’t have a financing and insurance system for long-term care,” she said. “There isn’t the political will to spend that much money.”
Most countries spend more than the United States on care, but middle-class and affluent people still bear a substantial portion of the costs. (Read More)
Despite medical advances that have added years to the average life span and allowed people to survive decades more after getting cancer or suffering from heart disease or strokes, federal long-term care for older people has not fundamentally changed in the decades since President Lyndon Johnson signed Medicare and Medicaid into law in 1965. From 1960 to 2021, the number of Americans age 85 and older increased at more than six times the rate of the general population, according to census records.
Medicare, the federal health insurance program for Americans 65 and older, covers the costs of medical care, but generally pays for a home aide or a stay in a nursing home only for a limited time during a recovery from a surgery or a fall or for short-term rehabilitation.
Medicaid, the federal-state program, covers long-term care, usually in a nursing home, but only for the poor. Middle-class people must exhaust their assets to qualify, forcing them to sell much of their property and to empty their bank accounts. If they go into a nursing home, they are permitted to keep a pittance of their retirement income: $50 or less a month in a majority of states. And spouses can hold onto only a modest amount of income and assets, often leaving their children and grandchildren to shoulder some of the financial burden.
At any given time, skilled nursing homes house roughly 630,000 older residents whose average age is about 77.
“You basically want people to destitute themselves and then you take everything else that they have,” said Gay Glenn, whose mother lived in a nursing home in Kansas until she died in October at age 96.
Her mother, Betty Mae Glenn, had to spend down her savings, paying the home more than $10,000 a month, until she qualified for Medicaid. Glenn, 61, relocated from Chicago to Topeka more than four years ago, moving into one of her mother’s two rental properties and overseeing her care and finances.
Under the state Medicaid program’s byzantine rules, she had to pay rent to her mother, and that income went toward her mother’s care. Glenn sold the family’s house just before her mother’s death in October. Her lawyer told her the estate had to pay Medicaid back about $20,000 from the proceeds.
A play she wrote about her relationship with her mother, titled “If You See Panic in My Eyes,” was read this year at a theater festival.
At any given time, skilled nursing homes house roughly 630,000 older residents whose average age is about 77, according to recent estimates. A long-term resident’s care can easily cost more than $100,000 a year without Medicaid coverage at these institutions, which are supposed to provide round-the-clock nursing coverage.
Nine in 10 people said it would be impossible or very difficult to pay that much, according to a KFF public opinion poll conducted during the pandemic.
Efforts to create a national long-term care system have repeatedly collapsed. Democrats have argued that the federal government needs to take a much stronger hand in subsidizing care. The Biden administration sought to improve wages and working conditions for paid caregivers. But a $150 billion proposal in the Build Back Better Act for in-home and community-based services under Medicaid was dropped to lower the price tag of the final legislation.
“This is an issue that’s coming to the front door of members of Congress,” said Sen. Bob Casey, a Pennsylvania Democrat and chair of the Senate Special Committee on Aging. “No matter where you’re representing — if you’re representing a blue state or red state — families are not going to settle for just having one option,” he said, referring to nursing homes funded under Medicaid. “The federal government has got to do its part, which it hasn’t.”
But leading Republicans in Congress say the federal government cannot be expected to step in more than it already does. Americans need to save for when they will inevitably need care, said Sen. Mike Braun of Indiana, the ranking Republican on the aging committee.
“So often people just think it’s just going to work out,” he said. “Too many people get to the point where they’re 65 and then say, ‘I don’t have that much there.’”
Private Companies’ Prices Have Skyrocketed
The boomer generation is jogging and cycling into retirement, equipped with hip and knee replacements that have slowed their aging. And they are loath to enter the institutional setting of a nursing home.
But they face major expenses for the in-between years: falling along a spectrum between good health and needing round-the-clock care in a nursing home.
That has led them to assisted living centers run by for-profit companies and private equity funds enjoying robust profits in this growing market. Some 850,000 people age 65 or older now live in these facilities that are largely ineligible for federal funds and run the gamut, with some providing only basics like help getting dressed and taking medication and others offering luxury amenities like day trips, gourmet meals, yoga, and spas.
The bills can be staggering.
As Americans live longer, the number who develop dementia, a condition of aging, has soared, as have their needs.
Half of the nation’s assisted living facilities cost at least $54,000 a year, according to Genworth, a long-term care insurer. That rises substantially in many metropolitan areas with lofty real estate prices. Specialized settings, like locked memory care units for those with dementia, can cost twice as much.
Home care is costly, too. Agencies charge about $27 an hour for a home health aide, according to Genworth. Hiring someone who spends six or seven hours a day cleaning and helping an older person get out of bed or take medications can add up to $60,000 a year.
As Americans live longer, the number who develop dementia, a condition of aging, has soared, as have their needs. Five million to 7 million Americans age 65 and up have dementia, and their ranks are projected to grow to nearly 12 million by 2040. The condition robs people of their memories, mars the ability to speak and understand, and can alter their personalities.
