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Policy Fundamentals For Better Health

To live longer, healthier lives, people should be empowered to engage in positive health behaviors. People also need access to affordable, high-quality health care, prescription drugs, and long-term services and supports as well as social engagement. Maintaining and improving cognitive health is critical to increasing quality of life as people age. Eliminating health disparities must be a priority.

Areas of Better Health

Health Living

Medicare

The Health care System

Medicaid

Long-Term Services and Supports

Enabling the improvement of people’s health depends both on people taking control of their health as they age to the extent they can and on systems that support healthy choices and provide everyone with affordable, high-quality care. To start, people should have access to care through the course of their lives, without regard to their health, wealth or location.

Further, while personal behaviors may affect longevity and disability, they are not the only determinants of healthy living and aging. Access to affordable, high-quality clinical preventive services and medical care is critical. Other factors outside the medical system also affect health and longevity. Socioeconomic factors like income, education and occupation are some examples. Environmental conditions, neighborhood characteristics, cultural norms and the historical legacy of discriminatory private- and public-sector practices also help determine health outcomes. Access to employment, education, housing, healthy foods, safe streets and neighborhoods, and other social supports also promote health and reduce health disparities across the population. Policies and interventions aimed at improving health must address both personal behaviors and systemic factors.

Healthy Living

Society can make wellness a higher priority through a holistic approach that supports healthy choices by individuals and public policies that help shape our neighborhoods, environment and options in life.

  • Individuals can do more to support their own health. People can reduce their risks of costly illnesses through the choices they make, such as eating healthy food, exercising, not smoking, limiting alcohol intake and adhering to a care plan they develop with their doctor. While individual choice is key here, policy can enable choice by helping to foster access and the availability of options.

  • Compensation for doctors should be based not just on treating illness, but also on efforts to promote health and prevent illness. Financial incentives can engage doctors more deeply in these goals. Insurance should fully cover recommended screenings, immunizations and interventions that promote healthy behaviors.

  • Social and economic policies should be crafted with a recognition that they can improve wellness. Policies that create neighborhoods that are safe and walkable, promote access to transportation and support education can also improve health outcomes.  Economic security and social supports and connectedness all affect well-being and life expectancy. Improving these conditions that shape daily life will enhance public health.

Medicare

Medicare provides vital health care coverage to adults 65 and older and to younger people with a disability. A key priority is to ensure a strong financial outlook for Medicare, while making it even more effective for those who rely on it.

  • Medicare should remain a social insurance program. People pay into the system for their entire working lives and earn the benefits they receive. Medicare must continue to guarantee health care coverage to older people and those with disabilities, regardless of income. Reforms should not saddle beneficiaries with out-of-pocket costs they cannot afford, or unfairly squeeze the middle class.

  • Medicare should be strengthened and improved for current and future beneficiaries. Preserving Medicare’s critical role means building on successful reforms currently underway and ensuring that the program continues to meet the health care needs of beneficiaries, while recognizing that more changes may be needed to keep it financially sound for future generations.

  • Policymakers can do more to improve the care available through Medicare. The program should offer benefits for vision, dental and hearing services to all beneficiaries. Medicare should reduce the price and out-of-pocket cost of prescription drugs, expand coverage for long-term services and supports, and improve mental health benefits. A cap on personal out-of-pocket medical costs would help ensure that no one is forced into bankruptcy due to health care expenses.

  • Medicare must encourage transformation. Medicare can drive system-wide reforms to achieve better and more efficient care at a cost society can afford. It should use its vast purchasing power to reduce cost and spark innovation and best practices throughout the health care system. It can offer incentives to promote high-quality care that is seamless, coordinated and easier for individuals and their family caregivers to navigate.

The Health Care System

Everyone should be able to get health care they need at prices they can afford, yet this is not the case. Various measures can make this promise a reality for all.

