Medicare

Medicare provides vital health care coverage to adults age 65 and older and to younger people with disabilities. A key priority is to ensure a strong financial outlook for Medicare, while making it even more effective for those who rely on it.

• Medicare should remain a social insurance program. People pay into the system for their entire working lives and earn the benefits they receive. Medicare must continue to guarantee health care coverage to older people and those with disabilities, regardless of income. Reforms should not saddle beneficiaries with out-of-pocket costs they cannot afford, or unfairly squeeze the middle class.
  
  
• Medicare should be strengthened and improved for current and future beneficiaries. Preserving Medicare’s critical role means building on successful reforms currently underway and ensuring that the program continues to meet the health care needs of beneficiaries while recognizing that more changes may be needed to keep it financially sound for future generations.
  
  
• Policymakers can do more to improve the care available through Medicare. The program should offer benefits for vision, dental and hearing services to all beneficiaries. Medicare should reduce the price and out-of-pocket cost of prescription drugs, expand coverage for long-term services and supports, and improve mental health benefits. A cap on personal out-of-pocket medical costs would help ensure that no one is forced into bankruptcy due to health care expenses.
  
  
• Medicare must encourage transformation. Medicare can drive system-wide reforms to achieve better and more efficient care at a cost society can afford. It should use its vast purchasing power to reduce cost, spark innovation, and promote best practices throughout the health care system. It can offer incentives to promote high-quality care that is seamless, coordinated and easier for individuals and their family caregivers to navigate.

The Health Care System

Everyone should be able to get the health care they need at prices they can afford, yet this is not the case. Various measures can make this a reality for all. Additionally, it is essential for the health care system to be prepared for future public health crises.

• Policymakers must protect and strengthen the Affordable Care Act. The Affordable Care Act (ACA) lays the groundwork for progress by creating a framework for expanding quality affordable coverage. The ACA removed major obstacles by prohibiting insurers from turning away consumers based on their health or pre-existing health conditions, and limiting the practice of charging older adults much higher health insurance premiums than younger adults for the same coverage. It is critical to keep these protections. 
  
  
• Access to high-quality care is essential for all. Direct consumer costs, such as premiums, deductibles and other out-of-pocket expenses, should not be burdensome or limit access to coverage or necessary services. Sufficient financial assistance should be available to ensure affordability. Public and private efforts are needed to remove barriers to appropriate medical care and ensure access to care that is supported by a robust, diverse and qualified workforce.
  

• Policymakers must take meaningful steps to eliminate health disparities. The COVID-19 pandemic brought to the forefront the need for immediate and meaningful action to address long-standing racial and ethnic health disparities in this country. People from communities of color were more likely than white people to experience severe illness and death from COVID-19. They also faced additional barriers to receiving testing, treatment, and high-quality care. It is imperative to address the lack of health coverage and provider shortages in underserved communities, including making concerted efforts to reduce bias in the type and quality of care that people in these communities receive.

• Drivers of rising health care costs, including prescription drugs, must be addressed. Public- and private-sector strategies can address the root causes of high health care costs. Efforts should target areas that affect costs and consumer finances, including examining rising health care and drug prices, improving care coordination, increasing health care price transparency, strengthening chronic care management, promoting healthy behaviors, reducing administrative costs, and eliminating fraud and waste, surprise medical billing, and medical errors.

• Both the public and private sectors must act now to prepare for future public health crises. The COVID-19 pandemic left a lasting impact and highlighted deficiencies in the health care system that need to be addressed in preparation for future health crises. The health system must be better equipped to handle large influxes of critically ill patients, provide easy and safe access to testing, and make treatment and care available to all who need it regardless of their ability to pay. In addition, an adequate supply of personal protective equipment must be available. When necessary, policymakers should collaborate on effective response plans for national, state, and local public health crises.

Medicaid

Medicaid is a vital safety net that provides health care and long-term services and supports to millions of people with low incomes who could not otherwise afford to receive these critical services, including older adults who have exhausted their resources.

• Medicaid should retain its essential role guaranteeing access to adequate and affordable health care and long-term services and supports. Medicaid should continue to improve the quality and efficiency of care for beneficiaries and maximize value for the program. Federal funding should be sufficient to account for the complex needs of individuals as well as changes in states’ circumstances that affect the number of people receiving benefits and other program costs. Proposals to cap Medicaid funding should be rejected because they weaken the program and undermine its mission. 
  
  
• Medicaid should cover a range of services that allow individuals to live as independently as possible in their homes and communities. Most people prefer to remain in the community rather than live in institutions, a choice that is often more cost effective. Medicaid should be improved to help people attain this widely shared goal.

Long-Term Services and Supports (LTSS)

LTSS consists of a broad range of assistance for people with chronic conditions and functional limitations. This can include support for activities, such as bathing and dressing, that people need to function in their own homes as well as services provided in institutions. Importantly, and contrary to what many consumers may assume, Medicare does not cover the costs of LTSS. The need for affordable options is increasing as more people are aging and living longer and a declining pool of family caregivers is available to help. 

• New financing options are needed to make LTSS affordable. The cost of LTSS exceeds what families can afford. A social insurance solution can best meet this growing need. Everyone should contribute if they can, and everyone should have the security of good coverage. A social insurance system is the best option because the need for LTSS is unpredictable while the costs can be catastrophic. In the meantime, innovations in private coverage that create valuable, financially sustainable products should be encouraged, and Medicaid should support the use of cost-effective home- and community-based services (HCBS).
  
  
• LTSS should be coordinated and person- and family centered. To ensure the best outcomes for people in need of LTSS, family caregivers must be acknowledged as part of the care team, and service providers must coordinate their activities and share information across settings. Individual caregiver circumstances, abilities and needs must guide all treatment decisions.
  
  
• More top-quality services should be available to help people remain in their homes and communities. The federal government should eliminate Medicaid’s bias favoring nursing facilities by mandating the provision of home- and community-based services for everyone who meets Medicaid nursing home eligibility criteria and chooses to receive services in HCBS settings. Services should be available in a range of settings, including supportive housing and adult day centers. 

• Long-term care facilities must take steps to ensure the health, safety, and quality of life of residents and should be held accountable for failure to do so. Long-term care facilities must be properly staffed and held accountable when residents are harmed, neglected, or abused. When necessary, facilities must help minimize disease transmission. 

• Family caregivers need more support for their crucial, unpaid efforts. Unpaid caregiving has become increasingly complex for the relatives, friends, and neighbors who provide it, often at significant emotional, physical, and financial cost. Federal and state governments can empower caregivers by ensuring that LTSS covers services that supplement their efforts and help them endure, such as respite care and adult day services. LTSS programs, including Medicaid and private long-term care insurance, should also allow for family caregivers to be paid for providing care when a paid worker otherwise would be needed. Medicaid and other programs should include assessments of family caregivers’ needs. Employers should allow greater accommodations for the many employees who also provide family caregiving.