The Free Webinar: Affordable Care Act and Prevention | June 16, 2011 | 1 p.m. Eastern Time

This webinar, intended for consumers, providers, and state officials, will provide basic information about the prevention provisions and activities that are included in the Affordable Care Act.


Register for the Affordable Care Act and Prevention Webinar  June 16, 2011, 1 p.m. Eastern

Upcoming Webinar Addressing Behavioral Health Services in the Affordable Care Act

Wednesday, May 18, 2011

3 p.m. Eastern Time

What does health reform mean for people in recovery from addiction, consumers of mental health services, and their families? The National Coalition for Mental Health Recovery, Faces & Voices of Recovery, and the National Alliance on Mental Illness jointly present a series of five webinars sponsored by SAMHSA to provide information on the Affordable Care Act (ACA) and its implementation in the states to state-based advocates from the mental health and addiction disorders consumer, recovery, and family communities.

Register now for the first webinar, an overview of ACA and how it helps people with mental health and addiction disorders and their families. The webinar will give advocates the tools they need to begin interacting effectively with state legislators, administrators, and others charged with development of mechanisms and regulations for implementation of ACA.

Register Online

Presenters

Alice Dembner, Deputy Policy Director, Community Catalyst
Carol McDaid, Co-Founder and Principal, Capitol Decisions, Inc.
Ron Manderscheid, Executive Director, National Association of County Behavioral Health and Developmental Disability Directors

NEJM - Remaking Health Care

The April 28th issue of the New England Journal of Medicine contains a series of papers on Health System Reform:

Consensus and Conflict in Health System Reform — The Republican Budget Plan and the ACA
Timothy Stoltzfus Jost, J.D.

The “Roadmap for America’s Future,”1 put forward by Representative Paul Ryan (R-WI) and adopted in principle as the Republican budget proposal for 2012, offers a vision of the role of government and the nature of a good society that contrasts sharply with the vision inherent in the Affordable Care Act (ACA). Nevertheless, the Roadmap and the ACA have much in common, suggesting that there is a growing consensus regarding the way in which the U.S. health care system should be structured. The Republicans have borrowed ideas from the ACA, and the ACA drew heavily on earlier Republican proposals. Exploring the shared elements of the two plans (see Similarities and Differences between the Affordable Care Act and the Ryan Plan) to clarify the extent to which consensus has emerged in U.S. health policy may enable us to begin addressing the serious conflicts that remain.

Reforming Medicare — Toward a Modified Ryan Plan
Gail R. Wilensky, Ph.D.

Medicare reform, an issue that is rarely out of the political spotlight for long, has once again achieved a position of prominence. The current focus is primarily on the role that Medicare and other entitlement programs play in driving up the deficit, but the need to reform Medicare long predates the economic collapse of 2008.

High-Risk Pools — Merely a Stopgap Reform
Linda J. Blumberg, Ph.D.

A central goal of health care reform is to ensure that everyone, regardless of health status, has access to adequate, affordable insurance coverage and medical care. The Affordable Care Act (ACA) aims to achieve this goal by prohibiting insurers from engaging in practices that discriminate against the sick and requiring that the vast majority of Americans have insurance coverage — allowing the costs of care for people with substantial health care needs to be shared broadly by the whole population. Because most people are healthy at any given time, the sharing of expected health care costs should mean only small increases in premiums for the healthy and large savings for people who may incur disproportionately high medical expenses. However, these broad-based reforms will not be implemented until January 1, 2014.

Medicaid at a Crossroads
John K. Iglehart

Approximately 68 million Americans were enrolled in Medicaid at some point during 2010, when the program spent $406 billion on acute and long-term care services for its beneficiaries.1 Another 16 million people are slated to gain Medicaid eligibility through the Patient Protection and Affordable Care Act (ACA), which would make the federal–state program responsible for financing services for more than one in four Americans. Enacted in 1965 as an afterthought to Medicare, Medicaid has become a vast public enterprise that underscores the limits of the private insurance market even as it squeezes state budgets already stretched by the recession. These realities, along with the fact that an increasingly conservative electorate has given Republicans control of the U.S. House of Representatives, raise a fundamental question for policymakers: What level of support should government provide to people who can’t afford private insurance and are not offered employer-sponsored coverage?

