Article on PPACA

After decades of indecision over health care reform, President Obama signed the Patient Protection and Affordable Care Act (PPACA) into law on March 23, 2010. This comment analyzes the effects of the PPACA on the elderly, especially those who reside in nursing homes. Although some seniors will face higher taxes under the Act, the legislation will provide more benefit options with an emphasis on non-institutionalized care. This comment examines the background of Medicare and Medicaid, the Medicaid application process, changes under the Act, application facilitation, and concludes that while some of the ramifications are unknown overall, the Act will benefit the elderly needing long-term care.

During the contentious debates regarding the health care reform legislation, I took my dog Beau to a nursing home to spend time with the residents. I was sitting to the side watching my dog do all the entertaining, when a talkative eighty-seven-year old lady introduced herself to me. “My name is Dorothy,” she remarked. After some small talk, I told her I was on my first break from law school, and Dorothy’s eyes started to sparkle. Unlike myself, Dorothy followed cable news daily and had many opinions on health care reform. Because she was in the nursing home only for mobility reasons, she yearned for another sound mind to talk to and wanted my opinion on the issue. 

Dorothy was born in the 1920s, right after the invention of the band-aid, in a time before Social Security and Medicaid. Dorothy said the current system of health care does not need another band-aid, and she believes with the input of the elderly and caretakers, the health care system can improve. What Dorothy thought would be a ninety-day stay in the nursing home to recover from a broken hip turned into four years, but her motivation to return home and to her husband of over fifty years has never waned. Notwithstanding four years of rehabilitation, Dorothy is still relegated to a wheelchair, and her mobility is no better than when she arrived. During her first year in the nursing home, she went to rehabilitation several times a week, but now her visits to the trainer are marked with irony. She remains optimistic that one day she will be able to walk so she can go home and eat dinner with her husband. Even though her motivation has never faded, Dorothy is pragmatic and knows that she has lived in the nursing home twice as long as the average resident and, despite her efforts, there is still no end in sight. As roommates have come and gone, time has slowly started to fade away the memories of her home-her one motivation for leaving.

Traditionally, the United States left health care up to the individual, but in 2010, that philosophy changed. In 2010, President Obama signed the PPACA and the Health Care and Education Reconciliation Act (HCERA) into law. This legislation will extend health coverage to millions of individuals and tie payments to better health care outcomes instead of to the number of treatments. The PPACA provides more options for the elderly when it comes to choosing long-term care benefits. Additionally, the government reinvigorated the dialogue on how to affordably care for seniors with programs that will make them happier and healthier instead of the current one-size-fits-all solution. 

Generally, seniors rely on using the equity in their home to pay for medical care later in life, but with home prices at all-time lows, seniors are forced to find other sources to fund their care. Today, seniors that saved and paid into Social Security for their lifetimes are using all their fixed savings and even going into debt to pay for health care needed in the last years of their lives. The PPACA will reduce the burdens on seniors by making it easier for them to qualify for Medicaid assisted Medicare thanks to improved “coordination of eligibility . . . determinations and individual assessments.” Seniors attempting to qualify for long-term care benefits should anticipate changes in the enrollment process and the administration of care. Along with the improvements and more long-term care options, the PPACA amended several provisions of the Tax Code, which will enable the Centers for Medicare and Medicaid Services (CMS) to better coordinate with the Tax Service. The PPACA focuses on better coordination of existing programs and the people that utilize those programs, which will make it easier for the elderly by reducing the amount of paperwork. With patient input and innovative-care options, the elderly, their families, and their communities will benefit from a system moving away from institutionalized care. 

This comment will address the effects of the PPACA on the long-term health care system. Part II of this comment will briefly discuss the background of Medicaid and the different parts of Medicare. However, the social and policy issues of who should be responsible for long-term care costs are beyond the scope of this comment. Part III will outline the standard application process to qualify for Medicaid and the difficulties with this system. Several examples from the Texas application process are included; Medicaid, however, is a “joint” federal-state program, in which the states and counties serve as “laboratories” for innovation to the system, making a national comparison impossible. Part IV lists several parts of the PPACA that are relevant to seniors either living in long-term care facilities or about to apply for Medicaid. Part V illustrates the amendments to the Tax Code and the process to close the Medicare Part D “doughnut hole.” Part VI discusses several approaches to implementing systems that will streamline the application process currently used in other states. Finally, Part VII concludes with the positive and negative implications of the health reform bill.