More than a year in the making, in March President Obama signed into law the Patient Protection and Affordable Care Act which was modified somewhat by a separate Reconciliation Act.  Together, the Healthcare Reform Package brings sweeping changes to our nation’s healthcare.  Portions of the law will have a significant impact on seniors.


  A number of provisions are aimed at promoting long term care services outside of the nursing home. These include the establishment of the Community First Choice Option, a state plan Medicaid program to provide community support and services.

With increased emphasis on less expensive community care, Medicare reimbursements to nursing homes will be cut by about $15 billion over the next decade.

Several measures provide for nursing home transparency requiring nursing homes to disclose their owners, operators, suppliers, and financers, as well as staffing and costs.

The law provides grants to support the Long Term Care Ombudsman program and to provide training recruitment and incentives for individuals seeking or maintaining employment in long term care.

The new law will include the first publicly funded long term care insurance.  The Community Living Assistance Service and Supports program (CLASS), a national long term care insurance program, will be funded through voluntary payroll deductions.


Seniors will be happy to know that the law will eventually close the gap in prescription drug coverage commonly called “the donut hole”.  Presently, medications are covered up to $2,830 per year (in 2010) and then the individual must pay out-of-pocket until spending reaches $4,550 at which point coverage begins again.  The new law will begin closing the gap with a $250 rebate in 2010, followed by a 50% discount on drugs in the “donut hole” in 2011, gradually increasing the discount until the gap closes completely in 2020.

Beginning January 1, 2011, Medicare will provide free preventative care for such things as glaucoma screening and diabetes self management.

The law will also introduce a new temporary reinsurance program that will help employers offset expensive health care for health benefits for retirees age 55-64.

Medicare will likely take the biggest hit as far as funding cuts and cost controls.

Most of the Medicaid cost savings measures will affect the Part C Medicare Advantage Plans.  Because they will be paid less, private insurers may discontinue their Medicare C Plans or curtail some of the extra benefits.

Medicare premiums will increase for individuals earning more than $200,000 per year or couples earning more than $250,000 per year.  Higher earning individuals will also face a payroll tax.


Fortunately, the new law modifies the spousal impoverishment statute to require states to use the same standards for home and community based waiver programs like PASSPORT and the ALF waiver as are used for nursing home Medicaid.  This has been a struggle for residents in many parts of Ohio.

Additional federal Medicaid matching funds will go to certain states to promote long term care in the community rather than the nursing home.

Medicaid will also expand coverage to individuals 64 and under with incomes up to 133% of the federal poverty line.


The new law includes The Elder Justice Act (EJA), which expands protections for seniors by establishing an “Elder Justice Coordinating Council” to make recommendations and coordinate the activities of federal, state, local and private agencies to prevent elder abuse, neglect, and exploitation.

The EJA will also provide federal funding to support state and community efforts to fight elder abuse including $400 million in funding for Adult Protective Services and $100 million for state grants to test a variety of methods to detect and prevent elder abuse.

The health care reform package extends a pilot program to conduct national criminal background checks for individuals who apply for jobs which include direct patient access.

These are just some of the changes gradually brought by the Health Care Reform Package.  Many provisions will be phased in over time, others will be temporary and only last a few years.  No doubt future legislation will amend and refine some of the provisions.

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