How Not to Reform Medicare 
Henry J. Aaron, Ph.D.

Medicare reform has become a hot political issue. The program is wildly popular but expensive. It is the principal source of projected increases in budget deficits. With deficits increasingly seen as a mortal economic threat, many believe that now is the time for Medicare reform.

The reform flavor of the day is “premium support.” What is it? What are its strengths and weaknesses?


The ACO Regulations — Some Answers, More Questions
John K. Iglehart

Recognizing that physicians allocate most of our health care resources, Congress and the Obama administration challenged doctors in the Affordable Care Act (ACA) to develop more accountable, quality-driven health care delivery systems, promising performance bonuses for those who succeed. The vehicle that Congress created for tackling this task is the accountable care organization (ACO), which is built on a strong foundation of primary care.1 To qualify as an ACO, a group of health care providers must have the capacity to deliver the full continuum of care to at least 5000 Medicare beneficiaries and to be held accountable for the costs and quality of their care. Although the law links ACOs to Medicare, the administration has encouraged private health plans to contract with these new organizations as well. With the launch of ACOs, the reform law raises new issues that are certain to roil relations between primary care physicians and specialists. Managing care utilization more efficiently could require a rewiring of long-standing referral and hospital relationships. And conflicts may well arise over how to divide ACO savings, with primary care doctors, whose incomes are appreciably lower than those of most specialists, striving to reduce that differential. The implications for hospitals could also prove profound, given the complex new equation for calculating shared savings under the ACA.

Economists Oppose Plans to Convert Medicaid to Block Grant

Dear Speaker Boehner, Minority Leader Pelosi, Majority Leader Reid, and Minority Leader McConnell,

We write this letter to oppose plans to convert Medicaid to a block grant and to cut Medicaid benefits.

These changes would do nothing to improve quality but would ration care to millions of America’s most vulnerable citizens.

Medicaid supports health care for nearly 60 million people, including 30 million children. Two-thirds of Medicaid expenditures support services for impoverished people who are elderly or who suffer from disabilities. By spreading the cost of care between federal and state budgets, Medicaid helps state governments maintain services during economic downturns.

Looming budget deficits have led some to propose capping federal spending by converting Medicaid into a blockgrant program. We recognize the challenges posed by budget deficits. Actions must be taken to close those deficits.

Yet block granting Medicaid is both unfair and unwise. During economic downturns it would expose states to the full costs of increasing enrollments just when their revenues are falling. The inevitable result would be curtailed services, reduced eligibility, and increased charges that many low-income patients would be unable to pay, forcing them to forego care or placing burdens for uncompensated care on hospitals and physicians.

Furthermore, a decision to tie the block grant to an economic index (the Consumer Price Index adjusted for population growth) that grows more slowly than medical care spending or actual Medicaid expenditures would cause steady erosion in all of these dimensions.

The only effective and equitable way to curb total health care spending, and the only way to address the fiscal burdens of that care, is to support systemic health reform. The best current hope for doing so is the Affordable Care Act, which should be implemented with vigor.

List of Economists Who Signed the Letter

In Campaign Against Health-care Law, Republicans Take on AARP - The Washington Post

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By Dan Eggen

House Republicans, who are continuing their efforts to chip away at President Obama’s health-care law, have now set their sights on a powerful group that strongly supported the legislation: the AARP seniors lobby.

Two GOP members of the House Ways and Means Committee released a report Wednesday alleging that the nation’s largest seniors group stands to gain financially from the Affordable Care Act, because the law could result in greater demand for supplemental Medicare policies that carry the AARP stamp of approval.

In addition, the Ways and Means health and oversight subcommittees have scheduled a joint hearing Friday to grill AARP officials about the organization’s financial ventures.
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The Conservative Case for the Affordable Care Act, Part III - Ezra Klein - The Washington Post

 

By Ezra Klein

Reihan Salam is tired of having to rebut the claim that the consistent thing for conservative supporters of subsidized-insurance exchanges for the over-65 set to do would be to support — or at least admit the potential viability of — subsidized exchanges for the under-65 set, which is a model better known as the Affordable Care Act.

