Elderly Americans shouldn’t expect a friend in Trump’s HHS pick

In nominating Alex Azar to be the next secretary of the Department of Health and Human Services, President Trump has, at least, selected someone with real administrative experience — experience disgraced former Secretary Tom Price lacked.

Azar, recently the president of Lilly USA, had previously served as deputy secretary and general counsel of HHS under the George W. Bush Administration. 

{mosads}If confirmed, Azar will run our nation’s largest civilian agency. By the most recent counts, 58.6 million Americans were on Medicare, and 74.3 million were enrolled in either Medicaid or the Children’s Health Insurance Program (CHIP).

This is a time of unprecedented uncertainty for HHS programs. Congress failed to reauthorize CHIP by Oct. 1, allowing the program to lapse with states now running out of funds. House Republicans passed a reauthorization this month, but did so, in large part, by robbing a preventive care fund — that approach may not fly in the Senate. Access to health care for 9 million kids hangs in the balance. 

A number of policy bills intended to repeal, and replace, the Affordable Care Act have failed, but the Trump administration is undermining the law it’s tasked with administering. Azar, an ACA opponent, is clearly on board with this process, having said of the ACA that “one of the nice things in it is it does give tremendous amount of authority to the secretary of HHS.”

More troublingly, failed ACA legislation was a stealth attack upon traditional Medicaid dating to 1965, and not simply Medicaid expansion under the 2010 ACA (expansion supported by many Republican governors). This attack upon the Medicaid that serves seniors in nursing homes and home-and-community-based settings is a huge component of the ongoing Republican tax cut process. The congressional budget resolution they passed, according to one recent analysis, relies upon $1.3 trillion in cuts to ACA subsidies and Medicaid in order to offset $1.5 trillion in tax cuts. 

Azar has been a proponent of cutting Medicaid through so-called “block grants.” Sold under the pretext of giving states more freedom, block grants would actually dismantle the federal-state partnership that is the Medicaid program by forcing states to make do with less.

There is no constituency, beyond ideologues, for these cuts. Trump once recognized this. In 2015, for example, he advertised himself to voters on Twitter as “the first and only potential GOP candidate to state there will be no cuts to Social Security, Medicare & Medicaid.” During the ACA debate last summer, polling by the Kaiser Family Foundation showed 74 percent of the public had a favorable view of Medicaid, and 71 percent opposed block grants. 

In praising block grants, Azar has said, “the states are the laboratory for experimentation.” Let’s consider “experimentation” already occurring in a system in which the federal government matches state spending.

In Oklahoma, for example, where the federal government pays 60 percent of Medicaid costs under the existing formula, many Medicaid providers face 9 percent reimbursement rate cuts due to a budget crisis. It is estimated 100 nursing homes will close if hit with a 4 percent rate cut Dec. 1, on top of longstanding funding neglect. One small facility preemptively closed, displacing 24 elderly residents.

How would cutting federal Medicaid help caregivers and the elderly in states like Oklahoma? What Azar and other cut proponents, like Speaker Paul Ryan (who admits discussing cutting Medicaid at college keggers), fail to understand is that human need can’t be reduced to artificial “caps.” 

By 2030, the Census tells us there will be 3 million more Americans who are 85-and-older than there were in 2012. That population will, inevitably, have some long-term care needs. Our aging society’s needs are already very hard to meet under the current federal matching formula, but that funding approach is, at least, dynamic and allows for additional state spending. It’s a crucial safety net that must not be dismantled.

Azar clearly has the experience to be a capable secretary of HHS. But will he be a compassionate one? Will he stand up for the millions of vulnerable Americans his agency serves? Fearful caregivers, and the elderly and those with disabilities that they serve, await answers. 

Brendan Williams is the president and CEO of the New Hampshire Health Care Association, which represents 90 long-term care facilities. Williams is also an attorney, former Washington state deputy insurance commissioner and former Washington state representative.