NCOA Public Policy Priorities for the 113th Congress (2013-14)
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NCOA Public Policy Priorities for the 113th Congress (2013-14)

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 The 113th Congress presents a variety of challenges and opportunities for accomplishing many of NCOA's public policy goals on behalf of America’s seniors. 

The priorities described here reflect areas where NCOA can make a unique contribution and will therefore devote significant time and resources. We believe these priorities reflect the concerns of our nation’s diverse aging network.

 TIER ONE PRIORITIES

Reduce the debt with a balanced approach that protects the most vulnerable.

Reducing the federal budget deficit is important to our nation’s economic future and will require difficult choices and shared sacrifice. This should be done through a thoughtful, balanced approach that includes budget savings from increases in revenue and gradual, targeted reductions in spending without increasing poverty, hunger, or income inequality. Any budget agreement should protect the economic and health security for low-income Americans. NCOA urges Congress to:

  • Reduce the rate of increase in federal health spending by addressing the systemic causes of health care inflation, not by shifting costs onto Medicare beneficiaries. While we recognize the need to bend Medicare’s long-term cost curve, any Medicare reforms should strengthen protections for the most vulnerable and build on delivery system reforms that promote prevention, coordination, and efficiencies, without jeopardizing quality or access to necessary services. Consideration should be given to developing an authentic Medicare prevention benefit. 

  • Oppose Medicaid block grants, Medicaid per capita caps, and other reforms that would jeopardize access to home and community-based services and supports. The essential structure and integrity of the Medicaid program must be maintained.

  • Safeguard investments in the Older Americans Act. Funding for OAA is cost-effective and helps seniors not poor enough to qualify for Medicaid remain independent and out of institutions. The purchasing power of the program has seriously eroded over the past decade due to the increasing cost of providing services and a rapidly growing number of older adults in need.

  • Reject cuts to domestic discretionary programs below the caps established in the Budget Control Act.  The savings already achieved under the caps should be counted toward deficit reduction targets. In particular, funding for vulnerable seniors should be protected, such as the Prevention & Public Health Fund, Elder Falls Prevention, Senior Corps volunteer programs, Housing Counseling, Section 202 Housing for the Elderly, Low-Income Home Energy Assistance Program (LIHEAP), the Commodity Supplemental Food Program (CSFP), and Social Services Block Grant (SSBG). 

  • Raise revenues by having households and corporations with substantial resources pay their fair share.  Preserve tax provisions that support charities and low and moderate income households. Provide that the ratio of spending cuts to revenues raised in any budget agreement be roughly equivalent.

  • Oppose federal efforts to cut spending by requiring beneficiaries dually eligible for both Medicare and Medicaid to enroll in mandatory managed care plans with no opportunity to opt-out and/or by imposing arbitrary caps on federal spending.

  • Recognize that Social Security does not contribute to the federal deficit and that negotiations to ensure long-term solvency should be addressed independently. Efforts to strengthen Social Security should ensure the adequacy of benefits, particularly for lower income, vulnerable seniors. Attempts to impose a chained CPI would cut benefits and harm vulnerable older Americans while doing nothing to reduce the federal deficit. 

  • Protect resources, eligibility, benefit levels, and program integrity of other mandatory programs that preserve and enhance the health and economic security of older adults. Oppose proposals to block grant the Supplemental Nutrition Assistance Program (SNAP), impose asset tests or limit or eliminate categorical eligibility that will deny benefits to the most vulnerable Americans and disproportionally affect older adults.

Reauthorize the Older Americans Act (OAA) with NCOA priorities.

The OAA delivers great value for dollars spent on services to keep seniors healthy, independent, and active in their communities. OAA programs save tax dollars by reducing premature nursing home placement, averting malnutrition, controlling chronic health conditions, and engaging well older adults to help meet the needs of their vulnerable peers.  

Reauthorization of the Older Ameri¬cans Act offers a prime opportunity to reshape and modernize aging services in this country in a manner that fuels economic growth, bends downward the long-term entitlements cost curve, enables seniors to provide solutions, and promotes greater program efficiency. NCOA urges Congress to reauthorize the OAA to: (1) promote economic security, (2) support modern senior centers, (3) advance evidence-based healthy aging initiatives, (4) restructure aging services research and development, (5) enhance the Senior Community Service Employment Program (SCSEP), and (6) empower and protect older adults. The comprehensive legislation introduced in the 112th Congress, S. 3562, the Older Americans Act Amendments of 2012, should be considered a starting point for 113th Congress efforts.

Improve access to evidence-based chronic care interventions.

Evidence-based programs such as falls and diabetes prevention, the Stanford Chronic Disease Self-Management program (CDSMP), enhanced wellness, and depression care management provide great value because they have been proven to work through rigorous scientific evaluation and peer review and have measurable results. Research shows that participation in community-based self-management programs can save money and improve health outcomes by significantly delaying functional impairments, helping to prevent secondary conditions and reducing hospitalization and other health resource utilization, particularly among those with multiple chronic conditions. 

