I grew up in middle-class America as the daughter of a teacher and a school psychologist, that is to parents who were lucky to receive a reasonable salary and excellent insurance and retirement benefits throughout their careers. They saved their money and helped put my sister and me through college and provided some support for me through medical school.
That’s why I never knew that my parents weren’t ready for retirement until it was obvious they weren’t. The cost of their medical issues overwhelmed them, as happens to so many older Americans who ultimately depend on Medicaid. Even though my family’s story is extremely common, the inability to pay mounting medical bills comes as a surprise to nearly all families, because few of us face the facts of aging until we have to.
The cost of their medical issues overwhelmed them, as happens to so many older Americans who ultimately depend on Medicaid.
My mom was the glue that held our family together and kept the household running. But when she started losing her memory around 60, running everything became Dad’s responsibility, and he already had a myriad of his own health problems: diabetes, kidney disease and heart failure. My sister and I were fairly oblivious then to what was happening. I was busy working full time and raising children, and she lived halfway around the world. Like many aging parents, ours insisted that everything was OK, and they did a pretty good job covering up that it wasn’t. But given the speed of Mom’s memory decline and the severity of Dad’s chronic illnesses, they couldn’t cover things up long.
They needed more care than they could provide each other and more than home health care visits could provide. They began by transitioning to what’s called “independent living” for my dad and assisted living for my mom. Even though my parents enjoyed comfortable retirement pensions, Social Security and private insurance, their new living arrangement was barely financially feasible, and I was constantly worried about what would happen when they needed a higher level of care.
This all came to a head about two years later when exacerbations of chronic health problems landed my father in the ICU. His health deteriorated so much with this hospitalization that it became obvious that he could no longer live independently. In fact, he needed so much help that he needed full-time skilled nursing — a nursing home. And I soon realized that despite my being a physician, there was so much that I didn’t know about nursing homes. I didn’t realize, for example, that my parents’ “good” private insurance didn’t cover nursing home care. But that’s fine, I thought; Dad’s old enough for Medicare. That’s when I learned Medicare doesn’t pay for nursing homes, either.
The private pay rate for the nursing home in his “life community,” I learned when I started investigating it, was $13,000 per month! I thought that surely was a mistake or that we had somehow chosen a particularly expensive place. But, no, in 2019 in greater Milwaukee, which has a relatively low cost of living, that price was about average. Some places cost slightly less, and some cost much more, but I, a physician, didn’t find a single place we could afford. We were already paying almost $6,000 per month for my mom’s assisted living. To pay for Dad’s nursing home care on top of that would have cost $200,000 per year, more than my parents ever made when they worked full time. They certainly didn’t have that kind of money saved.
My sister and I discussed one of us quitting our jobs but realized that even if one of us did, we couldn’t provide Dad the skilled care he needed at home. And neither of us could quit our jobs and still pay all our bills. I, specifically, was in the middle of the classic sandwich generation dilemma. I had a toddler and a child in elementary school. I was trying to pay off medical school loans, pay for child care, pay the mortgage, save for my kids’ college and my own retirement. Everything was untenable. We didn’t understand how people managed these situations.
An amazing social worker helped me understand that most non-wealthy Americans spend down their savings and apply for Medicaid. I was floored. My parents were average Americans with decent pensions and modest savings. What need did they have for Medicaid when they had private insurance? How could skilled nursing care cost so much that most people who need it are priced out of it?! That’s when I learned that Medicaid is how the majority of America receives skilled nursing care. At the time, 2019, Medicaid was the primary payer for 59% of nursing home care. As of July 2024, that proportion had risen to 63%. While enrolling my father was extremely complicated, I believe the process ensures that those who apply are truly eligible. What we learned is that almost all of my father’s pension and Social Security benefits went to pay his nursing home. He got to keep $30 per month for personal items. Also, the Medicaid negotiated rate for the nursing home was much lower than the $13,000 a month I’d been quoted. This arrangement was lifesaving for my father and will be lifesaving for my mother if she ever requires this level of care. The families of many elderly Americans may never imagine they’ll need Medicaid — until they need it. Republicans are proposing $880 billion in mandatory spending cuts in programs that fall under the purview of the House Energy and Commerce Committee. A cut of that magnitude would almost certainly slash Medicaid. That would be disastrous for the hundreds of thousands of elderly Americans who live in nursing facilities. The Republicans supporting this bill most likely have or will have family members who depend on Medicaid. It’s wrong of Congress to take an ax to the floor of the boat keeping so many Americans afloat. Slashing Medicaid would be that kind of heartless move.
Dr. Jennifer Jury McIntosh
Jennifer Jury McIntosh is a practicing maternal fetal medicine physician in Wisconsin. Her work focuses on high-risk pregnancies, with a particular interest in preeclampsia and hematologic complications. Dr. McIntosh is particularly passionate about the intersection of medicine and politics and speaks and writes on some of these topics. She lives in Milwaukee where she enjoys spending time with her family, traveling and baking. 
