What’s In It For Us?

By: Sanford R. Altman, Esq., retired

Question:
Now that Health Care Reform has finally passed and has been signed into law, how do we, as seniors, stand?

Answer:
Politics and partisan rhetoric aside, there are several key provisions of Health Care Reform which apply to seniors, most of which are positive, some very significantly.

The first of such provisions is the Community Living Assistance Services and Supports Program (the CLASS Act) which I wrote about in my column about three months ago. Since then, we had the election in Massachusetts which, for a while had many declaring the entire bill to be doomed, but, both the bill and the CLASS Act survived. Why is this so important? This is a practical way for the government to actually help seniors age in place – remaining in their homes rather than moving on to institutional settings such as nursing homes. Geared to those who are still working, it allows you to pay a small premium while at work which, after five years will make you eligible for payments for long term care when you need it to help defray the cost of such things as care in your own home. In essence, it is government run long term care insurance at an affordable rate. When combined with social security or pension payments and/or a smaller than previously needed amount of private long term care insurance, it should go a long way toward helping seniors stay in their homes. Since, at the time of writing this column, Congress is still working out miscellaneous fixes and voting down amendments, watch for when the CLASS Act will begin and consider buying into it. It is refreshing when the government actually puts it money where its mouth is.

The second provision of note is aimed at seniors already on Medicare with high yearly prescription bills- the dreaded doughnut hole. Clearly the product of political wrangling and compromise rather than any logical thinking, as it stands now Medicare will cover prescription drugs for up to $2,830.00. Then, knowing that those who spend over that amount are probably the most frail, Medicare disappears for the next $3,610.00 which must be paid by the individual. The return of Medicare after spending that amount undoubtedly assumes that so few will have been able to pay the $3,610.00 out-of-pocket to reach that point that, in essence, the government is off the hook. Not that I’m being cynical about the rational for the $3,610.00 doughnut hole but…. In any event, the New Health Care Reform law does away with the doughnut hole-but in painfully slow steps. It will disappear over the years through a series of rebates (hopefully not mail-ins) and percentage reductions until, by 2020 the doughnut hole will be just a sad and mysterious memory. Better late than never.

There are, of course, a few trade offs. One will be an increase in premiums charged to Medicare Part D and Part D recipients by moving them into higher income categories. In addition, government reimbursement payments to Medicare Advantage plans which provide Medicare benefits through private insurance companies, shall be reduced. Since there have been no provisions for reductions in mandated benefits, it is believed that Medicare Advantage plans may cut extra or optional benefits for such things as dental and vision care.

To leave us on a positive note, there are many other provisions which should have a positive impact. Beginning in 2014, insurance companies shall be prohibited from denying coverage based on pre-existing conditions. Lifetime caps and payment will also be eliminated. There will also be a state plan option which shall provide community based attendant services to those with disabilities who are both on Medicaid and require a level of care at an institutional

level. This is aimed at the laudable goal of keeping more seniors in their homes. Finally, in the category of protection from elder abuse, an Elder Justice Coordinating Council shall be established to make recommendations to coordinate efforts on federal, state and local governmental levels relating to elder abuse. Funds will be provided for adult protective services, long-term care ombudsmen programs and to enhance long-term care staffing. Further, there will be national criminal background checks for any individual applying for jobs that give them direct access to patients in long-term facilities and with home care agencies.

While viewed by many as landmark legislation for health care reform, only time will tell. Clearly there are many provisions which will be a great boon to seniors, the uninsured and the population as a whole. How these provisions are implemented may tell the tale. Fortunately, in our system of government, laws are not written in stone, and as time passes, and it becomes apparent that any portions of the law needs adjusting, we can hope that our leaders have the wisdom to make these changes for the benefit of us all.