The voices of Urban Institute's researchers and staff
July 19, 2017

If the Senate repeal-and-replace health care bill goes forward, it would cut Medicaid just as more elderly Americans need long-term services and support

Baby boomers will begin to reach their mid-eighties around 2030, causing the share of the elderly population ages 85 and older to rise dramatically. The number of 85-year-olds will double to 18 million from 2030 to 2050, and the share of elderly ages 85 and older will increase from 12 percent to 21 percent.

Cuts to Medicaid proposed by the Senate’s Better Care Reconciliation Act (BCRA) and the just-released House Budget Committee 2018 budget proposal would begin taking effect amid this surge in the elderly population, hampering efforts to meet seniors’ needs for long-term services and support (LTSS).

A long-term care crisis in the making

We know that the need for LTSS increases with age. Nearly 3 in 10 people ages 85 and older need substantial help with basic tasks of living (eating, bathing, dressing), three times the rate among 75- to 84-year-olds.

Meanwhile, Medicaid is the nation’s safety net for long-term care. Medicaid financed 51 percent of national long-term care spending ($158 billion) and 63 percent of the nation’s nursing home residents. Medicaid’s home- and community-based care served about 3 million people.

cuts to Medicaid under BCRA would happen as baby boomers need long term services and support

Budget concerns have already led states to constrain eligibility and availability of LTSS. Many states rely on waivers to create waiting lists for home- and community-based services.

Limited Medicaid LTSS leave families without support and people without care. Family caregivers face health and economic burdens, and elderly people are prone to suffer harm when their care is insufficient.

Cuts to Medicaid under BCRA would make matters worse.

The Congressional Budget Office estimates that the BCRA's per capita cap would cut Medicaid spending 25 percent in 2026 and 35 percent in 2036 when baby boomers are becoming very elderly with increased needs for LTSS and support from Medicaid.

Allotments tied to “base year” spending per elderly Medicaid beneficiary would constrain states’ ability to enhance services to meet the growing needs of an older elderly population. 

As baby boomers head into their eighties, we should prepare to meet their mounting LTSS needs rather than cut funding to programs on which they rely.

The U.S. Capitol is seen in a reflection on the side of an ambulance in Washington on Monday, June 26, 2017, as the Senate grapples with health care legislation. Photo By Bill Clark/CQ Roll Call.

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