Medicare
At issue: Medicare covers more than 64 million older Americans and people with disabilities, and that number is projected to reach 80 million by 2030. Workers and their employers pay into the program through a payroll tax. Within four years, Medicare’s Part A Hospital Insurance Trust Fund is projected to run short of funds as a result of rising enrollment, increasing health care costs and advances in medical technologies. Parts B and D will remain fully funded. Medicare continues to have coverage gaps, including coverage for dental, hearing and vision.
Status: The Build Back Better Act the House passed included some coverage for hearing aids and other hearing services for people enrolled in original Medicare. Already virtually all Medicare Advantage private insurance plans provide some dental, vision and hearing benefits. So far Congress has not begun any significant debate on how to shore up the hospital trust fund.
What older voters want: “We are going to be committed and keep fighting” to maintain and expand Medicare coverage, Sweeney says. During the COVID-19 pandemic, Medicare expanded its coverage of telehealth, something older voters want to be made permanent. To protect the program for the future, older voters also want Medicare to crack down on waste, fraud and abuse.
Caregiving/Long-Term Care
At issue: More than 48 million family caregivers form the backbone of America’s long-term care system, and AARP research has found that these caregivers spend more than $7,000 on average to help tend to their loved ones. Meanwhile the COVID-19 pandemic highlighted the problems in the nation’s nursing homes, where more than 200,000 residents and staff have succumbed to the virus and chronic staff shortages and inadequate oversight increased.
Status: In his State of the Union address, President Joe Biden called for a series of nursing home reforms, including minimum staff requirements, increased financial penalties for poor quality, and greater oversight of long-term care facilities.
In 2021, states across the country enacted laws to support caregivers and other long-term care services, including caregiver reimbursement programs in four states (Utah, Arizona, Maine and the District of Columbia), funding for respite care services in three states (Connecticut, Pennsylvania and Alabama) and workplace flexibility, including paid sick leave and paid family and medical leave, in seven states ( California, Maine, North Carolina, New Mexico, Nebraska, Nevada and New York). And in 28 states, funding and eligibility for home- and community-based services was either maintained or increased.
What older voters want: Medicaid doesn’t cover home and community-based services to the same extent as it covers nursing home care. An estimated 800,000 Americans are on state waiting lists for Medicaid-covered home care. An AARP 2021 survey found that three-quarters of adults 50 and older want to remain in their homes and communities for as long as possible. AARP strongly supports the Credit for Caring Act, which would provide tax credits to help family caregivers with their out-of-pocket expenses.
“When we think about providers of health care most of us don’t think about our family members,” Sweeney says. “But in many families many of the primary caregivers are our family members, our loved one — not doctors and nurses. Recognizing and elevating the important work that these folks are doing is really core to what AARP is all about.”
Dena Bunis covers Medicare, health care, health policy and Congress. She also writes the “Medicare Made Easy” column for the AARP Bulletin. An award-winning journalist, Bunis spent decades working for metropolitan daily newspapers, including as Washington bureau chief for the Orange County Register and as a health policy and workplace writer for Newsday.