Defending Medicaid, SNAP, and Equitable Access with Natalie Kean

Show Notes

Medicaid and SNAP have long provided essential support for vulnerable adults. However, a recent proposal in Congress to reduce funding for these programs threatens to undermine equitable access to care for millions of older Americans, many of whom are living with Alzheimer’s disease and related conditions.

This week, we’re joined by Natalie Kean, Director of Federal Health Advocacy at Justice in Aging, to explore the serious implications these proposed cuts could have on vulnerable adults.

Episode Transcript

Scott Frey:

Hello and welcome to This Is Growing Old, the podcast all about the common human experience of aging. My name is Scott, and I’ll be your host today. Medicaid and SNAP provide essential support for countless vulnerable adults such as those living with Alzheimer’s disease and related illness. As our population continues to age, the need for these programs will only grow. So when the new Congress proposed cuts to these critical services, patients, advocates, and experts responded with strong opposition. In response, leaders across the advocacy community took swift action, urging Congress to reject the cuts, warning of the devastating impact on access to affordable care and treatment.

One of the leading voices defending older Americans is Justice in Aging, a national organization that uses the power of law to fight senior poverty and secure access to healthcare, economic security, and justice for older adults with limited resources. Joining us today to unpack the implications of these proposed cuts and what we can do to push back is Natalie Kean, director of Federal Health Advocacy at Justice in Aging. Natalie, thanks so much for being with us.

Natalie Kean:

Thank you so much, Scott. I’m really excited to be here to have this conversation. As you noted, it’s really timely right now.

Scott:

Thanks. Let me get to our first question. How do programs like Medicaid and SNAP uniquely benefit Americans living with chronic disease and other disabilities?

Natalie:

So this intersection of aging and chronic illness and disability is quite well known, but unfortunately that also often intersects with poverty or in the case of the US really, a lack of comprehensive supports for people with disabilities and aging adults. But Medicaid and SNAP are the supports that we have. Medicaid is really the only affordable way for most people to get support to stay at home as they age with chronic diseases such as Alzheimer’s and dementia or with a disability. It supports people across the lifespan. And then programs like SNAP are also really important as economic supports and to keep people healthy as they age. We know there are strong connections between nutrition and health and aging.

Scott:

And what will happen to marginalized communities, particularly those living with Alzheimer’s or other chronic diseases if federal funding to these programs is reduced?

Natalie:

So the first impact in many states is likely to be less access to paid care at home if Medicaid funding is cut. This will impact people with limited incomes and people with higher healthcare needs, such as people living with dementia the most. The Medicaid program home and community-based services is how most people get this kind of help. And it’s not actually through Medicare, that’s a common misconception. Medicaid is the program that provides long-term care in our country, but states are not required by federal law to provide these supports at home. So that’s why if federal funding is cut to states and states are having to tighten their budget, they’re going to be looking to programs that they are not required to provide first.

And that would be home-based long-term care for older adults and people with disabilities. Also with the cuts to home-based care, that in turn will mean that a lot more people will have to go into nursing homes. But even then, with federal funding cuts of the size that we’re hearing being contemplated, we’re likely to see Medicaid provider payments to nursing facilities and other providers be reduced. And that will impact staffing and the quality of care in those facilities. And then also cutting a program like SNAP, that again, as I said before, is an economic support that really helps people stay at home.

When you’re living at home, you need all the supports. You need to be able to pay for your housing, pay for your food, and pay for your care. And many, many older adults are living on their social security income alone and really without support from Medicaid and SNAP could not afford to do that.

Scott:

We’ve heard many in Congress say recently that they won’t support direct benefit cuts. But what you’re saying is over any reduction in funding to the states will ultimately result in the same.

So at their core, Medicaid and SNAP are anti-poverty programs.

Natalie:

Exactly. That’s exactly right. It’s not simply a matter cutting a little bit of funding and states will be able to make up the difference. They can’t. They won’t be able to. Federal Medicaid funding makes up a large portion of states’ budgets across the US, and so every state will feel the impact of federal cuts and the choices. None of them are good. They all result in harm to older adults and people with disabilities and families who rely on Medicaid and SNAP.

Scott:

Thank you. Justice in Aging, along with nearly 150 advocacy organizations and individuals joined us recently in urging Congress to reject Medicaid and SNAP cuts. As a leading voice in the effort to combat senior poverty, how will these proposed cuts heighten inequity across the country?

Natalie:

So at their core, Medicaid and SNAP are anti-poverty programs. We say that these are key programs to keeping seniors out of poverty and out of deep, deep poverty. Medicaid is the only coverage of long-term care. As I’ve mentioned, it’s not affordable out of pocket for the vast majority of older adults, and it really prevents people from going into deep poverty. And then also something that a lot of people don’t realize about Medicaid is that it helps older adults and people with disabilities with Medicare costs. So Medicare itself is quite expensive.

