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Healthcare Reform: Sailing the Great Lakes During Sea
ChangeArt & Science of Aging Conference 2014
The HEART & SOUL OF AGING WELLFebruary 14 Grand Valley State University
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HEALTH DECISIONS CONVERSATIONS:
Yours. Your Community’s. Your Country’s.
Healthcare Reform, Medicare, Caregiving, Choosing, Paying
Andrew Farmer, AARP Michigan
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The Patient Protection & Affordable Care Act Medicare Health Spending Caregiving in the U.S. Michigan Long-Term Care Supports Services Options for Coverage & Payment Deciding for Others: Advance Directives Resources for Learning, Choices & Planning Questions, Discussion & Advocacy
Agenda
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Decision: Affordable Care Act or “Obamacare”?
Current System Reforms …or Destroying America
Affordable Care Act◦ Government
Marketplaces for Private Insurance
◦ Expanded Medicaid for Low Income Families
◦ Medicare Benefits Enhancements
◦ Protections & Affordability◦ Slowed Federal Spending◦ Mandates
“Obamacare”◦ Death Panels◦ Medicare Cuts◦ Jobs Killer◦ Biggest Tax Increase in
History◦ Exploding Deficits◦ Free Care to “Illegals”◦ Free Abortions◦ Care Rationing◦ Government Takeover
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Funny Story
Long ago, in a land far away (Europe) everybody believed the World was flat. They believed this for only a few reasons:
◦ No one ventured far enough to discover it was otherwise – or came back alive who did.
◦ It’s what everybody said.◦ It wasn’t safe to disagree.
Funnier Story: Most of us have flat worlds of our own we probably still live in – especially when we don’t realize it.
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Check Sources of Information: footnotes on research, data + methodologies = ingredients!
Check Organizations’ backgrounds using or reporting the information for possible biases.
Check Individual Authors’ developing and/or reporting the information for professional competence.
Check Funding Sources relied on to pay for and produce the information for possible values and influences.
Check if Additional Sources and Reporters have similar, validating conclusions; the more, the better.
Indeed, check a wide variety of sources and organizations, always.
Check if the Source(s), Organization(s) and/or Individual(s) have been Externally Recognized with reputable awards or other, widely recognized, independent honors.
Decision: Maintain a Healthy Information Diet
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Read up on AARP’s information on the Affordable Care Act at: www.healthlawanswers.org
Read The Patient Protection and Affordable Care Act itself: www.healthcare.gov + Enrollment
The 2009 Pulitzer Prize-winning website PolitiFact.com, published by the St. Petersburg Times, is a non-partisan fact-checking resource on politicians and pundits. To learn what’s true (and how true) and what’s not (and how much it’s not), go to: www.politifact.com
Decision: Sort the Facts from the Imaginary
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Understanding Medicare Enrolling in Medicare Issues in Medicare Advocacy
Decisions: Medicare Awareness
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Part A: Covers portions of Hospital, Nursing Home, Home Health, Hospice, Hospital Psychiatric, Blood
Part B: Covers portions of Physician Services, Medical Equipment, Outpatient Hospital Services, Outpatient Mental Health, Laboratory Tests/Screenings, OT/PT/ST, Home Health (non-hospital), Preventive Services, Blood
Part C: Private Managed Care Plans approved by Medicare
Part D: Private Prescription Drug Plans approved by Medicare and subsidized for low income
Medicare’s A-B-C-D
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50.7 million current beneficiaries, will reach 64 million by 2020 and 81 million by 2030.
17% of beneficiaries are under 65: recipients of Social Security Disability Insurance also join Medicare after 24 continuous months of SSDI.
40% are in poor health = 3+ chronic conditions
Half of all beneficiaries are poor and have limited savings: <200% FPL
Medicare’s People
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20% of medical charges generally not paid by Medicare = must be paid by beneficiaries, which can be high + add up fast.
Half of beneficiaries spend 16% of their income on these ($3,320 in 2010).
The poorest and sickest spend the most = 26%. Not-so-poor and well = 14%.
