Columbus
Dispatch...
Battle begins over
nursing-home cuts
By Jim Siegel, Catherine C and isky
Sunday, May 8, 2011
The 30-second ad that started airing Friday begins with a shot of a
frail, elderly woman in a bed and a picture of Gov. John Kasich in the
foreground. It ends with condemnation of the “Kasich cuts,” a hand
pulling a plug out of the wall, a flat-lined EKG - and a message to
call your state senator “before it’s too late.”
Over the years, the nursing-home industry in Ohio has been accused of a
lot of things. Being lousy at lobbying has never been one of them.
Outside of funding for public schools, no budget issue over the past
decade has caused more persistent head-banging among lawmakers and
governors than nursing-home funding. This year is no different.
“It’s a major part of the budget, and it’s a major responsibility to
take care of people,” said Sen. Scott Oelslager, R-Canton, a26-year
legislative veteran. “We always struggle with what is the best means to
take care of individuals in the most cost-efficient way to taxpayers.”
Ohio spends more per capita for nursing-home care than every state but
five, a statistic frequently cited by the Kasich administration when
talking about its plan to rein in spending on Medicaid, the
federal-state health-care program for the poor and disabled.
But that ranking is based on 7-year-old data, raising questions about
its validity.
Still, most agree the state can save money by serving fewer Medicaid
patients in costly nursing homes and directing more to less expensive
home- and community-based services.
The governor’s budget plan would expand home care for Medicaid-eligible
Ohioans and reduce spending on nursing homes by $427 million over the
next two years, with much of the savings achieved by cutting the rate
paid to nursing homes.
The House passed the budget last week, sending it to the Senate and
sparking the latest on-air salvo from the influential Ohio Health Care
Association, which has argued that the cuts will force nursing homes to
slash thousands of jobs and affect care.
But the fact that the nursing-home industry is turning to the TV
airwaves with a series of hard-hitting ads to make its case seems an
indicator that its almost-legendary Statehouse clout may be waning -
especially amid a tough budget, said Catherine Turcer, director of the
money-in-politics project of Ohio Citizen Action, a nonprofit watchdog.
“It shows that they’re trying to change the strategy that has worked in
the past, because they know it isn’t enough,” she said.
Of course, nursing homes still have the one attribute necessary for any
group to exert clout in state government: money.
Over the past decade, political action committees for the Ohio Academy
of Nursing Homes and Ohio Health Care Association have poured more than
$830,000 into statewide and legislative races, a Dispatch analysis
shows.
Individual contributions from current association staff and board of
directors members total an additional $700,000 over the same period.
Data compiled by Citizen Action show that nursing-home interests
contributed almost $1 million to elections last year for statewide
candidates and lawmakers who wound up as legislative leaders, and
almost $300,000 more to both of Ohio’s major political parties.
“It isn’t just about the fact that it is a lot of money; it is a lot of
money given to many policymakers over a long period of time,” Turcer
said. “They’re a strong lobby. Campaign contributions aren’t just about
the money. It also tells you who is attending fundraisers and who has
the ear of the policymakers.”
But unlike other generous groups that use campaign cash to get
legislators’ attention, nursing homes can appeal to a sense of
altruism: They aren’t just in it for themselves but for ailing seniors
- perhaps like a legislator’s parent, Turcer said.
“These are elderly people who are sick and in need of attention. It’s
pretty hard to say no to,” she said. “Their motives appear just a
little more pure. It’s that pull on your heartstrings plus the money,
and the money is the sugar on top - and it’s a lot of sugar. And it
certainly gets legislators’ ears. They’ve done this for a long time in
a really orchestrated way.”
Rep. Barbara Sears, R-Toledo, one of two House members assigned by the
speaker to work with a pair of GOP senators on nursing-home issues,
acknowledged that the size of the cuts in Kasich’s proposed budget is a
concern. But she also doesn’t appreciate the industry’s scare tactics,
which have included calls from frightened nursing-home residents to
lawmakers.
“For legislators who don’t take the time to really learn the issues,
you can make up a pretty scary story and get people to blink,” she
said. “Some of our folks are very concerned about what they are
hearing. You have to explain to them that we are going to do something,
but we want to do the right something.”
The legislative debate is far from over.
“I know they’re frustrated we didn’t make any changes in the House, but
we didn’t want to make changes that weren’t ready to be made,” Sears
said.
Asked what he would do if new money becomes available in June from
improved revenue estimates, Speaker William G. Batchelder, R-Medina,
named two areas that could get help: schools and nursing homes.
Greg Moody, director of the governor’s Office of Health Transformation,
justifies the cuts, saying Ohio ranks 45th in the nation for
affordability of nursing-home care. Ohioans paid $596 per capita for
care - 52 percent above the national average, according to 2004 data
from the Kaiser Family Foundation, the most recent state-by-state
report available.
Peter Van Runkle, executive director of the Ohio Health Care
Association, said those figures are misleading. Besides being old, the
numbers are based on all payers, not just those on Medicaid.
Ohio’s Medicaid program currently reimburses nursing homes $177 a day.
Both Van Runkle and the administration say that’s $4.75 higher than the
national average.
“We’ve been held flat for the last five or six years, and now we are
confronted by an actual reduction,” Van Runkle said. “It’s, on average,
$13 a day. That is going to harm care and result in fewer people at the
bedside.”
The nursing-home lobbyist said he’s been asked by legislative leaders
to meet with administration officials “to see what kind of solution we
can come up with,” but no gathering has occurred.
Lawmakers say it’s not just about cuts. Rep. Dave Burke,
R-Marysville, who will join Sears in crafting nursing-home plans, said
this budget must take big steps toward making the nursing-home industry
one that treats only patients with no other option who need skilled
care.
“In the long run, you will see savings in the nursing-home sector not
because we cut them, but because we gave patients alternatives,” he
said.
But this is not the first time lawmakers or governors talked about
major nursing-home changes.
“They rally an incredible amount of dollars and put them toward their
mission,” Sears said of the industry. “That’s what got us into this
problem - trying to Band-Aid the real issues.”
She added: “Term limits are a terrible thing when it comes to these
issues.”
The governor also has proposed to sharply reduce the amount the
state pays to “hold” a bed for Medicaid patients who temporarily leave
a nursing home when they are hospitalized or spend time with family.
Currently, Ohio pays half of the daily rate for up to
30 days for an empty bed. The new budget plan would pay nursing homes a
quarter of the daily rate for up to 15 days, which would save an
estimated $16.2 million over the next two years.
Paying for empty beds may have been necessary when nursing-home demand
was high, but Moody notes the vacancy rate for Ohio nursing homes is
15percent. More than 98percent of Medicaid beneficiaries live within 10
miles of a nursing home.
“You are more likely to live next to a nursing home than you are a
public high school,” Moody said. “We aren’t worried about access.”
Read it at the Columbus Dispatch
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