Public Policy & Aging E-Newsletter

Volume 3, Number 5, September 2009

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.

I. WHAT’S HAPPENING IN WASHINGTON?

A. Long-Term Care in Health Care Reform: Policy Options to Improve Both: A policy brief funded by the SCAN Foundation outlines four key ways to incorporate long-term care into health care reform. These include: expanding Medicaid support for home and community based services; improving coordination of care for dual eligibles; improving coordination of care for Medicare enrollees with chronic conditions; and establishing public insurance protection for long-term care for the broad population. The brief presents data on the nation's need for spending on long-term care and describes several related bills currently in Congress. Click here for the executive summary.

B. Older Americans Act Appropriations: The National Council on Aging (NCOA) has created a table that tracks the proposals and decisions related to FY 2010 funding of the Older Americans Act (OAA). The full House and the Senate Appropriations Committee passed their versions of the FY 2010 Labor-HHS-Education appropriations bill, which includes OAA funding. The House proposed an overall increase of 3.9 percent for the OAA, while the Senate proposed a 0.23 percent increase.

C. Strengthening the Health Insurance System: How Health Insurance Reform Will Help America's Older and Senior Women: This HealthReform.gov report addresses the unique situations and health care needs of America's 38 million women aged 55 and older that make them particularly susceptible to rising costs at a time in their lives when access to affordable health care is increasingly important. It identifies health insurance problems for older women and outlines solutions to these problems that will result through reform.

II. WHAT’S HAPPENING AROUND THE COUNTRY?

A. State Variation and Health Reform: A new online resource from the Kaiser Family Foundation's Commission on Medicaid and the Uninsured presents state-level data that can help policymakers and others understand the disparate impacts of potential health reform on the 50 states and the District of Columbia. The resource includes interactive tables and maps that present key information for each state. The data illustrate widespread regional and state variation in poverty rates, major industries, unemployment rates, fiscal conditions, health care costs, distribution of health coverage, primary care workforce shortages, unmet health care needs, and other indicators.

B. The Economic Crisis and Its Impact on State Aging Programs: Results of All-State Survey: A survey conducted by the National Association of State Units on Aging (NASUA) reports that although additional funding was provided by the American Recovery and Reinvestment Act of 2009, more than 20 percent of states still must cut services. Nearly 80 percent of states have waiting lists for home-delivered meals, and more than half have waiting lists for personal care, homemaker services, and respite care. Despite the increased need, more than 30 percent of states face cuts of between six and 10 percent for FY 2010.

C. Paid Family Leave: One Solution to Helping Today's Working Families Meet Their Family Responsibilities at Critical Times: A new brief, released by the Boston College Graduate School of Social Work's Sloan Work and Family Research Network, gives state policymakers a quick review of paid family leave (PFL) and its importance for working families, businesses, and government. It also presents an analysis of federal and state PFL policies, and compares three states' PFL laws (California, New Jersey and Washington), looking at compensation, length of benefit, structure, and funding.

III. THIS ISSUE'S MAJOR POLICY STORY: MEDICARE UPDATE

"More than four decades ago, this nation stood up for the principle that after a lifetime of hard work, our seniors should not be left to struggle with a pile of medical bills in their later years. That is how Medicare was born," observed Barack Obama in his address before members of Congress and the American people on September 9, 2009. The President assured older Americans that he would "protect Medicare"-preventing it from becoming a "privatized voucher system" as well as refusing to permit lawmakers to tap Medicare trust funds to finance health-care reform. That said, Obama claimed that "reducing the waste and inefficiency in Medicare and Medicaid will pay for most of [his] plan."

Now that the President has emphasized the importance of sustaining and refining Medicare as a critical part of any effort to "build a future," it is incumbent on the rest of us to look again at Medicare's role in delivering care today, to a cohort of senior citizens who differ in important ways from the cohort covered in 1965. In this section, we offer several pieces on Medicare financing and payments. We revisit the strengths and weaknesses of Medicare Part D. And we delve into the perspectives that various stakeholders-patients, hospitals, insurance companies, drug manufacturers-have in expressing their interests during coming months. How lawmakers and their constituencies reframe issues, reconcile conflicting arguments, and wrestle with numbers will determine whether we build on the strengths of existing programs to address the needs and disparities inherent in our aging society.

--Andy Achenbaum


A. Setting Medicare Payment Policy: Is There a Role for an Independent Entity?: This Kaiser Family Foundation issue brief examines the Obama Administration's proposal to establish a new entity that would have authority to recommend changes to Medicare policy. This proposed entity would serve to improve efficiency and control health care cost growth. The brief considers various options under consideration regarding the creation of this independent Medicare payment entity, and outlines implications for beneficiaries, other stakeholders, and program spending. It also explains the way Medicare payments are set under current law, including the advisory role now played by the Medicare Payment Advisory Commission (MedPAC).

B. A Primer on Medicare Financing: The Kaiser Family Foundation issued a primer that provides an overview of Medicare's financing and the fiscal challenges the program faces in the coming decades. It also discusses the factors that drive the growth in Medicare spending, and examines geographic variation in health care spending and its impact on the Medicare program. Finally, the primer offers an outlook for the future of Medicare financing and explains the potential for various policy proposals under discussion to change the current upward trajectory of costs, both for Medicare and for the health care system overall.

C. Payment for Medicare Advantage Plans: Policy Issues and Options: This white paper, drafted by the Office of Health Policy/Office of the Assistant Secretary for Planning and Evaluation explores several key policy issues related to Medicare Advantage (MA). These include whether to maintain MA rates at current levels or reduce them to levels commensurate with the traditional fee-for-service program, whether maintaining choices among competing private plans is the best option for improving value and financial sustainability within Medicare, whether there should be pay-for-performance in MA, and whether MA benchmarks should be determined by a competitive bidding process.

