ASA this year is concentrating on health and well-being as a theme. This post is one of many tackling that topic in a variety of ways.
From reproductive rights to Medicaid expansion, this year’s midterm elections will shape the future of healthcare for older Americans and their families at the state and federal levels. All 435 House seats are up for grabs and there are 35 seats up for election in the Senate. At the state level, 36 governors will be elected and places such as Kansas, Minnesota, Wisconsin and Pennsylvania could see a shift in party control of state houses.
With this level of activity, it’s no surprise that Democrats and Republicans alike are following the midterms closely, with an NBC News survey showing that 68% of Republicans and 66% of Democrats expressed a high interest in the midterms. This is especially true when it comes to healthcare issues. In fact, a Kaiser Family Foundation tracking poll found more than half of registered voters ranked healthcare-related issues as being “very important.”
Below are several key healthcare issues playing out across the country that are worth following this election cycle given their implications for healthcare access, equity and aging.
If you’ve consumed any news in the past year, it will come as no surprise that reproductive health is a hot button issue in communities across the country. Three states are weighing expanding abortion rights, including California, Michigan and Vermont. Voters in these states are considering “reproductive freedom” amendments that would enshrine abortion protections in their state constitutions. On the other end of the spectrum, Montana and Kentucky are advancing efforts to roll back abortion protections.
Roughly 2.2 million Americans are without healthcare coverage across the 12 states that have not expanded Medicaid.
You might be asking yourself, what does this have to do with healthy aging? It’s clear that healthcare is a lifespan issue and denying healthcare to people early in life can have ripple effects across their lifespans, potentially exacerbating long-standing inequities and disproportionately affecting low-income people of color, women, LGBTQ people and people with disabilities.
There are roughly 2.2 million Americans without healthcare coverage across the 12 states that have not expanded Medicaid. These Americans do not currently qualify for Medicaid and have incomes below poverty, making them ineligible for premium subsidies in the federal Affordable Care Act marketplace. As the largest provider of nursing home care and long-term services and supports, Medicaid is an essential program for low-income older adults and their caregivers, especially for people of color and people living with disabilities.
The midterms could alter the expansion landscape across these states with potential shifts in political power in Georgia, Kansas, Wisconsin and South Dakota. Notably, voters in South Dakota will have the opportunity to enact Medicaid expansion through a ballot measure that could expand coverage to 40,000 people in November, making it the seventh Republican-controlled state in the past five years to expand the program at the ballot box.
Approximately one in three adults in the U.S. have medical debt, making it the largest source of debt currently in collections. Black and Latino households are more likely to have medical debt than non-Hispanic White households. In response, Arizonans have put Proposition 209 on the ballot to protect consumers from predatory debt collection, limiting the interest rate on medical debt to no more than 3%.
While several health issues will be heavily influenced by shifts in congressional control at the federal level, two, telehealth access and capping the cost of insulin, present rare opportunities for bipartisan collaboration, no matter the results of the November midterms.
It’s no secret that the pandemic forced the healthcare sector to rethink long-standing issues such as access, paving the way for telehealth services and flexibilities to flourish. For example, reimbursing telehealth, and even some phone visits, at the same rate as in-person visits helped providers expand healthcare access during the pandemic. With the likely end of the official public health crisis during the new congress, states and federal policymakers will need to grapple with how to ensure consumers and patients can still access the telehealth services they have come to rely upon and expect.
Capping the Cost of Insulin
The Inflation Reduction Act capped the cost of insulin at $35 per month for older adults who have Medicare—including those who use insulin pumps—starting in 2023. According to data from the Kaiser Family Foundation, total out-of-pocket spending by people with Medicare Part D for insulin products quadrupled between 2007 to 2020, reaching $1.03 billion. However, a similar cap for people on private pay insurance was stripped from the final bill, presenting affordability and health equity challenges for the millions of Americans—especially people of color—who are not in the Medicare program. Both Republican and Democratic policymakers have introduced legislation to address this gap, and the new Congress presents an opportunity to revitalize these efforts.
Millions of older Americans—especially people of color with low incomes—will feel the consequences of the decisions made at the ballot box this November and the stakes are high. According to a poll from Consumers for Quality care, 60% of voters surveyed reported that they have skipped or delayed getting the healthcare they needed because they are concerned about issues of affordability. Voters will be presented with an opportunity to address this concern—and many others—at the polls in November.
Jason Resendez is the President & CEO of the National Alliance for Caregiving, in Washington, DC.