Republicans in Congress have big plans for Medicaid. The Congressional Budget Office estimates that the House bill would cut $834 billion and 17 percent of enrollees from the program over a decade. The Senate GOP is keeping its bill secret—only “13 guys in a secret room” know what’s going on—but word around the Capitol is it would make it even harder for low-income and disabled Americans to get the lifesaving care they need.
Slashing Medicaid would cause disproportionate harm to women, who make up 53 percent of all enrollees and, since they live longer, comprise 69 percent of the 9 million Americans who qualify for both Medicaid and Medicare. But this direct impact is just the beginning of the story—there’s also an intergenerational ripple effect. Women are far more likely than men to take on family caregiving responsibilities as their parents age. Without adequate backing from Medicaid, the next generation of caregiving women will find it much harder to keep their jobs and provide for themselves while supporting elderly family members.
The New York Times editorial board argued last week that “a system of caregiving that is already clearly strained would implode” if the GOP’s proposed Medicaid cuts go through. Daughters already provide 31 percent of all informal (that is, unpaid) elder care—the same amount as spouses and just under the combined caregiving hours of sons, children-in-law, grandkids, and other family members. About 17 percent of adults will care for an aging parent or two, contributing an average of 77 hours a month to that unpaid work. The time they spend on unpaid caregiving work in 2012 was worth about $522 billion, according to the Times’ estimates, more than twice as much as the $211 billion adults spent on formal elder care. Female caregivers are more likely than male ones to leave the workforce for caregiving duties, and they’re almost seven times as likely as men to cut back from full-time to part-time work.
Currently, almost 40 percent of the nation’s long-term care expenses and more than 62 percent of the 1.4 million U.S. nursing-home spots are paid for by Medicaid. If that funding diminishes or disappears, women will be left with the responsibility to fill in the gaps for seniors who no longer have access to paid care. They will put a larger proportion of their own income into parental care and may have to reduce their own earnings to spend more time at home. This means less money going into these women’s savings accounts and retirement funds, putting them at risk of financial peril when they reach their parents’ age.
If those women had reached old age with inadequate retirement savings under the current status quo, they might be eligible for Medicaid assistance. In 20 years or so, if Republicans get their way, it may be much harder to qualify, passing a costly burden onto the next generation of daughters. Those caregivers will be saddled with far greater elder-care responsibilities than any prior generation—the U.S. Census Bureau projects that one-fifth of the U.S. population will be 65 years of age or older in 2030, up from 13 percent in 2010. The number of dementia patients in the U.S. is expected to increase by more than 50 percent in that same time period. Without the Medicaid support previous caregivers have relied upon, a far greater number of family caregivers will be forced to leave the workforce or spend down their own savings to keep their parents in good care.
Some states are starting to address the looming elder-care crisis on their own. The Hawaii state legislature recently passed a bill that would give $70 worth of professional home care each day to family caregivers who work outside the home at least 30 hours a week. In Maine, advocates are trying to establish a universal home care system for all elderly adults. But the few pieces of in-progress state legislation out there could take years to become policy, and a patchy map of intermittent coverage does not a safety net make. Aging Americans, who make up a fast-growing proportion of the population, will undoubtedly suffer if their Medicaid support is snatched from under them. Their daughters will feel the repercussions for decades.