In Seattle, Margaret and Tim Newcomb sleep on separate floors of their two-story cottage, with Margaret ever mindful that her husband, who has dementia, can hallucinate and become aggressive if medication fails to tame his symptoms.
“The anger has diminished from the early days,” she said last year.
But earlier on, she had resorted to calling the police when he acted erratically.
“He was hating me and angry, and I didn’t feel safe,” she said.
She considered memory care units, but the least expensive option cost around $8,000 a month and some could reach nearly twice that amount. The couple’s monthly income, with his pension from Seattle City Light, the utility company, and their combined Social Security, is $6,000.
Placing her husband in such a place would have gutted the $500,000 they had saved before she retired from 35 years teaching art and French at a parochial school.
“I’ll let go of everything if I have to, but it’s a very unfair system,” she said. “If you didn’t see ahead or didn’t have the right type of job that provides for you, it’s tough luck.”
In the last year, medication has quelled Tim’s anger, but his health has declined so much that he no longer poses a physical threat. Margaret said she’s reconciled to caring for him as long as she can.
“When I see him sitting out on the porch and appreciating the sun coming on his face, it’s really sweet,” she said.
The financial threat posed by dementia also weighs heavily on adult children who have become guardians of aged parents and have watched their slow, expensive declines.
Claudia Morrell, 64, of Parkville, Maryland, estimated her mother, Regine Hayes, spent more than $1 million during the eight years she needed residential care for dementia. That was possible only because her mother had two pensions, one from her husband’s military service and another from his job at an insurance company, plus savings and Social Security.
Morrell paid legal fees required as her mother’s guardian, as well as $6,000 on a special bed so her mother wouldn’t fall out and on private aides after she suffered repeated small strokes. Her mother died last December at age 87.
“I will never have those kinds of resources,” Morrell, an education consultant, said. “My children will never have those kinds of resources. We didn’t inherit enough or aren’t going to earn enough to have the quality of care she got. You certainly can’t live that way on Social Security.”
Women Bear the Burden of Care
For seven years, Annie Reid abandoned her life in Colorado to sleep in her childhood bedroom in Maryland, living out of her suitcase and caring for her mother, Frances Sampogna, who had dementia. “No one else in my family was able to do this,” she said.
“It just dawned on me, I have to actually unpack and live here,” Reid, 61, remembered thinking. “And how long? There’s no timeline on it.”
After Sampogna died at the end of September 2022, her daughter returned to Colorado and started a furniture redesign business, a craft she taught herself in her mother’s basement. Reid recently had her knee replaced, something she could not do in Maryland because her insurance didn’t cover doctors there.
“It’s amazing how much time went by,” she said. “I’m so grateful to be back in my life again.”
Studies are now calculating the toll of caregiving on children, especially women. The median lost wages for women providing intensive care for their mothers is $24,500 over two years, according to a study led by Norma Coe, an associate professor at the Perelman School of Medicine at the University of Pennsylvania.
Lewis moved back from England to Nashville to care for her mother, a former nurse who had a stroke that put her in a wheelchair.
“I was thrust back into a caregiving role full time,” she said. She gave up a post as a research director for a nonprofit organization. She is also tending to her 87-year-old grandfather, ill with prostate cancer and kidney disease.
Making up for lost income seems daunting while she continues to support her mother.
But she is regaining hope: She was promoted to assistant dean for student affairs at Vanderbilt School of Nursing and was recently married. She and her husband plan to stay in the same apartment with her mother until they can save enough to move into a larger place.
Government Solutions Are Elusive
Over the years, lawmakers in Congress and government officials have sought to ease the financial burdens on individuals, but little has been achieved.
The CLASS Act, part of the Obamacare legislation of 2010, was supposed to give people the option of paying into a long-term insurance program. It was repealed two years later amid compelling evidence that it would never be economically viable.
Two years ago, another proposal, called the WISH Act, outlined a long-term care trust fund, but it never gained traction.
On the home care front, the scarcity of workers has led to a flurry of attempts to improve wages and working conditions for paid caregivers. A provision in the Build Back Better Act to provide more funding for home care under Medicaid was not included in the final Inflation Reduction Act, a less costly version of the original bill that Democrats sought to pass last year.
The labor shortages are largely attributed to low wages for difficult work. In the Medicaid program, demand has clearly outstripped supply, according to a recent analysis. While the number of home aides in the Medicaid program has increased to 1.4 million in 2019 from 840,000 in 2008, the number of aides per 100 people who qualify for home or community care has declined nearly 12%.
In April, President Joe Biden signed an executive order calling for changes to government programs that would improve conditions for workers and encourage initiatives that would relieve some of the burdens on families providing care.
Turning to Medicaid, a Shredded Safety Net
The only true safety net for many Americans is Medicaid, which represents, by far, the largest single source of funding for long-term care.
