Politics of Aging in the 21 st Century Aging in America 2009

1. Politics of Aging in the 21st CenturyAging in America 2009 William F. Benson Health Benefits ABCs Las Vegas, NV March 16, 2009

2. Who held up the reauthorization of the Older Americans Act for one full year with an entirely non-germane amendment? (Hint: 1991-1992 – amendment to eliminate the Social Security Earnings Test)

4. Safe Prediction I “The Future Ain’t What It Used to Be”- Yogi Berra

5. Safe Prediction II The much anticipated aging of the baby boomers begins on this next president’s watch: 2011

6. Medicare & Social Security Board of Trustees Report – March 26, 2008 Department of Treasury Secretary Henry Paulson: "If we do not take action soon to reform Social Security and Medicare, the coming demographic bulge will jeopardize the ability of these programs to support people who depend on them. Without changes, rising costs will drive government spending to unprecedented levels, consume nearly all projected federal revenues and threaten America's future prosperity.“ Source: Kaiser Daily Health Report 3-26-08

7. The Money: Three Funding Bills in Succession • Stimulus bill – American Recovery & Reinvestment Act (H.R. 1) – the “economic stimulus bill” – now law • FY ‘09 Appropriations Bill (H.R. 1105) – 9 Approps bills in one – now law • FY ’10 Budget & Approps bill – President’s budget released and approps – now in the works

8. The Money: The Stimulus Bill -- ARRA • Huge success for Obama • Not ONE Republican House vote; 3 in the Senate (for huge trade-off) • “Once-in-a-lifetime” opportunity for many federal programs & officials and their constituents • OAA: $100 million for meals & $120 million for Title V • Sure hope it works

9. The Money: FY 09 Omnibus Appropriations Bill (H.R. 1105) • Just signed into law • $400+ billion -- $30 billion (8%) over FY ’08 • Republican opposition: House leader calling for federal spending freeze & scrapping the omnibus spending measure • The “Earmarks” debate: 40% from Republicans – sets up interesting dynamic for FY ‘10 funding between President, Congressional Dems & Reps

10. The Money: FY 09 Omnibus Appropriations – OAA Tidbits • NEW Accountability for Title IV Program Innovations & Aging Network Support Activities • For FY 10 budget justifications and beyond AoA must provide a table of funding broken down by account, program & activity; and includes actual funding or estimates for previous, current & future FYs

11. The Money: FY 09 Omnibus Appropriations – OAA Tidbits • AoA’s Aging Network Support Activities $4 1.7 million ($10 over FY 08) -- $28 m for Choices for Independence Program • AoA must report to Congress on establishing national standards to evaluate CHOICES including performance measures & indicators states must use to track & report on “outputs & outcomes” achieved

12. The Money: FY 09 Omnibus Appropriations – OAA Tidbits • Bi-partisan earmarks: • $95,000 for Multnomah County Gatekeeper Project -- $48,000 – Wyden & Smith • NORC in Atlanta -- $95,000 – Chambliss • NORC in Indianapolis -- $438,000 – Carson & Lugar • Senior counseling services on Medicare, Medicaid & private insurance for UT SUA -- $95,000 -- Hatch

13. The Money: Obama’s FY ‘10 Budget Request • 10-year, $634 billion reserve fund for health care reform • Paid for by taxes on high-income earners & $318 billion in Medicare & Medicaid savings • Approach: spread the pain so no one sector hurt more than another & make changes incrementally – reaching out to diverse audiences (lessons from Clinton reform effort; March 5 “Summit”)

14. The Money: Obama’s Health Care Reform Funding: Many Challenges • Raising premiums for wealthier Medicare beneficiaries ($8.1 B over 10 years) • NAHC unhappy about cutting $37 billion in Medicare home care payments (note 3/13 GAO report) • Health Industry spends $1 billion on lobbying (Washington Post) • “Conservatives for Patients’ Rights” pledges multi-million campaign against “socialized medicine”

15. The Money: Obama’s Health Care Reform Funding: Many Challenges • Savings from “Program Integrity” oversight (Kusserow: savings from big fraud cases will lead to more enforcement re Medicare Parts C and D • $198 million for CMS health care fraud and abuse control • Competitive bidding for Medicare Advantage – saving $176.6 billion over 10 years

16. A Few Words About Prevention, Prevention, Prevention, Prevention

17. Health Care Expenditures for Chronic Conditions • 83% of all Health Care Spending Involved People with Chronic Conditions in 2001 • Medicare – 98% • Medicaid – 83% • Privately Insured – 74% • Uninsured – 72% Source: Medical Expenditure Panel Survey, 2001, and Partnership for Solutions

18. Federal Policy & Prevention • CDC, AoA, AHRQ promote evidence-based interventions • Dramatic increase in aging network adoption of evidence-based interventions – e.g., physical activity, chronic disease self-management, and closer collaboration with the public health world. • Medicare covers some good prevention services, but there’s little promotion • Bush 07-09 budgets “zeroed-out” out OAA Prevention funding (NO increase for FY ‘09)

19. ARRA & Prevention • Provides $1 billion for new Prevention & Wellness fund • $300 M for CDC Immunization Program • $650 M for “evidence-based clinical and community-based prevention strategies…that deliver specific, measurable health outcomes that address chronic diseases rates.” • $50 M for States for “healthcare-associated infections reductions strategies • Senate bill HAD $5.8 billion & House HAD $3 billion for Prevention

20. Social Services Block Grant (SSBG)

21. Social Services Block Grant (SSBG) • SSBG (Title XX, SSA) is a capped entitlement used by states, counties, and non-profit organizations to provide critical services that help people to remain in their homes or community. • For the elderly it funds such services as Adult Protective Services, Home-Based Services, Adult Day Care, Adult Foster Care, and Home-Delivered and Congregate Meals.

22. Social Services Block Grant (SSBG) • During welfare reform, Congress and the Governors agreed to reduce SSBG funding to $2.38 billion for 5 years and then return it to its former level of $2.8 billion in 2003. • Funding was reduced again in 1998 and is currently $1.7 billion a year. • Bush’s budget for ‘07-’09 called for further reduction of $500 million • Rejected by Congress -- $1.7 billion for FY ‘09

23. Elder Justice Act • Failed passage in past 3 Congresses • This Congress • Senate – Hatch/Lincoln • House H.R. 1783 – TBD • Senate bill amends the SSA by adding Elder Justice to an amended Title XX, entitled Block Grants to States for Social Services and Elder Justice and adding a new Subtitle 2 - Elder Justice

24. Elder Justice Act • Collection of Uniform National Data • Grants & Incentives for LTC Staffing • APS Funding • $100 Million to States for APS • $25 Million for APS Demonstration Grants • LTCOP Funding • $5-10 million for Capacity Improvement Grants • $10 for Training Grants • Pending introduction

25. Safe Prediction III Who gets elected in 2008 REALLY matters…White House, Congress & states

26. Our Tax Dollars • “Mr. President, instead of increasing taxes as the Democrats’ budget resolution envisions, and in turn spending that money on more federal programs or worse, earmarks, we should be focusing on less government, not more.  Americans want jobs, not new federal programs…. Keep their taxes low and stop spending so much of their money—that is what most Americans will say—and I know because I hear that every single day.” Presidential candidate Senator John McCain – March 13, 2008 (on Graham Tax Amendment)

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