  • Policymakers must protect and strengthen the Affordable Care Act. The Affordable Care Act (ACA) lays the groundwork for progress by creating a framework for expanding quality, affordable coverage. The ACA removed major obstacles by prohibiting insurers from turning away consumers based on their health or preexisting health conditions, and limiting the practice of charging older adults much higher health insurance premiums than younger adults for the same coverage — it is critical to keep these protections. 

  • Access to high-quality care is essential for all. Direct consumer costs, such as premiums, deductibles and other out-of-pocket expenses, should not be burdensome or limit access to coverage or necessary services. Sufficient financial assistance should be available to ensure affordability. Public and private efforts are needed to remove barriers to appropriate medical care, end disparities and ensure access to care that is supported by a robust, diverse and qualified workforce.

  • Drivers of rising health care costs, including prescription drugs, must be addressed. Public- and private-sector strategies can address the root causes of high health care costs. Efforts should include the following areas affecting costs and consumer finances: Address rising health care prices and drug prices, protect consumers from surprise medical billing, make health care pricing transparent, eliminate medical errors, improve care coordination, help people manage chronic illness, promote healthy behaviors, reduce administrative costs, and eliminate fraud and waste.

Medicaid

Medicaid is a vital safety net that provides health care and long-term services and supports to millions of people with low incomes who could not otherwise afford to receive these critical services, including older adults who have exhausted their resources.

  • Medicaid should retain its essential role guaranteeing access to adequate and affordable health care and long-term services and supports. Medicaid should continue to improve the quality and efficiency of care for beneficiaries and maximize value for the program. Federal funding should be sufficient to account for the complex needs of individuals, as well as changes in states’ circumstances that affect the number of people receiving benefits and other program costs. Proposals to cap Medicaid funding should be rejected because they weaken the program and undermine its mission. 

  • Medicaid should cover a range of services that allow individuals to live as independently as possible in their homes and communities. Most people prefer to remain in the community rather than live in institutions, a choice that is often more cost effective. Medicaid should be improved to help people attain this widely shared goal.

Long-Term Services and Supports (LTSS)

LTSS consists of a broad range of assistance for people with chronic conditions and functional limitations. This can include support for activities, such as bathing and dressing, that people need to function in their own homes, as well as services provided in institutions. Importantly, and contrary to what many consumers may assume, Medicare does not cover the costs of LTSS. The need for affordable options is increasing, as more people are aging and living longer and a declining pool of family caregivers is available to help.

  • New financing options are needed to make LTSS affordable. The cost of LTSS exceeds what families can afford. A social insurance solution can best meet this growing need. Everyone should contribute if they can, and everyone should have the security of good coverage. A social insurance system is the best option, because the need for LTSS is unpredictable while the costs can be catastrophic. In the meantime, innovations in private coverage that create valuable, financially sustainable products should be encouraged.

  • LTSS should be coordinated and person- and family-centered. To ensure the best outcomes for people in need of LTSS, family caregivers must be acknowledged as part of the care team, and service providers must coordinate their activities and share information across settings. Individual caregiver circumstances, abilities and needs must guide all treatment decisions.

  • More top-quality services should be available to help people remain in their homes and communities. The federal government should eliminate Medicaid’s bias favoring nursing facilities by mandating the provision of home- and community-based services (HCBS) for everyone who meets Medicaid eligibility criteria and chooses to receive services in HCBS settings. Services should be available in a range of settings, including supportive housing and adult day centers.

  • Family caregivers need more support for their crucial, unpaid efforts. Unpaid caregiving has become increasingly complex for the relatives, friends and neighbors who provide it, often at significant emotional, physical and financial cost. Federal and state governments can empower caregivers by ensuring that LTSS covers services, such as respite care and adult day services, that supplement their efforts and help them endure. LTSS programs should also allow for family caregivers to be paid in certain situations, such as when a paid worker would otherwise be needed. Medicaid and other programs should include assessments of family caregivers’ needs. Employers should allow greater accommodations for the many employees who also provide family caregiving.