Ever since the Affordable Care Act (ACA) was passed into law in 2010, members of Congress and the administration have been doing everything possible to repeal this important healthcare legislation. Another potential Supreme Court showdown impacting the ACA is on the horizon. Consequently, it got me thinking about ways the ACA impacts older Americans; in particular, how the ACA’s Medicaid expansion benefits older adults.
Medicaid is a cooperative, means-tested healthcare program that currently provides coverage to around 71 million people. It was created in 1965 to deliver medical care to various low-income populations, such as people 65 and older, children, adults and people with chronic disabilities. Because of the ACA, states have the option to expand Medicaid eligibility for people under the age of 65 with income up to 133 percent of the federal poverty level (FPL.)
So have older Americans benefited from the Affordable Care Act’s Medicaid expansion? The answer is a resounding yes!
For starters, the Urban Institute and the American Association of Retired People (AARP) report that because of the ACA’s Medicaid expansion and other reforms, the uninsured rate for older adults, ages 50 to 64, was cut in half by 2015. Also, the ACA’s premium tax credits have helped over 3 million people in this age range afford health insurance. This news isn’t just good for older adults before they turn 65, but is critical for when they are Medicare-eligible. As I reported in my blog, “Repealing and Replacing the Affordable Care Act and its Impact on Medicare,” evidence demonstrates that Medicare-eligible seniors with prior health insurance require less expensive health care than people who were uninsured before they enrolled in Medicare.
To further the point, the University of Michigan recently released a study that examined the impact Medicaid expansion had on the mortality rate of older adults (55 to 64 years old) in expansion states vs. non-expansion states. The study concluded that between 2014 and 2017, the ACA’s Medicaid expansion saved 19,200 older adults’ lives. Expansion could have prevented another 15,600 deaths in non-expansion states. Overall, I think the Center on Budget and Policy Priorities summed up Medicaid expansion best: “If all states had expanded Medicaid, the number of lives saved just among older adults in 2017 would roughly equal the number of lives that seatbelts saved among the full population, based on estimates from the National Highway Traffic Safety Commission.”
Furthermore, the study stated, “The estimated impact of the expansions increases over time, suggesting that prolonged exposure to Medicaid results in increasing health improvements.” Researchers reported that mortality reduction rates in Medicaid expansion states can be attributable to better health outcomes in the areas of cardiovascular disease, diabetes and early detections for breast and cervical cancers. I think it’s fair to conclude that government programs that expose more people to health care lead to healthier outcomes.
Strengthening the argument, last November, Kaiser Health News’ Laura Ungar, authored a fascinating article entitled “The Deep Divide: State Borders Create Medicaid Haves And Have-Nots” documenting the differences in health care between the states of Illinois and Missouri. While these two states lie right next to each other, only separated by the Mississippi River, the difference between their two Medicaid programs couldn’t be more different. For instance, the state of Illinois has reaped the benefits of Medicaid expansion by being able to provide health coverage to an additional 650,000 people, while Missouri’s decision not to expand Medicaid has denied health care coverage to 200,000 people.
The article further highlights the point with a human interest story about Patricia Powers, a resident of Missouri, who lost her health insurance. Because she was unable to afford health insurance, she never visited a doctor and was unaware of the cancerous tumors in her breasts. In addition, she discontinued taking medicine for high blood pressure and anxiety, because it was cost prohibitive. What makes the story even more tragic is that if she lived in Illinois, she would have qualified for Medicaid. Eventually, in her early 60s, the cancer was discovered upon visiting Casa de Salud, a low-cost medical clinic in Missouri. Since Powers was ultimately diagnosed for breast cancer, she became eligible for Medicaid that allowed her to receive treatment for the disease.
What makes the decision by some states not to expand Medicaid maddening is that often it’s significantly easier and cheaper to treat patients when the medical problem is in its infancy. Jorge Riopedre, president and CEO of Casa de Salud said, “Even if you didn’t care about the human cost, you should care about the economic cost. Treating a disease at its first stage is always going to be much cheaper than treating it at its advanced stage.”
