This week marks the two year anniversary of the Affordable Care Act. And, while we will devote plenty of space this week to highlighting the many successes of the ACA, we could think of no better place to begin than with the law’s benefits for seniors. Under the ACA, older adults have already seen concrete new benefits such as:

  • Decreased drug prices: In 2010, the ACA provided a $250 rebate check to seniors who hit the “donut hole” coverage gap, and last year, began offering a 50 percent discount on covered brand-name drugs in the donut hole. New data released over the weekend shows that more than 5.1 million seniors and people with disabilities on Medicare saved more than $3.2 billion on prescription drugs because of these provisions. This means real money back in the pockets of the people who need it most. And the savings will only continue. Under the law, this year, Medicare beneficiaries will receive a 50 percent discount from manufacturers on covered brand-name drugs and a 14 percent savings on generic drugs in the donut hole. These discounts will increase over time until the donut hole is completely closed in 2020.
  • Increased access to preventive services: In 2011, seniors started receiving a slew of new benefits aimed at keeping them healthy without breaking the bank. The law ended cost-sharing for wellness visits, flu vaccines and certain preventive services recommended by the US Preventive Services Task Force. The free annual wellness visit also includes a new health risk assessment intended to spot chronic diseases and urgent health needs.

These are all tangible benefits that seniors are already enjoying. However, there many lesser-known ACA provisions that hold the promise of improving the health and well-being of the frailest seniors while also reducing the cost of that care. The law created two new offices at CMS – the Center for Medicare and Medicaid Innovation (CMMI) and the Medicare-Medicaid Coordination Office (MMCO) – charged with finding ways to improve care and lower costs within the public programs. These offices have been hard at workdeveloping new programs aimed at finding cost-effective methods of better coordinating care, keeping people from being unnecessarily hospitalized or placed in a nursing home, and promoting overall good health. Two of the latest programs are especially worth mention:

  • Duals Demonstration Projects: More than nine million Americans have both Medicare and Medicaid coverage. These so-called “dual eligibles” include more than five million low-income seniors who tend to have a higher incidence of chronic conditions, poor care coordination and – as a result – higher rates of preventable (and expensive) hospital admissions and readmissions. Together, CMMI and MMCO have provided planning grants and new financing opportunities to help states design new programs aimed at improving care and lowering costs by better integrating Medicare and Medicaid services. Consumer advocates in many of these states are actively involved in helping to shape these programs so that they fulfill their promise.
  • Nursing home readmission initiative: Just last week, the MMCO announced a new program aimed at keeping long-term nursing home residents from bouncing back and forth to the hospital. These admissions are disruptive and disorienting, especially for frail elders who are vulnerable to the risks of hospital-acquired complications and other transition-related complications such as medication errors. They’re also expensive. This new program will wisely test whether providing enhanced on-site services and supports can support the goal of reducing avoidable hospital admissions.

These are but two of the many smart programs the ACA has created to improve the lives of older adults and their family members. We look forward to the continued rollout of these kinds of innovations and urge advocates to get involved at the local, state and federal levels in shaping them so they best suit the needs of those they intend to benefit. Happy anniversary, ACA!

— Renée Markus Hodin, Director, Integrated Care Advocacy Project