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Every non-profit or academic institution focused on aging in America (e.g. AARP, Older Women’s League, American Society on Aging, etc.) supports the American Care Act. It’s great news that the Supreme Court ruled the law was constitutional. With this ruling, insurance companies will no longer be able to deny coverage, or charge more because of a pre-existing condition, or force women to pay higher premiums than men. Preventive care will continue to be covered at no cost, and seniors will continue to save money on prescription drugs (5.3 million Medicare Part D beneficiaries have already saved $3.7 billion on prescriptions since the law was enacted).

The ACA is a major step toward ensuring affordable and quality health coverage for millions of working families, elders, and children. Therefore, it is surprising to me that many Americans don’t believe the ACA will help them. A Kaiser Family Foundation report found that people believe young adults and children are likely to benefit from the new law, but not themselves or their families. Thirty-seven percent of respondents felt the law will make no difference in their lives, thirty-one percent felt they will be worse off.

Where are these answers coming from? Is it that a case being brought to the Supreme Court is enough to reduced people’s opinions of the law? Who are the individuals against the ACA…do they understand the implications for American’s health system and the American people’s well-being?

The ACA is in no way perfect, but many of the laws are designed specifically to help older people acquire and pay for comprehensive health care. An AARP article lists the number of ways the law supports older adults:

  • Insurance companies cannot drop you if you become sick or disabled
  • They cannot have lifetime dollar limits on your coverage
  • Medicare recipients receive annual wellness visits, preventive services, and immunizations at no additional cost
  • As mentioned, people with Medicare Part D now receive discounts on prescription drugs while in the doughnut hole. The Part D discounts will gradually increase until 2020, when the doughnut hole will close
  • In 2014, insurers can no longer deny coverage if you have a preexisting condition
  • In 2014, insurance “exchanges” will provide better access and options to self-employed people, small businesses and others who are unable to find affordable coverage

The Supreme Court’s decision is a significant move in the right direction. It will help the United States build a health care plan for our future that is on par with what other developed nations provide already: Affordable health care coverage as a right, not a privilege.

The 2011 OWL Mother’s Day report  starts with a very strong statement: “Health care for all is a women’s issue…” Why would this be? Men also need and use our health system. Yet, the case is made for how women’s lives are affected by health care coverage or a lack there of. Women play a large role in managing care for sick family members, most often providing this care themselves. Widows can often be left impoverished if their husbands’ chronic illnesses dwindled savings accounts and assets. In late life, women find themselves 60% more likely to need help with basic daily activities (i.e. eating, dressing, bathing) compared to men. This paints a picture in our minds: Grandma spent her 60’s and 70’s caring for grandpa. He had heart problems and diabetes but she made sure he took his medications, got to his appointments, and was cared for till the end. Now in her 80’s, grandma finds herself sick, poor and alone in a big, empty house. Since women’s life expectancy continues to exceed that of men’s, this story is all too familiar.

“After a lifetime of caring for others, older women often need affordable care but find that the costs are high and their options are severely limited.” I’ve described to you a common late-life situation for women. Let’s keep this image in our minds as we discuss how the Affordable Care Act (ACA) aims to support Americans as they age. People, like grandma, find themselves skipping preventative services because Medicare requires them to pay a 20% co-payment. This cost is found to be a disincentive for approximately half of Medicare beneficiaries who do not use preventative services available to them.  Grandma lives on a fixed income of $1,000/month from Social Security (the average benefit is $1,177) and this means that paying a $30 co-pay to see her doctor gives her $30 less for grocery shopping that month. She isn’t feeling sick, so she prefers to spend the money on food. This begs the question: Should she have to make that choice?

 
The good news is changes to our health care system are happening over the next few years and should support people in old age. Below I’ve highlighted some of the changes but please read the full report or see this great summary of the Health Reform Law from the Kaiser Family Foundation for more details.

