Sinking home care

Maine’s members of Congress, with a little prompting from constituents, have been pointing out the problem for years, but health-care experts last week still seemed shocked that federal money for home care has dropped so low since the mid-1990s. When they recover from that shock, they might do the obvious: support a proposal to halt a further scheduled cut to this valuable program.

The Congressional Budget Office announced last week that Medicare spending on home health care has dropped 40 percent since 1997, after a law that year changed reimbursement levels for home-care agencies. The cuts have been particularly harmful in Maine and other New England states, which began with lower payback levels when the cuts took effect. Nationally, home care spending through Medicare fell from $17.5 billion in 1997 to $9.7 billion in ’99.

Not surprisingly, this has put a strain on the home-care system and may be responsible for the increasing use of more expensive nursing homes and hospitals. Several home care advocates pointed out that agencies are reluctant to accept patients who will need expensive long-term care. If this proves to be the case — the CBO didn’t examine causes in its latest report — it will mean Congress would have produced exactly the opposite effect it intended when it approved the ’97 legislation. Add to the reimbursement problem a worker shortage in both home-care agencies and nursing homes caused, in part, by low pay and the problem becomes significantly worse.

What is surprising is how few co-sponsors Sen. Susan Collins has on her bill to eliminate an automatic 15 percent cut in home health care, scheduled to take effect next year. So far, 24 Republicans and 14 Democrats have signed on. The rest, the public could assume, either are reluctant to draw attention to themselves by signing their names to the bill or do not read the reports from the CBO.

They should, and they shouldn’t be shocked. Information that the Medicare cuts were larger than first expected and were strangling the industry has been available for a couple of years. The CBO merely quantified how serious the problem is. And, thankfuly, it has removed any excuse Congress had for failing to support the Collins legislation.