Recent policy conversations related to the American Health Care Act (AHCA) have focused on proposals that would eliminate the Affordable Care Act’s critical protection for people with preexisting conditions. This controversial proposal has drawn a lot of attention for good reason. Eliminating this important protection, which keeps insurance companies in the individual (non-group) market from considering health status when making coverage decisions, could hurt millions—especially older adults who tend to develop more health conditions as they age.
But the preexisting condition protection is not the only serious concern. The proposed legislation would also make huge cuts to Medicaid by taking $880 billion out of the program by 2026. How? By, among other things, fundamentally changing the way the program is funded. Under the AHCA, Medicaid funding would move from a federal guarantee to match all legitimate state expenditures on health care and long-term services and supports (LTSS) for eligible beneficiaries, to a capped payment system that would give states a fixed dollar amount per enrolled beneficiary.[i] Although per enrollee caps respond to changes in enrollment, they do not respond to increases in health care costs attributable to medical or pharmaceutical innovation, nor do they respond to other changes in the health care environment that could affect per enrollee spending. Health care costs, we all know, are notorious for their rapid rise. The result: an ever-widening gap between cost and funding.
The impact of such a huge loss of federal Medicaid funds on people with disabilities and poor seniors will be devastating—especially for 11 million Medicare beneficiaries who are also eligible for Medicaid. These individuals—called dual eligibles, or duals—are the poorest and sickest of all Medicare beneficiaries and rely on Medicaid for critical LTSS services, like help with toileting, bathing, and eating.
Faced with major losses of federal funding for their Medicaid programs, states would have limited options. They could plug the funding hole with state revenues, which is unlikely given competing demands on state budgets. States could also cut provider rates, which could lead to significant access problems for beneficiaires because many providers may choose not to serve the Medicaid population. States could also eliminate optional eligibility categories, including some that provide access to LTSS. Finally, states could reduce or eliminate access to optional services, including home and community-based LTSS. Limiting access to needed LTSS for dual eligibles will most surely result in increased use of emergency room and hospital services, ultimately shifting costs to the Medicare program—creating a “pay me now or pay me later” situation for the federal government.
Rather than take billions of dollars out of Medicaid and shift significant costs to Medicare and states, it is time to have a reasoned conversation about how to improve the program in ways that don’t leave gaping holes in the health care safety net that millions of people and their family caregivers rely on.
[i] States have the option of receiving block grant funding for children and non-elderly, non-disabled adults. Block grants are fixed amounts of money that do not respond to changes in enrollment or program costs.
Lynda Flowers is a Senior Strategic Policy Adviser with the AARP Public Policy Institute, specializing in Medicaid issues, health disparities and public health.
In 2016, an estimated 5.4 million Americans had Alzheimer’s disease, the most common form of dementia. And while people of all ages can have dementia, 8.8 percent of adults age 65 and over have the disease.
With greater longevity and rapidly increasing numbers of individuals with dementia, we are all likely to encounter a person living with dementia as we go about our lives. We may witness a person living with the disease facing any number of challenges in navigating the community. Given the stigma around dementia in our society, people with the disease may be uncomfortable asking for help, or they may avoid venturing out in public at all — resulting in their suffering still further, from isolation.
To address these challenges, Dementia Friendly America (DFA) has launched a new tool that we can use to educate ourselves about how each of us as individuals can best interact with and support people living with dementia. We can take a few very simple and quick steps to become Dementia Friends. According to Ron Grant, who lives with dementia and is cochair of DFA, “Since there is no cure for dementia diseases and disorders, being a Dementia Friend will help those of us living with dementia to continue to live well in community.”
Dementia Friendly America, a multisector collaborative that includes AARP and a number of other leading national organizations and funding partners, is catalyzing a movement to more effectively support and serve those across America who are living with dementia and their family and friend care partners. While DFA catalyzes community-wide efforts, the Dementia Friends initiative enables each of us as individuals to play our part.
Dementia Friends U.S. is modeled after an effort that began in the United Kingdom as a way to help people learn more about what it is like to live with dementia and turn that understanding into action. DFA is the Dementia Friends U.S. licensee and has collaborated closely with the U.K. to bring the best aspects of the program to the U.S.
The first step in becoming a Dementia Friend is learning to recognize the signs of dementia (or other cognitive impairment), which could include any of the following signs:
- Difficulty communicating
- Getting lost
- Becoming frustrated
- Repeating words or phrases
- Poor judgment
- Unusual or inappropriate behavior
It doesn’t matter if a person exhibiting these signs actually has dementia; what matters is that all people are equipped to respond appropriately and in a supportive manner. A series of short online training videos depicts situations where you may encounter someone living with dementia in a variety of community settings including a restaurant, grocery store, library or bank or on a public transit system — and provides information on how you can help in such situations. After viewing the videos, you can become a Dementia Friend by committing to an activity that will help someone in your community with dementia.
Take just a few minutes to become a Dementia Friend at DementiaFriendsUSA.org. You can also check out Dementia Friendly America to learn how DFA is fostering “dementia friendly” communities across the country and how your community can become a safe and respectful place for individuals and families that are addressing this disease.
As we say at Dementia Friendly America: Living with value and purpose in the community is a human right.
Stephanie K. Firestone is a senior strategic policy advisor, health and age-friendly communities, AARP International, and a member of the Dementia Friendly America National Council.