On March 23, 2010, Congress passed the historic health care overhaul bill: the Patient Protection and Affordable Care Act (PPACA).  Subsequently, the Health Care and Education Reconciliation Act was passed, making small changes to PPACA.  These two bills together are now frequently referred to as: the Affordable Care Act (ACA).  Although the House of Representatives successfully voted to repeal the ACA in January, 2011, the Senate has said they would not vote on such a repeal (as the Senate is Democrat controlled, it would likely not pass), and President Obama has vowed not to sign a repeal of the ACA. The attempt to repeal the ACA by the House in January was largely a political demonstration of partisan power; and the conversation about the future of the ACA is not yet concluded.  Even though a formal repeal of the ACA has not pushed through Congress, political tactics to break down the bill will ensue: conservatives will try to dissemble the bill and liberals will advocate for its preservation.  While I will not go into specifics about the political song-and-dance that will undoubtedly emerge in Congress as the future of the ACA is debated, I do want to share with you what older Americans will lose if the ACA is not protected. Better Medicare Benefits with the Affordable Care Act One essential point that should be addressed up front regarding the ACA and older adults: basic Medicare benefits will not be cut.  Some coverage may change for older adults, but overall the ACA betters the Medicare benefit package in several important ways.  One of the most noteworthy ways the ACA helps older adults is by filling the ‘donut hole’– the Medicare Part D subscription drug benefit requires older adults to cover their prescription drugs out of pocket once they hit $2,830 in drug costs, until $6,440 in drug spending is reached.  As a result of the ACA: in 2010, all older adults who had fallen into the donut hole were cut a check for $250 from Medicare; in 2011 Medicare recipients in the donut hole will only be required to pay half of the charges for brand-name drugs; and by 2020, the donut hole will be completely eliminated through a series of slow changes. Another Medicare change through the ACA is the free annual wellness visit and prevention plan that is available starting this year.  Medicare beneficiaries will not be required to cost-share, or otherwise pay, for an annual exam with their physicians which includes time to set-up a preventive healthcare plan for the older adult.  Many other preventive services, like mammograms, bone mass measurement, flu shots, and screenings for: cancer, diabetes, and cholesterol, will all be available free of charge for Medicare beneficiaries who meet coverage criteria. The ACA will reduce Medicare spending over the next 10 years and extend Medicare solvency. The Congressional Budget Office (CBO) is a non-political and independent advisory group to Congress on economic and budgetary issues. The CBO has determined that over the next ten years, the growth of Medicare costs will lower and average spending per person will be slowed due to the ACA. In a nut-shell, this means that the Affordable Care Act effectively bends the cost curve of sky-rocketing health care costs associated with Medicare, and also extends the life of the Medicare program 9 more years, to 2026. Medicare covered 38.7 million Americans aged 65 and older in 2009, according to the 2010 Medicare Trustees Report. The baby boom generation will cause rapid growth of both individuals served through Medicare and growth in Medicare costs.  The ACA helps to strengthen Medicare and ensure its stability over the long-term—an essential reform to our health care system if we want to continue to provide our growing population of older adults with quality, affordable health care supports and services. The Affordable Care Act and Aging in Place The ACA will make it easier to provide long-term care services in a home and community based setting. Long-term care, however, is not primarily Medicare covered, but Medicaid covered.  In February of 2009, the Chicago Bridge monthly event featured Amy Wiatr, of the Administration on Aging, who discussed long-term care and the concept of long-term care reform at length.  Long-term care, or the need for assistance with activities-of-daily-living (ADLs), is needed due to a disability or chronic condition—and the incidence of both increases with age. Several Medicaid reforms in the ACA that will help older Americans with long-term care needs to age in a home or community based setting include:

• Extension of the Money Follows the Person (MFP) Rebalancing program.  MFP was originally introduced through the Deficit Reduction Act of 2005 and assists people living in nursing homes to transition back into the community.  Funding was originally slated to expire in 2011, but the ACA extends MFP through 2016. (Of note, Illinois has been a part of Money Follows the Person since 2007).

• The introduction of the Community First Choice Option: a Medicaid state plan option to pay for long-term services and supports in a community setting.

• Spousal impoverishment protection for Medicaid beneficiaries receiving home and community based long-term services and supports.

And lastly, there is the Community Living Assistance Services and Supports, or CLASS, Act, a long-term care insurance program that was introduced in the ACA.  The CLASS Act is a voluntary insurance program administered by the federal government that will provide a cash benefit to people who require long-term care assistance in a home or community-based setting.  While the eligibility details, rules, and regulations are forthcoming for the CLASS Act, this ACA provision represents a move forward to addressing the growing long-term care needs that aging and disabled Americans experience on a daily basis. What to Expect with the Affordable Care Act in the Future? As some members of Congress continue their attempts to breakdown the ACA, others will oppose this action.  Over the next year, expect a lively debate on the appropriation of funds for the ACA; this means small, frequent battles to keep the ACA alive and able to benefit the health of older Americans. While I cannot predict exactly how these debates will unfold, nor can I predict what the final outcomes or votes will be, I do know that the Affordable Care Act supports health care provision to older Americans in a more comprehensive, preventive, effective, affordable, and accessible manner.  My advice? Let’s stop fighting the Affordable Care Act, and figure out how we can help implement the provisions of the bill to ensure that all Americans, including older adults, have the opportunity to receive adequate health care. This post just scratches the surface of all of the ways the ACA benefits Americans, including older persons.  Feel free to contact me (kpavle@hmprg.org) to learn more about the ACA and to find out what is going on in Illinois to promote the ACA.