By Bob Blancato
Medicare and telehealth
I asked the pundits this question posed by webinar watcher Next Avenue’s Money & Policy editor, Richard Eisenberg: “How will Medicare change under the next president and why?”
Peter Kaldes: “I think there are some wonderful opportunities under a Biden administration to really focus on the salaries of our caregivers and the direct care workforce. To the extent Medicare gets more involved with actual covering more of these at-home costs that are very real for people, I think that would be a wonderful addition to Medicare.”
Jay Newton-Small: “I do think Donald Trump has certainly telegraphed that if he was re-elected, he would move towards a Paul Ryan, voucher-esque kind of plan for Medicare, which you definitely would never get through a Democratic-controlled House… It’s interesting to see Biden move to the left thanks to Bernie [Sen. Bernie Sanders] and [Sen.] Elizabeth Warren in the primaries on the issue of Medicare for All. He doesn’t support Medicare for All, but I think he has certainly moved further along than he was when the election started. That said, I know a lot of people in the caregiving world were disappointed that his only nod to caregiving was a $4,000-a-year kind of tax rebate for family caregivers… I think a lot will depend on the control of Congress. You’re not going to make massive changes to Medicare unless you control both houses of Congress and the White House, as Obamacare showed how hard it was to get that through.”
Rich Browdie: “There’s a lot of ways that Medicare can be adjusted to pragmatic solutions to things we’ve learned in this COVID experience… So, I would think that pragmatism would lead to a number of changes in Medicare. Partially for budget reasons, because it would be cheaper; partially because I think the sensibility about coverage has changed… You may not get to universal coverage by a particular government program, but I think the pressure to keep movement toward universal coverage will continue.”
Joel White: “I think if next year is a big budget year, we’re going to see big changes in Medicare… What is interesting to me is that both presidential candidates agree that there ought to be a cap in costs in out-of-pocket expenses in Medicare Part D [the prescription drug part]. I think it would put on the table in a big budget bill a cap on total costs, whether you’re in fee-for-service [traditional Medicare] or otherwise in the Medicare program [Medicare Advantage private insurance plans], which would be good, so you’re limiting your out-of-pocket costs… If a big budget deal is not in the works, I think Rich is right; there’s going to be much more in the way of these pragmatic little problems bubbling up that we’re going to fix and that’s across the board — home health, nursing care, hospital care, physician services. The Medicare program right now is kind of in need of some tender loving care and these kinds of bills come across about once every seven years and guess what next year is — it’s the seventh year in the process. So, I think something’s going to happen, whether it’s big or small.”
Also see: How to compare Medicare Part D plans
All panelists hailed the increased use of telehealth for Medicare beneficiaries during the pandemic, thanks to temporary COVID-19 rules, and hoped that many of the new policies enabling its greater use would remain permanent after the pandemic.
However, some panelists voiced concerns about access to telehealth caused by the “digital divide” that some older adults are facing.
Joel White: “I think that what we see in access is really that Black and brown communities are significantly disadvantaged here, largely because of access to broadband… And so, I think we need to … make telehealth available across the country: rural, suburban and urban.”
Peter Kaldes: “I think telehealth is here to stay. I would echo the sentiment that the guidelines need to be made permanent.”
Jay Newton-Small: “I think that telehealth is the genie that is not going to be put back in the bottle now that people have realized how convenient it is.”
John Zogby: “It’s here to stay and to expand as well.”
Prescription drug prices
I asked the panelists whether the ability for Congress and the president to agree to a meaningful prescription drug bill had passed this year.
Jay Newton-Small: “I think it has, unless they tack it onto the larger spending bill.” (Kaldes and Browdie agreed.) But, Newton-Small added, “There usually is a very productive lame-duck session after the presidential election as they clear the decks for either the next president coming in or the next term of the current president. And I would say there’s a potential for that if there’s enough bipartisan agreement. But I don’t think before the election, unless it somehow miraculously gets piggybacked onto a COVID bill.”
Joel White: “I think it’s more likely that the president is going to issue some programs around the executive orders that he signed at the end of July…The other thing that we are seeing here is that drug prices are actually down; they were negative last year, at 1.7% this year, a full percentage and a half point lower than they were under President Obama so I think a lot of the political desire to go after the drug companies has dried up.”
The aging policy change they’d most like to see
One of the more interesting questions during the webinar was posed by an audience member who asked what the panelists thought the top aging-related policy change should be, whoever’s elected president. The responses:
White and Zogby called for expanded intergenerational mentoring programs.
Browdie wanted to see the age for Medicare eligibility lowered from 65 to 60, which Biden has proposed.
Kaldes hoped for greater enforcement of age discrimination employment laws.
Newton-Small favored increased reimbursement for home health care under Medicare.
I found it interesting that none of the panelists talked about long-term care and long-term services and supports as election issues. This may suggest that the biggest financial liability issue facing boomers may not yet be seen as a political imperative issue.
No panelist was willing to give a definite answer as to who they thought would win the presidential election. Time, as pundits like to say, will tell.
Clearly the realities of 2021 will ensure the next Panel of Pundits will have plenty to discuss.
Bob Blancato is national coordinator of the Elder Justice Coalition, a national advocacy voice supporting elder justice in America, and president of Matz Blancato and Associates. He is a 2016 Next Avenue Influencer in Aging and winner of the American Society on Aging’s 2020 Hall of Fame Award.
This article is reprinted by permission from NextAvenue.org , © 2020 Twin Cities Public Television, Inc. All rights reserved.