More than 4 in 5 middle-class people 65 or older who need long-term care for five years or more will eventually enroll, according to an analysis for the federal government by the Urban Institute. Almost half of upper-middle-class couples with lifetime earnings of more than $4.75 million will also end up on Medicaid.
But gaps in Medicaid coverage leave many people without care. Under federal law, the program is obliged to offer nursing home care in every state. In-home care, which is not guaranteed, is provided under state waivers, and the number of participants is limited. Many states have long waiting lists, and it can be extremely difficult to find aides willing to work at the low-paying Medicaid rate.
Qualifying for a slot in a nursing home paid by Medicaid can be formidable, with many families spending thousands of dollars on lawyers and consultants to navigate state rules. Homes may be sold or couples may contemplate divorce to become eligible.
And recipients and their spouses may still have to contribute significant sums. After Stan Markowitz, a former history professor in Baltimore with Parkinson’s disease, and his wife, Dottye Burt, 78, exhausted their savings on his two-year stay in an assisted living facility, he qualified for Medicaid and moved into a nursing home.
He was required to contribute $2,700 a month, which ate up 45% of the couple’s retirement income. Burt, who was a racial justice consultant for nonprofits, rented a modest apartment near the home, all she could afford on what was left of their income.
Markowitz died in September at age 86, easing the financial pressure on her. “I won’t be having to pay the nursing home,” she said.
Even finding a place willing to take someone can be a struggle. Harold Murray, Sheila Littleton’s grandfather, could no longer live safely in rural North Carolina because his worsening dementia led him to wander. She brought him to Houston in November 2020, then spent months trying to enroll him in the state’s Medicaid program so he could be in a locked unit at a nursing home.
She felt she was getting the runaround. Nursing home after nursing home told her there were no beds, or quibbled over when and how he would be eligible for a bed under Medicaid. In desperation, she left him at a psychiatric hospital so it would find him a spot.
“I had to refuse to take him back home,” she said. “They had no choice but to place him.”
He was finally approved for coverage in early 2022, at age 83.
A few months later, he died.
Reed Abelson is a health care reporter for The New York Times. The New York Times' Kirsten Noyes and graphics editor Albert Sun, KFF Health News data editor Holly K. Hacker, and JoNel Aleccia, formerly of KFF Health News, contributed to this report originally published .
US Health and Retirement Study Analysis
The New York Times-KFF Health News data analysis was based on the Health and Retirement Study, a nationally representative longitudinal survey of about 20,000 people age 50 and older. The analysis defined people age 65 and above as likely to need long-term care if they were assessed to have dementia, or if they reported having difficulty with two or more of six specified activities of daily living: bathing, dressing, eating, getting in and out of bed, walking across a room, and using the toilet. The Langa-Weir classification of cognitive function, a related data set, was used to identify respondents with dementia. The analysis’s definition of needing long-term care assistance is conservative and in line with the criteria most long-term care insurers use in determining whether they will pay for services.
People were described as recipients of long-term care help if they reported receiving assistance in the month before the interview for the study or if they lived in a nursing home. The analysis was developed in consultation with Norma Coe, an associate professor of medical ethics and health policy at the Perelman School of Medicine at the University of Pennsylvania.
The financial toll on middle-class and upper-income people needing long-term care was examined by reviewing data that the HRS collected from 2000 to 2021 on wealthy Americans, those whose net worth at age 65 was in the 50th to 95th percentile, totaling anywhere from $171,365 to $1,827,765 in inflation-adjusted 2020 dollars. This group excludes the super-wealthy. Each individual’s wealth at age 65 was compared with their wealth just before they died to calculate the percentage of affluent people who exhausted their financial resources and the likelihood that would occur among different groups.
To calculate how many people were likely to need long-term care, how many people needing long-term care services were receiving them, and who was providing care to people receiving help, we looked at people age 65 and older of all wealth levels in the 2020-21 survey, the most recent.
The U.S. Health and Retirement Study is conducted by the University of Michigan and funded by the National Institute on Aging and the Social Security Administration.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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While admitting that Medicare and Medicaid “help many,” the authors of Project 2025 nonetheless declare that the programs “operate as runaway entitlements that stifle medical innovation,
by Sonali KolhatkarConservatives have done the United States a huge favor by explaining in detail what they’ll try to do if Donald Trump is reelected.
Project 2025, a “presidential transition project” of the Heritage Foundation, helpfully lays out how a group of former Trump officials would like to transform the country into a right-wing dystopia where the rich thrive and the rest of us die aspiring to be rich.
Declaring in its Mandate for Leadership that “unaccountable federal spending is the secret lifeblood of the Great Awokening” (really!), the plan focuses heavily on reversing social progress on the rights of racial and sexual minorities.
It also promises to decimate the most popular benefits programs in the U.S.: Medicare and Medicaid.
In a section dedicated to the Department of Health and Human Services, Project 2025 declares that “HHS is home to Medicare and Medicaid, the principal drivers of our $31 trillion national debt.”
