- The ACA is Here to Stay, Improving Medicare and Health Security for Millions
- Senators Introduce Bipartisan Observation Status Bill to Help Vulnerable Medicare Beneficiaries
- Lack of Oral Health Coverage in Medicare Has Catastrophic Effects
- Report: To Solve the Direct Care Workforce Challenge, Inequities Must be Addressed
- Support the Center
The Center for Medicare Advocacy is relieved that the Supreme Court has left the Affordable Care Act (ACA) intact as the law of the land. Today’s decision in California v. Texas is critical for the older adults and people with disabilities who rely on Medicare. They will continue to benefit from the Affordable Care Act’s many improvements to the program, such as closing the “donut hole” deductible in the Part D prescription drug program, eliminating out-of-pocket costs for many preventive services, and strengthening the fiscal solvency of Medicare. All of these provisions – and so much more – were at risk. The case should never have been brought and certainly should never have reached the Supreme Court, leaving health coverage for millions in the balance, including during a global pandemic.
“California v. Texas represented a cynical attempt to use the courts to repeal the ACA, which has provided coverage and made improvements to Medicare and the U.S. health care system for over a decade,” said Judith Stein, Executive Director of the Center for Medicare Advocacy. “The doors to health care for millions of Americans remain open as result of this ruling.”
The Center hopes that today’s decision will finally end attempts to repeal, sabotage, or undermine, the ACA. We will continue to work with our colleagues on strengthening the ACA and Medicare, as we push for health justice for all.
Read the amicus brief that the Center for Medicare Advocacy and colleagues submitted to the Supreme Court, urging it to uphold the Affordable Care Act and highlighting the law’s protections for Medicare’s beneficiaries.
The Improving Access to Medicare Coverage Act, S. 2048, introduced by a bipartisan group of Senators this week, led by Senators Sherrod Brown (D-OH), Susan Collins (R-ME), Sheldon Whitehouse (D-RI), and Shelley Moore Capito (R-WV). The bill allows the time that patients spend in a hospital under “observation status” to count toward the three-day inpatient hospital stay that a beneficiary needs in order to qualify for Medicare Part A coverage of post-hospital care in a skilled nursing facility. The companion bipartisan House bill, H.R. 3650, was introduced last week, with Representative Joe Courtney (D-CT) as chief sponsor. Both bills are endorsed by more than 30 national organizations, including AARP, Alliance for Retired Americans, American Health Care Association, Center for Medicare Advocacy, LeadingAge, National Committee to Preserve Social Security & Medicare, National Consumer Voice for Quality Long-Term Care, and the Society for Hospital Medicine.
Although the Center for Medicare Advocacy believes that the Administration has authority under existing law to count time in observation status toward the three-day inpatient requirement (see: https://medicareadvocacy.org/cms-has-authority-under-existing-law-to-define-inpatient-care/), we fully support the legislation. A Medicare billing technicality should not prevent beneficiaries from getting the post-hospital care they need.
A recent article in The New York Times by Mark Miller calls attention to the catastrophic effects the lack of oral health coverage in Medicare has on older adults and people with disabilities. The article carefully outlines the need for oral health coverage in Medicare, while highlighting recent advocacy efforts aimed at expanding traditional Medicare to include such coverage. The story refers to the experience of one of the Center for Medicare Advocacy’s clients, who desperately needs oral health care. It also cites Center Senior Attorney Wey-Wey Kwok, who has worked in coalition to fight for current Medicare coverage for oral health needs for individuals with serious medical conditions, as well as the broader expansion efforts that would benefit the overall health of all Medicare beneficiaries.
By 2030, all Baby Boomers will be at least 65 years old and will account for 20 percent of the nation’s population. This demographic shift, along with a growing number of people who have chronic conditions, means that the demand for long-term services and supports will increase.
