The National Partnership for Women & Families submits this written statement on the impact of the Affordable Care Act (ACA) on older women.  The National Partnership is a non-profit, non-partisan consumer organization with 40 years of experience working to make life better for women and families by promoting access to quality health care, fairness in the workplace, and policies that help women and men meet the dual demands of work and family.

Access to affordable, quality health care is central to the well-being of women and families.  It is a key determinant of their quality of life, their economic security, and their ability to thrive, prosper and participate fully in our society.  This is especially true for older women. 

Women 65 and older make up more than half the nation’s Medicare beneficiaries and comprise 70 percent of the oldest beneficiaries (ages 85 and older).  They are the primary consumers of health care – using more health care services as they age.  And because women tend to live longer than men, older women are more likely to have chronic conditions, many of which can be costly to treat and can affect all aspects of their lives.^[1] 

As caregivers and patients, women bear the brunt of poor care coordination in our current health care system – often having to navigate the system alone.  Worse too, older women are more vulnerable than men to increasing health care costs – having earned less during their working years[2] and often having scaled back their careers and compromised their economic security to meet family caregiving responsibilities.[3]

But the Affordable Care Act lays the groundwork for improving quality and care coordination so that older women and caregivers are better protected.  Our written statement highlights some of the ways the ACA helps older women. 

Lower Costs, Immediately

Medicare is a critical program that offers older women secure, essential health coverage.  It protects millions of older women who otherwise could not purchase coverage in the private market, which historically has been plagued by gender rating and other forms of discrimination.  However, prior to enactment of the Affordable Care Act, there were some notable gaps in traditional Medicare coverage.  In particular, annual wellness visits were not covered, leaving beneficiaries to pay out of pocket for critical preventive services.   Beneficiaries also had to cover the full cost of prescription drugs once they reached the “donut hole” – leaving them on the hook for nearly $3500 out of pocket.

As of January 1^st, older women on Medicare are able to get a free annual physical.  This will include time for their health care providers to conduct a comprehensive health risk assessment and create a personalized prevention plan.   And older women – whether they are Medicare beneficiaries or continue to purchase private health insurance – will be able to access a number of preventive services, such as mammograms and colorectal screenings, without expensive copays.

Older women are also benefitting from more affordable drug coverage – saving thousands of dollars over the next ten years – as the ACA closes the “donut hole.”  Last year, beneficiaries who fell in the “donut hole” received a $250 rebate. This year, they will benefit from 50 percent off brand name drugs in the “donut hole.” By 2020, the “donut hole” will be closed.

Retired women over age 55 who are not eligible for Medicare will also benefit from the new temporary reinsurance program provided for in the ACA.  It lowers retiree health costs and encourages employers to continue to offer coverage.[4] 

Safer Care

A goal of our reformed health care system is to get and keep patients healthy.  This would seem self-evident but, in the past, too often interaction with the health care system has actually harmed patients.  For instance, nearly one in every five Medicare patients discharged from the hospital is readmitted within 30 days,^[5] and each year, about 1.7 million health care associated infections occur in hospitals, resulting in about 100,000 deaths.^[6]

The Affordable Care Act prioritizes and invests in efforts to improve patient safety.  More attention and resources will go toward making sure older women are safe when they transition from a hospital to home or another facility – the most dangerous point in the continuum of care for vulnerable patients.[7]  In addition, starting in 2015, Medicare will begin to reduce payments to hospitals that have the highest rates of hospital-acquired conditions, like falls, pressure ulcers and infections.

Women with multiple chronic illnesses, who in some cases take more than 50 separate prescriptions each year,[8] will benefit from new medication management services.  Pharmacists will perform comprehensive medication reviews to identify, resolve, and prevent medication-related problems, and/or educate and train patients and caregivers about their medications to help reduce dangerous medication interactions and medical errors. 

Better Care

Millions of Americans have suffered needlessly because our health care system is not providing comprehensive, coordinated, quality care to those who need it most.  Nine in 10 older Americans (age 65 and older) have at least one chronic health condition and 77 percent have multiple chronic conditions.[9]  Yet our system is not equipped to provide the help these patients need.  Large numbers of older adults with multiple chronic health conditions are left on their own to navigate often-conflicting diagnoses and instructions from multiple specialists.  They report duplicate tests and procedures, conflicting diagnoses for the same set of symptoms, and contradictory medical information.[10]  This lack of coordination and communications puts their health at grave risk. 

The Affordable Care Act is a significant – indeed, unprecedented – advance in changing the way we pay for and deliver health care so that patients can receive high quality care.  The ACA created the Center for Medicare and Medicaid Innovation to test, evaluate and rapidly expand new care delivery models that improve quality and care coordination.  And, if evidence shows that these new care delivery models foster patient-centered care, improve the quality of care patients receive, and reduce costs, the Innovation Center will be able to expand the model broadly across the Medicare and Medicaid programs. 

One of the models that the Innovation Center has begun to test is the patient-centered medical home.  This new model pays primary care practices to better coordinate and manage the care of patients, ensuring that they have someone in the health care system who looks out for their interests and is available when they need help.  Eight states have been selected to take part in the Multi-Payer Advanced Primary Care Practice Demonstration, where Medicare will join ongoing multi-payer demonstrations to provide one million beneficiaries with medical homes.  In addition, up to 500 Federal Qualified Health Centers will have the opportunity to participate in an Advanced Primary Care Practice Demonstration and provide patient-centered, coordinated care to nearly 200,000 low-income Medicare beneficiaries. 

To ensure older women understand their health care options and receive the care they want, the ACA also calls for the development and use of shared decision making tools which help patients and their caregivers understand the risks and benefits of treatment options and make informed decisions about their care.

Long Term Savings

There is little dispute that our skyrocketing health care costs are unsustainable and disastrous, for the country, for individuals and for families.  In particular, costs related to treating chronic conditions could soon overwhelm patients, families and caregivers and are already straining the system badly. 

As the new law begins to bend the cost curve, older women are likely to see decreasing health care costs.  The traditional payment system undermines quality through perverse incentives for quantity of service regardless of quality, value or appropriateness.  For example, doctors are paid for the number of tests they run – not for the time it takes to talk patients about their preferences and values, nor whether what they prescribe actually makes their patients healthier. 

The Affordable Care Act takes critical steps to begin to change the way we pay for care.  The new law opens the door for important payment reforms that will move us away from a system that pays for volume of services to one that pays for value by supporting primary care and rewarding better quality, coordination and communication among providers, patients and family caregivers.  This will lead to more affordable care for older women and help ensure the Medicare program is around for the long haul.

Stronger Health Care Workforce

Low reimbursement rates and a lack of training and support have led to a shortage of health care practitioners trained in primary care and geriatrics.  To ensure that we have a health care workforce capable of delivering the care older women need, the reform law will increase payments for primary care services under Medicare and Medicaid and provide enhanced training and support for nurses and other primary care providers. 

Family caregivers – who are mostly wives and adult daughters – will benefit from new supports that help them care for their loved ones while also taking care of themselves.  For example, the Affordable Care Act establishes Geriatric Education Centers (GECs) to support training in geriatrics, chronic care management, and long term care issues for family caregivers, as well as health professionals and direct care workers. The GECs are required to train family caregivers at minimal or no charge and to incorporate mental health and dementia best care practices into their curricula.

Conclusion

The Affordable Care Act is helping millions of older women.  Repeal of the law would be a painful and unnecessary step backward for women and the loved ones they care for.   We need to move forward to implement the Affordable Care Act to ensure older women can benefit from the high quality, patient- and family-centered health care system they urgently need.

Submitted by, Debra L. Ness, President