Archive for the ‘Senior Health Care Reform’ Category

As national health care reform is currently one of the most hotly debated issues among Americans, it’s important to understand how proposed changes would impact seniors, now and in the future. The Department of Health and Human Services has identified several funding highlights that address how the $76.8 billion budget will support its mission to protect the health of all Americans. In particular, the following highlights are relevant to seniors and health care:

1. Accelerates the adoption of health information technology and utilization of electronic health records.

As a result of the American Recovery and Reinvestment Act of 2009, $19 billion is currently set aside for health information technology, which will ensure that efficiencies are made in maintaining health records and protecting privacy. In practical terms, the health care providers of seniors have amassed extensive health records and the process of transferring such documents to specialists is currently cumbersome and time-consuming. Reviewing medical history through computerized health records will facilitate the provision of high-quality health care with timeliness and reduced medical errors.

2.Expands research comparing the effectiveness of medical treatments to give patients and physicians better information on what works best.

The treatment of chronic diseases that are commonly associated with advanced age, including Alzheimer’s and Parkinson’s disease, remain a significant priority for research in our country. With additional funding for medical research, progress can be made in effectively improving quality of life among those suffering age-related diseases and potentially preventing them in the future. At the same time, physicians treating seniors with multiple diagnoses will likely be more well-informed with regard to potentially negative medication interactions.

3. Strengthens the Medicare program by encouraging high quality and efficient care, and improving program integrity.

With regard to seniors and health care, they have expressed concern about the effect of health care reform on access to Medicare and, specifically, the Medicare Advantage program. This program allows seniors to buy Medicare coverage through private insurance plans, which offer lower premiums than traditional Medicare plans. Critics question the sustainability of a program that ultimately charges taxpayers 14% more per patient than regular Medicare. According to the non-partisan Congressional Budget Office, eliminating the program would save $150 billion over 10 years. This savings is anticipated to result from 1) reducing Medicare payments to private insurers, 2) improving Medicare and Medicaid payment accuracy, 3) improving care after hospitalizations and reducing readmission rates, and 4) expanding the Hospital Quality Improvement Plan. If successful, an investment in savings now will ultimately extend the viability of Medicare until 2024.

Seniors and Health Care Reform: According to a Gallup poll conducted in late July of 2009, seniors represented the least optimistic demographic with regard to the benefits of health care reform. In fact, only 20% of Americans 65 years and older say health care reform would improve their own medical care. Ironically perhaps, three quarters of seniors currently receive health care through government-sponsored plans including Medicare and Medicaid. For seniors, health care reform in the future may suggest the possibility of changing what is currently a good thing.

Written by gerontologist Sara Shelton

President Obama’s Health Care plan is now in the hands of Congress, who produced House Bill 3200, America’s Affordable Healthy Choices Act of 2009. This bill could improve health care and lower costs for seniors in Assisted Living.

What is CLASS?

The bill would create a voluntary national long-term insurance plan for adults who become functionally disabled. Under this plan (called CLASS for Community Living Assistance and Supports), individuals would pay monthly premiums and be eligible for benefits within 5 years. CLASS prevents insurance companies from denying coverage for pre-existing conditions or charging more based on health status.

CLASS targets the cost of living in an Assisted Living Facility, but it would not cover all costs. Two-thirds of Assisted Living seniors pay for care themselves with help from family or Medicaid. ALFA (Assisted Living Federation of America) calls CLASS a “strong first step towards encouraging personal responsibility in saving for long-term care.”

Current Regulations Have an Assisted Living Gap

ALFA explains that because of costs and coverage, seniors are often moved to a nursing home, which provides more care than they really need or want. Medicare covers only hospitalization and physical therapy, and most private insurers follow suit. But many seniors need help with custodial care–daily activities like bathing, dressing, grooming, toileting and getting around-and state laws often prevent Medicaid from paying for these services. With CLASS, more of these costs would be covered, so that many seniors could stay in Assisted Living. According to ALFA, the median monthly rate for assisted living is $2,350, about two-thirds the cost of skilled nursing facilities.

HR 3200 also ends limits on lifetime benefits and sets minimum standards for core benefits. These include outpatient hospital and clinic services and emergency room visits. HR3200 will not force seniors to give up or switch their current insurance.

New Rules for Skilled Nursing

The bill outlines new rules for skilled nursing homes, requiring them to disclose information about owners, operators, and board members, develop accountability procedures, quality measures, and ethics rules to prevent crime and abuse, and establish systems for formal complaint. Penalties would be imposed for non-compliance. Less clear is whether Assisted Living will be included in these provisions.

The bill proposes tax increases only on those with annual incomes over $350,000. Despite rumors, the government will not pay for reform by pushing seniors toward euthanasia. HR 3200 requires Medicare to reimburse physicians for visits involving end-of-life planning, such as living wills and health care proxies. Eligibility for such reimbursement is limited to once every five years, and New York already has a similar provision.

On September 1, 2009, AARP’s website clarified its support of health care reform that lowers drug costs, eliminates waste, protects seniors’ choice of insurers, and prevents denial of coverage based on pre-existing conditions, or higher costs due to age or gender.

Obama’s health care plan responds to the urgent need to curb health care and insurance costs. According to ALFA, over 50% of Medicaid funding goes to skilled nursing care for older Americans. By 2020, approximately 12.5 million Americans over 65 will need long term care. Find nonpartisan comparisons of current health care reform proposals at http://www.kff.org/healthreform/sidebyside.cfm.

Written by senior housing writer Lisa Logan, Ph.D.