Last Thursday, November 12th, we held a virtual townhall to share some thoughts on the election and its impact on healthcare in America, and then discuss the importance of America’s caregivers, especially in our current COVID-19 environment, and to offer some resources that are available to caregivers. If you want to see a recording of the townhall click here.
I started out by pointing out that there are three ways to institute changes to our healthcare; legislation, Executive Orders (EO) or rule changes. On the legislative front, the Democrats, rather than increasing their majority in the House, lost seats, with the final tally looking like they will have just a five to ten seat majority. That leaves a lot of room for the Republicans to have influence over legislation in the House.
The Democrats were also hoping to gain a majority in the Senate but now, the best they can do, depending on the outcome of the two Georgia senate runoffs, is a 50/50 tie, which gives them the chance to choose the majority leader and for the Vice President to break any tie votes but the Senate calendar and priorities will have to be done in conjunction with the Republican leaders. Many pollsters are saying that the Republicans are more likely to win the Senate seats in Georgia, but we’re not to keen on pollsters right now so we’ll just have to wait and see. What all this means is it will be tough for the President Elect to pass any large healthcare legislation.
I then reviewed some of the proposed healthcare changes and discussed their chances of being implemented in the near future:
- Medicare for All – Won’t happen.
- Biden’s plan, lower age to 60, offer younger people the choice of joining a government healthcare plan – Not this year and probably not for at least two years.
- Let government negotiate drug prices – Some bi-partisan interest but not by itself, could be part of a “deal” that gets negotiated.
- Importation of drugs – Already an EO, logistically won’t work, probably will die as an option.
- IPI (international pricing index) or most favored nation pricing method – Already an EO – Hard to implement, I don’t think it’s a change that the President Elect wants to pursue.
- Limiting the amount of drug price increases over a year – Has some bipartisan support, might be part of a “deal”
- The ACA – The President Elect will work hard to expand, may be a place for some of the other changes to get done.
- Telehealth – Will be have bipartisan support to expand its use.
- Cap on yearly Medicare Part D out-of-pocket costs – May be something that would gain bipartisan support.
- Fee-for-service versus value-based care – The migration to value based care will be accelerated.
Covid-19 has put near term changes to healthcare on the back burner, but President Elect Biden promised healthcare changes and he could use budget reconciliation to pass some items. We need to be vigilance to identify those changes that help and those that hurt the patient’s access to, and the cost of, their healthcare.
I then turned the time over to John Schall. He is the CEO of the Caregiver Action Network (CAN) and has over 30 years’ experience both on the Hill and with advocacy organizations.
John started out by pointing out how much the Senate has changed since he worked for Bob Dole and how hard it was to predict what changes would happen going forward.
John reminded us that this month was National Family Caregivers Month and that CAN’s theme this year is caregiving in crisis. He said that every caregiver and their loved one should be involved in reviewing their Medicare coverage during the open enrollment period that we are currently in, not just because Medicare and insurance plans change but that the beneficiary’s health changes. A link to an informative webinar on Medicare that John recommended is here.
John then discussed that the historical profile of the caregiver is a 49 year old women with kids and a job, caring for her mother or mother-in-law. He said that caregiver is still on the job but there has been a huge increase, over a million, in millennials becoming primary caregivers. This has had an impact during the COVID-19 pandemic because many of them have had a reduction in income and their financial burden has increased. They are experiencing the toll that caregiving extracts. The facts are, caregivers have a higher chance of depression, high blood pressure, diabetes and having a stroke. COVID has magnified these problems.
In this environment the caregiver has to weigh the risk of even being around their loved one, taking them to the doctor or helping them in other ways. These are tough decisions that weigh heavily on the caregiver. John spoke as to the financial cost that often accompanies care giving and that it can cost as much as $10,000 a year to give care to a loved one.
John pointed out the huge increase in the use of telehealth but reminded us that it also has its challenges. If that caregiver is not part of the discussion then they don’t get the doctor’s guidance first hand and they also can’t share the knowledge they have of their loved one’s condition.
National Family Caregivers Month has always been a good time to check up on those we love. The Thanksgiving edition of USA Today will have a special insert sponsored by CAN that will offer tips and help to caregivers. John mentioned that there is now a Family Health History day on Thanksgiving Day. This is a day to share and obtain health history from your family and information about your ancestors. Health history is becoming very important as treatments become more and more personalized. This important information has the chance to save a life.
After John’s discussion the meeting was opened up for any questions. I started off by stating how important vaccines were in keeping our loved ones healthy and that the just announced good news about a COVID-19 vaccine may open the door for older Americans to get their other life improving and even life saving vaccines. I asked John if this is important for caregivers. John stated an emphatical yes, and stated that because of the reduction by the CDC in their recommendation for some vaccines it is very important for the caregiver to do all they can to ensure that their loved ones get the various vaccines that can have such an impact on their life.
A question from a viewer stated that they were struck by the statistics on depression and asked if there were any tips or helps that John had. John stated that the caregiver needed to keep themselves healthy, both physically and mentally, so they can continue to giver care rather than becoming unhealthy and needing their own caregiver. He also pointed out that CAN has a help desk, tasked with professionals, that could be a resource for caregivers. The link to that help desk is here.
Another question was directed to me asking if I thought that a cap on Medicare Part D might be a candidate for bipartisan cooperation and get implemented. I said that President Elect Biden might try to pass and infrastructure bill first, which could have a lot of bipartisan support, and then go to a Part D cap. The cap could be an excellent candidate since it shows Biden accomplishing something in the healthcare arena.
The final question concerned a Biden proposal which allowed support and payments for services that kept patients out of institutional care. John said that CAN enthusiastically supports this approach, and he was especially pleased with the multi-pronged approach this proposal championed.
It was honor to be on this townhall with John. Please look for more of these virtual townhalls as we cover topics that affect older Americans.