Forecasting The Future of Health Care for Seniors
Last Wednesday I had the pleasure of being guest speaker at the Annual Luncheon of the Women’s Auxiliary to Chester County Hospital held at the Hershey’s Mill Golf Club. Betty Hindorff, my contact with the group, and Joan Atkins, its President, could not have been more gracious along with the other ladies attending and a lively time was had by all.
The topic was challenging in that we were going to attempt to forecast results into the future for senior health care. Since the U.S. Supreme Court was rumoured to be deciding the Patient Protection and Affordable Care Act (otherwise referred to as the ACA and, more casually, as “Obamacare”) in June, I did not know whether we would have the results by the time of the presentation or not.
As it turned out, we could make some informal projections regardless. Here are some ideas.
· Health Insurer Actions Regardless of the Decision on the Affordable Care Act.
o First, in dealing with healthcare specifically for seniors, which in my definition would be those age 65 and over, few changes concern the fundamental Medicare arrangement regardless whether the ACA is affirmed or not. In other words, Medicare would continue under the Act as it is now. However, the Affordable Care Act has been in the process of ratcheting down the cost of prescription drugs for seniors, the so-called “doughnut hole” that would be eliminated entirely by the year 2020. If the Act is overturned in its entirety, that would leave the closing of the doughnut hole up in the air and the cost of prescription drugs for seniors would likely increase. Similarly, the cost of preventive care which, under the Act, is without copayments, would reinstate the copayments.
o For non-seniors, that is those under the age of 65, three major health insurers have stated recently that they will keep some provisions of the Act regardless how the Supreme Court rules. United Health Group, Inc., Aetna and Humana all plan to retain children on their parents’ plans, if desired, until age 26 and to continue free preventive care both for seniors and non-seniors. United Health and Humana will eliminate lifetime benefit limits for policyholders, another provision of the Act, and will not rescind policies except for fraud. The Act prohibited canceling policies because claims were made. All three companies will retain a simplified appeals process as indicated in the Act.
· Provisions that would change. Under the ACA, the requirement that most Americans obtain health insurance is woven into other provisions, the most obvious being that insurance companies allow coverage for pre-existing conditions. This provision is already in effect for children and is scheduled to go into effect for others on January 1, 2014. If the Court finds that Americans do not need to obtain health insurance, insurers would be in a difficult position to provide this coverage. It is too early to say whether provisions for “medical homes” or incentives for efficiency would be eliminated. One concern of State and local governments has been the expansion of Medicaid as a backup form of insurance for those within certain income limitations. The federal government under the Act would provide subsidies based on certain guidelines for those unable to afford coverage.
While these likely would not affect seniors, we also do not know what would happen to “insurance exchanges” – the marketplaces for insurance described in the Act to be set up by the States and, in some cases, a national marketplace so that shoppers for health insurance could compare prices and benefits. One potential contined concern regardless of the Act is a distinction now being made between hospital “admissions” and “under observation” status. The short answer is that “under observation” status can cost and seniors especially need to watch that they are considered admitted when they go to the hospital and not “under observation.”
· The Changing Scene Regardless of the ACA. Technology is going to play more of a role with healthcare. Provisions of the Act encourage this but, in order to remain competitive, it will probably be necessary for hospitals to join in developing medical records and other systems anyway. At home care with physicians might include monitoring through Skype or other means. There will be many new developments in the future.
For more, listen to “50+ Planning Ahead” a weekly radio program on WCHE 1520 on every Wednesday from 4:30 pm to 5:00 pm with Janet Colliton, Colliton Law Assocs., PC, and Phil McFadden of Home Instead Senior Care.
About the Author Janet Colliton
Esquire, Colliton Law Associates, P.C. Janet Colliton has practiced law for over 38 years, 37 of them in Chester County, Pennsylvania, a suburb of Philadelphia. Her practice, Colliton Law Associates, PC, is limited to elder law, Medicaid, including advice, applications and appeals, and other benefits planning including Veterans benefits, life care and special needs planning, guardianships, retirement, and estate planning and administration.