High income people pay more Part B and D premiums + payroll taxes= 5% of beneficiaries.
Medicaid picks up cost-sharing for lowest income Medicare beneficiaries.
Medicare’s OOPs (Out-of-Pocket$$)
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Part A is administered via The Medicare Hospital Insurance Trust Fund [H1], generated mainly by payroll taxes, also by interest from Social Security assets; high income wage earners started paying an additional .9% on Payroll Tax in 2013.
Part B is administered via Supplemental Medical Insurance Trust Fund [SMI], generated by beneficiary premiums (25%) and federal general revenues (75%).
Part C (private Medicare Advantage plans) benefits are paid out of both H1 and SMI Trusts.
Part D (private Medicare Prescription plans) benefits are paid via a separate SMI account; 11% premiums, 89% general revenues + states.
Medicare’s Financing = Trust Funds
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$574 billion spent on benefits in 20122013 Medicare Trustees Report
33%
12%
9%
22%
12%
1%11%
Medicare Spending
Hospital
Rx Drugs
Post-Acute
Private Medicare Plans
Physician
Administration
Other
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Per Capita Medicare spending is projected to slow to 1% above inflation through 2022.
But Total spending growth will be rapid due to rising enrollment of aging baby boomers (3.9% of GDP).
The Affordable Care Act further slows spending growth even though it enhanced several benefits and made other changes, adding over a decade of new solvency to the Trust Funds. -- Congressional Budget Office
Medicare Solvency Trends
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“Health care spending is growing at the slowest rate on record.”
2013 Council of Economic Advisors
General Health Spending Trends
Health Price Inflation at 50 Year Low. Health Purchasing down due to Recession. Structural Changes to Healthcare under the
ACA also making intended impacts. Lower cost growth seen across Medicare,
Private Insurance and Medicaid. “Spillover” effects from the ACA also
helping: wealth freed from healthcare available again to the general economy.
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TAKE A BREAK?
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Decision: Caregiving Choices in the U.S.
Family Caregiving Paid Caregiver Workforce
Provide 57% of all caregiving = 65.7 million caregivers or 29% of all U.S. adults
Mostly Women & Getting Older too
Put in @4 years of care 74% also work Yet provide ~19 hours/wk
caregiving $450 billion impact
◦ National Alliance of Caregivers & AARP Public Policy Institute
156,000 Michigan direct care workers = the state’s largest occupational group
Found in all settings, in-home to facilities.
Provide up to 80% of ADLs, dementia help
Uncompetitive wages & health coverage = 46% below 200% FPL◦ Paraprofessional Healthcare Institute
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Decision: Where is the Care?
YOUR HI TCHHI KER’S GUI DE TO LONG TERM CARE ATTRACTI ONS
TRADITIONAL LEVELS OF CARE IN LTC
- ADLS/IADLs +
Complete Dependence Full Independence
TRADITIONAL SETTINGS FOR LEVELS OF CARE
Hospital Nursing Home Adult Foster Care/Home for the Aged Own Home/Apartment
POTENTIAL SOURCES OF LTC PAYMENT (per LoC)
Medicare LTC Insurance Personal Funds Medicaid
? ? ?
(better scenario)
? ? ?
(not so much)
? ? ?
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AARP Caregiver Resource Center: www.aarp.org/home-family/caregiving
Decision: Stay Informed.Decision: Get Help.
Decision: Change Your Mind.
LONG TERM CARE HI TCHI KER’S RESOURCES & REST AREAS
Licensed Facilities – Nursing Homes, Adult Foster Care and Homes for the Aged:
(866) 485-9393 MICHIGAN STATE LONG TERM CARE OMBUDSMAN PROGRAM
Program of All-Inclusive Care for the Elderly (“PACE”) – In-Home Multidisciplinary Nursing:
(517) 373-6313 LONG TERM CARE & OPERATIONS SUPPORT SECTION
MEDICAL SERVICES ADMINISTRATION, STATE OF MICHIGAN
[Available only through seven PACE Centers across southern and western lower Michigan]
Area Agencies on Aging & The MiChoice Home and Community Based Waiver Program: (800) 677-1116 ELDERCARE LOCATOR
Michigan Adult Home Help Program: County Department of Human Services offices
Michigan Centers for Independent Living:
(517) 339-0539 MICHIGAN DISABILITY NETWORK
Legal Hotline for Michigan Seniors: (800) 347-5297
Michigan Medicare Medicaid Assistance Program: (800) 803-7174
Assistive Technology and Strategies (800) 760-4600 MICHIGAN DISABILITY RIGHTS COALITION
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Assessment All Over Again: Many causes of “dementia” can be treatable and reversible!