It’s not free, even though people pay into it throughout their working career, there’s still $185 a month premium for Medicare part B. But Medicaid helps pay those costs and the co-payments for Medicare for over 10 million older adults and people with disabilities. Having that $185 a month back in your pocket helps people pay their utilities, it helps them buy groceries. And again, SNAP and other programs are just indispensable for helping people afford to live in the community.

And then talking about inequities, the people who are most marginalized, such as older women of color, who are more likely to live alone than other older adults, and LGBTQ+ older adults who are more likely to live in poverty and less likely to have family caregivers will again be hurt the most by these cuts. These programs are absolutely a lifeline for these.

Scott:

Especially at a time when costs are increasing across the board.

Natalie:

That’s right.

Scott:

Well, this is going to be a long budget process apparently that Congress has designed. What are the next steps and how do we ensure that our concerns, our demands are heard?

Natalie:

So it is a long process. As you mentioned, many listeners have probably heard this described as a marathon, but within that marathon, there are some sprints that we have to do. Congress is still at the first stages of the process for budget that they want to use to pass these Medicaid cuts. And so that means we still have many, many opportunities to stop the cuts from being enacted. Just last week, the Senate passed a new budget resolution, which the House is considering this week.

And again, that’s the first step that lays the outline for the type of cuts that they would need to make. But it’s not legislation. It does not actually make the cuts. So even if the House agrees to that resolution, there’s still many more steps in the process. And again, I like to see them as opportunities to stop these cuts from happening.

Scott:

That’s helpful. Thanks, Natalie.

Natalie:

That’s all right. So Congress and policymakers everywhere really need to hear about the importance of Medicaid and we really need to be united in our messaging. We’re not asking for a carve-out for older adults and people with disabilities. Carve-outs don’t work. The only way we can really ensure that Medicaid will be here for the people who currently rely on it and grow to meet the growing need. As you mentioned, Scott, for ourselves and our loved ones in the future, is to prevent any cuts to the program. I just cannot overemphasize how massive these cuts would be and how they would fundamentally change the Medicaid program as we know it.

The single most important thing to do is to tell your story.

Scott:

And on that score, as we go through this process, how can our listeners, the thousands of family caregivers struggling to care for a loved one in the home, others who are just concerned generally, how can they support your efforts to ensure these programs are protected as we go through this process? How can they engage?

Natalie:

The single most important thing to do is to tell your story. And the story does have to be of any certain mold or you don’t have to be talking about what would happen if Medicaid went away. But just talking about the importance of Medicaid to you, your family, your community is really, really important. And to make it local and make it personal. So yes, absolutely. Tell your story to Congress. Call your members of Congress repeatedly throughout this fight. They need to be hearing from us. If they are supporters of Medicaid, members of Congress are using those stories to help fight back.

And if they’re considering Medicaid cuts, they really need to hear from their own constituents. That’s the most persuasive voice. And then also think about amplifying your story through local media, letters to the editor, contacting local news sources to make sure that people in your community are hearing about the importance of this program. One thing we hear a lot is that a lot of people, especially people receiving home and community-based services through Medicaid, don’t understand that they are on Medicaid, that they get help from Medicaid. It goes by many different names.

Many of these programs are called waivers. So just chances are, if you or a loved one are getting some help with long-term care, Medicaid is likely involved. And so please tell that story.

Scott:

Thanks so much. Now I think as we come to our close here, Natalie, thank you so much. Two questions that we ask all of our guests. So first, when you were younger, what did you imagine growing older would look like?

Natalie:

I love these questions. Thank you for asking. I feel really lucky to be working at an organization like Justice in Aging, where I get to think about these questions and reflect back on. I don’t think I thought a whole lot about aging when I was younger, but I was lucky to have many older adults in my life who provided great support and showed me that aging, getting older is something that I want to do. My grandmothers, especially my mom’s mother, I spent many summers with her on the farm. And one thing I remember she shared with me once when we were watching the news and they were showing people who were turning a hundred, 101.

My grandma said, “Oh gosh, I’m tired. I can’t imagine living that long.” And she was in her late eighties at that point. And I just really remember that striking me and causing me to think, “Wow.” It was a comfort to know. Hopefully at one point in my life I will get to the point too where I’m satisfied with my life. So I again had a very positive image of aging.

Scott:

It’s great to have such role models. And finally, as an adult, what do you enjoy most about growing older?

Natalie:

I think right now I really enjoy knowing who I am, but also being open to the change. Many people who fight ageism point out, we live a long time in what society considers old age. And just knowing that I can continue to learn and change, but also comfortable in who I am. And I’ve also recently come to really appreciate having friendships with people across the age spectrum. I’m no longer always the youngest person in the room, and I really enjoy sharing my life experiences and also, again, continuing to learn from people who are older and younger than me.

Scott:

Well, Natalie, thank you for sharing your wisdom with us and thank you for all the great work that you and Justice in Aging are doing, particularly in this fight we’re in. But in all that you do. And I want to thank our listeners again for tuning in and always be sure to check out the Alliance’s website, agingresearch.org, to stay updated on the policy team’s work in this important area. Thanks so much, Natalie. Thanks everyone.