Health Insurance Reforms

  • Medicaid will be expanded to cover 16 million Americans (all legal residents up to 133% of the federal poverty level will be eligible)
  • Retroactive cancelling of insurance because of accidents or sickness, denying coverage because of pre-existing conditions, and basing premiums on health status, gender and genetics will all be prohibited
  • Insurance companies must devote at least 80 – 85% of premium dollars received to medical benefits and quality improvement and they must provide justifications for any excessive rate increases, making this information available to consumers

Medicare

  • People who reach the “donut hole” on prescription drug coverage will get a large discount on drugs and biologics and this discount will grow each subsequent year.  The hole will be closed in 2020
  • Beneficiaries will receive a free annual exam, free flu and pneumonia shots, and any covered service that is given a grade A or B by the U.S. Preventive Services Task Force must be provided at no cost
  • Medicare payments will be reduced for hospitals that have high HAC rates (hospital-acquired conditions) and incentives will be provided to hospitals that improve their transitional care and partner with community services to reduce readmission rates

Long-Term Care 

  • The Community Living Assistance Services and Support (CLASS) Act will provide a voluntary long-term care insurance program available to all working Americans. When an individual becomes eligible and needs long-term care services an average cash benefit of $50/day will be given to help them pay. Beneficiaries have control over their own care, so this includes paying family or friends who provide help at home.
  • Home and Community Based Services (HCBS) aim to provide a network of services within state and local areas to meet the needs of elders aging in place. A new protection called under HCBS will attempt to prevent “spousal improverishment” by only counting the ill spouse’s income when determining eligibility.
  • Nursing home care will be improved as the ACA aims to make the system, procedures, staffing and care more transparent and regulated. The Elder Justice Act is a part of this, in an attempt to identify and prevent elder abuse.

In the United States everyday people are providing 85% of needed long-term care for their family members and friends. These roles are generally unpaid and at the expense of their own careers, health, and well-being.  Rather than creating a health system that works, we have created a system that to a large extent depends on informal caregivers yet still costs us 17% of GDP.  The ACA is not a perfect system and will not be fully up and running for a few years. Still, it is a step in the right direction and will expand coverage to 95% of the population and support those who care for the people they love.

If you find yourself bombarded with mixed messages or feeling confused about the new health care changes, I encourage you to at minimum read the OWL Mother’s Day report’s appendix. Here the authors address a number of major myths about the Affordable Care Act and answer some common questions about the policies and coverage.

Social Security was projected to be in the red 6 years from now, yet it’s happening this year. Due to the current economic downturn and waves of individuals retiring earlier than expected because of unemployment, both the CBO and the Social Security Administration were taken by surprise.

But lets get one thing straight, you won’t notice. This above all else worries me. Because of the trust fund, the system will be able to pay all its checks on time. And since people will be receiving their checks, thoughts of increasing taxes, reducing benefits, or modifying the system in any way will continue to be met with opposition.

You won’t notice, but that doesn’t mean it doesn’t matter. For the first time Social Security will start to add to the deficit rather than subtracting from it. As the SSA states in their 2009 report, “Projected long run program costs are not sustainable under current program parameters” and after 2016 taxes will only be able to support 76% of scheduled benefits. In 2037 the combined OASDI Trust Fund is projected to be exhausted.  This is a big deal.

Talking with people, it seems some are confused about the trust fund, assuming it is similar to their 401(k) or savings account. It isn’t a pile of money in a bank vault. It’s actually a stack of IOUs from Uncle Sam. But don’t be too worried, we know how to fix it! The reform options are relatively well understood and have been for decades. The choices, however, are difficult and politically charged. Some combination of tax increases and benefit cuts will have to be put in place and the longer we wait the more painful both will be.

Dare I bring up Medicare? As the SSA says, “Its cost growth can be contained without sacrificing quality of care only if health care cost growth more generally is contained.” The problems for Medicare are coming sooner and will be more severe than those approaching Social Security.  Obama has said that fixing Social Security is on his agenda for next year. While there is much debate over the health care bill, I believe that if he can actually reform health care in America, Social Security will be a walk in the park and we may have a bright future ahead.

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