But moving on from it is easier said than done. The policy Reihan is trying to defend — the Ryan-Rivlin bill (pdf) — appears to mimic the Affordable Care Act. One of its two namesakes, Alice Rivlin, believes that it mimics the Affordable Care Act and has said so on-the-record. Its other sponsor, Paul Ryan, says he disagrees, but he can’t explain why. When asked, he said, “how I would do exchanges are very different than how Alice wants to do exchanges.” He didn’t go into further detail. I subsequently asked Ryan’s staff if Ryan would like to do an interview explaining how his exchanges would differ. The request was declined. I then asked his staff if they could explain to me how Ryan’s exchanges differ. They didn’t respond.
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National Quality Strategy Will Promote Better Health, Quality Care for Americans

Image via WikipediaCreated under the Affordable Care Act, first-ever strategy will guide local, state and national efforts to improve quality of care The U.S. Department of Health and Human Services (HHS) today released the National Strategy for Quality Improvement in Health Care (National Quality Strategy).

The strategy was called for under the Affordable Care Act and is the first effort to create national aims and priorities to guide local, state, and national efforts to improve the quality of health care in the United States.

"The Affordable Care Act sets America on a path toward a higher quality health care system so we stop doing things that don't work for patients and start doing more of the things that do work," said HHS Secretary Kathleen Sebelius. "American hospitals, doctors, nurses and other health care providers are among the best in the world. With this ground-breaking strategy, we are working with local communities and health care providers to help patients and improve the health of all Americans."

The National Quality Strategy will promote quality health care that is focused on the needs of patients, families, and communities. At the same time, the strategy is designed to move the system to work better for doctors and other health care providers - reducing their administrative burdens and helping them collaborate to improve care. The strategy presents three aims for the health care system:

. Better Care: Improve the overall quality, by making health care more patient-centered, reliable, accessible, and safe.

. Healthy People and Communities: Improve the health of the U.S. population by supporting proven interventions to address behavioral, social, and environmental determinants of health in addition to delivering higher-quality care.

. Affordable Care: Reduce the cost of quality health care for individuals, families, employers, and government.

To help achieve these aims, the strategy also establishes six priorities, to help focus efforts by public and private partners. Those priorities are:

. Making care safer by reducing harm caused in the delivery of care.

. Ensuring that each person and family are engaged as partners in their care.

. Promoting effective communication and coordination of care.

. Promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease.

. Working with communities to promote wide use of best practices to enable healthy living.

. Making quality care more affordable for individuals, families, employers, and governments by developing and spreading new health care delivery models.

The strategy was developed both through evidence-based results of the latest research and a collaborative transparent process that included input from a wide range of stakeholders across the health care system, including federal and state agencies, local communities, provider organizations, clinicians, patients, businesses, employers, and payers. This process of engagement will continue in 2011 and beyond.

The National Quality Strategy is designed to be an evolving guide for the nation as we continue to move forward with efforts to measure and improve health and health care quality. HHS will continue to work with stakeholders to create specific quantitative goals and measures for each of these priorities. In addition, as different communities have different needs and assets, the strategy and HHS will empower them to take different paths to achieving these goals.

The National Quality Strategy is just one piece of a broader effort by the Obama Administration to improve the quality of health care, and will serve as a tool to better coordinate quality initiatives between public and private partners. For example, the Affordable Care Act established a new Center for Medicare and Medicaid Innovation that will test innovative care and service delivery models. These new models are being tested to determine if they will improve the quality of care and reduce program expenditures for Medicare, Medicaid, and the Children's Health Insurance Program (CHIP).

Read the report at www.HealthCare.gov/center/reports.

For more information about the National Quality Strategy, visit www.ahrq.gov/workingforquality/.

Success Factors in Five High-Quality, Low-Cost Health Plans - The Commonwealth Fund

Authors: Robert A. Berenson, M.D., and Teresa A. Coughlin, M.P.H.
Contact: Robert A. Berenson, M.D., The Urban Institute, rberenson@urban.org
Editor: Deborah Lorber

Downloads

• Full Report (922K PDF)

Overview

In this report, the authors conducted case studies of five health plans that received high scores on quality and resource utilization, using data collected by the National Committee for Quality Assurance. The focus of this study was to understand how health plans with delivery systems that include a significant network of independent, community physicians achieve high performance. Plan leaders identified several factors they believe contribute to being a high-performing plan: building a physician–plan partnership, establishing the plan as a resource for physician practices, providing physician quality and cost data on performance, and emphasizing a local area orientation. Because employers are primarily responsible for arranging the health insurance coverage for their employees, there is market pressure for health plans to work with broader networks than they would otherwise want, which in turn interferes with the factors that lead to high performance.