D. Medicare Part D Update-Lessons Learned and Unfinished Business: A new article, published in the New England Journal of Medicine, examines the most recently enacted major federal health care legislation, the Medicare Part D prescription drug benefit. The authors assess the effectiveness of the program and evaluate the impact of Part D on drug coverage, access to medications, out-of-pocket spending, cost-related non-compliance, and overall Medicare spending. This article concludes with identifying Part D's strengths, shortcomings, and potential areas for improvement.

E. Supporting Integrated Care for Dual Eligibles: Policy Options: This Center for Health Care Strategies, Inc., policy brief addresses opportunities for integrating care for adults who are dually eligible for Medicaid and Medicare. The brief provides rationale for integrating care for dual eligibles, reasons why integration has been slow to progress, and emerging vehicles to accelerate the pace of fully integrated care. A companion resource paper provides additional details on promising integrated care models and the challenges and opportunities for supporting integrated approaches.

IV. WORTH NOTING

A. The Process of Health Reform Legislation: KaiserEDU.org presents a new narrated slide tutorial in which Alan Schlobohm of the Kaiser Family Foundation explains the steps in the legislative process to pass health reform. He defines the role of the president, highlights the key leaders in the administration and Congressional committees, and identifies how Congress' annual budget resolution might affect health reform. Schlobohm also describes how the House and Senate plans will be combined and voted on in the full House and Senate before the final bill reaches the president's desk.

B. America's Seniors and Health Insurance Reform: Protecting Coverage and Strengthening Medicare: A new report from the White House outlines why health reform will strengthen health care for America's older adults. The report asserts that rising health care costs, persistent gaps in the use of recommended services, and the threat of Medicare insolvency all undermine the current health care that Medicare beneficiaries need and deserve. It concludes by listing ways that health insurance reform will improve access, quality, and affordability for America's seniors.

C. Long-Term Cost of the American Affordable Health Choices Act of 2009; As Amended by the Energy and Commerce Committee in August 2009: A new study, released by the Peter G. Peterson Foundation and conducted by The Lewin Group, analyzes how current proposals for health care reform might affect America's federal fiscal burden in 20 years. The report concludes that if America's Affordable Health Choices Act of 2009 becomes law, it would nearly pay for itself over the next 10 years. Budget projections extending beyond the traditional 10-year budget projection period, however, indicate that the Act could not remain self-funding beyond its initial 10-year run.

A. An Aging World, 2008: International Population Reports: This U.S. Census Bureau report examines nine international population trends identified by the NIA and the U.S. Department of State: the aging of the world's population; increasing life expectancy; the rising number of the oldest old; populations that are declining in size; the growing burden of noncommunicable diseases; changing family structures; shifting patterns of work and retirement; evolving social insurance systems; and emerging economic challenges. The report also provides information on life expectancy, health, disability, gender balance, marital status, living arrangements, education, labor force participation, and retirement among older people around the world.

B. Is Latin America Retreating From Individual Retirement Accounts?: Released by the Center for Retirement Research at Boston College, this research brief reviews Latin America's past pension reforms to determine whether Latin American countries are moving away from individual retirement accounts (IRAs). Key findings include: many Latin American countries adopted IRAs to supplement or replace traditional social security systems; recently, a number of these countries have enacted reforms to better balance individual saving and social risks; and new reforms generally aim to improve-not abandon-IRAs and to provide more adequate protection against old-age poverty.

C. Transforming Pensions and Healthcare in a Rapidly Ageing World: Opportunities and Collaborative Strategies: In this report, the World Economic Forum addresses the aging of the world's population in terms of healthcare and pensions. It highlights 11 opportunities to better cater to changing retirement and healthcare expectations: promote work for older cohorts; create a patient-centered healthcare system; enable healthy behaviors; provide financial education; encourage higher levels of retirement saving; facilitate the conversion of property into retirement savings; stimulate micro-pensions for the poor; enhance pension fund performance; realign healthcare suppliers' incentives; ensure that cross-border healthcare delivery benefits all stakeholders; and promote annuities markets to hedge longevity risk.

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

Women's Health and Retirement Security

The latest issue of Public Policy & Aging Report addresses gender biases that affect women. Such problems often are exacerbated in old age when economic, health, and family pressures mount in multiplicative fashion.

Pamela Herd introduces the issue, emphasizing the marginal place of older women on the current national policy agenda. Anticipating articles to come, Herd enumerates a range of needs: income, physical and mental health, isolation, and care provision and receipt. Madonna Harrington Meyer and Carroll Estes note women's exceedingly heavy reliance on Social Security, and propose an agenda to avoid benefit cuts, maintain the programs' stability, and modify elements of the benefit formula to make it more responsive to older women's income requirements. Charlene Harrington and colleagues identify ongoing problems associated with Medicaid home and community based services (HCBS), and call for new directions in cost containment, worker retention, and coordination among multiple programs at different levels of government. Janet Wells addresses nursing home care, paying particular attention to the proposed Nursing Home Transparency and Improvement Act. Finally, Eliza Pavalko and Joseph Wolfe examine the interplay of workplace, caregiving, and family concerns as they pertain to older women. The grounded solutions they pose revolve around family leave, sick and vacation days, and flexible hours.

Together, these articles highlight a range of problems confronting older women, but they also set forth concrete and feasible policy steps to address these concerns.

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Newsletter Editors: Sarah Frey 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.