Last Thursday, a group of top New Jersey Democratic politicians — including both U.S. senators, Robert Menendez and Cory Booker, the two congressmen who represent the local area, longtime Representative William Pascrell of the 9th District and freshman Representative Josh Gottheimer of the 5th; State Senate Majority Leader Loretta Weinberg of Teaneck, and many other local politicians met at the Englewood Hospital and Medical Center to talk about the dangers posed by the Republican effort to repeal and replace the Affordable Care Act (aka Obamacare).
Most of the dangerous effects of the bill, as pointed out by the speakers, would affect all Americans, and all New Jerseyans, who benefit from Medicare or Medicaid or any of the range of services whose funding the new bill would change. But there also are Jewish agencies that would be affected.
Any discussion of the bill must begin with a caveat. The bill keeps changing. The American Health Care Act that the House of Representatives passed in May, which morphed around the edges before it was passed, is not exactly the same as the Better Care Reconciliation Act, the Senate’s version, which was kept away from all but a group of 13 Republican senators for most of its existence and now is undergoing tinkering. The bill, the BCRA, might well die, or at least go into a deep, possibly irreversible coma, possibly by the time this story hits newsprint.
Acknowledging the uncertainty, some local agency heads discussed the bill’s likely effects.
Jason Shames is the CEO of the Jewish Federation of Northern New Jersey. His organization provides some funding to many of the agencies that work with the elderly and with people with developmental or physical disabilities, populations most likely to be affected by the cuts proposed in the new bill.
“Any cuts in funding to Medicare or Medicaid obviously create a bigger gap for people in need,” Mr. Shames said. “We don’t have details now, but I do have a general concern. We know that there are a lot of elderly Jews, and also a lot of adults with development disabilities, who are very dependent on these programs that look to be at risk in the bill. That’s what we’re worried about.
“I don’t have a sense right now about exactly where that gap will be, but nonetheless we are holding our breaths. If people fall through the gaps, we have no place to turn.
“It is a complex bill and we are acutely aware that it could be amended and changed at any time. We are not looking forward to any of it being great for our population.”
Jordan Shenker is the CEO of the Kaplen JCC on the Palisades in Tenafly. He stressed that he has not read the bill, “but if what we’ve heard reported is accurate, there are two specific provisions in it that would be problematic for us,” he said.
“The first one is related to reductions in funding for Medicare and Medicaid, and the second one is related to changes in the tax code that would eliminate charitable giving as an itemized deduction.
“We get much of the funding for our special needs programs from Medicare and Medicaid, especially for adults with developmental and physical challenges,” Mr. Shenker said. “Once you reach the age of 21, you no longer get funding through the school system, so you have to get it through other agencies. We are one of those agencies.
“We have dozens and dozens of people in multiple programs, adults with a wide range of disabilities. They are funded through Medicaid, and any cuts in funding, either direct or indirect, would directly affect those clients’ capacity to get funding for those services.”
And then there is the matter of itemized deductions. People often talk about how the bill will cut Medicare and Medicaid and pull back the Medicaid expansion. The fact that the bill also includes a large tax cut for the wealthiest group of Americans is mentioned as well, although less often. The detail that despite that tax cut, charitable donations no longer will be able to be used as a deduction, is less known still. Mr. Shenker worries about it.
“It is hard to assess and calculate what percent of donations we receive from those who would be disinclined to give them if those donations no longer were deductible,” Mr. Shenker said drily. “I don’t think that a significant number of our donors would take their checkbooks and put them back in their pockets without writing a check first, but I suspect that the change would have some impact.
“How much impact? Would it be 10 percent? 20 percent? 30 percent? I don’t know if it would be toward the high end or the low end, but I suspect it would have a significant impact.”
The JCC has not yet made any plans to deal with possible cutbacks. “It’s hard to make plans until you know what the impact will be,” Mr. Shenker said. “It’s possible that they could cut back on Medicare and Medicaid, but have those cuts affect the population that is not disabled — maybe it would affect people in nursing homes, or assisted living facilities. In which case it would have a marginal effect on our services. Until we know what the bill is, we can’t assess what we can or cannot put into place.
“We only know what we know,” he concluded.
Carol Silver Elliott is the president and CEO of the Jewish Home Family.
“Obviously it is hard to speculate, not knowing what will happen,” she said. “But certainly we are very concerned about the future of Medicaid, especially at the Jewish Home at Rockleigh.” The Jewish Home is the organization’s nursing home and subacute care facility.
“We are required by the state to have 45 percent of our patients be Medicaid patients,” Ms. Elliott said. “At the assisted living facility, we have 10 percent on Medicaid.
“At Rockleigh, we take a significant loss on every Medicaid patient every day, because Medicaid pays far less than our cost.”
The problem is also financial, but it is by no means only financial, she added. “What will happen to these people?” she said. “These are the people who are the most in need. Who are the most vulnerable. They are people who have outlived their resources. We see that every day.
“What happens to those folks who have worked all their lives, who are living perhaps far longer than they ever expected to live. Their resources are all gone. What will happen to them?
“And then there are the people who receive necessary health care through community Medicaid. Those are substantial numbers of people. What will happen to them?”
And what happens if the funding is cut? Will the mandate to have 45 percent of patients be on Medicaid be retained? If yes, who will pay for them? And if no, where will they go? Who will care for them? What will happen to them? “No one really knows what will happen,” Ms. Elliott said. “But we know that it is not good either way.
“What it comes down to for me is that we are talking about individual lives,” she continued. “It is not just about numbers and economics. It is about lives.
“I see our residents every day. We exist to take care of the most frail and most vulnerable. That is what we do every day. To think that their well-being can be compromised — it disturbs me that so much of our cost-cutting, on the state and national level, is done on the backs of the elderly.
“Ageism is alive and well in the United States,” Ms. Elliot concluded. “We are not revering our older adults. We are not valuing them. Instead, we are taking from them.”
Loretta Weinberg is disgusted with the proposed bill. “We don’t even know what the bill is,” she said. “It seems to be disintegrating. It is hard to talk about something that does not exist in reality.”
It’s odd, she said, given how Republicans have spent the last seven years talking about repealing and replacing Obamacare. “Obviously the majority party and the administration in Washington have not spent any time thinking about what they have been talking about for seven years,” she said.
The proposed bill would hit New Jersey particularly hard, Ms. Weinberg said. “Anyone who does not have health insurance can go into an emergency room and be treated,” she said. “New Jersey taxpayers pay the hospitals. They never pay the full amount, but part of it. That’s called charity care. With the expansion of Medicaid, and the fact that hundreds of thousands of people got health insurance, we weren’t paying for it in New Jersey, and so we saved a lot of money over the last two years. And because people had health care, they went to the doctor when they had, say, a sore throat, instead of waiting until it because a much more major problem.
“So Obamacare was keeping them healthier and the taxpayers were helped because they didn’t have to pay for healthcare from the emergency room, which is the most expensive healthcare setting.”