4 tenets of health care for an aging populationArticle added by Marlene Y. Satter on January 30, 2017
Marlene Satter

Marlene Y. Satter

Joined: April 29, 2015

The American Geriatric Society sent letters to the president-elect and to Congress opposing any cuts that would affect seniors and the quality of their care.

The American Geriatric Society has come out swinging in defense of health care for older people who might find themselves left out in the cold by potential changes to, or repeal of, the Affordable Care Act.

Although no details have been nailed down on the future of health care under the Trump administration, prior to the inauguration the AGS proactively sent letters to the president-elect and to Congress opposing any cuts that would affect seniors and the quality of their care and suggesting some tenets it said “could serve as guideposts for evaluating and responding to change” as the new administration pursues changes in health care.

“These tenets,” it continued, “are grounded in the recognition that chronic disease, the management of multi-morbidity and the care of those with complex care needs remain the critical challenges.”

Since Medicare and Medicaid likely will also face changes, based on potential changes to and policy proposals for the ACA—not the least of which is a possible shortfall in funding, according to the Center on Budget and Policy Priorities, since the ACA affects not just health care policies, but also Medicare and Medicaid—the AGS warned that without “a consistent core message and set of principles,” it’s likely that coming tradeoffs could unduly affect seniors and their care.

The AGS warned that a range of proposals to control Social Security costs could be proposed, including an increase in the age of eligibility and a change from the current Social Security benefit into a fixed contribution similar to a 401(k).

Other options, such as an increase on the cap on salaries/incomes or more aggressive taxes on benefits, would likely not be popular with the new administration. “Candidate Trump pledged to leave Social Security benefits intact,” the AGS reminded, “setting up a possible conflict with Congress.”

In its report, the CBPP said that while eliminating the revenue-producing provisions of the ACA—a top goal of Republicans—would “produce roughly $1 trillion in net savings over the next decade,” approximately two thirds of that is on Republicans’ radar to be used to finance tax cuts that would most benefit the wealthiest households.

Without that money, Congress will have to look elsewhere if it is not to destabilize the individual insurance market; the CBPP cited figures from the Urban Institute estimating that if the ACA is not replaced, the number of uninsured will increase by 30 million by 2019. Since the president has promised “better” and “cheaper” health care, Congress may turn elsewhere to save money.

The CBPP report said, “Given Republicans’ opposition to revenue increases, such as those used to fund the ACA, they most likely would turn to Medicaid and Medicare as their primary source of savings to finance a ‘replacement’ measure, creating tremendous pressure to radically restructure those programs along the lines of past Republican proposals.”

It continued, “Such changes would put the health and financial status of tens of millions of Americans at risk—including low-income families, people with disabilities, and seniors covered through Medicaid and Medicare—on top of the people who would lose coverage due to ACA repeal.”

And that could, at the very least, derail retirement as retirees increasingly use retirement savings to pay for health care, and at the worst, jeopardize their health and very lives.

Here are the tenets the AGS says are necessary to remember as changes to the ACA are debated.

4. As boomers age, the eldercare workforce must be expanded to meet the demographic challenge that presents.

AGS said that coming policies “need to support increasing the number of health care professionals with geriatrics expertise.” In addition, those who care for the elderly must have access to training in geriatrics—training that is developed to be “effective and accessible” and “relevant to the worker.”

In addition, policies must support a living wage with benefits for those who work with the elderly.

3. Care of seniors exists in a greater social context of families and communities.

One problem with modern medicine can be that patients—and their symptoms or illnesses—are treated as if in a vacuum. However, the AGS pointed out that “[t]he health of the population across all age groups has important implications for the health of seniors.”

The functioning of the family units and communities in which seniors live affects their quality of life and health. In addition, transportation and housing programs are essential in preserving community integration. But the care given to younger people affects how healthy they are—and how much must be spent on Medicare for them—after they turn 65.

Also, failing to support informal caregivers and families suffering the financial and physical consequences of caregiving, by shifting costs and responsibilities to them from the health care system, threatens not just their ability to provide that care, but their own health as well.

2. Health care payment and delivery system change should be evidence based.



The Centers for Medicare & Medicaid Services (CMS), said the AGS, is the largest payer of health care in America. Because of that, it said, CMS “should not be a passive buyer; but should shape care by the development and testing of innovative models of care that address chronic disease and multi-morbidity management.”

Testing and objective independent evaluation, focused on “metrics and outcomes that are relevant to the most vulnerable and complex beneficiaries,” must take place before any payment or care delivery change is adopted.

1. Care must be patient-centered and reflect patient preferences.

Access to community-based long-term services and supports (LTSS), according to the AGS, must be meaningful, and health and long-term care services should be available no matter which state patients call home.

In addition, care should be focused on the person and not the condition, with behavioral and mental health care integrated with medical care. Also, mental health benefits must have parity.

Originally published on BenefitsPro.com
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