National Health Reform: The Affordable Care Act, Includes Great Benefits for Older Adults

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.

7 Comments

  • Clara

    While we are at it, lets redefine Heatlhcare for the elderly and disabled! I am not certain but it seems to be like a big mistake to seperate healthcare for the elderly and disabled from the living assistance they require. If elders had more trained, human supervision and care I argue they would overall need less medication, hospitalization, and rehab thus saving us all a bunch of money. Perhaps Medicare and other insurance should help cover the cost of caregiving, that’s what I mean to say. Care requirements are a HUGE health concern and they affect the cost of care for all of us. If no one is watching grandpa at the nursing home and he falls out of his wheelchair and breaks a bone, he’s going to the hospital and then to rehab and Medicare or Medicaid will foot a good chunk of those bills. Wouldn’t it be far less expensive or possibly cost neutral to prevent the fall by assigning a reasonably skilled, human set of eyes. I think I can extrapolate and say Caregiving could be a healthcare profession more akin to Doctors, Nurses, X-Ray technicians and so forth and the cost should be paid for, when warranted and wanted, by Medical Insurance. Would it be cost effective or not? I can’t predict that but its worth discussing. Medical needs and caregiving needs should be coordinated by the primary physician or the social worker assigning caregiving should coordinate with the primary physician. Currently, as far as I can figure, the State doles out caregiving and there is no coordination of it with Medical providers. In nursing facilities its no better. So few eyes – so many meds. Talk about a donut hole! Yes I think insurance should pay for your grandpas babysitter, the person who washes his butt, drives him to the doctor, and who can prevent him from breaking his hip in the bathtub. But – they’d rather give him some Morphine and buy him a new hip. Ah… its a pipedream, drugs and medical devices are far cheaper than Caring.

  • Kristen Pavle

    Clara,

    Great points! I am hearing you suggest a few things:
    1.) caregiving should be more recognized, prioritized AND better reimbursed.
    2.) preventive care would be more beneficial in the long-term
    3.) more care coordination is necessary for our health care system to work effectively
    4.) medication management is very important and currently lacking

    I think you should write your own blog post, you’ve got quite the list of great ideas about how to reform healthcare!

    I completely agree with you, caregiving is currently an under recognized, under paid work force; actually, quite often caregivers are not formally trained individuals but family and friends. Giving and receiving care is part of being human, it is a shame that our health care system jumps to the high-cost, reactive solutions: medication fix after the fact, and a new hip (for example). Instead, it would be much more cost effective (in theory) to provide well-trained workers to coordinate the care for older persons and act in a preventive manner, not a reactive one. This represents a large scale systems-change of how we currently operate. I am all for it!

    As our country (and world) rapidly ages over the next few decades [http://www.nytimes.com/interactive/2011/02/04/business/aging-population.html?emc=eta1], changes in the US health care system are necessary if we want to thrive as a society. Thanks for being part of the discussion to move things forward for a positive change.

    -Kristen

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