Volume 5 Number 4, July 2011 (Topic: Medicaid)

Public Policy & Aging E-Newsletter

Volume 5, Number 4, July 2011

This bimonthly e-newsletter highlights key developments and viewpoints in the field of aging policy from a wide variety of sources, including articles and reports circulating in the media, academy, think tanks, private sector, government and nonprofit organizations.

The goal of this email publication is to reach teachers, students, and citizens interested in aging-related issues, especially those who may not have sufficient access to policy information disseminated both in Washington and around the country.

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I. WHAT’S HAPPENING IN WASHINGTON?

A. Caring For An Aging America Act Reintroduced: The Caring for an Aging America Act (Senate Bill 1095) was reintroduced on May 26, 2011, by Senators Boxer (D-CA), Collins (R-ME), Kohl (D-WI), and Sanders (I-VT) to address the shortage of skilled health care workers to care for a rapidly aging population. If passed, the law would provide health care professionals who specialize in gerontology and geriatrics with access to loan repayment programs in exchange for agreeing to work in underserved areas. The legislation is based on recommendations from the 2008 Institute of Medicine report, "Retooling for an Aging America: Building the Health care Workforce."

B. The CLASS Act: Established by the Affordable Care Act (ACA), the health-care reform legislation passed by Congress and signed by President Obama in 2010, the Community Living Assistance Services and Supports (CLASS) Plan was designed to help people financially should they become disabled and need long-term services and supports. This policy brief from Health Affairs and the Robert Wood Johnson Foundation (RWJF) examines the program, and highlights how policy-makers can make the program sustainable. Options range from changing the premium structure and lengthening the vesting period, to incentivizing employers.

C. Senior Hunger and the Older Americans Act: The Senate Subcommittee on Primary Health and Aging hosted a hearing focused on the Older Americans Act (OAA) and the role it plays in allowing seniors to age in place by connecting them with food and nutrition though programs including home delivered nutrition services, Congregate Nutrition Services, and Nutrition Services Incentive Program. Chairman Sanders (I-VT) released a report in conjunction with the hearing, and explained that he sees senior hunger as a financial and moral issue for the one million seniors who go hungry because they can't afford food.

II. WHAT’S HAPPENING AROUND THE COUNTRY?

A. Life Expectancy Across the U.S.: This interactive map from The Washington Post breaks down life expectancy by geographical regions, race, and sex. American women live an average of 2.5 years longer than men, but as life expectancies vary across the country, both men and women in certain counties, particularly in the South and Southeast, can expect to die more than a decade sooner than others.

B. Aging in Place, Stuck without Options: This Transportation for America study ranks metro areas by access to public transit. The report finds that 15.5 million seniors over the age of 65 will be unable to access public transportation, with Atlanta having the highest percentage of immobile seniors of any city with a population over 3 million. Riverside-San Bernardino, Houston, Detroit and Dallas also ranked high on the list. For a summary, click here.

C. The Fiscal Survey of States: While state revenues have increased from FY 2011, this National Governor’s Association and the National Association of State Budget Officers report finds that states still face a combined gap of over $75 billion for their FY 2012 budgets. The report examines state Medicaid spending and projects future costs associated with an aging population.

III. THIS ISSUE'S MAJOR POLICY STORY: Medicaid

Amidst riots in Greece and protests in London, the United States faces its own day of fiscal reckoning if the nation's debt ceiling is not raised by August 2^nd. The President has already announced his willingness to cut spending in vital areas. Raising some taxes seems inevitable. In the spirit of bipartisan compromise over Social Security in 1983, thoughtful policy analysts are giving serious attention to ways to constrain the rate of growth of two of this country's most important pieces of social insurance: Social Security and Medicare. Experts and journalists typically include Medicaid reform in the mix. Unfortunately, most people do not have a deep understanding about how Medicaid works. Myths abound. Accordingly, we highlight some fundamental realities about Medicaid and offer several in-depth reports.

