Political Division, Healthcare Policy & Long-term Care: Who Cares?

The Obamacare vs. Trumpcare debate has pitted Americans against each other and has failed to focus on the real issues that affect American healthcare. While the ACA has its flaws, it is a sound starting point to continue building upon.

In coming days, the passage of the Senate Republican’s health-care bill, Better Care Reconciliation Act of 2017, would repeal and replace the Affordable Care Act. With potentially drastic healthcare changes looming, political polarization is particularly pronounced.

Some Americans are celebrating the anticipated changes while others are apprehensive about the fate of healthcare. Moreover, political “branding” has increased political division and has complicated healthcare policy.

As gerontology researchers, we are concerned with how the repeal of Obamacare and transition to “Trumpcare” will affect the proliferation of older Americans who will require long-term care in coming years.

Regardless of one’s political perspectives, we can agree that our current long-term care system is outdated, expensive, and inefficient. Changing healthcare preferences and complex healthcare requirements demand significant improvements in long-term care options.

Long-term Care Under Obamacare

The passage of Obamacare gave more than 16 million Americans access to healthcare - an option that was previously only a dream for many.

Ironically, however, despite the deception of its name, the Affordable Care Act’s main shortcoming was its inability to curtail skyrocketing premiums and prescription drug costs. Over time, financial strains would only exacerbate, especially for older adults who require the most care and often struggle with limited financial resources.

The Obama Administration attempted to mitigate the costs of long-term care through the Community Living Assistance Services and Supports (CLASS) Act, that intended to create a voluntary, public, long-term care insurance program.

Despite its best efforts, the program never launched due to an inherently flawed design. It lacked universal mandates and therefore would have inevitably attracted too many high-risk individuals and persons with preexisting conditions - an insufficient population pool to contain soaring costs.

Envisioning Long-term Care Under the Trump Administration

Based on healthcare reform proposals from the Republican front, we speculate that Trumpcare will have several key implications for long-term care.

First, to cut long-term care costs, Republicans favor shifting financial responsibility from the government to individuals. Heatlhcare consumers will be encouraged to utilize Health Savings Accounts (HSAs), or purchase their own insurance policies with government-issued tax credits. Republicans also support significant reductions in federal Medicaid funding, which covers long-term care costs for millions of low-income seniors.

Second, we speculate that the disparity between upper and lower-income healthcare consumers will magnify. The Republican healthcare plan, aims to eliminate the Affordable Care Act’s taxes on the wealthy and would allow insurers to charge older people up to five times as much as younger people. Those who can afford to pay for long-term supports and services out-of-pocket will have an abundance of first-class care options while those who lack the financial wherewithal to pay will have far fewer choices and diminished care quality.

Finally, contrary to the discouraging fate of the Republican healthcare plan, the pending healthcare changes could strengthen opportunities for digital health technologies that reduce healthcare costs and improve quality of care. For instance, the “hospital-at-home” model could flourish under the Republican healthcare agenda as it addresses both affordability issues and preferences of consumers to age-in-place.

Can the Free Market Solve the Long-term Care Crisis?

Both Democrats and Republicans agree that Americans deserve access to affordable and efficient healthcare, yet the two parties are in constant disagreement about how to achieve this end. Crafting healthcare policies that uphold free-market principles and support fair access for all Americans has proven remarkably difficult to implement.

While it is the opinion of the authors that a single-payer healthcare model is ideal, we recognize that such a drastic change is unlikely to occur in the near future. It is, however, plausible to consider that a hybrid free-market healthcare system could spur the needed changes in long-term care.

We suggest that an incentivized savings program and an opt-in long-term care public insurance program would give individuals decision-making power for their own long-term care needs and would reduce the amount of money the government spends on long-term care.

In addition, we recommend that rather than reducing Medicaid funding, money spent on long-term care should shift to state-led savings programs. Finally, we suggest a revival and redesign of the CLASS Act that addresses the inherent design flaws of the incipient model and encourages long-term care preparation for younger generations.

The Bottom Line

The Obamacare vs. Trumpcare debate has pitted Americans against each other and has failed to focus on the real issues that affect American healthcare. While the ACA has its flaws, it is a sound starting point to continue building upon.

A hybrid free-market system would be optimal as it would give individuals options to choose, yet would also ensure that Americans have access to affordable healthcare coverage. Ultimately, encouraging individual choice will urge us all to think about and plan for who will care for us as we get older.

Authors

Jai Kyeong Kim

jai@magnuscare.co

Bryan McDermott

bryan@magnuscare.co