Thankfully, Medicaid expansion advocates in the state of Missouri are trying to get the issue on the November 2020 ballot. We can only hope that after election day, thousands more Missourians will be eligible for health care coverage.
The benefits of the ACA don’t just stop with improving the rate the of insurance. They also extend to protections for people with pre-existing conditions and curtailing what insurance companies can charge older adults compared to younger people in the marketplace.
Despite the millions of Americans that have benefited from the ACA, it continues to be under attack. If the congressional ACA fights of 2017 taught us anything, it’s that Congress is no closer to agreeing on healthcare than they are on immigration, taxes or any other “hot button” issue. The benefits of the ACA in the older adult community can’t be denied any longer. However, we can only hope that once again, this legislation can withstand judicial scrutiny.
Evan Carmen, Esq. is the Legislative Director for Aging Policy at the B’nai B’rith International Center for Senior Services. He holds a B.A. from American University in political science and a J.D. from New York Law School. Prior to joining B’nai B’rith International he worked in the Office of Presidential Correspondence for the Obama White House, practiced as an attorney at Covington and Burling, LLP, worked as an aide for New York City Council Member Tony Avella and interned for Congressman Gary Ackerman’s office. Click here to read more from Evan Carmen.
It has been a busy 2017 at the Center for Senior Services (CSS), and we are pleased to report on our advocacy efforts. Throughout the year we have been advocating on a wide range of senior issues relating to health care (Medicare and Medicaid), Social Security and affordable housing. Our work included meetings on Capitol Hill, organizing tours of B’nai B’rith sponsored buildings and co-sponsoring rallies on affordable housing. During the year we were excited that our work was noted by the Jewish Telegraph Agency (JTA), The Times of Israel and the New York Jewish Week.
Our advocacy efforts went into high gear in March when the White House’s proposed 2018 “skinny” budget was released, which called for a 13 percent reduction in the Department of Housing and Urban Development’s budget. A few months later when the administration’s more detailed budget was announced, B’nai B’rith was severely disappointed that Section 202, which is housing that was developed for low-income seniors, was underfunded and the White House proposed a rental increase for residents.
Staying on top of the issue, the CSS team started visiting senator and representative’s offices on Capitol Hill that represent B’nai B’rith sponsored buildings. Specifically, we met with offices that work on the House and Senate Appropriations Subcommittees on Transportation, Housing and Urban Development. These committees are responsible for writing legislation that funds rental subsidies for the Section 202 program. During the course of these meeting we explained to staff members how damaging the White House’s budget would be for low-income Section 202 residents. While the 2018 budget has not been finalized we are hopeful that our advocacy efforts on Capitol Hill will lead to the Section 202 program being funded more.
In addition, we followed up those visits by inviting members of Congress and their staff to tour B’nai B’rith Section 202 buildings throughout the country. We are pleased to report that Reps. Jamie Raskin (D-Md.), Matt Cartwright (D-Pa.), Grace Meng (D-N.Y.) and Charlie Dent (R-Pa.), representing both political parties, toured our sponsored properties. Furthermore, three of the four members who visited B’nai B’rith sponsored buildings work on the Appropriations Committees. These tours were a fantastic opportunity for members of Congress to see the benefits of the Section 202 program, and gave residents a chance to speak with their elected representative. Residents were able to directly tell their member of Congress the vital role Section 202 housing plays in their lives.
B’nai B’rith was also pleased to co-host with LeadingAge the “Save HUD 202” Rally and partner with the National Low Income Housing Coalition for the “National Housing Day of Action” over the summer. These rallies took place on Capitol Hill and featured representatives and senators who spoke about the need for affordable housing. We were certainly delighted members of Congress who represent B’nai B’rith sponsored buildings attended the event.
Our advocacy during the course of the year didn’t just stop with affordable housing. We spoke out against the White House and Congress’ attempts to repeal and replace the Affordable Care Act (ACA). After analyzing various proposed bills, B’nai B’rith was very concerned how these policies could negatively impact seniors. For example, many of the proposed replacement bills would have cut critical funding to Medicaid, allowed older Americans to be charged more for insurance, repealed vital taxes that help fund Medicare and waive important regulations that protect health care consumers. We spoke out on these issues by releasing press releases, blogs and joined with liked minded organizations opposing this legislation in a full page advertisement in Politico.
