Published on
SavannahNow.com (http://new.savannahnow.com)
Column:
Medicaid reforms hurt people
who did things right
By Savannah
Morning News
Created 2006-08-25
21:42
Saturday, August
26, 2006 at 12:30 am
Paying for nursing home care
for our aging seniors is a
painful issue, but there are
solutions that involve
rationality and less
'whacking' that some
officials want.
ASHEBORO, N.C. - This letter is in
response to your Aug. 18
editorial, "The 'other'
death tax." Paying for
nursing home care for our
aging seniors is a painful
issue, a much misunderstood
issue and has been the
subject of a bit of
demagoguery by a few elected
officials.
I am a Certified Elder Law
Attorney practicing
primarily in North Carolina,
and am currently the
legislative chair of the
N.C. Bar's Elder Law
Section. I practiced for
many years in Savannah and
have both family and
professional ties to the
area; accordingly I have
carefully followed this
story.
I disagree with a number of your
assertions, and I believe
framing some of the
arguments in a different
context will be helpful.
Make no mistake; I believe the
subject of paying for
long-term care should be a
high priority. With plenty
of aging boomers and great
health care to help everyone
live longer, a trip to the
nursing home could be a
reality for millions. The
status quo is not
sustainable.
There are plenty of solutions,
both immediate and long
term, that involve a bit of
rationality and a lot less
"whacking" that some
officials may find
immediately gratifying. My
issues are with the federal
legislators and regulators
who set the base rules, and
their state counterparts who
have some leeway in
implementation.
On the federal side, as Bill
Broker of Georgia Legal
Services in Savannah
observed, the current
"reform" efforts will hurt
people who have done
everything right. They
worked hard, did without and
paid down their mortgages.
They've amassed "fortunes"
worth a hundred thousand or
so. They bought health
insurance and paid their
Medicare premiums every day.
To many, in retrospect, it
may now look like they
should have taken those
foregone vacations and spent
a bit more freely. To many,
I am sure, political
rhetoric along the lines of
"We want to help families
SAVE more!" sounds hollow.
The assertions of U.S. Rep. Nathan
Deal, R-Georgia, (a major
Medicaid foe) about wealthy
seniors "gaming" the system
(a favorite adjective for
those resorting to
demagoguery on this issue)
are absurd. I am
disappointed that this paper
has bought into those
arguments. The vast majority
of people harmed are just
trying to hang on to the
modest estates they've
worked so hard for.
A few wealthy seniors have no
doubt abused the system, and
that can be fixed. But think
of it: Why would most
millionaires want to go
through the painful
financial contortions
involved in some of the
abusive scams in order to
save $60,000 or so a year?
Nevertheless, those few have
handed Deal and his allies a
very attractive hammer to
nail down the rest of the
system.
Comparing the estate Medicaid
recovery scheme to the
estate tax by calling estate
recovery the "other death
tax" is interesting. The
seniors "gaming" the system
are perhaps the same ones
benefiting from planning
opportunities in the "real"
estate tax.
Deal has consistently favored
completely repealing that
tax (which would benefit
about 1 in every 1,400
people dying every year and
result in the loss of about
$17 billion in annual
revenue). While Deal was
voting for major Medicaid
nursing home cuts last
December, the amount that
wealthy people could leave
free of any estate tax
automatically bumped up
another $500,000. A bit of
consistency in our public
policy arguments would be
refreshing.
On the state side, I applaud Gov.
Sonny Perdue's action to
scale back the retroactive
application of estate
recovery. I'm sure the
action was motivated by a
sincere concern for the
measure's draconian effects
on many citizens. There may
have been a bit of
practicality involved, as
well. Applying the measure
retroactively would have
been a bureaucratic
nightmare and expensive.
Perdue's actions also illustrate
legal realities of the
Medicaid system. The feds
set the basic rules. Georgia
has been almost defiant in
failing to institute estate
recovery that Congress
mandated 16 years ago.
Michigan is the lone
holdout, and it won't hold
out much longer.
Perdue's act also illustrated
another facet: The states do
have some discretion. Here
is something many Georgia
voters may want to ask: Why
has Georgia decided to go
after non-probate assets?
Non-probate assets are
assets that a person may
hold jointly with other
people (life estates in real
property, insurance death
proceeds, and the like).
Many states (North Carolina,
for example) have elected to
leave non-probate assets
alone. If the state really
wanted to help in an area
that it had some discretion,
this would have been a way.
For the lawyers in the crowd, go
to 42 USC § 1396p(b)(4)(A).
Seizing non-probate assets
is completely within the
discretion of the states.
After Georgia's 16 year
holdout, this may be a
stickup.
Bob Mason, formerly of
Savannah, is an attorney in
Asheboro, N.C., and one of
only five members of the
State Bar of Georgia who are
designated "certified elder
law attorney" by the
National Elder Law
Foundation.
Source
URL:
http://new.savannahnow.com//node/126502
Links:
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