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Policy Analysis Paper

Aging and Health Care, Obama Care

Denisa Llangos
10/27/14
SW4710
Ey8514

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Policy Analysis Paper

There is no illness that is not exacerbated by stress.-Allen Lokos


Health is the state of being free from illness or injury. It is the most fearful and scaring issue
among all humans. Recently, to prevent all these health care difficulties such as money, no
recourses, and expenses, the high rise of the poor and ill population, president Obama signed into
law The Affordable Act. (Whitehouse n.d) There have been many questions and doubts about
the new act, therefore it decided to expand the knowledge on this new issue.
According to Nowak (2013) The Affordable Care Act (ACA) is intended to expand
Americans access to health care. Millions of Americans will become newly insured, and
millions of others will change the source of their health insurance. Changes introduced by the
law include new requirements for employers to offer coverage, tax credits and subsidies for
individuals who lack affordable coverage, and a Medicaid expansion in participating states.
(Nowak, 2013) It also made it mandatory for anyone who doesnt have health insurance to get it.
These changes could have a significant impact on consumers health care spending. The law
widely reduces out-of-pocket spending, as well as the risk of experiencing catastrophic health
expenditure. (Berenson, 2010) Effects on total health spending are varied, with some individuals
experiencing a decrease and others experiencing an increase. (Bartelestone, 2013)
ACA will have varied impacts on consumers health care spending, depending on their
income level and their insurance status compared with what it would otherwise be in 2016 in the
absence of the ACA. (Nowak 2013) Out of pocket health care spending will decrease for the
newly insured, as well as those changing their source of insurance. Decreases in out-of pocket
spending will be largest for those who would otherwise be uninsured. (Barlestone, 2013)

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Policy Analysis Paper

In some cases these reductions will be dramatic. For example, the largest reduction in
out-of-pocket spending will be for the 11.5 million newly insured who join Medicaid after
implementation of the ACA. (Cdc,gov. n.d)
Their reduction in out-of-pocket spending will be from $1,463 to $34 per year. Effects on
total spending will vary, depending on income levels and the type of insurance transition. Some
consumers, such as the 11.5 million who become newly insured by Medicaid and the 3.9 million
with incomes below 400 percent of the federal poverty level (FPL) who are insured on the preACA individual market without the ACA and who transition to the new ACA-regulated
individual market, will see total spending, which includes both out-of pocket and consumer
spending on health insurance premiums, fall. (Theodore, 2009)
Others, such as the 16.5 million consumers who are uninsured without the ACA and who
become newly insured on the individual market, will see their total spending rise under the ACA.
Of these 16.5 million consumers, the 3.3 million with incomes over 400 percent of the FPL will
experience the greatest increase in costs. These consumers will spend $7,202 under the ACA,
compared with $5,368 without the ACA. (Whitehouse n.d)This increase is explained largely by
the fact that newly insured consumers are paying premiums for the first time those with incomes
above 400 percent of the FPL, these premiums are not subsidized by the government their total
spending on health care will increase even though their out of pocket spending will go down.
(Cdc, gov n.d) Consumers will have reduced risk of catastrophic medical costs.
Consumers at all income levels undergoing insurance transitions considered in this
analysis will be less likely to have catastrophic medical costs after implementation of the ACA.
Those consumers with the lowest incomes will see the most dramatic reductions in risk of
catastrophic medical costs. For example, the 11.5 million individuals who become newly insured

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Policy Analysis Paper

by Medicaid will see their risk of spending at least 10 percent of income on medical costs
decrease from 45 percent to 5 percent. (Manofo, 2011-12) That as we read the information given
to us it is clear that money has to be spent but the percentage of people spending more on
insurances versus before without this affordable act was is less. It is not mandatory and you do
not have to change anything if you choose not to. They also have to have in consideration the
population that is uninsured, where do they go in this direction. They estimate that in 2016,
approximately 11.5 million previously uninsured people will obtain new coverage under
Medicaid. About 10.6 million of these individuals will have incomes below 138 percent of the
FPL. (As noted, this estimate takes into account that at least 14 states have declared their
intention not to expand Medicaid eligibility to 138 percent of the FPL.) (Theodore, 2009)
Individuals with incomes above 138 percent of the FPL with no insurance must become
newly insured in Medicaid if they were to enroll due to the individual mandate. Furthermore,
between 138 and 400 include many Americans from ages 65 and up. Older adults make up the
fastest growing population in North America. (Berenson, 2010)
Current demographic trends, increasing health care costs, and concerns about the quality
of health care, financing and delivery of care for older people is a critical health care policy
challenge. Health services research is needed to assure that older people benefit from recent
advances in biomedical, clinical, and behavioral and social science research with respect to a
host of aging related issues.(Sorell, 2009) The changing composition of the population is putting
increasing pressure on the health care system. In 2011, 77 million baby boomers will begin to
turn 65, and by 2025, the number of Medicare beneficiaries is expected to reach 69.3 million,
representing 20.6 percent of the U.S. population, with the "old old"those over age 80
comprising the fastest growing segment of the population. With the increased number of older

