NCOA Public Policy Priorities for the 111th Congress (2009-2010)

The National Council on Aging (NCOA) is a national voice for older Americans — especially those who are vulnerable and disadvantaged — and the community organizations that serve them. Since 1950, the NCOA has brought together non-profit organizations, businesses and government to develop creative solutions that improve the lives of all older adults. NCOA is a service and advocacy organization that works with thousands of organizations across the country to help seniors find jobs and benefits, improve their health, live independently and remain active in their communities.

The 111th Congress presents a variety of challenges and opportunities for accomplishing many of our 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

Increase appropriations for Older Americans Act (OAA) programs

The OAA funds services to keep seniors healthy and independent, including: nutrition, senior centers, home and community services, family caregiver support, protection against abuse and neglect, older worker training and employment, transportation, and health promotion/disease prevention. OAA programs save tax dollars by reducing premature nursing home placement, averting malnutrition and controlling chronic health conditions.

The purchasing power of OAA funding has seriously eroded over the past eight years due to the increasing cost of providing services and a growing number of older adults in need. Funding has been stagnant except for a mandatory increase for the Senior Community Service Employment Program (SCSEP) in order to account for the higher minimum wage level. Despite a proposed increase to $1.98 billion for FY 2009, OAA funding is still at least 12 percent less than the level needed to keep pace with inflation.

NCOA urges Congress to reinvest in the core OAA programs to meet the increasing demand for assistance, and provide additional new funding for initiatives created by the 2006 reauthorization to proactively respond to the needs of a growing senior population. The OAA programs added in the 2006 reauthorization that deserve additional funding include:

• The National Center on Benefits Outreach and Enrollment (under Section 202) will marshal person-centered, cost effective techniques to enroll seniors in a broad range of federal, state and private programs.
• Within the Choices for Independence initiative, evidence-based health promotion and disease prevention programs promote education and behavioral changes to reduce the risk of injury, disease, and disability, while reducing Medicare and Medicaid spending.
• Civic engagement strategies (under Section 417) enable seniors to make important contributions to their communities and build the capacity of local organizations to effectively engage older adults in addressing community needs, including through multigenerational projects.

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

Enrolling low-income seniors in needs-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) and Medicare Savings Programs (MSPs). The LIS provides generous financial assistance to beneficiaries in paying for their needed prescription drugs. 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:

• Raising asset eligibility levels for LIS and MSP benefits, so that low-income seniors who did the right thing in creating a modest nest egg of saving are not penalized;
• Simplifying and aligning the LIS and MSP programs so that if you are eligible for one, you will automatically be eligible for the other;
• Making permanent the QI program, which pays Medicare premiums for beneficiaries with incomes between 120 and 135 percent of poverty. The program is due to expire on December 31, 2009; and
• Providing additional funding for low-income outreach and enrollment efforts.

Promote access to home and community services through a national long-term care financing strategy, Medicaid improvements, direct care worker reforms, and family caregiver supports

America faces a growing long-term care crisis and needs a national strategy to help seniors maintain their independence and dignity. Most seniors must bankrupt themselves before receiving help under Medicaid after working their entire lives, and too many enter nursing homes prematurely. Long term services and supports reforms should: eliminate the current bias towards institutional care, enhance the capacity of seniors to live at home and stay connected to their communities, and sustain family support systems through expanded choices, increased resources, and better information for decision-making.

• The public sector should provide a strong, universally available foundation of support that the private sector can supplement--not unlike the 3-legged retirement stool of Social Security, savings and pensions. NCOA supports the Community Living Assistance Services and Supports (CLASS) Act, which would create a voluntary, budget neutral program with premium payments during working years and a guaranteed cash benefit upon becoming disabled.
• Much can and should be done to address the institutional bias in the Medicaid program and improve access to home and community-based services (HCBS). NCOA supports the Empowered at Home Act, which would strengthen the Medicaid HCBS State Plan Amendment option; provide impoverishment protections for spouses of Medicaid HCBS recipients, and permit low-income beneficiaries in need of HCBS to keep more of their assets and be eligible for Medicaid, giving them the resources to stay in the community.
• In response to dangerously high rates of vacancies and turnover among direct care workers, NCOA supports efforts to address this growing problem.
• Family caregivers struggle with enormous financial, emotional and physical burdens to try to keep loved ones out of institutions. NCOA supports refundable tax credits for persons with functional limitations and their caregivers and a Medicaid family caregiver assessment.

