WEST VA

2. WEST VA • Wonderful to be at this 33rd Summer Institute on Aging. Thank you Jacki and Sherry for your work and your friendship. • Commend planning committee for again producing great conference—rich and varied in content—intergenerational in focus and of course positive in theme—LIVING WELL, STAYING WELL, AGING WELL

3. Glad to maintain this annual tie to the WVU Center on Aging • A year ago when I was here we had no Tea Party– Donald Trump was not a household political name— • But a year ago we did have a new law called the Patient Protection and Affordable Care Act just starting.

4. This law is called landmark legislation by its supporters and a landmine of uncertainty by its detractors • Its passage came as you know after a fierce and partisan fight encompassing a Presidential campaign and a full session of Congress. • Achieved with dramatic votes on Christmas eve in snowstorms—Senator Byrd nearing death showing up to vote

5. Achieved with no Republican votes which is easier to do when you are in majority. • Well we know HCR issue in 2008 presidential campaign---so too was it in 2010 congressional election AND to no one’s surprise—will be in 2012 • But results of 2010 election—House going to Republicans, Democrats margin in Senate narrowed have put HCR front and center again because

6. In that same election the senior vote took on special significance—went from 16 to 23% of electorate from2008 to 2010 • The vote split 59-38 for Republicans..and when surveyed as to why---HCR and the concerns about its impact on Medicare—dominant issue followed by concerns about deficit and impact on grandchildren. • Result more than 20 percent of Congress is new and a portion of those elected for opposition to health care reform

7. So when new House convenes—first vote—repeal health care reform—a vote passed the House but not Senate so • No repeal of this law comes from Congress • Focus shifts to Supreme Court expected to rule on health care reform and its constitutionality early next year---in one of 3 directions.

8. Strike down the individual mandate for coverage provision from the bill and as a result strike the whole law down. • Strike down the individual mandate and sever it from bill meaning rest of bill ok. • Rule the whole law including individual mandate is constitutional.

9. While we wait the Obama Administration has had a law to implement since last March and they are doing just that. • On the other side opponents who cant repeal instead now move to other approaches such as delay—investigate-withhold funding all intended to slow implementation.

10. You wanted me to focus on changes to health care and seniors in the Affordable Care Act (ACA)—where now—where we are going. • Seniors have much to show in terms of benefits under the ACA. • First and foremost—all guaranteed benefits under Medicare are protected if not strengthened under this bill • The savings that will be achieved in Medicare under ACA are those achieved from cracking

11. down on waste, fraud and abuse—and making delivery system reforms • All told ACA supposed to add nine years t solvency of Medicare. • Also for seniors—last year millions got the one time $250 rebate check to help offset falling into donut hole under Part D • In 2011 a senior who hits donut hole provided with a 50 percent discount

12. on brand name drugs and the entire donut hole to be gone by 2020. • Important new focus on preventive benefits under Medicare. Now seniors can get free preventive services such as colorectal cancer screenings and mammograms and a free welcome to Medicare physical exam. • In addition to choice of doctor is preserved

13. The law increases the number of primary care doctors, nurses and physician assistants to provide better access to care and the ACA also provides a special incentive bonus for physicians who work in medically underserved areas. • On delivery system reform side ACA improves care coordination in a number of areas including for those who are dually eligible for Medicare and Medicaid. Bill specifically created a new

14. Federal Coordinated office for Dual Eligibles. • In an important announcement made on June 6 HHS announced a new $42 million initiative over 3 years for up to 500 Federally Qualified Health Centers to coordinate care working in teams for over 195,000 Medicare patients. It will show how patient centered medical home model can improve quality of care • Bill also creates an exciting new Center for Medicare and Medicaid Innovation to try out new models some of which include care coordination

15. As many know, CMS issued proposed rules to allow Medicare to pay new Accountable Care Organizations to improve coordination of patient care. These proposed rules have generated a great deal of comments which will have to be assessed before moving forward. • Other initiatives in ACA for seniors include a new commitment to improve the care and offer greater options in care for older persons with multiple chronic conditions especially at the community level.

16. Important new initiative related to transitions of care for high risk Medicare individuals—CMS committing $500 million to this important effort.

17. These are provisions many of which are in effect—still to come— • National pilot on bundled payments • Independence at home demonstration • More specific action to reduce Medicare payments for higher rates of hospital readmissions. • Medicare value based purchasing

18. Greater Medicaid coverage of preventive • Health exchanges

19. IPAB– The Independent Payment Advisory Board seen as a pro senior feature but lot of controversy—about reducing spending in Medicare if spending goes above certain amount Congress cant reject recommendations without equal savings. • 15 member commission 6 year terms.

20. Also changes to Medicare advantage—don’t get the generous subsidy from the past and must now spend more of the funds on health care vs. administrative costs

21. ACA also establishes a health care workforce commission to develop a short and long range strategy for improving the quality of our health care workforce to adapt it to our changing world. • Bill has a number of features intended to expand our national efforts to rebalance health care coverage by providing greater incentives especially under Medicaid to states with robust home and community based services. • For younger seniors who may still be in workforce the CLASS Act was created as a

22. Voluntary insurance program to provide long term care supports and services at home for working persons who contribute 5 years into a plan can receive a daily cash benefit of $50-75 subject to final rules • Bill calls for specific nutritional labeling of foods-something important to consumers of all ages. • For those who wish to retire before 65 the ACA has an early retiree program to help offset the cost of maintaining employer based retiree health plans for those mostly 55-64 before they can go on Medicare.

23. If you have a preexisting condition which has barred you from gaining insurance coverage—ACA set up PCIP transitional high risk pools—and by 2014 insurance companies cannot deny coverage • ACA extends ADRC’s for 5 years as well as the Money Follows the Person program for an additional ten years.

24. Includes the Elder Justice Act which we covered in previous years. Our nation’s most comprehensive response to the growing problems of elder abuse, neglect and exploitation. • One in 10 Americans over age 60 are victims of elder abuse according to Justice Department. Victims of elder financial abuse lose an estimated $2.9 billion a year according to new study by Met Life Mature Market Institute and the National Committee for the Prevention of Elder Abuse.

25. Bill authorizes $777 million over 4 years but for this to happen it will take passage of a separate funding bill which is being worked on. President Obama did include elder justice funding in his FY 2012 budget which is a helpful sign.

26. So there is a lot in the category of what is in the bill. I cited things that are either in effect or will be before end of year • Invite me back next year and we can talk the 2012 provisions and beyond. • But in the category of where are we going—there the picture is not as clear

27. Some of the provisions I have cited were controversial from outset and continue to be today for different reasons. • Early retiree overenrolled • Low enrollments in high risk pools • CLASS act stuck • Costs of bill • IPAB

28. Then you add to this ongoing debate some other realities that can effect Medicare and health care down the road • Situation with the debt ceiling • Medicare reforms as part of an overall deal • Ryan plan and the pushback • Trustees report noting Medicare’s date of doom is coming sooner.

29. Health care issues involving seniors will be on center stage for years to come. • Some realities– it is not some homogenous group we speak of- older adults. • Some have a number of chronic conditions and better and more coordinated care involving more than doctors is an approach worth pursuing • Greater emphasis on prevention and coverage of prevention benefits

30. Entitlement reforms– heart of future budget debate—Medicare and Medicaid as well as Social Security • Means testing—lower health care costs changes in eligibility age and more • Yet aging policy of the future will be about what the Older Americans Act has called for—to promote the independence and dignity of older persons yet I believe the goal of national aging policy may be found in the title of this conference • LIVING STAYING AND AGING WELL. • Thank you.