Larry Letters

Health Reform and the Supreme Court Ruling

by Published On: Jun 28, 2012
U.S. Supreme Court

A Zen proverb, "Before enlightenment; chop wood, carry water. After enlightenment; chop wood, carry water," applies to the aging services field in the face of the U.S. Supreme Court's decision on the Patient Protection and Affordable Care Act (ACA).

LeadingAge's mission is to expand the world of possibilities for aging. We help people obtain the long-term services and supports they need, when they need them, in whatever place they call home.

Our members help families in caring for loved ones in many settings. As not-for-profits, LeadingAge members find ways to cover the cost of high-quality, essential services.

Supreme Court action will not change the expectations the public has of us and we have of ourselves around our responsibilities.

Our members have served for generations before the Affordable Care Act, and even before Medicare and Medicaid were passed. They will continue to do so regardless of the U.S. Supreme Court's decision or whatever Congress may subsequently do to the ACA.

While there has been endless debate about the ACA, LeadingAge supported it because we believe in 4 major directions in which it will take health and long-term care.

The ACA facilitated innovative service delivery.

  • It covered people without coverage.
  • It helped lower-income people pay for their medications.
  • Its CLASS Act provisions established an insurance approach to helping people and families plan and pay for basic services in the event of disabling conditions.

If the ACA is overturned, modified or sustained, we will have to find different and better ways to fulfill our missions. Because our work is essential and will become even more so as the population ages more rapidly.

Part of our not-for-profit responsibility is to develop innovative solutions to these demographic challenges to meet complex needs at a time when people -- especially older women -- often have outlived most of their financial resources.

Health reform and long-term services

Regardless of opinions about the ACA, it elevated debate over fundamental themes that have great resonance for the field of long-term services and supports.

In terms of societal values, these themes raise big questions for all of us:

  • How much responsibility do individuals have to plan for their health, especially long-term care needs? How can individuals be encouraged to obtain coverage early and less expensively? The paradox of coverage is that younger people who don't believe they need it can get it less expensively, while people who wind up needing it find few affordable options. A huge and growing problem.

  • What responsibility does society as a whole have to assist those who are physically, mentally, and/or financially vulnerable? There always will be people facing catastrophic health or long-term care costs that are beyond their means to cover.

  • Are health and long-term care basic human rights or are they luxuries to be allocated according to the means individuals may have to pay for them? At LeadingAge, we believe these are basic human rights, and we would note that this is not even a question in many developed countries.

Other questions relate to reforms of the health and long-term care delivery systems which were an important feature of the Affordable Care Act:

  • How can we enhance our mission of service to those most in need, especially the poor, who are often dually eligible for Medicare and Medicaid coverage? This issue will become increasingly important as our elder population expands while public financial resources shrink. Another paradox of the time is that Medicaid is cutting back while serving seniors on Medicaid better actually could help reduce health care spending.

  • How can we best meet our responsibilities to ensure that people who do the hard and rewarding work of hands-on care have competitive wages and benefits? The best proxy for quality is staffing. Another paradox: the more that we respect these folks through better compensation and opportunity, the better the quality and the lower the overall costs of care. And these are jobs that cannot be outsourced to another country.

  • How can we help long-term services and supports providers leverage the technologies that promise to improve the quality and efficiency of their services and increase independence and quality of life for those they serve? Investment by providers and payers in simple technologies that do things like monitor medications, prevent falls, and coordinate patient records are quality accelerators and cost reducers.

  • Is it necessary to preserve business as usual in our health and long-term care systems, or are reforms needed to make care and services more efficient and cost effective? No, we can't spend our way out of our budget deficit dilemma. Drastic cuts, however, only make the cost issue worse. Therefore, the only way to a better life for vulnerable seniors while reducing health care costs is innovation: providing better service at less cost -- another paradox. It is possible because our members are actually doing it.

The debate over these themes will continue even though the Supreme Court has ruled. LeadingAge members will continue to be leaders in the debate, to craft the right policies for the right reasons and to provide innovative solutions.

With the ruling, we anticipate the Affordable Care Act will now move forward. We have a responsibility to our aging population to come up with policies and programs to meet their needs now.

We will continue to work with members of both political parties, of both houses of Congress, the White House and federal agencies to move forward toward a healthy, ethical and affordable system of long-term services and supports.

Chop wood, carry water.


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