This is a popular conservative framing used to justify ending social programs. In fact, per person Medicare spending has plateaued for more than a decade and represents one of the greatest reductions to the federal debt.
While admitting that Medicare and Medicaid “help many,” the authors of Project 2025 nonetheless declare that the programs “operate as runaway entitlements that stifle medical innovation, encourage fraud, and impede cost containment, in addition to which their fiscal future is in peril.”
To solve these imaginary problems, they suggest making “Medicare Advantage the default enrollment option” rather than traditional Medicare.
But Medicare Advantage (MA) is not a government-run healthcare program. It’s merely a way to turn tax dollars into profits for private health insurers. The more that MA providers deny coverage, the more money their shareholders make. There is no incentive for them to cover the health care needs of seniors.
There is plenty of evidence that MA programs not only fleece taxpayers by submitting inflated reimbursement bills to the government but also routinely deny necessary medical coverage.
In other words, they’re drinking out of both sides of the government trough.
The Center for Economic and Policy Research pointed out in a March 2024 paper that the “insurance companies that run these MA plans spend significant sums of money to blanket seniors with marketing” while relying on “heavily restricted networks that damage one’s choice of provider along with dangerous delays and denials of necessary care.”
But Project 2025 claims, without evidence, that “the MA program has been registering consistently high marks for superior performance in delivering high-quality care.”
Medicaid, the government program that covers health care for the lowest-income Americans, including millions of children, is also a major target of the conservative authors.
They want to add work requirements to the benefit, adopting the familiar conservative trope of low-income Americans living off tax dollars because they’re too lazy to work. And like the MA programs, they want to allow private insurers to get in on the game.
Calling Medicaid a “cumbersome, complicated, and unaffordable burden on nearly every state,” Project 2025 complains about the program’s increased eligibility while at the same time claiming to care about how it impacts “those who are most in need.”
But a June 2024 report by the Center on Budget and Policy Priorities concludes that Medicaid’s expanded eligibility rules have helped insure millions of Americans who would otherwise be uninsured and saved money in state budgets.
Most encouragingly, “the people who gained coverage have grown healthier and more financially secure, while long-standing racial inequities in health outcomes, coverage, and access to care have shrunk.”
Project 2025 claims to have the underlying ideology to “incentivize personal responsibility,” as if its authors simply want Americans to begin acting like responsible grownups. But they mysteriously don’t apply this same standard to wealthy elites — perhaps because that’s precisely who they are.
Sonali Kolhatkar is the host of “Rising Up With Sonali,” a television and radio show on Free Speech TV and Pacifica stations. This commentary was produced by the Economy for All project at the Independent Media Institute and adapted for syndication by OtherWords.org.
Government pandemic policies that gave free Covid vaccines and tests to the general public will disappear in two months. The medical and insurance industries are gearing up to capitalize on what looks like a voluptuous revenue stream the virus that will likely never end starting on May 11.
by Julie Appleby Kaiser Health News
We see a double-digit billion[-dollar] market opportunity
The White House announced this month that the national public health emergency, first declared in early 2020 in response to the pandemic, is set to expire May 11. When it ends, so will many of the policies designed to combat the virus's spread.
Take vaccines. Until now, the federal government has been purchasing covid-19 shots. It recently bought 105 million doses of the Pfizer-BioNTech bivalent booster for about $30.48 a dose, and 66 million doses of Moderna's version for $26.36 a dose. (These are among the companies that developed the first covid vaccines sold in the United States.)
People will be able to get these vaccines at low or no cost as long as the government-purchased supplies last. But even before the end date for the public emergency was set, Congress opted not to provide more money to increase the government's dwindling stockpile. As a result, Pfizer and Moderna were already planning their moves into the commercial market. Both have indicated they will raise prices, somewhere in the range of $110 to $130 per dose, though insurers and government health programs could negotiate lower rates.
"We see a double-digit billion[-dollar] market opportunity," investors were told at a JPMorgan conference in San Francisco recently by Ryan Richardson, chief strategy officer for BioNTech. The company expects a gross price — the full price before any discounts — of $110 a dose, which, Richardson said, "is more than justified from a health economics perspective."
That could translate to tens of billions of dollars in revenue for the manufacturers, even if uptake of the vaccines is slow. And consumers would foot the bill, either directly or indirectly.
If half of adults — about the same percentage as those who opt for an annual flu shot — get covid boosters at the new, higher prices, a recent KFF report estimated, insurers, employers, and other payors would shell out $12.4 billion to $14.8 billion. That's up to nearly twice as much as what it would have cost for every adult in the U.S. to get a bivalent booster at the average price paid by the federal government.
As for covid treatments, an August blog post by the Department of Health and Human Services' Administration for Strategic Preparedness and Response noted that government-purchased supplies of the drug Paxlovid are expected to last through midyear before the private sector takes over. The government's bulk purchase price from manufacturer Pfizer was $530 for a course of treatment, and it isn't yet known what the companies will charge once government supplies run out.
