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The healthcare industry is in constant flux. Factor in the rapidly aging population and corresponding increased demand for healthcare services, and the picture grows even murkier. What is the current state of the American healthcare system, and what can older adults expect looking ahead? Here’s a closer look at the state of healthcare as it pertains to seniors, along with what’s ahead on the horizon.
No discussion of older adults and healthcare in America is complete without acknowledging the drastic impact the aging “Baby Boomer” generation — people born between the years of 1946 and 1964 — will have in reshaping the system.
Which begs the question: Just how many older Americans are there? According to a 2016 report from the Population Reference Bureau (PRB), the number of senior Americans (ages 65 and older) will more than double between 2016 and 2060, skyrocketing from 46 million to 98 million. Additionally, their share of the total population will increase from 15 percent to 24 percent. In other words, nearly a quarter of all Americans will be over the age of 64 by the year 2060.
The PRB report also revealed good news for seniors and the people who love them: The average US life expectancy increased from 68 to 79 between 1950 and 2013.
However, the fact that older adults are living longer also means an increasing need for medical care — particularly given some of the major healthcare challenges they face, including rising obesity rates and increases in the number of Americans living with Alzheimer’s disease.
Specifically, approximately 40 percent of older Americans in the 65-74-year-old category were obese at last count, and these numbers continue to rise. Additionally, forecasts suggesting that Alzheimer’s cases will nearly triple from 2013’s 5 million to 14 million in 2050, meaning a major increase in demand for elder care.
One last factor which merits acknowledgment when it comes to senior health? The senior living landscape. According to PRB, the aging senior population may trigger a 75 percent hike in the number of seniors in need of nursing home care — a massive 2.3 million by 2030. Factor in an increasing preference among seniors to “age in place” — 27 percent of 65-74-year-old women live alone, a figure which leaps to 42 percent among 75-84-year-old women, and spikes to a staggering 56 percent for women ages 85 and older — and the need for more senior living options is also critical.
Signed into law in 2010 by President Obama, the Affordable Care Act (ACA) — also known as also known as the Patient Protection and Affordable Care Act (PPACA) or simply as Obamacare — was created to improve the American health care system by expanding access to health care coverage to more citizen while simultaneously safeguarding the interests of existing policyholders.
And while the success of the ACA has been widely debated, President Trump’s repealing of the legislation with no replacement in place jeopardized seniors and their care, according to national non-profit senior legal advocacy organization Justice in Aging, Specifically, said Justice in Aging, the repealing of the ACA could lead to the loss of coverage for more than 4.5 million Americans between the ages of 55 and 64. Additionally, many programs designed to help seniors and people with disabilities stay in their homes might also come to an end. Higher prescription drug costs and bigger cuts to Medicare and Medicaid are also among the top concerns associated with doing away with the ACA.
Many also suggest that ending the ACA will also stifle innovations aimed at strengthening care for seniors. According to national non-profit senior legal advocacy organization Justice in Aging, “With repeal, low-income older adults could lose help they currently receive managing their doctors’ visits, medications, and social supports. The Medicare-Medicaid Coordination Office (MMCO), the financial alignment demonstrations (duals demonstrations), and delivery system reforms funded through the Center for Medicare and Medicaid Innovation could all be stopped in their tracks due to repeal, resulting in lower quality care and higher costs for seniors and people with disabilities….A full repeal of the Affordable Care Act would also remove the increased protection that the ACA provides against discrimination in health care.”
But repealing the ACA was exactly what Republicans intended to do, debuting the American Health Care Act (AHCA) in March of 2017. This proposed legislation would cut the deficit and reduce average premiums in the long-term while simultaneously leading to the loss of health insurance for 24 million, according to the Congressional Budget Office (CBO).