Recently, B’nai B’rith has been very vocal against the recently passed tax reform legislation. We expressed serious reservations about this bill because of the damaging impact it could have on funding for Medicare and Medicaid attributable to rising deficits that will give cover to members of Congress to slash spending. In addition, the negative consequences repealing the ACA’s individual mandate will have on older Americans. We brought our concerns straight to congressional offices during our regular scheduled Capitol Hill visits regarding Section 202. However, we certainly applaud Congress for not eliminating the Low Income Housing Tax Credit which is critical for affordable housing construction, and the medical expense deduction which is incredibly important to countless seniors with high health care costs.
The CSS team embarks on 2018 looking to continue our success from 2017. We will certainly look to invite more members of Congress and their staff to B’nai B’rith sponsored buildings, and advocate for the Section 202 program and other policies that are vital to seniors.
B’nai B’rith International Senior Services Staff: Mark Olshan, associate executive vice president of B’nai Brith International and director of the B’nai B’rith International Center for Senior Services; Janel Doughten, associate director of the B’nai B’rith International Center for Senior Services; Breana Clark, senior program associate; Evan Carmen, assistant director for Aging Policy.
Medicaid is a cooperative, means-tested health care program that currently provides health care coverage to 6.9 million people who are aged 65 or older. It was created in 1965 to deliver medical care to various low-income populations such as people 65 and older, children, adults and people with chronic disabling conditions. Because of the Affordable Care Act (ACA), states have the option to expand Medicaid eligibility for people under the age of 65 with income up to 133 percent of the federal poverty level (FPL).
Presently, Medicaid funding comes from the federal and state governments, with the federal government obligated to pay a pre-determined share of a state’s Medicaid costs. The federal government’s pre-determined share varies by state, however averages 57 percent. Under the current Medicaid matching structure, federal funding fluctuates in concert with the health care needs of the individual states. The current policy furthers Medicaid’s central goal by giving beneficiaries the security of a health care safety net.
Low-income seniors have greatly benefited from the Medicaid program. For example, since Medicaid states sometimes fills coverage gaps on dental, vision and hearing services Medicare does not cover, seniors are able to receive care they could not cover on their own. In addition, low-income seniors are aided in the cost sharing and out of pocket costs in their Medicare coverage. Many seniors depend on Medicaid to cover the cost-sharing in Medicare—without this coverage they would not be able to afford co-payments and would skip needed care.
In addition, Medicaid helps seniors with long-term services and supports (LTSS) by providing funding for such senior health care services like nursing facilities. In 2015, the median nursing facility annual cost was $91,250, which exceeds what most elderly people and their families can afford. Because Medicare financing for LTSS is limited, Medicaid has been a critical to rounding out funding so low-income seniors can receive the appropriate long-term health care services.
Recently, Congress had seriously considered the American Health Care Act (AHCA) as legislation to repeal and replace the ACA. While Congress was unable to pass the AHCA it is important to examine how this proposed legislation would have impacted Medicaid. Specifically, Congress was deliberating on whether to change Medicaid to a per capita cap financing structure between the federal government and the states. Under a per capita cap, federal spending on the Medicaid program would have been capped on a per-beneficiary basis. While the AHCA exempted Medicaid aid for low-income Medicare beneficiaries from the per capita cap proposal, changing any portion of the Medicaid funding to a per capita cap proposal would have added an additional layer of pressure to state budgets, and put the health care and financial security of millions of older adults at risk. For instance, a per capita cap proposal could have drastically decreased the amount of federal financing available for states to pay for nursing facilities.
From 2015 to 2035, the number of low-income older adults is expected to rise from 15 million to 27 million people. Proposals that cap the federal government’s financial responsibility will put an increasing amount of Medicaid beneficiaries at risk when they need more care as they age. State Medicaid programs operating under a fixed federal contribution could face the daunting choice of finding billions of additional dollars in their own budgets or being forced to offer even more limited health care access to their most vulnerable low-income seniors.
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