ACA: What it Means for the Elderly

¶ … affordable Care Act (also known as the ACA or Obamacare) on the elderly Obamacare: Its impact upon the elderly The impact of the Affordable Care Act (ACA) (often called 'Obamacare') upon America is often discussed by politicians as if it had a uniform impact upon all citizens. However, the ACA's effects have been relatively disparate, depending upon the nature of the population. This paper will specifically focus upon the impact of the ACA on the elderly of a variety of socio-economic categories.

One of the criticisms of the American healthcare system before the passage of the ACA was the spiraling cost of entitlement programs such as Medicare, the federally-provided health insurance program for seniors. "One good result of all this [ACA] is that the burden of Medicare for taxpayers in future years has been drastically lowered. In fact, the day Barack Obama signed the ACA into law he cut the long-term unfunded liability of Medicare more than in half" (Goodman 2014).

However, the ACA accomplishes its cost-cutting objective by imposing a cap on Medicare spending, including reimbursements to physicians that take such patients (and Medicare already reimbursed physicians at a far lower rate than private insurance). "One bad result is that that Medicare beneficiaries are likely to be pushed into a second tier health care system -- where access to care will become increasingly difficult, as seniors less financially attractive to providers become Medicaid patients" (Goodman 2014).

For seniors reliant upon Medicare and Medicaid as their primary sources of healthcare -- not private insurance -- some argue that this could compromise the care they receive. Others counter that the law has actually had a number of salutary effects for the elderly. For example, "in New Hampshire, Medicaid pays for in-home care for nearly all of its developmentally disabled residents. For frail elders, the opposite is true. Most wind up in nursing homes.

To remedy this imbalance, New Hampshire is taking advantage of Affordable Care Act funding for a program aimed at removing existing barriers to providing long-term care in people's homes and communities" (Vestal 2014). For patients who are released from the hospital, the Community Care Transitions Program (CCTP), "helps high-risk Medicare beneficiaries prevent readmissions by connecting them to services in their communities, such as a home health agency, an Area Agency on Aging or an Aging and Disability Resource Center" rather than going to a nursing home (Leonard 2014).

Most elderly patients prefer to remain in their home settings as long as possible and research indicates that their long-term outcomes are better when elderly patients are allowed to do so. The law provides additional provisions to file complaints about nursing homes and greater transparency about the records of quality control at nursing homes (Leonard 2014). To further enhance the chances of seniors taking advantage of preventive care, the ACA contains incentives for the elderly to see their healthcare providers on a more frequent basis.

"Under the health law, Medicare provides yearly wellness visits, which allow seniors to consult with their doctor and agree on a personalized plan to stay healthy" (Leonard 2014). Medicare recipients will not have to 'go on the healthcare exchange' to buy their healthcare plans (their reliance upon this federally-provided insurance program will not change) but they will still receive additional services as a result of the law.

They will also have expanded access to a number of other preventative services that they did not previously, including, according to the National Committee to Preserve Social Security and Medicare (NCPSSM) report on the benefits of the ACA: "flu shots, tobacco cessation counseling, as well as no-cost screenings for cancer, diabetes and other chronic diseases…Because of the ACA, over 37 million seniors have received at least one of these preventive services with no out-of-pocket costs in 2013." On average, seniors take more prescription drugs than any other segment of the population.

Ensuring that seniors have access to costly but potentially life-saving drugs was another impetus behind the passage of the ACA. "Medicare Part D, or the portion that covers prescription drugs, is administered by private health insurance companies on behalf of the federal government. Before health care reform many seniors entered the 'doughnut hole,' or a gap in which they were responsible for all costs of their prescription drugs until they spent a total of $4,550 for the year" (Leonard 2014).

As a result of the law seniors now receive "a 50% discount on brand name prescription drugs and a 20% discount on generic drugs" to defray costs (Leonard 2014). On average, seniors have saved $866 per person based upon the new law (Leonard 2014). The 'doughnut hole' will be abolished in 2020 and until then drug discounts will increase on an annual basis to further cushion the costs of prescription drugs for this vulnerable population (Leonard 2014). However, for higher-income Medicare recipients the prices of their prescription drugs may go up.

Before the ACA, "Medicare beneficiaries who earn more than $85,000 ($170,000 for a couple) pay more for their Medicare Part B premiums, which cover physician and outpatient services. The health law brought that same sliding-scale approach to beneficiaries' prescription drug coverage in Medicare Part D for those with incomes of more than $85,000 ($170,000 for a couple). Those income thresholds will be frozen through 2019" ("FAQ," 2013). The ACA was particularly concerned with assisting the low-income elderly by expanding Medicaid funding as well as provisions of Medicare.

Unlike Medicare, Medicaid is a state-administered program that provides healthcare for those living below the poverty level. There is a specified federal poverty level but the determinants of Medicaid eligibility for individuals earning slightly more than that vary from state to state although the federal government does provide assistance to recipients.

According to the Kaiser Family Foundation publication "Medicaid Moving Forward," the ACA expansion applied "to nearly all adults under age 65 with income at or below 138% FPL, effective January 1, 2014." But a senior's state of residence will have a critical impact upon how he or she is affected by the law, given that states are given considerable leeway in terms of how they may enforce the Medicaid expansion provisions of the ACA. "States can decide to implement the Medicaid expansion at any time," or not at all ("Medicaid Moving Forward," 2013).

While for the very poor -- at least in some states -- the cost of some aspects of healthcare may go down, this does not mean that the bill will have a uniformly salutary impact upon all individuals (except for the wealthy). For older middle-aged women not covered by healthcare in particular, the cost of health insurance they purchase on the exchange (given that they are not yet eligible for Medicare) will likely go up.

"Women age 55 to 64 will face a huge spike in cost when they go out to buy individual insurance on the federal exchange. These women bear the brunt of the increased premiums and out-of-pocket expenses after the Affordable Care Act" (Weiner 2014). This category of patient is costly to ensure but are not poor.