How Much of That Pinch Will Consumers Feel?
One thing is certain: How much, if any, of the boosted costs are passed on to consumers will depend on their health coverage.
Medicare beneficiaries, those enrolled in Medicaid — the state-federal health insurance program for people with low incomes — and people with Affordable Care Act coverage will continue to get covid vaccines without cost sharing, even when the public health emergency ends and the government-purchased vaccines run out. Many people with job-based insurance will also likely not face copayments for vaccines, unless they go out of network for their vaccinations. People with limited-benefit or short-term insurance policies might have to pay for all or part of their vaccinations. And people who don't have insurance will need to either pay the full cost out-of-pocket or seek no- or low-cost vaccinations from community clinics or other providers. If they cannot find a free or low-cost option, some uninsured patients may be forced to skip vaccinations or testing.
Coming up with what could be $100 or more for vaccination will be especially hard "if you are uninsured or underinsured; that's where these price hikes could drive additional disparities," said Sean Robbins, executive vice president of external affairs for the Blue Cross Blue Shield Association. Those increases, he said, will also affect people with insurance, as the costs "flow through to premiums."
Meanwhile, public policy experts say many private insurers will continue to cover Paxlovid, although patients may face a copayment, at least until they meet their deductible, just as they do for other medications. Medicaid will continue to cover it without cost to patients until at least 2024. But Medicare coverage will be limited until the treatment goes through the regular FDA process, which takes longer than the emergency use authorization it has been marketed under.
Another complication: The rolls of the uninsured are likely to climb over the next year, as states are poised to reinstate the process of regularly determining Medicaid eligibility, which was halted during the pandemic. Starting in April, states will begin reassessing whether Medicaid enrollees meet income and other qualifying factors.
"This is our No. 1 concern" right now, said John Baackes, CEO of L.A. Care, the nation's largest publicly operated health plan with 2.7 million members.
"They may not realize they've lost coverage until they go to fill a prescription" or seek other medical care, including vaccinations, he said.
What About Covid Test Kits?
Rules remain in place for insurers, including Medicare and Affordable Care Act plans, to cover the cost of up to eight in-home test kits a month for each person on the plan, until the public health emergency ends.
For consumers — including those without insurance — a government website is still offering up to four test kits per household, until they run out. The Biden administration shifted funding to purchase additional kits and made them available in late December.
Starting in May, though, beneficiaries in original Medicare and many people with private, job-based insurance will have to start paying out-of-pocket for the rapid antigen test kits. Some Medicare Advantage plans, which are an alternative to original Medicare, might opt to continue covering them without a copayment. Policies will vary, so check with your insurer. And Medicaid enrollees can continue to get the test kits without cost for a little over a year.
State rules also can vary, and continued coverage without cost sharing for covid tests, treatments, and vaccines after the health emergency ends might be available with some health plans.
Overall, the future of covid tests, vaccines, and treatments will reflect the complicated mix of coverage consumers already navigate for most other types of care.
"From a consumer perspective, vaccines will still be free, but for treatments and test kits, a lot of people will face cost sharing," said Jen Kates, a senior vice president at KFF. "We're taking what was universal access and now saying we're going back to how it is in the regular U.S. health system."
KHN correspondent Darius Tahir contributed to this report.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
Trump campaigned on a promise to repeal and replace the Affordable Care Act, or ACA. In the White House, Trump supported a failed effort to do just that. He repeatedly said he would dismantle the health care law in campaign stops and social media posts throughout 2023.
President Joe Biden and former President Donald Trump, the presumptive Democratic and Republican presidential nominees, shared a debate stage June 27 for the first time since 2020, in a confrontation that — because of strict debate rules — managed to avoid the near-constant interruptions that marred their previous encounters.
Biden, who spoke in a raspy voice and often struggled to articulate his arguments, said at one point that his administration “finally beat Medicare.” Trump, meanwhile, repeated numerous falsehoods, including that Democrats want doctors to be able to abort babies after birth.
Illustration: Richard Duijnstee/Pixabay
Trump took credit for the Supreme Court’s 2022 decision that upended Roe v. Wade and returned abortion policy to states. “This is what everybody wanted,” he said, adding “it’s been a great thing.” Biden’s response: “It’s been a terrible thing.”
In one notable moment, Trump said he would not repeal FDA approval for medication abortion, used last year in nearly two-thirds of U.S. abortions. Some conservatives have targeted the FDA’s more than 20-year-old approval of the drug mifepristone to further restrict access to abortion nationwide.
“The Supreme Court just approved the abortion pill. And I agree with their decision to have done that, and I will not block it,” Trump said. The Supreme Court ruled this month that an alliance of anti-abortion medical groups and doctors lacked standing to challenge the FDA’s approval of the drug. The court’s ruling, however, did not amount to an approval of the drug.
