Mary's Question

Over the past 11 months, I have interviewed dozens of people and had rewarding opportunities to speak with community audiences about healthcare.  As I have spoken with groups about this issue, I have been amazed that when we connect as citizens the media noise and the political rhetoric disintegrates.  Healthcare is an issue we all care about and we all want clear answers.  Therefore, for the next few weeks I will be doing a series called “Concerns from the Community”.  These are questions and concerns raised to me by people I have met through speaking engagements, e-mails, phone calls and my Facebook page.  

This week's question is from Mary in Southeastern Pennsylvania.

Oil on Canvas:  "The Birthday Party" by Skip Rohde

In 2011 the infamous “Baby Boomers” officially retired.  While we are seeing a growing population of seniors, this is also coupled with the fact that American’s life expectancy has increased 1.4 years over the past decade, according to the Center’s for Disease Control.  As our population is aging and this aging population is growing larger, we are seeing an unusual trend.

After one of my speaking engagements I received a phone call from Mary, an 85 year old senior in assisted living.  She had a question about the provision of long-term care in the PPACA, but it wasn’t for herself.  The question was for her 61 year old daughter, a woman who was also looking to acquire a long-term care facility.  An interesting dynamic is echoing the changing demographics of family:  parent and children living out their “golden years” together!

However, this dynamic also presents an ongoing struggle and financial burden on our healthcare system as we try to provide this much needed long-term care for our aging population.  Under current policy, Medicare will only cover a skilled nursing facility for up to 100 days, after that, it does not cover long term care.  The only alternative for many people is to “spend down” their life savings on long term care until they are deemed impoverished and therefore qualify for medicaid.  Two-thirds of nursing home residents are financed through medicaid, whereas, 7% are financed through private insurance.

It is quite obvious that our current policy is a harsh one:  impoverish our seniors so that they can receive the care they need.  In the original drafting of the PPACA in 2010, there was a provision called The CLASS Program which was scheduled to begin in 2014.  This program would have been a voluntary insurance program established to help people pay for long-term care and services.  It was an attempt on the part of the PPACA to tackle this overwhelming public health issue.

Unfortunately, in response to Mary’s concern, I had to inform her that in October of 2011, Secretary of Health and Human Services, Kathleen Sebelius, announced that the program was deemed unsustainable and therefore repealed.  From the announcement put out by the Secretary, the program was susceptible to a phenomenon known as “Adverse Selection”.  This means that higher risk people and those with already existing disabilities were more likely to enroll in the program as opposed to younger and healthier people.  As a result, more money would be paid out for services than paid in from premiums.

As mentioned before, the PPACA has made a lot of progress towards giving unprecedented access to healthcare for millions and provided much needed consumer protections to others, it is a constant reminder that we still have work to be done.  While the dynamic of mother and daughter sharing their “golden years” together may be a quaint scene, seeing them do so in poverty is not.