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Govs vs. Feds: Who Will Play The 'Power Card' In The Medicaid Struggle? - Kaiser Health News

  by Grace-Marie Turner, President of the Galen Institute

Medicaid is the rope in the current tug of war between the states and the federal government over health reform. So far, the feds think they are winning. But don't discount the strength and endurance of the states -- and especially the governors.

States are facing severe budget pressures. The 2009 stimulus package provided short-term cash to the states to shore up Medicaid -- the jointly funded federal-state health program for lower-income people. But in exchange, states had to agree to maintain their 2010 Medicaid eligibility levels or risk losing all federal matching funds.

In January, 33 governors and governors-elect wrote to President Barack Obama and congressional leaders requesting "flexibility and relief" from the "excessive constraints placed on us by healthcare-related federal mandates." States say they need to trim their Medicaid rolls now because they already are swimming in red ink and this circumstance will only get worse -- partly because stimulus funding that initially helped many of them pay for the added enrollment ends in June. And, while Health and Human Services Secretary Kathleen Sebelius has responded by sending her agency's Medicaid experts to the states to help them explore options to trim Medicaid spending, she is still urging states to do everything they can to keep Medicaid enrollment at current levels before the health law’s changes take effect in 2014.

These pleas for flexibility are bipartisan.

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One in Five Think Health Law Repealed - Kayser Family Foundation

A Third Judge Validates Health Care Overhaul Law - NYTimes.com

Image via CrunchBase
by Kevin Sack

A third federal judge upheld the constitutionality of the Obama health care law on Tuesday, reinforcing the divide in the lower courts as the case moves toward its first hearings on the appellate level.

Judge Kessler adopted the government’s position on whether Congress’s authority to regulate interstate commerce is so broad that it can require people to buy a commercial product. Past Supreme Court decisions have established the standard that Congress can control “activities that substantially affect interstate commerce.”

The judge suggested in her 64-page opinion that not buying insurance was an active choice that had clear effects on the marketplace by burdening other payers with the cost of uncompensated medical care.
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Affordable Care Act Supports States in Strengthening Community Living

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Yesterday Health and Human Services (HHS) Secretary Kathleen Sebelius announced that nationally, $4.3 Billion in new funds will be provided to help establish and expand community-based alternatives to institutional long term care.  Through the Affordable Care Act (ACA) 13 states will receive additional funding for two programs, the Money Follows the Person (MFP) demonstration program and the Community First Choice Option program, in support of the goal to help move Medicaid beneficiaries out of institutions and into their own homes or other community settings now and in the near future. 

The Money Follows the Person (MFP) demonstration program, which was set to expire in fiscal year 2011, is extended through the Affordable Care Act for an additional five years.  The 13 States receiving awards today join the 29 States and the District of Columbia already operating MFP programs.  Together, these States will receive more than $45 million in the first year of the program, and more than $621 million through 2016. 

Many of the same goals under the MFP demonstration are shared and supported by the Community First Choice (CFC) Option, created by the Affordable Care Act. Today, nursing homes and institutions are too often the first or only choice for people with Medicaid who need long term care. The goal of this new option is to give States additional resources to make community living a first choice, and leave nursing homes and institutions as a fall back option.  Starting in October, this option will allow States to receive a six percent increase in federal matching funds for providing community-based attendant services and supports to people with Medicaid.  Over the next three years—through 2014—States could see a total of $3.7 billion in new funds to provide these services.  States currently receive Federal Medicaid matching funds for these activities at the State’s normal matching rate. 