CNN hosted the debate, which had no audience, at its Atlanta headquarters. CNN anchors Jake Tapper and Dana Bash moderated. The debate format allowed CNN to mute candidates’ microphones when it wasn’t their turn to speak.
Our PolitiFact partners fact-checked the debate in real time as Biden and Trump clashed on the economy, immigration, and abortion, and revisited discussion of their ages. Biden, 81, has become the oldest sitting U.S. president; if Trump defeats him, he would end his second term at age 82. You can read the full coverage here and excerpts detailing specific health-related claims follow:
Biden: “We brought down the price [of] prescription drug[s], which is a major issue for many people, to $15 for an insulin shot, as opposed to $400.”
Half True. Biden touted his efforts to reduce prescription drug costs by referring to the $35 monthly insulin price cap his administration put in place as part of the 2022 Inflation Reduction Act. But he initially flubbed the number during the debate, saying it was lowered to $15. In his closing statement, Biden corrected the amount to $35.
The price of insulin for Medicare enrollees, starting in 2023, dropped to $35 a month, not $15. Drug pricing experts told PolitiFact when it rated a similar claim that most Medicare enrollees were likely not paying a monthly average of $400 before the changes, although because costs vary depending on coverage phases and dosages, some might have paid that much in a given month.
Trump: “I’m the one that got the insulin down for the seniors.”
Mostly False. When he was president, Trump instituted the Part D Senior Savings Model, a program that capped insulin costs at $35 a month for some older Americans in participating drug plans.
But because it was voluntary, only 38% of all Medicare drug plans, including Medicare Advantage plans, participated in 2022, according to KFF. Trump’s plan also covered only one form of each dosage and insulin type.
Biden points to the Inflation Reduction Act’s mandatory $35 monthly insulin cap as a major achievement. This cap applies to all Medicare prescription plans and expanded to all covered insulin types and dosages. Although Trump’s model was a start, it did not have the sweeping reach that Biden’s mandatory cap achieved.
Biden: Trump “wants to get rid of the ACA again.”
Half True. In 2016, Trump campaigned on a promise to repeal and replace the Affordable Care Act, or ACA. In the White House, Trump supported a failed effort to do just that. He repeatedly said he would dismantle the health care law in campaign stops and social media posts throughout 2023. In March, however, Trump walked back this stance, writing on his Truth Social platform that he “isn’t running to terminate” the ACA but to make it “better” and “less expensive.” Trump hasn’t said how he would do this. He has often promised Obamacare replacement plans without ever producing one.
Trump: “The problem [Democrats] have is they’re radical, because they will take the life of a child in the eighth month, the ninth month, and even after birth.”
False. Willfully terminating a newborn’s life is infanticide and illegal in every U.S. state.
Most elected Democrats who have spoken publicly about this have said they support abortion under Roe v. Wade’s standard, which allowed access up to fetal viability — typically around 24 weeks of pregnancy, when the fetus can survive outside the womb. Many Democrats have also said they support abortions past this point if the treating physician deems it necessary.
Medical experts say situations resulting in fetal death in the third trimester are rare — fewer than 1% of abortions in the U.S. occur after 21 weeks — and typically involve fatal fetal anomalies or life-threatening emergencies affecting the pregnant person. For fetuses with very short life expectancies, doctors may induce labor and offer palliative care. Some families choose this option when facing diagnoses that limit their babies’ survival to minutes or days after delivery.
Some Republicans who have made claims similar to Trump’s point to Democratic support of the Women’s Health Protection Act of 2022, which would have prohibited many state government restrictions on access to abortion, citing the bill’s provisions that say providers and patients have the right to perform and receive abortion services without certain limitations or requirements that would impede access. Anti-abortion advocates say the bill, which failed in the Senate by a 49-51 vote, would have created a loophole that eliminated any limits on abortions later in pregnancy.
Alina Salganicoff, director of KFF’s Women’s Health Policy program, said the legislation would have allowed health providers to perform abortions without obstacles such as waiting periods, medically unnecessary tests and in-person visits, or other restrictions. The bill would have allowed an abortion after viability when, according to the bill, “in the good-faith medical judgment of the treating health care provider, continuation of the pregnancy would pose a risk to the pregnant patient’s life or health.”
Trump: “Social Security, he’s destroying it, because millions of people are pouring into our country, and they’re putting them onto Social Security. They’re putting them onto Medicare, Medicaid.”
False. It’s wrong to say that immigration will destroy Social Security. Social Security’s fiscal challenges stem from a shortage of workers compared with beneficiaries.
Immigration is far from a fiscal fix-all for Social Security’s challenges. But having more immigrants in the United States would likely increase the worker-to-beneficiary ratio, potentially for decades, thus extending the program’s solvency.
Most immigrants in the U.S. without legal permission are also ineligible for Social Security. However, people who entered the U.S. without authorization and were granted humanitarian parole — temporary permission to stay in the country — for more than one year are eligible for benefits from the program.