Improve access to evidence-based chronic care community interventions in health care reform

These evidence-based programs such as falls prevention and the Stanford Chronic Disease Self Management program (CDSMP) provide great value meeting high standards because they have been proven to work through rigorous scientific evaluation and peer review, and have measurable results. Research shows that if older adults maintain healthy habits they can significantly delay disability by as much as 10 years, use fewer healthcare resources, and reduce the period into a shorter time prior to death. CDSMP has been proven to be a particularly effective, low-cost intervention for those with multiple chronic illnesses.

Community-based interventions are an important component of a broader effort to restructure healthcare (e.g., patient-centered medical homes, improved care coordination, and increased attention to prevention and health promotion). As we work to improve prevention and care for those with chronic illness, NCOA approaches these issues with a unique perspective:

• A focus on vulnerable/disadvantaged older adults — those with multiple chronic conditions, dual eligibles and others with low incomes, and populations experiencing health disparities;
• An emphasis on self management, consumer direction, empowerment, informed and activated families, and a holistic approach to chronic care and falls prevention; and
• Expertise with evidence-based models that enhance the interface between primary care and cost effective community services.

TIER TWO PRIORITIES

Increase funding for efforts to prevent and reduce senior falls.

The nation's increased focus on prevention must also include injury prevention. Falls are the leading cause of injury-related deaths among seniors, accounting for 1.85 million emergency room visits, and 460,000 hospitalizations in 2005. The lifetime cost of senior falls is expected to rise from $19 billion in 2000 to nearly $43 billion in 2020. NCOA supports funding of $20.7 million within the Centers for Disease Control for falls prevention activities implemented by the National Center for Injury Prevention and Control.

Enact legislation to promote seniors' civic engagement

Research demonstrates that future generations of retirees are concerned about the future of the country and want to give back. The key to meeting the challenge of an aging America is to develop the human resource capital of this demographic. NCOA has been a national leader in creating opportunities for older Americans to give back to their communities. NCOA's RespectAbility initiative seeks to help non-profit organizations make more effective use of older Americans in their community-based efforts. This partnership project creates opportunities for older Americans to renew their communities through volunteer work or work in retirement.

NCOA supports the enactment of the Generations Invigorating Volunteerism and Education (GIVE) Act, the Encore Service Act, and the Serve America Act, and particularly those proposals that seek to utilize the energy and talents of older Americans to help their local communities and build the capacity of nonprofits to make the best use of volunteers. These proposals would create a Silver Scholarship Program to award seniors, who volunteer for at least 500 hours of tutoring, mentoring or caregiving activities, with a $1,000 transferable education award. The program would utilize the energy and talents of older Americans to help their local communities and provide them an additional legacy for their children and grandchildren.

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. NCOA supports:

• Legislation that places immediate focus on the re-employment and re-training needs of these older, dislocated workers, including economic stimulus investment in the Senior Community Service Employment Program (SCSEP);
• The Health Care and Training for Older Workers Act, which would extend COBRA health coverage for workers aged 62+ who phase down their work hours; improve access to job training by amending the Workforce Investment Act (WIA); require states to report on the participation of older workers in WIA activities; and establish a DoL clearinghouse of best practices for hiring and retaining older workers; and
• The Older Worker Opportunity Act, which would create a tax credit for employers who employ workers aged 62+ in flexible work programs. Flexible work program employ workers for no more than 20 hours per week (and 1000 hours per year). The credit equals 25% of the older worker's wages.

