Jewish groups that care for the elderly are looking forward to the election, and not because they favor a candidate or a party -- they want Washington’s fractious establishment to get back to figuring out how best to fund programs the groups say are essential.
Between the Nov. 6 election date and Jan. 1, Congress and the Obama administration – whether lame duck or reelected – are set to head off “sequestration,” when massive across-the-board cuts go into effect with the new year.
Elderly care groups want to make their voices heard on the matter, given the condensed time that Congress will have to address the issues – but getting through is hard right now.
“It's a little difficult to do serious advocacy. It’s difficult right now to get anyone to focus on anything but the congressional elections,” Joyce Garver Keller, the chief lobbyist for Ohio Jewish Communities, said. “Everyone is focusing on the election. The best I can do, what I try to do is to keep some of our members of Congress aware of the fact that this is something very much on our minds.”
The two federal programs that provide the bulk of funding for elderly care, Medicare, which funds care for the elderly, and Medicaid, which provides medical care for the poor, will be relatively unscathed should sequestration kick in, with its across-the-board cuts of about 8.5 percent. Medicaid is not designated for cuts; Medicare is designated for 2 percent cuts.
Health industry professionals predict that even the 2 percent in cuts for Medicare could prove far reaching. A report by American Hospital Association, the American Medical Association and the American Nurses Association anticipates close to 500,000 jobs lost in the first year, Kaiser Health News reported on Wednesday.
Even with Medicare and Medicaid spared, however, ancillary programs coming under other rubrics will sharply affect elderly care, said William Daroff, the director of the Washington office of Jewish Federations of North America.
“While Medicaid and Medicare are exempt, we are concerned about the devastating impact sequestration could have on important Jewish communal programs that provide necessary assistance to the most vulnerable among us,” he said. “The specifics of the potential cuts are uncertain at this time, pending a report due shortly from the administration. We remain confident that when the election season is over, Congress and the executive branch will reach agreement that prevents draconian cuts from occurring.”
Rachel Goldberg, who directs aging policy for B’nai B’rith International, outlined a number of sources of funding for elderly care that would be subject to the across-the-board 8.5 percent cuts.
Cuts to housing payments administered by the Housing and Urban Development department, she said, could within a year see homes for the elderly close units. “People could be evicted,” she said.
Also affected by the sequestration cuts would be departments that administer programs authorized under the Older Americans Act, including the Departments of Health and Human Services and of Agriculture, Goldberg said. On the ground, this would affect funding for caregiver support, distribution of meals and subsidized transportation for the elderly.
Goldberg noted that it’s not just sequestration. An array of laws that the Republican House and the Democratic Senate have failed to address are set to lapse on Jan. 1, and some of these would affect care for the elderly. Congress periodically votes to delay imposing “sustainable growth rates” on Medicare spending mandated by a 1990s law, for instance. No such delay has been approved this Congress, and should the law kick in, payments to doctors would drop substantively.
The challenge for elderly care lobbyists in the relatively short period between the election and Jan. 1 is to remind lawmakers and the administration to focus on the non-defense cuts sequestration would bring.
“There are two major advocacy groups dealing with sequestration,” said Keller. “People who sell things to the military” and “those of us who work in the charitable nonprofits, programs that serve the elderly, children, the disabled, housing emergency food and shelter.”
In anticipating sequestration negotiations, the Republican House has emphasized the dangers to national security of defense cuts, and is urging Obama to use the National Security and Job Protection Act the House passed as a basis for discussions.
“The House has approved a plan to protect our troops, jobs and our homeland,” Rep. Eric Cantor (R-Va.), the House majority leader, said in a statement. “We have repeatedly asked the White House to work with us to replace the sequester, meet us halfway or to present a plan.”
Regional leaders of B’nai B’rith who attended its policy conference in September met with congressional officials on the Hill to make the case for addressing non-defense cuts, Goldberg said.
“We took our people on [Capitol] Hill and talked about the effect of the sequester on housing programs and the immediate impact on old people,” she said. “Our focus is making sure that deficit reduction does not create more poverty.”
In the longer run, the Jewish organizational officials who deal with the elderly are pressing Republicans for more information on how they would change Medicare and Medicaid. Republicans want to replace some federal administration of Medicare with an array of private options that Democrats have described as “voucherizing” the program. The GOP also wants to reduce federal administration of Medicaid by handing the money over to states in block grants.
Rabbi Steve Gutow, the president of the Jewish Council for Public Affairs, says he has concerns about the vouchers, but that these could be assuaged if the Republicans fleshed out their plan.
“They might work if they are pegged to inflation, if there were details that would show they would make it work, but I haven't seen that kind of discussion,” he said.
Keller of Ohio Jewish Communities voiced a similar concern about the proposal to deliver Medicaid money in block grants to the states. If the number of Medicaid-eligible citizens increases, as it now stands, federal funding for the program is guaranteed to increase proportionally. Block grants could cut off that option.
In any case, she said, charitable giving, while critical, was not by itself a salve.
“There are lots of programs that are public private partnerships which take charitable donations for serving people at risk but which could not survive without government support,” she said.