Said an article in The Atlantic on the AHCA, “Proportionally, the group of people that would see the most coverage losses under the AHCA is the population of people aged 50 and older. Although they’re more likely to have coverage in the first place, owing to more stable employment and a higher likelihood of public insurance coverage, CBO estimates show the uninsured rate of people over 50 would skyrocket from around 13 percent currently to just under 30 percent by 2026. Included in that number are near-elderly adults with low incomes, a group that’s most likely among all non-Medicare enrollees to be sick, and one of the most expensive groups to cover in American health markets today.”
Its overarching flaw according to The Atlantic? “Essentially, the AHCA works by abandoning a key goal of health reform altogether, and carving out some of the most expensive people to cover—while simply not offering them a more affordable coverage option.”
However, concerns over the switch were proven moot just a month later when the bill collapsed in Congress in April of 2017.
As the Republicans sort through next options, one particular plan — perhaps most notable for its biggest champion, Bernie Sanders — is getting significant buzz– the “single payer” or Medicare for All” movement.
What, exactly, is single-payer national health insurance? Explains Physicians for a National Health Program, (PNHP), “Single-payer national health insurance, also known as “Medicare for all,” is a system in which a single public or quasi-public agency organizes health care financing, but the delivery of care remains largely in private hands. Under a single-payer system, all residents of the U.S. would be covered for all medically necessary services, including doctor, hospital, preventive, long-term care, mental health, reproductive health care, dental, vision, prescription drug and medical supply costs.”
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PNHP continues, “The program would be funded by the savings obtained from replacing today’s inefficient, profit-oriented, multiple insurance payers with a single streamlined, nonprofit, public payer, and by modest new taxes based on ability to pay. Premiums would disappear; 95 percent of all households would save money. Patients would no longer face financial barriers to care such as co-pays and deductibles, and would regain free choice of doctor and hospital. Doctors would regain autonomy over patient care.”
As Jeff Weaver, president of Our Revolution, told People’s World, “We all know the Affordable Care Act was a critically important step towards the goal of universal health care. But 29 million Americans today still do not have health insurance and millions more are underinsured because health insurance companies are making our health care unaffordable and inaccessible….Medicare for All puts power and choice when it comes to health care decisions right where it should be in the hands of patients and their doctors, because nobody should be squeezed by the insurance industry’s bottom line.”
While health insurance may garner the lion’s share of attention, experts are also calling for new care models, including one in particular: Age-Friendly Health Systems, a joint initiative of the John A. Hartford Foundation, the Institute for Healthcare Improvement, and the American Hospital Association.
According to a Health Affairs blog entry by Terry Fulmer and Amy Berman, age-friendly health systems share the following characteristics:
- Leadership committed to addressing ageism
- A geriatric care model designed specifically for older adults.
- Specifically trained staff with expertise in the care of older adults
- High performing care teams with the ability to demonstrate measurable results.
- A systematic approach for coordinating care with other organizations
- Strategies aimed at coordinating, communicating with, and supporting caregivers.
- A protocol for determining patient goals and preferences in order to prioritize concordant care.
Meanwhile, how can seniors stand to benefit from age-friendly health systems with these characteristics? For starters, according to Health Affairs, senior patients will benefit from care aligned with their goals. Many also become more independent and functional while reducing the risk of common geriatric concerns, such as polypharmacy, delirium, falls and incontinent. An age-friendly health care system can also lead to better pain management, more proactive decision making during transitions, and increased recognition and support for families.
Continues Health Affairs blog, “As health systems redefine care for older adults, they will bring to bear the full resources of all involved. Health professionals will need to adopt a new way of thinking that replaces paternalism and foisting of expensive, unwanted care on patients. This means seamless care transitions; real-time information sharing; and ongoing, meaningful engagement with patients, families, and community-based services essential to meeting these challenges.”
The overall takeaway? The state of healthcare in the U.S. is not static but dynamic. From new technologies like telemedicine and wearables to changes — not to mention complete reversals — in coverage, the best way to navigate this uncertain terrain is to stay apprised of the issues in order to position yourself as your own best advocate. Be sure to sign up for our newsletter to keep up with everything from senior housing to legal and financial help for seniors.