Here, as promised, are the remaining three steps that Kevin Prindiville, the Executive Director of Justice in Aging advocates to fight senior poverty — and though he doesn’t say so, the hardships of those who’ll remain poor or nearly so.
Increase Assistance With Healthcare Costs
Rising healthcare costs are “one of the drivers of seniors’ economic vulnerability,” Prindiville says. We can go a step further.
Medical out-of-pocket costs are the main reason the senior poverty rate rises when the Census Bureau uses its Supplemental Poverty Measure, instead of the official measure. Factoring them out would produce a 6.3% drop in the SPM senior poverty rate — about 2.8 million fewer poor seniors.
Prindiville advocates reducing or altogether eliminating medical out-of-pockets for low-income seniors. He also urges unspecified expansions of programs designed to help poor and near-poor seniors afford health care — Medicaid, Medicare Savings Programs and the low-income subsidy for Medicare Part D.
Basically, the savings programs help low-income individuals and married couples pay for Medicare premiums — both Part A (hospital costs) and Part B (out-patient costs) for the lowest-income group. The program for these Qualified Medicare Beneficiaries also helps them pay those out-of-pockets.
The subsidy program pays for either the full or partial costs of the optional Part D insurance program, which generally covers some share of prescription drug costs. Here too, how much help beneficiaries get depends on their income level.
Prindiville again stresses the need to protect these programs from cost-shifting proposals. I earlier suggested that he was referring to Republicans’ premium support, a.k.a voucher, programs for Medicare.
But a recent Part D reform needs protection as well, since Republicans seem set on repealing the Affordable Care Act. That would reopen the so-called donut hole, which the ACA has shrunk and will ultimately close.
More seniors would again have to pay the full costs of prescription drugs that exceed a fairly low maximum — just $2,830 in 2010, when the ACA was passed.
And they’d have to continue paying those costs till they reach another maximum — more than $6,000 by 2020, according to Families USA, which optimistically forecast, in 2012, that the ACA will stay in place.
Provide Federal Support for the Long-Term Care Safety Net
Seniors, as well as younger people with severe disabilities can face formidable costs for in-home help with daily activities, e.g., bathing, dressing, housework, and for community-based services like transportation.
Medicaid covers some long-term care costs for some beneficiaries — for whom and how sufficient depends on their state’s policies. A patchwork then — and no safety net at all for seniors with more than minimal incomes and assets.
We’re often advised to take out long-term care insurance, which will partially defray the costs of services in our homes and communities or, when they won’t suffice, residence in a nursing home or assisted living facility.
I have long-term care insurance. Let me tell you, it’s not cheap, especially if you don’t buy in while you’re young and spry. My annual premium is well over twice the average monthly Social Security benefit for retirees.
The ACA attempted to address this problem and the related low-coverage problem by creating a voluntary long-term care insurance program structured somewhat like Social Security. But the U.S. Department of Health and Human Services concluded that the program couldn’t, as intended, pay for itself.
So HHS suspended it. And Congress subsequently repealed it. We’re thus back to square one — a long-term care safety net for some seniors, inordinate costs and/or burdens on younger family members for the rest.
Prindiville launches a preemptive strike against what might surface next. Proposals that would instead rely on seniors, including the poor and potentially poor, to save more for their long-term care needs are “simply unrealistic,” he says.
So he advocates strengthening and expanding public programs to meet long-term care needs, especially through services that enable seniors to age in place — or at the very least, in their communities. Specifics yet to come, I suppose. But we see glimmers in the last of his five steps.
Reauthorize the Older Americans Act
OAA is one of those programs that provides state and local agencies with grants they can use for a wide range of services — all for seniors, of course, but not necessarily only those in poverty.
We’re perhaps most familiar with Meals on Wheels, but it’s also a source of funding for transportation, legal services, benefits counseling, divers health-related services and more.
Poor seniors rely on OAA-funded services heavily, Prindiville says. For seniors more generally, they’re often the difference between aging in place, as most of us want to do, and living out the rest of our days in a nursing home.
In this respect, one could view them as part of the long-term care safety net — and a cost-effective one too. A semi-private room in a nursing home costs, on average, more than $80,00 a year.
Medicaid picks up all or most of the costs for about 70% of elderly nursing home residents. So there’s a compelling fiscal case, if needed, for the OAA-funded services that complement the in-home and community services that Medicaid funds.
OAA is also one of those programs that Congress should have reauthorized some years ago. A pending bipartisan bill in the Senate would do that. Here’s one step that might actually get taken.
Getting the program adequately funded to meet the needs of our graying population is a whole other matter.
Prindiville’s steps — both protecting what we have and gaining what we don’t — all hinge on persuading our federal policymakers that we view the well-being of seniors as a high priority. Justice in Aging has a petition we can sign. And it does it need more signatures!