Assess YOURSELF: know your limits -- mentally, emotionally, physically, financially and with other relationships.
Michigan Office of Services to the Aging - Caregiver Assessment Resources “TCARE®” & “Confident Caregivers™”: 517-373-8230
“Plan A” is always planning: discuss the future with the person as far ahead of time as possible; gather information, talk with experts, include the person in those activities, use Person Centered Planning.
www.aarp.org/othertalk [Check out print or e-book]
Decision: Before deciding for Others
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Know the choices and alternatives in services and settings in their/your community, including accessing assistive technologies: the right care strategy can also prevent or delay the need for legal intervention.
Major in-home care programs are: Adult Home Help, “MiChoice” Home & Community Based Waiver, Area Agencies on Aging & Centers for Independent Living.
Advocate continually for your desired options with your elected officials.
Decision: Staying Home…or Not
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Decision: Deciding for Others
Advance Directive Type Elements & Limits
Durable Power of Attorney
Must be executed while the person is still “competent.”
Employs “springing authorities.”
Scope and Limits defined under “Letters of Authority.”
Vulnerable to Challenge if not Updated.
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Decision: Deciding for Others
Advance Directive Type Elements & Limits
Guardianship Must apply through Probate Court.
Must prove “incompetence” to make informed choices and decisions.
May be temporary and/or limited in scope and authorities.
Generally confers total decision-making.
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Decision: Deciding for Others
Advance Directive Type Elements & Limits
Conservatorship Likewise apply through the Probate Court.
Must prove “incompetence” to make informed financial choices and decisions.
May be temporary or limited.
Often conferred along with Guardianship powers.
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Living Wills Patient Advocate (DPOA) Resident Representative Living Trusts Person Centered Independent Facilitator Talk with a Qualified Attorney Licensed in
Michigan. Consult the Legal Hotline for Michigan Seniors at ElderLaw’s (800) 347-5297 and/or the Michigan State Bar Lawyer Referral and Information Service at (800) 968-0738.
Decisions: Deciding for Others…or Not
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Not All “Homes” are Licensed in Michigan: the State licenses Nursing Homes, Homes for the Aged and Adult Foster Care Homes.
“Assisted Living” is an industry marketing term which can mean any of the above OR an unlicensed operation.
SHOP: visit as many “homes” as possible, as many times as possible, as many different times of day as possible, to get your sense of which Homes have seem to have mostly good days.
Decision: Leaving Home for a “Home”
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Your Michigan Long Term Care Ombudsman Program can assist you with State inspection reports and other background information, assistance and advocacy: 1-866-485-9393.
Placement into these facilities can be considered temporary.
Your caregiver roles will still be needed after you move someone into a facility but they will need to shift in some ways.
Decision: Don’t Be “Home” Alone
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Continuing ACA Implementation: Enrollment Periods, Payment Reforms, Quality Initiatives, Utilization, States Medicaid Expansions, 2015 Small Business Mandate, Shift to Primary Care
Rising Healthcare Costs & Deficit Debates Most current projection by Trustees for Medicare
Trust Fund H1 insolvency is 2026 “Doc Fix” SGR Legislation…or Not = $$$ Michigan Dually Eligible Integration Project Direct Care Worker Shortage Crisis What’s in your Watch List?
Health & LTC Issues Watch List
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DiscussionNo Stupid Questions
Maybe Some Stupid Answers
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www.healthlawanswers.org
THANK YOU
Andrew Farmer AARP Michigan (517) 267-8921
