Republican tax cuts share blame for Iowa nursing home sale

Chris Schwartz | Iowa View contributor

Show Caption Hide Caption Grassley open to changes in Medicare and Social Security Sen. Chuck Grassley answered questions from constituents during a town meeting Jan. 12, 2018, in Logan, Iowa.

Events in Washington can seem remote. But the devastating impact of last year’s Trump-GOP tax cuts — supported by our Republican Congressman, Rod Blum — can be felt just a few miles north of downtown Waterloo, at the Country View nursing home.

After 150 years of direct service to the community by Black Hawk County, Country View is being sold to a Chicago-area private company, an unsettling prospect for both residents and staff. A big reason for the sale is insufficient funding from Medicaid, the federal-state public health program for low-income and disabled people. This problem has been further exacerbated by Republican actions to privatize the management of Medicaid in Iowa, a move that has been an absolute disaster for both patients and providers.

Medicaid and its sister program, Medicare — which primarily serves the elderly — both turn 53 years old this week. But thanks to the Trump-GOP tax cuts, the only birthday presents they can look forward to this year are severe budget cuts.

The new Republican tax law, which mostly benefits the wealthy and corporations, will add nearly $2 trillion to federal deficits. President Trump and House Republicans are trying to cover that shortfall by slashing public services working families rely on, with the biggest cuts reserved for health care.

Trump wants to cut a combined $1.3 trillion from Medicaid, Medicare and the Affordable Care Act (ACA), the new kid on the health care block that’s improved both older programs as well as offering many other vital reforms. Rep. Blum’s GOP colleagues in the House want an ever deeper slice out of all three programs: $2 trillion.

More than a million Iowans are covered by Medicare or Medicaid (some by both). That includes the 140 residents at Country View who, along with nearly half of all other nursing-home residents in our state, are covered by Medicaid. But Medicaid pays only about 80% of the cost of Country View residents, and now even that share is threatened by the proposed GOP cuts to the program.

Black Hawk County is forced to make up the difference, which in recent years has cost millions of dollars. That’s why, over my objections and significant public resistance — based largely on the fact that monitoring quality of service is more difficult in a private facility than in a public one — Country View is being sold.

Across our state, around 150,000 low-income people now qualify for Medicaid thanks to the ACA, which also provides affordable coverage for 50,000 other Hawkeye State residents through its private insurance exchange.

In contrast to the million-plus Iowans facing cuts to their health care, just 15,000 families are among Iowa’s richest 1%. Their average annual income is $1.2 million, and they are getting an average tax cut of $43,000 from the Trump-GOP-Blum tax cuts.

Another big winner from the new tax law is the drug industry, which is one of the principal drivers of higher health care costs. Five big U.S. pharmaceutical companies will share in more than $6 billion of tax savings this year alone, a perverse reward for jacking up prices on widely prescribed medications by 15% annually in recent years.

Local elected officials like me are forced to confront the consequences of these cruel tax-cuts-for-the-wealthy, budget-cuts-for-the-needy tradeoffs. The fate of Country View is a good example. It's more than a nursing home: it also has two mental health units. The company buying it has no experience running mental-health units.

Rather than selling off public health facilities — which in addition to raising questions about future patient care usually eliminates good-paying jobs with decent benefits — we should be expanding quality, affordable health care. That means strengthening instead of cutting Medicare, Medicaid and the ACA.

If Republicans want to give an appropriate birthday gift to Medicare and Medicaid, they would repeal the tax cuts for the wealthy and corporations. They could then use the money saved to protect the health care we have and make it much more affordable in the future.

Chris Schwartz is a Black Hawk County Supervisor.