Falls are the leading cause of injury-related deaths among seniors, accounting for more than 2.1 million emergency room visits and over 500,000 hospitalizations in 2008. The total direct medical cost of senior falls is currently $19 billion; by 2020, the annual direct and indirect cost is expected to reach $54.9 billion. Increased investments should be made for cost-effective falls prevention programs and other evidence-based self-management, such as through the Prevention & Public Health Fund.

The Affordable Care Act (ACA) provides a variety of opportunities to take proven pilots to scale and bend the cost curve by improving access to evidence-based programs that promote self-care and patient engagement—through senior centers and other community-based organizations and online—that target older adults with multiple chronic conditions. NCOA supports effective implementation of ACA that takes full advantage of opportunities to these programs, including but not limited to, provisions on the Center for Medicare and Medicaid Innovation, the Annual Medicare Wellness Visit, the Care Transitions Program, and the Medicare Shared Savings Program.

Improve access to long-term services and supports.

Long-term services and supports (LTSS) are essential to the community participation, health, and economic security of millions of seniors, individuals with disabilities, and families. The Affordable Care Act provides opportunities to significantly improve access to home and community-based services. It also aims to improve integration of acute care and LTSS for individuals receiving both Medicaid and Medicare (often referred to as “dual eligibles”). NCOA is working collaboratively to implement these provisions and advance additional reforms. Specific NCOA priorities include:

  • Promoting successful implementation and state adoption of the Medicaid home and community-based services reforms in the Affordable Care Act, including the Balancing Incentives Program and Community First Choice Option.

  • Ensuring consumer protections, aging and disability stakeholder engagement, and LTSS quality measures and reporting requirements for the duals integration demonstrations and transformations within states to managed LTSS.  

  • Promoting initiatives to assist family caregivers across the lifespan, including adequate appropriations for caregiver programs, development of caregiver assessments, and a refundable tax credit for caregivers.

  • Supporting efforts to ensure adequate supply and compensation of the direct support workforce, including improved access to health insurance through the Affordable Care Act.

  • Actively engaging with the newly formed Long-Term Care Commission.

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 TIER TWO PRIORITIES

Strengthen low-income Medicare programs to ensure that vulnerable and disadvantaged beneficiaries are able to access their needed prescription drugs and other health care services. 

Enrolling eligible seniors in need-based benefits programs is critical to their health and independence. Unfortunately, participation rates for these programs are very low, due to lack of awareness, complicated application forms, and insufficient resources dedicated to outreach and enrollment. NCOA will work to make significant improvements to both the Medicare prescription drug low-income subsidy (LIS, or Extra Help) and Medicare Savings Programs (MSPs). MSPs assist beneficiaries in paying their Medicare premiums and cost sharing through the Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), and Qualified Individual (QI) programs. NCOA supports: 

  • Ending discrimination against low-income individuals over age 65 by providing protections equivalent to those under age 65. Eligibility levels for cost sharing protections for those under age 65 are income levels below 138% of the federal poverty line, with no asset test. Eligibility levels for those over age 65 are below 100% of poverty with a strict asset test that penalizes low-income seniors who did the right thing during their working years by creating a modest nest egg of savings.

  • Providing additional resources for community-based low-income outreach and enrollment efforts.

  • Simplifying and aligning the LIS and MSP programs so that if you are eligible for the LIS program, you are automatically enrolled in the appropriate MSP program.

  • Making permanent the QI program, which pays Medicare premiums for beneficiaries with incomes between 120% and 135% of poverty.

  • Aligning criteria for available need-based benefit programs while supporting benefits counselors to streamline outreach and enrollment efforts that will result in the maximization of resources and removal of existing barriers to participation.

Enhance nutrition assistance for food insecure seniors.

The Supplemental Nutrition Assistance Program (SNAP, formerly known as Food Stamps) helps reduce hunger by providing access to food assistance for 2.85 million low-income older adults. Currently, only 35% of eligible older Americans receive SNAP benefits. The Commodity Supplemental Food Program (CSFP) provides nutritious food packages to low-income seniors, mothers, and children in 39 states. NCOA urges Congress to reauthorize the Farm Bill and include the following priorities:

  • Restore the American Recovery and Reinvestment Act (ARRA) SNAP benefit boost and increase the minimum benefit, which would significantly affect elderly households.

  • Eliminate asset tests. Currently, 38 states have no asset test, using the broad-based categorical eligibility option. The asset test is so low that low-income seniors are not eligible for SNAP benefits due to excess (but still limited) resources.

  • Maintain “broad based” categorical eligibility. At present, 43 states and jurisdictions have opted to use categorical eligibility to expand and ease access to SNAP eligibility. A significant number of seniors would lose SNAP eligibility if the broad-based categorical eligibility is ended.