Direct care workers – comprised of home health aides, nursing assistants, and personal care aides – provide these essential services, and the demand for these positions is rising in correlation with the changing population. With 7.8 million direct care jobs needing to be filled by 2026, this workforce sector is projected to grow more than any single occupation in the country. For decades, however, the demand for direct care workers has outpaced the supply of people seeking to fill these jobs. Policy and lawmakers have been grappling with how to solve this challenging workforce dilemma before it is too late. During the presidential campaign, the Biden-Harris platform recommended that career ladders for direct care workers should be created to help mitigate this staffing issue. A new report by Brookings, however, suggests that those who need the career ladders the most might get left behind.
Written with the goal of helping policymakers understand, navigate, and potentially combat the challenge of career mobility (the ability to advance towards higher-paid work), “Moving up: Promoting Workers’ Economic Mobility Using Network Analysis” reports that the nation’s low-wage workforce is disproportionately female, Black, and Hispanic. Those very demographics – gender, race, and ethnicity – strongly influence a person’s mobility prospects. The report furthermore reveals a labor market landscape “riddled with mobility gaps and barriers.”
In the nursing field in particular, the report found that White workers had more upward mobility, climbing the ranks from home health aides (HHAs) to Licensed Practical Nurses (LPNs) to Registered Nurses (RNs) at a higher rate than Black and Hispanic workers. Furthermore, Black and Hispanic workers were “far more likely to transition downward” from LPNs to HHAs. The report states that:
“It is revealing that Black and Hispanic workers significantly outpace their White colleagues in only two occupational transitions: from LPN to home health aide jobs, and from home health aide to personal care aide jobs, which represent wage declines of $9.82 an hour and $1.46 an hour, respectively. By contrast, transitions into RN jobs offer median wage boosts of more than $12 an hour.”
The Brookings report also offered recommendations to “modernize the social safety net to meet workers’ needs” with an aim of helping those stuck in low-wage jobs. They include bolstering minimum wage policies, offering “wage subsidies” to targeted occupations to facilitate job transitions, and “portable benefits” that would allow workers to both acquire benefits and keep them during job transitions or times of unemployment.
U.S. Census Bureau. By 2030, All Baby Boomers Will Be Age 65 or Older. (May 26, 2021). Available at: https://www.census.gov/library/stories/2019/12/by-2030-all-baby-boomers-will-be-age-65-or-older.html
 U.S. Census Bureau. Nation’s Older Population to Nearly Double. (January 16, 2017). Available at: https://www.census.gov/newsroom/press-releases/2014/cb14-84.html#:~:text=%22The%20United%20States%20is%20projected,Census%20Bureau’s%20Population%20Projections%20Branch
 Campbell, S., Del Rio Drake, A., Espinoza, E., and Scales, K. Caring for the Future. (January 15, 2021). PHI. Available at: https://phinational.org/resource/caring-for-the-future-the-power-and-potential-of-americas-direct-care-workforce-executive-summary/
 Campbell, S. New Research: 7.8 Million Direct Care Jobs Will Need to Be Filled by 2026. (January 28, 2019). PHI. Available at: https://phinational.org/news/new-research-7-8-million-direct-care-jobs-will-need-to-be-filled-by-2026/
 Scales, K. It Is Time to Resolve the Direct Care Workforce Crisis in Long-Term Care. (August 27, 2020). The Gerontologist, 61(4), 497–504. Available at: https://doi.org/10.1093/geront/gnaa116
 Biden-Harris Plan to Make Nursing Homes and Long-term Care Facilities Safe. Joe Biden for President: Official Campaign Website. (October 16, 2020) Available at: https://joebiden.com/covid-nursing-homes/
 Escobari, M., & Krebs, E. The American Dream in crisis: Helping low-wage workers move up to better jobs. Brookings. (June 15, 2021). https://www.brookings.edu/blog/up-front/2021/06/14/the-american-dream-in-crisis-helping-low-wage-workers-move-up-to-better-jobs/
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