Following a review of the recently released MacArthur Amendment to the American Health Care Act (AHCA), the American Geriatrics Society (AGS) remains opposed to this legislation that would repeal and replace the Affordable Care Act (ACA), and which AGS experts believe would harm access to key health services for older adults, caregivers, and healthcare professionals.
The MacArthur Amendment creates additional concerns for older Americans–particularly people in states that might pursue waivers from current protections benefitting individuals with pre-existing conditions, such as provisions requiring benefits and restricting carriers from charging more based on a person's health background. The Amendment also would allow states to waive essential health benefits defined under ACA–emergency-room visits, outpatient services including home health services and hospice care, and care for chronic conditions and rehabilitative services, for example. Nothing in the Amendment remedies any of the AGS's concerns with the original legislation.
"Policy changes that would increase costs, reduce coverage, or cut benefits put health, independence, and quality of life at risk for all of us as we age," notes Nancy E. Lundebjerg, MPA, Chief Executive Officer of the AGS. "We are committed to working with Congress and the Trump Administration on meaningful reforms that would improve health care, for example, by reducing regulatory burdens, but we continue to oppose changes like those proposed in the AHCA, which might jeopardize access to high-quality, person-centered, and affordable health coverage for all older Americans."
As previously noted, AGS experts in care of older adults note that the bill would enact drastic changes to the Medicaid program, including capping federal financial support to each state to a limited, preset amount per person. With reduced federal funding for Medicaid and increased costs imposed on states, key services for older adults could be cut, impacting access to long-term services and supports, nursing homes, and home health care for the millions of older adults and caregivers who rely on these resources for well-being. Ten million people with Medicare rely on this funding, and may be subject to fewer services, reduced care quality, and increased care costs under the current proposal to repeal and replace the ACA.
Among other notable concerns, the AHCA would phase out existing expansions of the Medicaid program-cutting health services for beneficiaries between the ages of 55 and 64 who cannot afford coverage but are not yet eligible for Medicare (the program that provides care for all older Americans 65-years-old and older). The bill further removes premium cost protections for this particularly vulnerable group by ending an ACA provision that prevented significant increases in insurance premiums for those 55-64 compared to charges for younger individuals. Premium ratios proposed in the AHCA could increase costs by several thousand dollars a year for older adults, making health coverage cost prohibitive. The MacArthur Amendment could exacerbate the disparity in pricing for older adults by allowing states to set an age ratio "higher" than the 5-to-1 ratio proposed in the AHCA, setting insurance premiums even further out of reach for older adults.
Additionally, the AHCA proposes to repeal the Hospital Insurance (HI) tax on individuals in high-income brackets. This provision will impact the solvency of the HI Trust Fund, which will have implications for all Medicare beneficiaries. It is currently unclear how the bill plans to make up for this lost revenue.
Finally, the AGS expresses disappointment at the proposed repeal of the Prevention and Public Health Fund, which was established to provide funding for key public health programs that improve the health and safety of all Americans through disease prevention initiatives, immunizations, and health screenings. The Fund provides crucial support for older adults with chronic conditions, as well as support for evidence-based falls prevention programs that have benefitted more than 30,000 older Americans and adults with disabilities since 2014. Such strides are important, since Medicare alone spends nearly $31 billion annually treating injuries from falls.
With an eye toward future federal and state policies and proposals, the AGS has reiterated that legislation must:
- Expand older adults' healthcare options to include in-home and other care that enable us to live independently as long as possible.
- Help older adults and caregivers better understand healthcare needs and make the most of Medicare and other benefits.
- Provide caregivers with adequate resources and support.
- Ensure that value-based purchasing and other quality initiatives take into account the unique healthcare needs of all older people.
- Strengthen primary and preventive care and care coordination.
- Address the acute and growing nationwide shortage of geriatricians (physicians with advanced training in the care of older people) and all geriatrics healthcare professionals, and ensure that other healthcare providers have training that prepares them to meet the unique healthcare needs of older people.
- Step-up research concerning healthy aging; the prevention, diagnosis, and treatment of age-related health problems; and the cost-effectiveness of various approaches to care; and ensure that older adults are adequately represented in clinical research trials.
Health policies that embrace these critical recommendations will support a future when all older adults can receive high-quality, person-centered care, say AGS officials. The AGS will continue to monitor plans and proposals for health reform, lending expertise on the needs of older adults, caregivers, and healthcare professionals. We welcome opportunities to provide feedback to Congress and the Administration moving forward.
About the American Geriatrics Society
Founded in 1942, the American Geriatrics Society (AGS) is a nationwide, not-for-profit society of geriatrics healthcare professionals that has–for 75 years–worked to improve the health, independence, and quality of life of older people. Its nearly 6,000 members include geriatricians, geriatric nurses, social workers, family practitioners, physician assistants, pharmacists, and internists. The Society provides leadership to healthcare professionals, policymakers, and the public by implementing and advocating for programs in patient care, research, professional and public education, and public policy. For more information, visit AmericanGeriatrics.org.
Daniel E Trucil