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Policy Analysis Paper

Americans, the elder population is becoming increasingly diverse; it is expected that by the year
2030, one in four people over the age of 65 will be from a racial or ethnic minority. According to
the Health Literacy program for older adults there is concern that changes in fertility, women's
labor force participation, and increases in the divorce rate may reduce the ability of families to
take care of older family members who have disabilities, placing even greater demands on public
and social programs. (Whitehouse n.d.) Furthermore, because of these demographic trends,(1)
there is concern that health care costs for the elderly population will continue to grow
dramatically. Per capita expenditures for elderly living in the community were more than three
times those of the nonelderly in 1996$5,644 vs. $1, 8651and are projected to increase to
$7,674 (in 1996 dollars) by 2005. (2) Medicare and Medicaid long-term care expenditures are
also projected to double by 2005.(3) These projected increases in taxpayer-funded costs will
place great pressure on the health literacy programs for older adults to reduce costs.
Consequently, there is apprehension that continuing and rising pressures to contain costs will
adversely affect health care quality and access. (Manofo, 2012)
Furthermore, the rapid changes in the health care system have had significant effects on
the care provided to elderly people. For example, previous efforts to control costs have resulted
in an increase in Medicare managed care, market instability, and shifting of care to ambulatory
settings. There have also been significant changes in the provision and financing of long-term
care, with growing use of community-based long-term care such as home care and assisted living
communities. (Nache elderly care n.d.)The role of institutions has also changed, with nursing
homes being used more extensively for sub-acute care. Nursing homes are confronting many
other changes, such as capitation and prospective payment for skilled nursing home care and
quality measurement and reporting. There are many unanswered questions about the effect of

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Policy Analysis Paper

these changes on quality and cost. Can the US meet its aging populations health care needs?
Despite all of the advances of modern medicine, old age continues to bring with it chronic
disease and so with the projected increase in elderly Americans will have a projected growth
in the portion of the U.S. population that will suffer from chronic diseases. (Berenson, 2010)
Some estimates say that by 2030, more than 170 million Americans will be afflicted by such
conditions and most of them, it can be presumed, will be demanding treatment.
Leading to the concern of how can we pay for all of this. However, according to the
White House information on Affordable Care Act- strengthens Medicare meaning; cheaper
prescription drugs, end to limit on care, and also free preventive services. As previously
described above, the white house showing that we do not have to worry about how to pay for all
this as the years pass and our baby boomers are reaching an older age therefore in increase health
care. Also, as the most or all Americans get health care the health care profession will bloom,
another positive outcome that President Obama touches on. (Whitehouse n.d.)
When it comes to geriatric and mental disabilities Obamas Affordable Healthcare Act is
the ideal health care system. The coordination of care between doctors and the overall quality of
care will improve so that you will be less likely to experience preventable and harmful readmissions to the hospital for the same condition. (Nowak, 2013) Hospitals will have new, strong
incentives to improve your quality of care. As shown on the picture above the Affordable Care
Act is closing the gap in drug coverage known as the donut hole. In 2014, people with
Medicare in the donut hole received a 53 percent discount on covered brand name drugs and a
28 percent discount on generic drugs. And thanks to the health care law, coverage for both brand
name and generic drugs will continue to increase over time until the coverage gap is closed.
Nationally, over 8.2 million people with Medicare have saved over $11.5 billion on prescription

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Policy Analysis Paper

drugs since the laws enactment, for an average savings of $1,407 per beneficiary. By having
these savings we can afford to have everyone in a health care plan that benefits them but also
affordable for us as a nation and preventing any inflation. (Sorell, 2009)
Furthermore, stopping medical fraud, the federal government is taking strong action to
reduce payment errors, waste, fraud, and abuse in Medicare. The health care law helps stop fraud
with; tougher screening procedures, stronger penalties and new technology. Over the last five
years, the administrations fraud enforcement efforts have recovered $19.2 billion from
fraudsters. (Whitehouse n.d.) For every dollar spent on health care-related fraud and abuse
activities in the last three years the administration has returned $8.10. As any other issue there
are many opinions that comes with change some are good and some are bad, there are many
Americans that are still skeptical about the promises that everything will be fine as we move
forward into the future. (Theodore, 2009)
As US today writes about where this new health care system will lead us, 1 in 8
Americans (13% or 40.3 million) are 65 or older, and that is projected to grow to 1 in 5 (19.3%,
or 72.1) in 2030, the year all members of the Baby Boomer generation will have turned 65,
according to Census data. By 2050, seniors will make up 25% of the population. (Karger, 2014)
Those 85 and older are projected to increase from 5.8 million in 2010 to 8.7 million in 2030.
Nearly 8 in 10 seniors are living with at least one chronic health condition; 50% have two or
more, the Centers for Disease Control and Prevention estimates. About 25% of older Americans
are obese; 20% have been diagnosed with diabetes; more than 70% have heart disease; nearly
60% have arthritis, a leading cause of disability. Adults 65 and older spend nearly twice as much
as those 45 to 64 on health care each year; they spend three to five times more than all adults
younger than 65, according to CDC. If not addressed, the increased burden of chronic disease