To read the complete press release regarding this announcement, which includes a list of the 13 states that received funding, please go to http://www.hhs.gov/news/press/2011pres/02/20110222b.html   

Health Care Opinion Leaders' Views on Congressional Priorities - The Commonwealth Fund

More than nine of 10 leaders in health care and health care policy believe the general direction set by the Affordable Care Act is appropriate, with nearly seven of 10 favoring implementing the law with little or no change, according to a Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey. A large majority of leaders support moving forward with each of the major elements of reform, including the individual mandate, state-based health insurance exchanges, and Medicaid expansion. Survey respondents believe payment approaches that encourage care coordination for patients with chronic diseases, establish greater alignment across public and private purchasers, and incentivize the use of evidence-based medicine will be effective in achieving a high performance health system. Eighty-one percent of leaders support expanding successful cost-containment pilots contained in the Affordable Care Act as part of a federal budget deficit reduction strategy.

Citation

K. Stremikis, S. Guterman, and K. Davis, Health Care Opinion Leaders’ Views on Congressional Priorities, The Commonwealth Fund, February 2011.

Downloads

• Data Brief (540K PDF)
• Chartpack (62K PDF)
• Chartpack (216K PPT)
• Tables (343K PDF)

Affordable Care Act Sets Nation on Right Course for Health Reform, Experts Say - The Commonwealth Fund

In New Survey, Majority of Health Care Opinion Leaders Favor Implementing Health Reform Law with Little or No Change

More than nine of 10 leaders in health and health care policy believe the Affordable Care Act sets the right course for health reform, according to a new survey. And despite wide differences of opinion in Congress, and varied levels of support among the general public, nearly seven of 10 (68%) experts favor implementing the law with little or no change, according to the latest Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey, which asked respondents their views about priorities for the 112th Congress.

Few leaders surveyed expressed clear opposition to the law: only 9 percent believe the health reform law sets the wrong course for the nation; none said that the health system as it stands now requires no major changes.

Respondents voiced strong support for moving forward with all the major provisions of the law, note Commonwealth Fund researchers Kristof Stremikis, Stuart Guterman, and Karen Davis, in a new data brief on the survey findings. More than eight of 10 think it is important or very important to implement state-based health insurance exchanges (86%), the requirement that individuals purchase insurance coverage (84%), and the expansion of Medicaid to cover more lower-income individuals (82%). In addition, delivery system reform provisions including the Center for Medicare and Medicaid Innovation to develop and implement new payment and delivery system approaches (83%), the Patient-Centered Outcomes Research Institute to develop best practices in health care delivery and organization (79%), and the Independent Payment Advisory Board to help reduce the growth of Medicare spending (71%) received support from a large majority of experts.

"While health reform very much remains a work in progress, it is heartening to see broad support among health care leaders for the direction laid out in the Affordable Care Act," said brief coauthor and Commonwealth Fund President Karen Davis. "The law's major provisions for expanding coverage, creating new methods of payment, and encouraging integration and innovation are supported by leaders from a range of sectors—including academia, care delivery, business, and consumers. That sort of consensus is encouraging indeed."

Health care leaders were asked about their views on new payment methods to curb costs and promote efficiency. Nine of 10 leaders believe that improving care coordination for patients with chronic conditions will be effective. Other options that received substantial support include permanent increases in Medicare and Medicaid payments to primary care physicians (72%), aligning payment methods and rates across public and private payers (69%), and accelerating the implementation of bundled payment methods (66%). Few leaders believe allowing consumers to purchase insurance across state lines (38%) or expanding the use of health savings accounts (22%) will be effective in achieving a high performance health care system.

Reducing federal health spending can play an important role in helping to shrink the federal budget deficit. The survey asked respondents for their views on several proposed cost-reduction measures included in recent proposals, most notably from the National Commission on Fiscal Responsibility and Reform. Health care leaders surveyed support expanding successful cost-containment pilots included in the Affordable Care Act (81%) and extending Medicaid prescription drug rebates to individuals who are dually eligible for Medicare and Medicaid (61%). Few leaders support converting Medicaid into a block grant program for states (26%) or converting Medicare into a premium support or voucher program (22%).

The survey is the 24th in a series from The Commonwealth Fund, and the 16th conducted in partnership with the publication Modern Healthcare. Commentaries by David M. Cutler, the Otto Eckstein Professor of Applied Economics at Harvard University, and Gail Wilensky, a senior fellow at Project HOPE, appear in the February 21 issue of Modern Healthcare. The commentaries are also posted on the Fund's Web site, along with a Commission data brief discussing the survey findings. 

