05/29/2026
I’m attending a two day advanced elder law intensive in conjunction with the annual conference of the National Academy of Elder Law Attorneys. One of the most unsettling slides out of the fifteen hours of presentations I’ve been in so far is the one about the effect of the “One Big Beautiful Bill.” That Republican budget reconciliation bill is expected to result in $1 trillion in cuts to Medicaid over the next 10 years. To put this in perspective for what it means for ordinary citizens, Medicaid isn’t just something that “other” people use “somewhere else.” Medicaid is what pays the long-term care bill for between 45% and 65%  of all nursing home beds in the United States. (The government insurance program Medicare does not cover long-term care. The similarity in names between Medicaid and Medicare is, in my view, unfortunate because it leads to confusion about the programs.) Medicaid is what kicks in as our social safety net after ordinary, middle class, people have used up all of their life savings and assets and become impoverished as the result of long-term care needs in old age (or in event of disability), Medicaid is the funding of last resort. These cuts to Medicaid will also affect Medicare, due to funding provisions in place that trigger automatic cuts for Medicare. In fiscal year 2026, PAYGO triggers will cut $45 billion from Medicare, and over the next nine years it will cut $536 billion out of Medicare. The short story coming out of that long story is that if you haven’t started thinking about how to fund your old age care (which currently costs $290 per day as a national average), you’d better start thinking about it now. And God help the millennials and those younger, whose futures have been robbed by the exploitation economy.