Enact legislation to improve protections against elder abuse and neglect

Protecting seniors from abuse and neglect is critical to their continued health and independence and is a fundamental responsibility of a just society. NCOA supports the Elder Justice Act, which would: (1) create a federal funding stream for states' Adult Protective Services (APS); (2) identify an office to provide coordination and technical assistance for APS systems; (3) establish a federal Elder Justice Coordinating Council and an expert Advisory Board; (4) provide demonstration grants on training and detection and prevention of financial exploitation; and (5) define and report on guardianship and other fiduciary concerns.

TIER THREE PRIORITIES

Increase funding for various aging services programs

NCOA supports new or increased appropriations for a variety of federal aging services programs that play a significant role in supporting and facilitating the independence, health and continuing community involvement of older Americans, including: (1) the Lifespan Respite Care program; (2) Real Choice Systems Change Grants; (3) Nursing Home Diversion and Aging and Disability Resource Center (ADRC) provisions under the OAA;
(4) the Social Services Block Grant (SSBG); (5) Section 202 Housing for the Elderly; (6) Senior Corps programs; and (7) geriatric education and training.

Engage in a national discussion on Medicare's long-term sustainability

Our nation needs to have a rational, nonpartisan discussion about the sustainability of Medicare over the long-term, recognizing that Medicare spending is directly related to health care spending generally, and that future challenges arise primarily from the increasing number of eligible beneficiaries. NCOA believes a national Medicare dialogue should be guided by these principles:

• The affordability of Medicare should be protected by opposing substantial increases in beneficiary copayments, deductibles, or premiums, particularly for those least able to pay;
• Issues associated with chronic illness under Medicare should be recognized as a national priority. An estimated 25 percent of beneficiaries account for 85 percent of annual Medicare spending.
• Serious consideration should be given to addressing the significant geographic variations in Medicare spending that are unrelated to regional differences in beneficiary health status;
• Options for increasing revenues to support the program should be on the table;
• Conduct analysis to determine the savings potential from improvements in and wider use of evidence-based health promotion and disease prevention programs and health information technologies and systems; and
• Medicare "solvency" issues should be discussed, including: current solvency distinctions between Medicare Parts A and B; defining long-term program sustainability; and measures comparing Medicare spending relative to the Gross Domestic Product and per capita increases in similar private sector spending.

Improve senior transportation services

New funds are needed to address the estimated $1 billion per year in unmet transportation needs that exists for seniors — a level of need that will only increase over the next five years. NCOA is a member of the Senior Transportation Task Force and has endorsed their priorities for the reauthorization of SAFETEA-LU:

• Increasing funding for the Federal Transit Administration Section 5310 program to $350 million per year, expand access to funding for operating assistance, and improve the availability of program information;
• Providing incentives and support for coordination of transit and other human services programs by increasing accountability, transparency, and integration;
• Increasing funding for the National Center on Senior Transportation to $5 million per year;
• Enhancing access to mobility management services by establishing a dedicated funding source; and
• Offering greater incentives to help transit and human services programs to recruit and retain volunteers.

Improve access to Medicare prescription drugs for vulnerable beneficiaries

In addition to LIS improvements, NCOA also supports the following reforms: (1) improving the Part D appeals/exceptions process; (2) capping cost sharing and providing appeal rights for those taking drugs in the specialty tier; (3) beginning to address affordability issues surrounding the Part D doughnut hole; (4) improving standards to make it easier for beneficiaries to choose among Part D plan options; and (5) making policy changes that can improve access to Patient Assistance Programs (PAPs).

Modernize the federal poverty measure

NCOA supports the Measuring American Poverty Act, which would create a new Modern Poverty Measure. The current poverty threshold is based on a measure of "income inadequacy" developed in 1964 and fails to reflect the current cost of meeting basic needs. A key aspect of the legislation is the proposal for a new National Academy of Sciences study to define a "decent living standard threshold," or "the amount of annual income that would allow an individual to live beyond deprivation at a safe and decent, but modest, standard of income."

Modernize the Supplemental Security Income (SSI) program

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.

January 8, 2009

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