Medicaid, enacted in 1965 along with Medicare, originally aimed at providing health services to low-income Americans of all ages. Thanks to the Children's Health Insurance Program (CHIP) among other features, most of us associate Medicaid as a program for youth and poor families. While more than three-quarters of all those enrolled in Medicaid fit that definition, nearly two-thirds of all Medicaid spending goes to older Americans and people with disabilities. Many Medicare beneficiaries--those who utilize long-term facilities or require acute care--depend on Medicaid to cover provisions excluded from Medicare. Medicaid also is invaluable to front-line, direct-care health workers, whose health insurance needs will not be covered by the Affordable Care Act until 2014. Medicaid is state administered in accordance guidelines that vary from state to state. As most state officials try to eliminate their own budget shortfalls, their lawmakers have tried to impose barriers (such as cutting staff and making bilingual information about benefits harder to obtain) in order to reduce the numbers of those potentially qualified for applicant pools and to curtail the growth of expenditures. Instances of waste and fraud, which have tarred Medicaid from the outset, make it palatable to present draconian measures to voters. There is more abuse in Medicaid than in Social Security. But the bottom line is this: poor people like the rest of us have real health needs, conditions that ought to be verified and analyzed, but cutting Medicaid radically is unlikely to eliminate costs. Expenditures will appear on the ledger elsewhere or their elimination will become a sore spreading across the nation's conscience.

This is why our readers need to inform themselves about Medicaid. Those who would like a bit more information before plunging into the pieces below might read Barbara Gay's "Medicare and Medicaid: Myths and Realities" or consult the website of the U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services.

--Andy Achenbaum

A. Cutting Medicaid: Harming Seniors and People with Disabilities Who Need Long-Term Care: Recently, Congress has offered a wide array of proposals that would significantly cut the Medicaid program. These proposals have come in different forms, including a proposal to convert the program to a block grant with much less federal funding, straightforward cuts in the program, and global caps on spending. Since Medicaid was established to serve those with nowhere else to turn, deep cuts would cause great harm to the children, families, seniors, and people with disabilities who rely on the program. This Families USA report provides data on Medicaid's role in financing long-term care, including serving as the primary payer for an estimated 63.6% of all nursing home residents.

B. The High Cost of Capping Federal Medicaid Funding: Recent proposals have sought to change a long-standing financial arrangement that, over the years, has ensured that the Medicaid program is there for people when they need it. This AARP fact sheet discusses reasons why some state and federal policymakers prefer capping Medicaid funding and why this type of funding arrangement is not ideal for beneficiaries. According to an analysis by the Congressional Budget Office, if total funding for Medicaid is converted into a block grant, states would be required to provide less extensive coverage or pay a larger share of program costs.

C. House Republican Budget Plan: State-By-State Impact of Changes in Medicaid Financing: Looking at the House Budget Plan’s proposal to convert Medicaid into a block grant and eliminate the planned expansion of the program, this Kaiser Family Foundation analysis projects the state-by-state impact of these changes. It finds that the plan would trigger major reductions in Medicaid program spending that could result in significant enrollment decreases compared to current projections. This would have big implications for states, hospitals and tens of millions of low-income Americans who likely would wind up uninsured. For a summary, click here

D. Medicaid's Role for Black Americans: This Kaiser Family Foundation fact sheet examines Medicaid's role for black Americans. It includes data on Medicaid's coverage of black Americans and the program's impact on their access to care, as well as the impacts of the recent recession and the coming expansion of Medicaid under health reform on enrollment in Medicaid among black Americans. The fact sheet also has a chart showing state-by-state data on health insurance coverage of black Americans.

E. The New Health Care Law’s Effect on State Medicaid Spending: According to this CATO Institute report, the Patient Protection and Affordable Care Act (PPACA) of 2010 promises to increase state government obligations for Medicaid by expanding Medicaid eligibility and introducing an individual health insurance mandate for all U.S. citizens and legal permanent residents. This study estimates and compares potential increases in Medicaid expenditures from PPACA by the five most populous states: California, Florida, Illinois, New York, and Texas.

IV. WORTH NOTING

A. The Maturing of America – Communities Moving Forward for an Aging Population: Due to the Great Recession, many U.S. communities have been unable to make significant progress in preparing to meet the needs of the country’s rapidly aging population. This National Association of Area Agencies on Aging report reveals that at best, communities have managed to maintain the status quo for the past six years. Findings also show that some important advances have been made, including an increase in specialized training for emergency and public safety staff in dealing with older adults; growth of in-home supportive services; greater support for advanced education for the direct care workforce; and expanded volunteer opportunities.

