Currently in its 14th year of existence, the Patient and Protection Affordable Care Act (P.L. 111-148) represented a monumental effort to produce a major transformation of health care in the United States. The Center for Medicare & Medicaid Innovation (CMMI) was created by this legislation. It conducts pilot programs, known as models, that test new ways to deliver and pay for health care in Medicare, Medicaid, and the Children’s Health Insurance Program, with the goal of identifying approaches that reduce spending or improve the quality of care. A new report prepared at the Congressional Budget Office in September 2023 presents findings from an analysis of CMMI’s activities during the first decade of operation and uses those findings to update its projections of CMMI’s effects on federal spending. The report explains changes to CBO’s analytic method and discusses the agency’s revised approach to estimating the effects of legislative proposals that would change CMMI’s models or operations. CBO previously estimated that CMMI’s activities would reduce net federal spending, but now estimates that they increased that spending during the first 10 years of the center’s operation and will continue to do so in its second decade.
A State Scorecard On Long-Term Care Services And Supports
The 2023 Long-Term Services and Supports Scorecard (LTSS) developed by AARP is a compilation of state data and analysis based on a new vision of a high-performing system. Released every three years, the Scorecard uses data from a wide range of sources to describe how state LTSS systems are performing. The intention is to identify strengths and weaknesses in state systems to spark and inform the development of actionable solutions at the local, state, and national levels— solutions that respond in meaningful ways to individual preferences and family choices and care needs as well as to new pressures and challenges.
The latest version of the scorecard released on September 28, 2023 finds long-term care for older adults and individuals with disabilities in the United States profoundly inadequate. Long-term care is evaluated across five different dimensions: affordability and access; choice of setting and provider; safety and quality; support for family caregivers; and community integration. It also includes several new measures of racial equity. The scorecard finds major deficiencies in every state, especially related to support for family caregivers, the long-term care workforce, equity in nursing homes, and emergency preparedness, Minnesota (1st) and Washington State (2nd) outperformed all other states. Both offer particularly strong supports for family caregivers as well as varied choice of care providers and long-term care settings. The lowest-scoring states were in the Southeast, with Alabama and West Virginia ranking 50th and 51st, respectively.
Financing Struggles Facing Older Medicare Enrollees
A common misconception is that once beneficiaries are eligible for Medicare, they no longer need to worry about medical bills or choosing a health plan. Individuals electing to enroll in traditional Medicare tend to rely on supplemental coverage to help meet the cost-sharing payments and deductibles that are required. This supplemental coverage can be either a Medigap plan that they purchase, coverage from a union or former employer, or coverage from Medicaid. Some beneficiaries in traditional Medicare cannot afford to buy a Medigap plan or are restricted from purchasing one, do not qualify for Medicaid, or lack access to employer or union-based coverage. Beneficiaries who choose to be covered through a Medicare Advantage plan — private insurance plans that contract with the federal government to provide Medicare-covered benefits — can have lower cost-sharing requirements and some coverage of benefits not included in traditional Medicare. These plans, however, typically use tools, such as prior authorization requirements, to manage enrollees’ use of services, which can pose barriers to care.
A data brief issued on September 18, 2023 from the Commonwealth Fund indicates that about one in five adults age 65 and older with Medicare (19%) were underinsured, meaning their out-of-pocket expenses are high relative to their income. More than one in five (23%) adults age 65 and older with Medicare reported that they struggled to afford their premiums. For those with incomes under twice the federal poverty level (FPL), two of five (39%) reported struggling to afford premiums.