Immigrants lacking legal residency in the U.S. are generally ineligibleto enroll in federally funded health care coverage such as Medicare and Medicaid. (Some states provide Medicaid coverage under state-funded programs regardless of immigration status. Immigrants are eligible for emergency Medicaid regardless of their legal status.)
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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The sleek corporate offices of one of Amazon’s air freight contractors looms over Villaspring of Erlanger, a stately nursing home perched on a hillside in this Cincinnati suburb. Amazon Prime Air cargo planes departing from a recently opened Amazon Air Hub roar overhead. Its Prime semi-trucks speed along the highway, rumbling the nursing home’s windows.
This is daily life in the shadow of Amazon.
“We haven’t even seen the worst of it yet,” said John Muller, chief operating officer of Carespring, Villaspring’s operator. “They are still finishing the Air Hub.”
Amazon’s ambitious expansion plans in northern Kentucky, including the $1.5 billion, 600-acre site that will serve as a nerve center for Amazon’s domestic air cargo operations, have stoked anxieties among nursing home administrators in a region where the unemployment rate is just 3%. Already buckling from an exodus of pandemic-weary health care workers, nursing homes are losing entry-level nurses, dietary aides and housekeepers drawn to better-paying jobs at Amazon.
The average starting pay for an entry-level position at Amazon warehouses and cargo hubs is more than $18 an hour, with the possibility of as much as $22.50 an hour and a $3,000 signing bonus, depending on location and shift. Full-time jobs with the company come with health benefits, 401(k)s and parental leave. By contrast, even with many states providing a temporary covid-19 bonus for workers at long-term care facilities, lower-skilled nursing home positions typically pay closer to $15 an hour, often with minimal sick leave or benefits.
Nursing home administrators contend they are unable to match Amazon’s hourly wage scales because they rely on modest reimbursement rates set by Medicaid, the government program that pays for long-term care.
Across the region, nursing home administrators have shut down wings and refused new residents, irking families and making it more difficult for hospitals to discharge patients into long-term care. Modest pay raises have yet to rival Amazon’s rich benefits package or counter skepticism about the benefits of a nursing career for a younger generation.
“Amazon pays $25 an hour,” said Danielle Geoghegan, business manager at Green Meadows Health Care Center in Mount Washington, Kentucky, a nursing home that has lost workers to the Amazon facility in Shepherdsville. The alternative? “They come here and deal with people’s bodily fluids.”
The nursing home industry has long employed high school graduates to feed, bathe, toilet and tend to dependent and disabled seniors. But facilities that sit near Amazon’s colossal distribution centers are outgunned in the bidding war.
“Chick-fil-A can raise their prices,” said Betsy Johnson, president of the Kentucky Association of Health Care Facilities. “We can’t pass the costs on to our customer. The payer of the service is the government, and the government sets the rates.”
And while gripes about fast-food restaurants having to close indoor dining because of a worker shortage have ricocheted around Kentucky, Johnson said nursing homes must remain open every day, every hour of the year.
“We can’t say, ‘This row of residents won’t get any services today,’” she said.
Reaching Upstream
Nationwide, long-term care facilities are down 221,000 jobs since March 2020, according to a recent report from the American Health Care Association and National Center for Assisted Living, an organization that represents 14,000 nursing homes and assisted living communities caring for 5 million people. While many hospitals and physicians’ offices have managed to replenish staffing levels, the report says long-term care facilities are suffering a labor crisis worse “than any other health care sector.” Industry surveys show 58% of nursing homes have limited new admissions, citing a dearth of employees.
Kentucky and other states are relying on free or low-cost government-sponsored training programs to fill the pipeline with new talent. Luring recruits falls to teachers like Jimmy Gilvin, a nurse’s aide instructor at Gateway Community and Technical College in Covington, Kentucky, one of the distressed River Cities tucked along the Ohio River.
On a recent morning, Gilvin stood over a medical dummy tucked into a hospital bed, surrounded by teenagers and young adults, each toting a “Long-Term Care Nursing Assistance” textbook. Gilvin held a toothbrush and toothpaste, demonstrating how to clean a patient’s dentures — “If someone feels clean, they feel better,” he said — and how to roll unconscious patients onto their side.
The curriculum covers the practical aspects of working in a nursing home: bed-making, catheter care, using a bedpan and transferring residents from a wheelchair to a bed.
“It takes a very special person to be a certified nursing assistant,” Gilvin said. “It’s a hard job, but it’s a needed job.”
Over the past five years, Gilvin has noticed sharp attrition: “Most of them are not even finishing, they’re going to a different field.” In response, nursing schools are reaching further upstream, recruiting high school students who can attend classes and graduate from high school with a nurse’s aide certificate.
“We’re getting them at a younger age to spark interest in the health care pathways,” said Reva Stroud, coordinator of the health science technology and nurse’s aide programs at Gateway.