  • Provide adequate resources to states and community partners for administration of SNAP and for outreach and nutrition education.

  • Transition CSFP to a seniors-only program while grandfathering in current participants. Nearly 97% of the 588,000 monthly program participants are older adults.

Enact legislation to improve protections against elder abuse, neglect, and exploitation.

Protecting seniors from abuse and neglect is critical to their continued health and independence and is a fundamental responsibility of a just society. As many as 5 million older adults suffer from abuse annually, and the annual loss by victims of financial abuse is estimated to be at least $2.6 billion. Enactment of the Elder Justice Act in 2010 was an important first step, but this statute has yet to be funded and a number of bills remain that must be passed to support national, comprehensive protection and remediation of abuse.

NCOA supports legislation to expand elder abuse research and training for law enforcement; enhance elder justice capacity at the Department of Justice; create Silver Alert plans nationwide; and promote senior financial empowerment. NCOA also supports the efforts of the Consumer Financial Protection Bureau Office of Financial Protection for Older Americans to monitor, prevent, and inform consumers and industry about financial exploitation.

Improve access to Medicare prescription drugs for vulnerable beneficiaries

In addition to LIS improvements, NCOA also supports the following reforms: (1) improving standards to make it easier for beneficiaries to choose among Part D plan options; (2) improving the Part D notice and appeals/exceptions process; (3) providing for exceptions to a lower cost tier and appeal rights for those taking drugs in the specialty tier; and (4) making policy changes that can improve access to Patient Assistance Programs (PAPs). 

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 TIER THREE PRIORITIES

Enact legislation that assists older workers.

The number of older workers remaining in the workplace was already expected to grow; 80% of baby boomers expect to work past traditional retirement age. With the current economic downturn, an increasing number of older Americans are contemplating delaying retirement or returning to the workforce, while others are facing the massive layoffs affecting younger generations. The unemployment rate of older workers continues to be at record levels. In general, NCOA supports legislation that places immediate focus on the re-employment and re-training needs of these older, dislocated workers; promotes pathways to employment and sector strategies; reduces financial penalties for work beyond traditional retirement age; provides workplace flexibility; and provides incentives for employers to retain or hire older workers.

Modernize the measures of poverty and economic insecurity.

NCOA supports efforts to update the federal poverty threshold and adopt new measures of economic insecurity. Current federal poverty levels fail to reflect the current cost of meeting basic needs. Modern measures should take into account the costs of providing for food, clothing, shelter, and other very basic necessities; factor in both income assistance and necessary expenses (taxes, out-of-pocket health costs); and reflect geographical cost-of-living differences. The methodology and data collection for the Consumer Price Index for the Elderly (CPI-E) should be revisited to account for elders’ true expenses.

Amend the Independent Payment Advisory Board (IPAB).

The ACA includes a provision to create a new Independent Payment Advisory Board that would limit Congress’ authority over Medicare policy and could jeopardize beneficiaries’ access to care by further widening the gap between Medicare and private payment rates. While it includes important protections against increases in beneficiary costs or cuts in benefits or eligibility, NCOA is concerned that the provision would make it increasingly difficult to make future needed program improvements for beneficiaries. Other concerns that should be addressed include:

  • A continued narrow focus of binding recommendations on Medicare, as opposed to broader public and private health care spending in general.

  • Dangerously low target thresholds for Medicare spending growth after 2020 that would trigger recommendations for spending reductions.

  • Insufficient representation of Medicare beneficiaries’ interests and concerns on the Board itself.

  • Exclusion of payments to Part A providers, which limits efforts to extend Trust Fund solvency.

Modernize the Supplemental Security Income (SSI) program.

The SSI resource limit has not been updated to reflect inflation in over 20 years. SSI income disregards have not been adjusted since the program was enacted in 1972. It is unconscionable that these thresholds have not been updated. NCOA supports adjusting these levels for low-income Americans in need.

Improve the availability and quality of mental health preventive and treatment services to older adults and their families.

The Approximately 20% of adults aged 55 and over experience specific mental and cognitive disorders that are not part of the “normal” aging process. Two-thirds of older adults with a mental disorder do not receive needed services. Tragically, older adults have the highest suicide rate of any age group, with persons aged 85 and older having a rate almost double and older white men having a rate almost six times the suicide rate of the general population. NCOA supports the following:

  • Promoting collaboration between the Administration on Community Living (ACL) and Substance Abuse and Mental Health Services Administration (SAMHSA), including designation of an older adult mental health leader/coordinator within AoA and other federal, state, and local agencies.

  • Integrating evidence-based mental health interventions for seniors within implementation of provisions in the Affordable Care Act, including efforts to improve care coordination and integration of services and supports within Medicare and Medicaid.

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Public Policy Priorities

See the issues we're fighting for in the 113th Congress, including the budget, Older Americans Act, and long-term services and supports.