Home Alone

The cuts Congress will likely make to fund federal health care reform will take an extra large swipe at Texas, a state that has worked hard to let the elderly age at home.

Texas home health agencies, which provide in-home nursing for homebound Medicare patients, would face between $7 billion and $9 billion in reimbursement cuts over the next decade. That’s 16 percent of all cuts nationally, and more than any other state, including home health-heavy Florida and California.

Advocates for the industry say if the cuts pass, two-thirds of Texas’ home health agencies would be operating in the red by 2016.

“Those funding reductions are going to cut into services, into the ability of providers to stay in business,” said Mike McLamore, public policy director for the Texas Association for Home Care. “It’s going to reduce the number of providers available. And we’re going to have to evaluate whether we can offer services to as many Medicare beneficiaries as we are now.”

Congressional Democrats have recommended cutting Medicare spending on home health care by up to $57 billion over the next 10 years to help subsidize coverage for the uninsured. They say the cuts would encourage home health companies to operate more efficiently — and that improved access to insurance will mean home health providers see more paying customers.   

But Carlos Higgins, the Austin-based speaker of the National Silver Haired Congress, which advocates for senior citizens, said lawmakers are taking a short-sighted approach to home health care.

The less home health care there is, he said, the more elderly patients will end up in the hospital. The more elderly patients end up in the hospital, the more infections they’ll contract. The more infections they contract, the longer they’ll stay in the hospital — and the more their health care costs will mount.

“The people who are making these decisions fail to realize how soon they’re going to be in this boat themselves,” Higgins said.

Industry experts say the cuts are not just unfair to the elderly; they’re unfair to the home health care providers. Home health care, which makes up just 4 percent of Medicare dollars, will account for 10 percent of the cuts.

And they say the cuts will force Texas to reverse course, after years of efforts to help the elderly stay out of nursing homes and other institutions.

“We’ve been a state that’s been out front on converting people from nursing homes, on giving them the option to stay at home,” McLamore said. “We really should be expanding home care, as opposed to cutting back on rates.”

State Sen. Eddie Lucio Jr., who chairs Texas’ Joint Legislative Committee on Aging, said the proposed legislation “challenges this vital and necessary industry to perform more efficiently and more effectively.”

But the Brownsville Democrat said he thinks federal lawmakers could find better areas to target for savings, including Medicare fraud and over-utilization of procedures.

“I’m hoping when the dust settles, we can find a middle ground that won’t hurt our seniors and our special needs individuals,” Lucio said.