Stroud has watched, with optimism, the hourly rate for nurse’s aides rise from $9 an hour to around $15. But over the years that she’s directed the program, she said, fewer students are choosing to begin their careers as aides, a position vital to nursing home operations. Instead, they are choosing to work at Walmart, McDonald’s or Amazon.
“There is a lot of competition for less stress,” Stroud said. A staunch believer in the virtue of nursing, she is disheartened by the responses from students: “‘Well, I could go pack boxes and not have to worry about someone dying and make more money.’”
Even for those who want a career in nursing, becoming a picker and packer at Amazon carries strong appeal. The company covers 100% of tuition for nursing school, among other fields, and has contracted with community colleges to provide the schooling.
Amazon is putting Kayla Dennis, 30, through nursing school. She attended a nursing assistant class at Gateway but decided against a career as a nurse’s aide or certified nursing assistant. Instead, she works at the Amazon fulfillment center in Hebron, Kentucky, for $20.85 an hour with health insurance and retirement benefits while attending school to become a registered nurse, a position requiring far more training with high earning potential.
“Amazon is paying 100% of my school tuition and books,” Dennis said. “On top of that, they work around my school schedule.”
Waiting for a Rising Tide
The nursing home workforce shortages are not a top concern for the state and local economic development agencies that feverishly pursue deals with Amazon. Cities nationwide have offered billions of dollars in tax breaks, infrastructure upgrades and other incentives to score a site, and the spoils abound: Amazon has opened at least 250 warehouses this year alone.
Amazon has been a prominent force in northern Kentucky, resurfacing the landscape with titanic warehouses and prompting pay bumps at Walmart, fast-food franchises and other warehouse companies. The company has “made significant investments in our community,” said Lee Crume, chief executive officer of Northern Kentucky Tri-County Economic Development Corp. “I’m hard-pressed to say something negative.”
Amazon representatives did not respond to interview requests for this story.
Some labor experts said Amazon’s “spillover effect” — the bidding up of wages near its hubs — suggests companies can afford to compensate workers at a higher rate without going out of business.
Clemens Noelke, a research scientist at Brandeis University, said that is true — to a point. Because Amazon draws workers indiscriminately from across the low-wage sector, rather than tapping into a specific skill profile, it is hitting sectors with wildly different abilities to adapt. Industries like nursing homes, home health care agencies and even public schools that rely on government funding and are hampered in raising wages are likely to lose out.
“There are some employers who are at the margin, and they will be pushed out of business,” Noelke said.
A survey conducted in November by the Kentucky Association of Health Care Facilities found 3 in 5 skilled nursing facilities, assisted living communities and care homes were concerned about closing given the number of job vacancies.
The solutions proffered by state legislators rely largely on nurse training programs already offered by community colleges like Gateway. Republican Rep. Kimberly Poore Moser, a registered nurse who chairs the state’s Health and Family Services Committee, said that while legislators must value health care jobs, “we have a finite number of dollars. If we increase salaries for one sector of the health care population, what are we going to cut?”
Moser said Kentucky’s bet on Amazon will pay off, eventually. “The more we inject into our economy, the more our Medicaid budget will grow,” she said.
That confidence in a rising-tide-lifts-all-boats approach frustrates Johnson, president of the Kentucky Association of Health Care Facilities. Lawmakers have difficulty grasping the complexity of financing a nursing home, she said, noting that Kentucky’s Medicaid reimbursement rates stagnated at a one-tenth of 1% increase for five years, before receiving a larger increase to offset inflation the past two years.
The Biden administration’s Build Back Better Act, still before Congress, would infuse billions of dollars into in-home care and community-based services for seniors, largely through federal Medicaid payments. It includes funding aimed at stimulating recruitment and training. But the measure is focused largely on expanding in-home care, and it’s not clear yet how it might affect nursing home pay rates.
For now, the feeding frenzy continues. Just off Interstate 65 in Shepherdsville, Wendy’s, White Castle and Frisch’s Big Boy dangle offers of “work today, get paid tomorrow.” FedEx signs along the grassy medians that once advertised $17 an hour are stickered over with a higher offer of $23. The colossal Amazon warehouse bustles with workers in yellow safety vests.
And in nearby Mount Washington, Sherrie Wathen, administrator of the Green Meadows nursing home, strains to fill a dozen vacancies, knowing she can’t match Amazon’s package for her entry-level slots. Instead, Wathen, who began her own nursing career at 18, tells prospective employees to consider life at a factory: “You’re going to have the same day over and over.”
At the nursing home, she said, “I am the only family this lady has. I get to make an impact rather than packing an item in a box.”
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I’ve always known my Arab culture is worth celebrating.
I heard it in Syrian tenor Sabah Fakhri’s powerful voice reverberating in my mom’s car on the way to piano lessons and soccer practice during my youth. I smelled it in the za’atar, Aleppo pepper, allspice, and cumin permeating the air in the family kitchen. Read more . . .
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