Paul Kusuda’s column
Paul H. Kusuda
local community.  Most people have a preference, they’d like to get services in their own homes or apartments.  That costs
less than institutional care, thus being a cost-effective alternative.

“Under the BCRA, the federal government would give states a fixed dollar amount for each person enrolled in Medicaid.  If
the amount proves insufficient, the states are responsible for the additional funding…”  Calculations to arrive at the fixed
amount are reported not to be related to actual long-term services and health-care costs or to increase in costs over time.  
The authors reported that a February 2016 Research Brief of the Office of the Assistant Secretary for Planning and
Evaluation noted:  “More than half (52 percent) of people turning 65 today, for example, will need assistance with basic
functions or have a severe cognitive impairment.”  They also pointed out that “…more than 22 million adults ages 18-
64…live with some type of disability, and nearly one-third of this group…receive health and LTSS coverage through
Medicaid…an important last resort…”  Before having to rely on that last resort, family caregivers provide financial help to the
extent possible.

Use of home and community-based services (HCBS) gained momentum during the past 30 years as reliance on nursing
homes declined in favor of other alternatives, part of the national de
-institutionalization movement—primarily, to reduce
public costs rather than necessarily to improve conditions of confined persons.   In federal fiscal year 2015, more than half
of Medicaid long-term services and support funds went to HCBS as alternative to nursing-home or other institutional care.  
The burgeoning aged and frail elderly populations will require more attention to filling the anticipated demand.  As they
increase, need for more nursing-home facilities will also increase as will the need for personnel.  The Affordable Care Act
contains provisions
needing improvement; however, plans to replace it fall considerably short of providing the amount of
patient coverage
currently present.  
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By Paul H. Kusuda

What’s BCRA?  The full name is Better Care Reconciliation Act, considered by the U.S. Senate
to replace the Patient Protection Affordable Care Act (aka Obamacare).   A July 17, 2017, report
by AARP’s Public Policy Institute’s Susan Reinhard, Jean Accius, Brendan Finn, and Ari Houser
noted: “According to the Congressional Budget Office (CBO), the BCRA would cut federal
funding to Medicaid by 26 percent, or about $772 billion, in 2026.  This cut would increase over
time to about 35 percent in 2036.”  That will negatively affect states as well as Medicaid
enrollees because of the shift in who has to pick up the costs.  Millions could lose coverage
under Medicaid.   States will have to stay within limits of allocated caps, thus being forced to
make massive cuts inservices.

“Each year, millions of people with physical, cognitive, or mental impairments receive some type
of long-term services and supports (LTSS) through Medicaid.  These include assistance with
bathing, dressing, and toileting as well as complex care such as wound care and managing
medications.”  Services are provided in an institution such as a nursing home or at home or in
The Wisconsin Council on Children
and Families issued a report in July
2017 showing implications for
Wisconsin.  It included an Urban
Institute finding “…that 286,000
children and non-elderly adults are at
risk of becoming uninsured…by 2022
(60,000 children…226,000 non-
elderly adults).”  It noted:  “Wisconsin
has a higher percentage of people in
the individual health insurance
market than many other states, in part
due to the fact that the state rolled
back BadgerCare (Medicaid) eligibility
for parents to 100% of the Federal
Poverty Level, stating that they could
get insurance coverage through the
marketplace…32,000 people in
Wisconsin are at risk of losing their
Medicaid coverage and WI is at risk of
losing $293 million in federal support
by 2022.”  Access to affordable health
care of people with pre-existing health
conditions will be threatened by

Public concerns about negative
impacts on the welfare of people
should be channeled to encourage
voting and non-voting Americans to
speak out against the Better Care
Reconciliation Act or any like
counterpart introduced to replace the
Affordable Care Act.  Rather than to
dispose of ACA, our Representatives
and Senators should find ways to
improve it.   Political “gotcha”
considerations must be set aside to
make room for effective attention to
the public good.