B. The Changing Demographic Profile of the United States: Aside from the total size, one of the most important demographic characteristics of a population for public policy decisions is its age and sex structure. This Congressional Research Service report illustrates how the United States has been in the midst of a profound demographic change as reflected by the rapid aging of its population.

C. The MetLife Study of Elder Financial Abuse: Crimes of Occasion, Desperation, and Predation Against America's Elders: This MetLife study demonstrates how elder abuse crimes continue to decimate incomes, impact the health and well-being of its victims, and fracture families, yet it still is underreported, under-recognized, and under-prosecuted. Findings include that women are twice as likely as men to be victims of elder financial abuse, with most being between the ages of 80 and 89. Click here to view Metlife’s Planning Tips: Preventing Elder Financial Abuse for Older Adults.

V. WHAT'S HAPPENING ABROAD?

A. “A Total Indifference to our Dignity”: Older People’s Understandings of Elder Abuse: This Centre for Ageing Research and Development in Ireland (CARDI) report offers a new perspective on elder abuse, shedding light on how older people understand this type of abuse and what they think is needed to prevent it. Also on the topic of elder abuse on a global scale, June 15^th marked World Elder Abuse Awareness Day. Resources include the International Network for the Prevention of Elder Abuse website and a blog post from IAHSA– The Global Ageing Network.

B. Past Caring? Widening the Debate on Funding Long-Term Care: Focusing on the question of how to fund long-term care, this International Longevity Centre UK (ILC-UK) report explores elements of various models proposed in recent years. The report concludes that many aspects of care provision should be more closely integrated with health provision, paid for by the taxpayer but with scope for individuals to access state-funded provisions. Furthermore, it develops a short-term solution which builds upon aspects of ILC-UK's social insurance model.

C. The Elephant in the Room: Age Discrimination in Employment: Although older workers make a massive contribution to Australia’s economy, the country loses an astounding $10.8 billion a year by not making use of the skills and experience of older Australians who want to work. Which prompts the question– why are we overlooking these older workers? This National Seniors Australia report explores that question, and finds that age discrimination is widespread– in recruitment, in promotion, and during times of retrenchment. Age discrimination, although widespread, is “the elephant in the room”– palpable but unmentionable.

VI. PERSPECTIVES ON POLICY: ROB HUDSON, EDITOR, PP&AR

This most recent issue of Public Policy & Aging Report (Volume 21, Number 2) is devoted to the critical public policy topic of whether to raise the Social Security retirement age. Unlike other issues, this PP&AR showcases the interdisciplinary strengths of The Gerontological Society of America (GSA) by bringing together authors from across GSA’s disciplinary Sections and Task Forces. Eric Kingson, representing GSA’s Social Research, Policy, and Practice Section, and Nancy Altman provide both history and context to this current debate swirling around Social Security. Jacqueline Angel and Stipica Mudrazija, representing GSA’s Task Force on Minority Issues in Gerontology, raise concerns with this global perspective, arguing that the idea of raising the early and full retirement ages among people with differential exposure to the multiple risks of low income, physically demanding jobs and poor health—disproportionately minority-group members—is fundamentally flawed. Taking the perspective of GSA’s Task Force on Women, Pamela Herd returns to the theme of differential impact. Finally, psychologists Neil Charness and Sara Czaja, invoking human factors engineering, stress the need for work settings to be adapted to recognize better the physical and cognitive abilities and limitations of older workers. Their article succinctly lays out both the individual and environmental factors that must undergird any intelligent debate of raising eligibility ages for Social Security benefits.

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Newsletter Editors: Dani Kaiserman, Sarah F. Wilson, and Greg O'Neill, National Academy on an Aging Society; Andy Achenbaum, University of Houston.

The Public Policy and Aging E-Newsletter is supported in part by a grant from the AARP Office of Academic Affairs. The views expressed are those of the authors and not necessarily those of The Gerontological Society of America, the National Academy on an Aging Society, or the AARP Office of Academic Affairs.