By Rachel Goldberg
Come November, someone new will be elected president. Somehow, despite our country’s deep divisions over race, class, immigration status, who we love and how we live, we will still go forward with the president-elect.
Getting elected to the presidency isn’t just about the best candidate. It’s about 50 states, with primaries and caucuses, years of campaigning, raising money, debates, ads, speeches, shaking hands and baby holding. As I think about what I want from this new president, what he or she can do for older adults, I see where our elected chief executive can make a difference, and the many elements that have to come together just right to move forward on our shared goals.
Very little this year has gone as pundits expected, and I won’t even try to guess how it all works out. As a trained political scientist, I find myself much better at explaining why things happened than predicting what will happen. What I can foresee are the pieces of the puzzle with respect to aging, and what I hope this new president will understand, and what she or he should do about it.
Aging advocates have spent decades talking about simple goals, like healthy aging in place. We want “the golden years” to be lived in as good health as possible, in the community, as independently as possible. Families shouldn’t go bankrupt caring for their elders. Older adults shouldn’t have to choose among food, shelter and medicine as money runs out.
And with years of experience advocating for and providing options to older adults, we at B’nai B’rith know that reaching this goal requires a complex web of policy decisions at the federal and state level. And the next president can help, or stand in the way. Here’s a tip sheet for the next POTUS to follow:
The healthier we are as we age, the longer and better we will live. Preventing diabetes, cancer, heart disease and (someday) dementia would dramatically reduce health care costs and service needs, which would be good financial news for families and the country.
The Affordable Care Act (ACA, aka “Obamacare”) made headway here by making many preventive services free or at low cost through both public and private insurance. Because of the ACA, people with chronic conditions are not priced out of health care access anymore, which helps them stay healthy—untreated chronic conditions can be very expensive once people hit Medicare age. We need to do more, including tackling the outrageous costs and inflation in drug prices, which make treatment and cures out of reach for many Americans, even those on Medicare.
The next president will have the opportunity to pursue various strategies to contain prescription drug costs, including through Medicare price negotiation, which B’nai B’rith has long supported. The new president will also face questions about how to use payment incentives to affect health care quality and cost. We hope the next president recognizes that Medicare has considerable cost sharing already—and we need to stabilize health care costs as a country rather than shift spiraling costs onto older adults.
While some older adults work happily into their 80s or beyond, many older workers are in the work force only because they can’t afford to retire. While there was once supposed to be a “three-legged stool” of retirement security, two of the legs—pensions and individual savings—have both taken serious hits, leaving only the third leg, Social Security, as the primary source of retirement income for two-thirds of retirees. Government can and should do more by expanding Social Security benefits. In the computing of benefits, credit should be given to workers who have taken time out for care giving.
In addition, for all federal programs affecting older adults, the cost of living adjustment should accurately reflect prices across the board. Congress and the president should ensure the survival of traditional pensions for current or future retirees. Still, only a real increase in wages will provide workers with enough disposable income to save for retirement.
Long Term Services
Just this spring, we finally succeeded in getting Congress to reauthorize the Older Americans Act, which funds hundreds, if not thousands, of programs in your community that help older adults stay independent and at home. These include caregiver support, respite care and home-delivered meals. But, as the aging population grows and boomers seek to avail themselves of these services, they will find the funding levels haven’t kept up with the costs—something the next president must address.
Many of the services that help people stay at home, even those with physical challenges or limitations, come through the Older Americans Act. But inadequate funding makes it harder for people to stay out of institutions. Moreover, most people do not have long-term care insurance, and Medicare pays for only short-term care after a hospitalization. That leaves most older Americans on limited incomes and with few assets dependent on Medicaid. So we are working to encourage states and the federal government to cover services at home, and that effort has been successful in many ways. Except one.
Many states have something called a Home and Community Based Waiver, which allows them to provide support for nursing home-qualified people at home instead. But most of those states have waiting lists for “waiver slots” because the state can’t afford to do more. Then, often when a waiver slot is offered to an eager nursing home resident, he or she cannot move back to home care because of a lack of affordable and appropriate rental housing for people with service needs.
Over more than 40 years, B’nai B’rith has established 40 low income senior residences to house more than 7,000 people. We would like to do more, but it’s gotten increasingly difficult. Money to build new supportive housing for the elderly through a federal loan program known as “Section 202” has dried up. Instead we find ourselves working with the public-private partnership program known as the low-income housing tax credit, with some success. But now this program is one of the only funding sources available for all sorts of new development in affordable housing—and it just isn’t enough.
Now, Back to You
So, Mr. or Mrs. President, we look forward to sitting down with you to discuss how to make low-income senior housing a priority, and how to expand services, support and funding for seniors across the board. When you have time. We are free on January 21, 2017. Would that work?
Rachel Goldberg, who holds a doctorate in political science, is B’nai B’rith’s director of aging policy.