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Policy Analysis Paper

will not only have severe economic consequences but affect older adults' overall well-being. This
is a really important time in the nation's history for us to take a look at this demographic change
and the health and behavior outcomes for this population. (Nache elderly care n.d.) Many
insurance companies have dropped long-term care plans, or offer plans that are not much more
attractive to individuals than Medicaid. For long-term care insurance to work, adults need to
purchase it in their 30s, not when they are approaching or in retirement. But given that younger
adults are not likely to think that many years down the road to often have many competing
financial pressure this is unlikely. To ensure viability of a program, insurance companies require
large numbers of policyholders. (Berenson, 2010)
As for my advocate I choose McWilliams MSW Working at the Veterans Hospital
working with the veterans, she believes she has her doubts about this insurance as some seniors
do have it and it works and some do not care for it much as their initial insurance was better to
begin with. Judging these results she stated that it does work and it doesnt it is just a preference
of that specific person. I spoke by the phone as we physically couldnt meet due to the different
times of our schedules.
In conclusion, our health care system as of 2014 has a lot of controversy. Some
people believe that the Affordable Act system is a positive resource and is pointing our nation
into a more secure when it comes to our health insurance and its leading us into the right
direction. Wheres few believe that this health care system will lead us in debt. By understanding
and researching the Affordable Act system to get a better idea and maybe give it chance to run by
and maybe we can see then that it is a good solution in the long run. The federal state predicts
that Medicare and Medicaid will drive costs from 2016-2013, with average annual increases of
7.3 percent and 6.8 percent respectively. For Medicare, its partly due to the retirement of the

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baby-boom generation, while Medicaid will see higher use of services by elderly and disabled
beneficiaries. Furthermore, the federal, state and local government share of health care spending
will keep steadily rising, from 44 percent in 2012 to 49 percent in 2023. The share of costs
covered by businesses will decline from 21 percent to 19 percent according to NACHC. When
we weigh the pros and cons to this issue there are more positive elements that the Affordable Act
covers. My main focus on this paper was the aging population and the affordable Act, as
mentioned above as our baby boomers proceed to retirement making our nations biggest group
and all those whom dont have insurance be covered by this Act can lead to living longer and
have proper care. Included in this paper are also credible research and articles that explain
statistics of Affordable Health Care Act through our government, CDC website, NACH, even
newspapers such as the New York Times. It covers the benefits that the aging population will
receive under this Act, but also the money that will be saved eliminating fraud, and also the job
increase on health care. Also, as mentioned above the donut hole, saving money through our
prescriptions. On the other hand it also explains the reasons and concerns that people have
towards this act, as mentioned above the key questions still remains on who is going to pay for
all of this? As much data they have provided they are still not able to predict the future but as the
pros outweigh the cons I think we are stirring in the right direction.
As you can see there are many controversial when it comes to the current health care
status of this country. Some like the idea and see what the future holds where others find
concerns and dont seem that this system is working and eventually will fail in the future. On
their defense although Medicare and Medicaid fund care at levels that federal and state
governments cannot afford, the quality of care and quality of life provided by these programs are
not up to the level that Baby Boomers will most certainly demandor the programs could

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provide if they were funded appropriately. Individual long-term care insurance could be used to
ensure a level of care higher than that expected from public programs, but these policies have not
been popular.

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References
Bartelestone, Rona. (2013) Journal of Geriatric Care Management: Care Management and the
Affordable Care Act (ACA) The Possibilities, The Realities, and The Concerns. Arizona.
National Association of Professional Geriatric Care Managers
Berenson, Robert & Holahan, John. (July 2010) How Will the Patient Protection and
Affordable Care Act Affect Seniors? Timely Analysis of Immediate Health Policy Issues
Urban Institute, Robert Wood Johnson Foundation
Karger, H.J., & Stoez, D., (2014): Privatization of Human Service Corporation: American
Social Welfare Policy A Pluralist Approach (7th edition) 2014; Pearson.

Manofo, Elizabeth & Wong, Sharon (2011-2012). Health literacy programs for older adults: a
Systematic literature review. School of Nutrition, Ryerson University, 350 Victoria
Street, Toronto, ON, Canada M5B 2K3 Vol.27 no.6 2012 Pages 947960 Advance Access
published 29 June 2012

Sarah A. Nowak, Christine Eibner, David M. Adamson, Evan Saltzman. (2013). Effects of the
Affordable Care Act on Consumer Health Care Spending and Risk of Catastrophic
Health Costs Sponsored by Commonwealth Fund and produced within Rand Health :
CA, DC, PA, LA, MS etc.
Sorrell, J. M. (2009). The Obama health care plan: What it means for mental health care of older
adults. Journal Of Psychosocial Nursing And Mental Health Services, 47(1), 21-23.
doi:10.3928/02793695-20090101-12
Theodore Marmor, PhD; Jonathan Oberlander, PhD; and Joseph White, PhD. (3 March 2009)
The Obama Administrations Options for Health Care Cost Control: Hope Versus Reality.
Ann Intern Med. 2009;150:485-489 www.annals.org
http://www.nachc.com/elderly-healthcare.cfm
www.whitehouse.gov

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http://www.cdc.gov/aging/