Methodology

The Commonwealth Fund/Modern HealthCare Health Care Opinion Leaders Survey was conducted online within the United States by Harris Interactive on behalf of The Commonwealth Fund between January 3, 2011, and February 1, 2011, among 1,311 opinion leaders in health policy and innovators in health care delivery and finance. The final sample included 203 respondents from four sectors: academic/research institutions, health care delivery, business/insurance/other health care industry, and government/labor/consumer advocacy, for a response rate of 15.5 percent. The complete methodology is available on The Commonwealth Fund Web site.

• News Release (26K PDF)

HHS Announces $750 Million Investment in Prevention

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New health care law provides new funding to reduce tobacco use, obesity and heart disease, and build healthier communities

Department of Health and Human Services Secretary Kathleen Sebelius today announced a $750 million investment in prevention and public health, funded through the Prevention and Public Health Fund created by the new health care law.  Building on $500 million in investments last year, these new dollars will help prevent tobacco use, obesity, heart disease, stroke, and cancer; increase immunizations; and empower individuals and communities with tools and resources for local prevention and health initiatives.

"Prevention is something that can't just happen in a doctor's office.  If we are to address the big health issues of our time, from physical inactivity to poor nutrition to tobacco use, it needs to happen in local communities," said Sebelius.  "This investment is going to build on the prevention work already under way to help make sure that we are working effectively across the federal government as well as with private groups and state and local governments to help Americans live longer, healthier lives."


The Prevention and Public Health Fund, part of the Affordable Care Act, is designed to expand and sustain the necessary capacity to prevent disease, detect it early, manage conditions before they become severe, and provide states and communities the resources they need to promote healthy living.  In FY2010, $500 million of the Prevention Fund was distributed to states and communities to boost prevention and public health efforts, improve health, enhance health care quality, and foster the next generation of primary health professionals.  Today, HHS posted new fact sheets detailing how that $500 million was allocated in every state. Those fact sheets are available at www.HealthCare.gov/news/factsheets/prevention02092011a.html. 

This year, building on the initial investment, new funds are dedicated to expanding on four critical priorities:

. Community Prevention ($298 million): These funds will be used to help promote health and wellness in local communities, including efforts to prevent and reduce tobacco use; improve nutrition and increase physical activity to prevent obesity; and coordinate and focus efforts to prevent chronic diseases like diabetes, heart disease, and cancer.

. Clinical Prevention ($182 million): These funds will help improve access to preventive care, including increasing awareness of the new prevention benefits provided under the new health care law.  They will also help increase availability and use of immunizations, and help integrate behavioral health services into primary care settings.

. Public Health Infrastructure ($137 million): These funds will help state and local health departments meet 21st century challenges, including investments in information technology and training for the public health workforce to enable detection and response to infectious disease outbreaks and other health threats.

. Research and Tracking ($133 million): These funds will help collect data to monitor the impact of the Affordable Care Act on the health of Americans and identify and disseminate evidence-based recommendations on important public health challenges. 

The Obama Administration recognizes the importance of a broad approach to addressing the health and well-being of our communities. Other initiatives put forth by the Obama Administration to promote prevention include:

. The President's Childhood Obesity Task Force and the First Lady's Let's Move! initiative aimed at combating childhood obesity.

. The American Recovery and Reinvestment Act of 2009 that provides $1 billion for community-based initiatives, tobacco cessation activities, chronic disease reduction programs, and efforts to reduce healthcare-acquired infections.

. The Affordable Care Act's National Prevention, Health Promotion and Public Health Council, composed of senior government officials, charged with designing a National Prevention and Health Promotion Strategy.

For more information about the FY2011 Prevention and Public Health Fund investments, visit www.HealthCare.gov/news/factsheets/prevention02092011b.html.

Sebelius Vows To Ensure CLASS Program Is Financially Viable - Kaiser Health News

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By Marilyn Werber Serafini

The Obama administration is working aggressively to fend off critics of the CLASS Act, a voluntary insurance program created by the new health law to help individuals who require long-term care remain in the community. Health and Human Services Secretary Kathleen Sebelius today promised to pursue changes to ensure the program is financially self-sustaining into the future.

