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Medicare Beneficiary Advocates Await ACA Changes Warily

Analysis  |  By Gregory A. Freeman  
   December 14, 2016

Medicare itself was not a debating point during the presidential race, but the ACA was, and now advocacy groups are on alert for changes that may negatively affect older Americans.

It's an understatement to say that the fate of the Patient Protection and Affordable Care Act is a hot topic for conversation in the nation's capital.

Advocacy groups for older Americans are among those working to ensure that Medicare benefits are not cut back in all the negotiating and deal making to come.

The ACA boosted Medicare benefits in ways that are popular with the 57 million seniors and disabled Americans who depend on the program. Increased availability of free preventive health services and phasing in of reduced Part D prescription drug prices are making a real difference in the lives of elderly Americans and should not be sacrificed as the Trump administration revamps the healthcare insurance landscape, they say.

Republicans have said they want to approve repealing the ACA early in 2017, but even if they do, dismantling the system will take a while.

A repeal, or even significant reform of the ACA threatens to leave older Americans with less healthcare and higher costs, according to the AARP, which is organizing its members to lobby for safeguarding Medicare.

Unlike some presidential elections in which Medicare cost was a focus of debate, the issue received little attention this year, says Terry Fulmer, PhD, RN, FAAN, president of The John A. Hartford Foundation, a non-profit, non-partisan organization that works to improve conditions for the care of older adults in the healthcare system.

"We noticed during the election that there was almost no discussion of the concerns of older adults," Fulmer says.

"We have 10,000 people turning 65 every day and the way we care for them will affect our economy. We have to wait and see what happens, but we have no reason to believe that there are plans to focus on improving care for the elderly, because we heard nothing from the Trump administration about that."

Concerns for Dual-eligibles
The lack of attention during the presidential campaign and since the election isn't the only concern.

"We're also worried about people who are dual-eligible, those who are elderly and poor," Fulmer says. "Anything that adjusts Medicare of Medicaid, options like block grants that go to the state, those are things that we should look at very carefully to see how it impacts older people."

Medication costs are a particular concern, after recent price increases for insulin, Epi-pens, and other commonly used drugs, Fulmer notes. Any increase in medication costs can have a significant impact on older patients who often are on fixed incomes, and the dual-eligible are affected the most, she says.

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Fulmer holds out hope that the Trump administration will work to improve healthcare for the elderly, and her wish list includes things like more support for family caregivers. About 30 million in the United States care for elderly relatives and they can be overlooked when politicians start tinkering with healthcare legislation, she says.

"There's no such thing as paid family leave for caring for an elderly relative. We'd like to see some positive steps in that direction," Fulmer says.

"We'd also like to make sure there is support for older people at the end of life and no retraction of what we're doing to support palliative care and hospice care."

Gregory A. Freeman is a contributing writer for HealthLeaders.

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