The ACA Can Mean a Better Future for America's Elders
In late March 2012, while the Aging in America (AiA) conference convened in Washington, D.C., the Supreme Court heard three days of arguments over the constitutionality of the Affordable Care Act (ACA). The ACA's potential for elders was discussed in-depth by advocates in aging during AiA's March 29 "National Forum on the Affordable Care Act: A Way Toward Aging with Dignity in America."
The Forum, hosted by ASA's Public Policy Committee and underwritten by a grant from The SCAN Foundation, was inspired by the Spring 2011 issue of ASA's journal, Generations, which focused on "The Affordable Care Act: A Way Toward Aging with Dignity in America." Moderated by ASA Immediate Past President Cynthia Stuen, expert panelists included Dr. Bruce Chernof, The SCAN Foundation; Dr. Bruce Leff1 Johns Hopkins University; Brenda Sulick, formerly with the National PACE Association; Kirsten Sloan, National Partnership for Women & Families; Carol O'Shaughnessy, National Health Policy Forum; Diane Justice, National Academy for State Health Policy; and Richard Kaplan, University of Illinois College of Law.
"These are controversial times," Chernof said, and the current healthcare system "is not adequate to meet the needs of older adults." He noted that public policy is hard to generate, and "we now live with a legacy of public policy that is made in the past, with an eye toward the future that is a 'best guess' on what the future would look like. And guess what-the future looks really different than what was predicted." In the last century, medical advances have given people many more opportunities to live with chronic illness, but "the public policy to keep up with the broader range of needs that people have really isn't there." Policy solutions have been "born on the back of the medical system and somewhat on the economic security system." A case in point: the Medicare system, one of the most important purchasers of long-term care in America, is ever straining to provide long-term services and supports to older adults.
The focus now, Chernof said, is to try to solve problems through solutions across the spheres of health, economic and functional security. What's needed to bolster policy change is data from disease and chronic condition management. But that data isn't there. "The net we're using to capture data is too large." The net must be narrowed to accurately identify the population being served and at what cost.
There will be, Chernof said, enormous pressure to act in the aging policy arena vis a vis the current budget deficit proposals and the ongoing cries for draconian cuts. He believes the policy solutions on the table exist in and across healthcare silos, and in how people pay for and afford care.
Then there's language. "Our policies are riddled with the kind of language that is not effective in engaging the broader public about issues in aging," Chernof said. Language should focus on the function and abilities people retain as they age, not on capacities lost. "Rationalizing our language and focusing our platforms on dignity, choice and independence are the ways toward a broader health policy argument that includes the things we all care about."
The ACA Drives New Care Models
The ACA can transform the current system by finding new ways, via innovative care delivery models, to pay for and deliver healthcare services. Presentations by Dr. Bruce Leff, policy expert Brenda Sulick and federal health issues expert Kirsten Sloan focused on the potential of different care models-or Accountable Care Organizations (ACO)-that can "bust" and cut across extant self-contained healthcare silos. Leff discussed four silo-busting models-Guided Care, Medical House Calls, Hospital at Home and the Geriatric Care Portfolio-all involving a team-based approach that consolidates service delivery, eases access to care, brings medical services in-home, helps patients stay out of the hospital- and, in the event of unavoidable hospitalization, uses a business-model "portfolio" approach to help older patients navigate the care system safely and make a good transition home. …