The Community Living Assistance Services and Support Act, to be run by HHS, would provide cash benefits that could be used for a variety of non-medical expenses, such as paying for a home health aide or a family member who provides care, modifications to a home and special transportation needs.

Full Article

AARP: CLASS Program Gives Americans New Option to Plan for Long-Term Care

AARP Executive Vice President John Rother released this statement following today’s remarks by Health and Human Services Secretary Kathleen Sebelius on the Community Living Assistance Services and Supports (CLASS) program, a voluntary insurance option for long-term services and supports created in the Affordable Care Act:

“American families are struggling with the staggering cost of long-term care while state governments look to reduce costs in their Medicaid programs—the largest payers of long-term care.  The CLASS program created by the Affordable Care Act gives Americans a new option to plan for the cost of long-term services and supports through a voluntary insurance program.  At the same time, the program will help take some of the burden off of Medicaid over time as more people are able to plan and pay for their own care.

“We know that 86 percent of our members want to live in their homes for as long as possible, yet too few are able to get the services they need to continue living independently.  The CLASS program can help offer peace of mind to American families and help cover some of the costs of services and supports they need to live independently in their homes and communities.  AARP is committed to giving our members and all older Americans the information they need in the coming months and years to decide if CLASS is right for them.”

Straight Talk for Seniors on Health Reform

Confused about health reform? Wondering what it means for older Americans?

NCOA out to set the record straight. It's launched a national educational campaign to help seniors understand what’s in the new health reform law and how it will affect them. The facts are drawn from the law itself and from numerous non-partisan sources.

Straight Talk Fact Sheets

• 5 Key Facts on the Affordable Care Act (Health Reform) [ HTML | PDF ]
• Frequently Asked Questions about Health Reform and Seniors [ HTML | PDF ]
• Medicare Advantage Plans  [ HTML | PDF ]
• Long-Term Care [ HTML | PDF ]
• Financing the Medicare Program [ HTML | PDF ]
• Straight Talk for Seniors Presentation [ PDF ]

Straight Talk Toolkit for Aging Services Professionals

• Download a toolkit with resources to help you educate the seniors you serve. [ ZIP ]

A Challenge for States: Assuring Timely Access to Optimal Long-Term Services and Supports in the Community - Kaiser Family Foundation

The Medicaid program is a major payer for long-term services and supports (LTSS) in the United States, accounting for 40 percent of total spending for long-term services and supports. The federal government has played an active role in sponsoring initiatives to promote a shift to community-based care; and evidence from several states suggests that providing care in the community can be less expensive than providing institutional care.

The Affordable Care Act (ACA) provides incentives for states to implement certain policies and practices that have proven effective at promoting access to long-term services and supports in the community. States’ experience has shown that operational details can have a significant impact on whether plans to provide more services and supports in the community succeed.

This brief highlights two important aspects of operations in state Medicaid programs that affect access to long-term services and supports in the community: efforts to provide accurate and timely information to consumers, and procedures to make Medicaid eligibility determinations quickly and efficiently.
Issue Brief (.pdf)

Information provided by the Kaiser Commission on Medicaid and the Uninsured
Publication Number: 8144
Publish Date: 2011-02-07

Is Richard Foster Right About Health Care Costs? - Kaiser Health News

by Jonathan Cohn, Senior Editor of The New Republic

Last week, before a lower federal judge in Florida declared the Affordable Care Act unconstitutional, another relatively obscure government figure generated news about health care reform. It was Richard Foster, the chief actuary at the federal agency that runs Medicare and Medicaid.

During a Capitol Hill hearing, Foster was asked to judge claims that the health law would "hold down costs." Foster said he thought the claim was "false … more than true." Critics of the overhaul seized on his comments as proof that they have been right -- and proponents have been wrong -- about the law's fiscal impact.

It's a legitimate argument. Unlike the controversy over death panels, the issue of how much health reform will ultimately cost is both complicated and open to honest differences of opinion. And unlike, say, the right-wing scare-monger Betsy McCaughey, Rick Foster is a bona fide expert with a record of intellectual integrity. Remember those stories about the government official who, in 2003, challenged the Bush Administration's optimistic projections about what the Medicare drug bill would cost? Foster was that official.

But if we're going to take Foster seriously, it's important to be clear about what he said, what he didn't say, and what it all it means.
Full Article