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Top 5 Issues That Will Determine How 50-Plus Americans Vote

Winners will have to repair the economic, health and social devastation of 2020

Voter twenty twenty buttons in red, white and blue

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En español | More than in any other election in recent history, voters this November will elect leaders whose decisions and actions will directly affect their lives. This is especially true, experts say, as Americans continue to cope with the coronavirus and the economic toll it has taken on the country.

"This is the election that hits home,” says John J. Pitney, professor of politics at Claremont McKenna College in California. “The coronavirus affects every single American. I don't think anybody in this country has been unscathed.”

Older voters are going to be assessing candidates largely on this issue, agrees Robert Blendon, professor of health policy and political analysis at the Harvard T.H. Chan School of Public Health. “This election is going to be about whether Washington really did all that could have been done,” he says.

Public opinion surveys have consistently shown that older adults want to know where candidates stand on a range of key issues, among them Medicare, Social Security, the cost of prescription drugs, the economy and long-term care. Here's a snapshot of what's at stake and where AARP stands on these topics.

The economy

What's at stake: Ensuring that older workers can recover from the economic downturn that the nation has faced since the pandemic began.

Where AARP stands

Congress should extend emergency unemployment benefits until the pandemic's economic effects end.

• Federal and state lawmakers should require paid sick and family leave benefits for all workers.

• State and federal lawmakers should provide more support, including tax credits, to family caregivers.

• Employers should be monitored and held accountable for not discriminating against older workers when hiring picks up.

The issue: In April the unemployment rate for older workers reached its highest level since the federal government began keeping records in 1948, according to Richard Johnson, director of the Program on Retirement Policy at the Urban Institute. Unlike in past recessions, Johnson says, the jobless rate (as of June) was higher for workers age 65 and older than for those 25 to 54.

As employers have moved to open the economy, Americans 50-plus are having to balance their personal health concerns with their need to work. Many older people also have had to take on caregiving duties during the pandemic, which means they may not be able to work at their full capacity.

The players

President: Whoever is president in 2021 and will set the nation's economic agenda and decide whether to sign legislation Congress passes and sends to his desk.

Senators and members of the House of Representatives: They will have oversight over the administration's economic policies and the power to pass legislation that would help stop age discrimination; change the nation's tax structure; and provide any added stimulus payments, federal paid sick and family leave, or enhanced jobless benefits.

Governors and state legislators: These leaders can decide whether to enact laws on age discrimination or paid sick and family leave, and have the power to set levels of unemployment insurance.

What older Americans think

According to a poll done for AARP this spring, 58 percent of Americans over age 50 had to contact a credit card company to seek relief from a bill they couldn't pay, and 39 percent said their financial situation had gotten worse since the coronavirus pandemic began.

Medicare

What's at stake: Ensuring that Medicare can continue to provide access to quality and affordable health care for older Americans.

Where AARP stands

AARP has asked Congress and state lawmakers to take these actions:

Allow Medicare to negotiate for lower prescription drug prices.

• Make sure benefits are affordable, including premiums and cost sharing.

• Ensure that all people with Medicare have access to enough qualified health care providers.

• Sustain Medicare for the future by cracking down on waste and fraud.

The issue: More than 62 million people 65 and older or with disabilities are enrolled in Medicare. Funding is an issue: The program's trustees estimate that within six years, Medicare won't be able to pay full hospital benefits. The results of November's elections could determine whether there will be an overhaul of the nation's entire health care system, an expansion of Medicare or a continuation of the current systems, with potentially smaller corrections.

The players

President: Whoever is president in 2021 and will appoint the leadership of the Centers for Medicare & Medicaid Services (CMS), which runs Medicare. He will also have the power to sign or veto any legislation that makes changes to Medicare — from funding the program to altering how it works and who is allowed to enroll.

Senators and members of the House of Representatives: They oversee Medicare and enact legislation to make any changes to the program's structure and its funding. A number of lawmakers have crafted bills to create a “Medicare for All” system that would expand the program to younger Americans, but so far none has been voted on.

What voters think While opinions vary widely on how to fix the overall U.S. health care system, almost all voters want Medicare to remain strong and consistent; 93 percent of 50-plus voters say that to win, candidates must talk about what they will do to prevent cuts to the program, according to an AARP public opinion poll.

Prescription drugs

What's at stake: How to reduce what consumers in the United States have to pay for life-sustaining prescription drugs.

Where AARP stands

AARP's Stop Rx Greed campaign calls on lawmakers to act on these principles:

Allow Medicare to negotiate for lower prescription drug prices.

• Allow the importation of drugs.

• Increase price transparency.

• Speed up the process of getting generic drugs to the marketplace.

The issue: For many years drug prices have increased at rates far higher than inflation. In 2017, for instance, the average cost for a year's supply of a single prescription drug for someone with a chronic illness was over $19,000 — that's more than some retirees’ annual Social Security retirement benefit.

The players

President: Whoever is elected president and must decide whether to sign any bills Congress passes to reduce or regulate drug prices. His administration could also enact regulations that would allow the importation of lower-cost drugs from other countries.

Senators and members of the House of Representatives: They can enact legislation to curb prices. Bills being considered range from allowing Medicare to negotiate prices to creating penalties for companies that raise prices more than the rate of inflation.

State elected officials: Governors and state legislators can pass bills allowing drugs to be imported from other countries or limiting drug-price increases. Some states already have laws creating drug-price monitoring boards, improving price transparency and recommending limits on price increases for specific medications, such as insulin.

What voters think: More than 80 percent of Americans do not believe that Congress is doing enough to lower prescription drug costs, a Kaiser Family Foundation survey showed. And 81 percent of voters 50-plus said candidates who ignore the rising cost of prescription drugs and other issues important to older Americans risk losing their vote, according to an AARP poll.

Social Security

What's at stake: Ensuring that current and future generations will get the retirement benefits they have earned and rely on.

Where AARP stands

Social Security should be financed and protected not only for current retirees but for generations of Americans to come.

• Reforms should ensure adequate benefits for those most reliant on Social Security and those who would have trouble postponing retirement.

• Social Security is a benefit that Americans earn through their working lives, and the program should be financed to ensure long-term adequacy and solvency.

The issue: About 45 million retired workers and 3.1 million dependents receive Social Security benefits; currently, 1 out of every 3 of these households rely on Social Security for 90 percent or more of their income. Social Security also covers about 6 million survivors of deceased workers and 10 million disabled workers and their dependents.

According to the most recent estimates, the trust funds that help pay for the program will be exhausted by 2035. Without any changes to the system, the program at that point would still be able to pay 79 percent of its current benefits. But that report was based on data before the pandemic. A May report from the Wharton School of the University of Pennsylvania suggests that the trust funds could be exhausted sooner because millions of workers have lost their jobs, so less money is coming into the system.

The players

President: The president typically sets the agenda for Social Security, and no legislation can pass without the president's involvement.

Senators and members of the House of Representatives: They have the power to enact legislation to adjust Social Security taxes, payouts, ages, oversight and more. Lawmakers last made major changes to the program in 1983.

What voters think: In an AARP poll, 91 percent of voters over age 50 said politicians who fail to protect their health and financial security are out of touch. What's more, 93 percent of respondents in the same poll said that to win, candidates must talk about the issues that matter to older voters, including preventing cuts to Social Security.

Long-term care

What's at stake: How to protect residents of nursing homes and other long-term care facilities against sickness, neglect and isolation, especially during the COVID-19 pandemic, and how to ensure that older Americans can have the choice to age in their homes.

Where AARP stands

AARP has asked Congress and state lawmakers to take these actions:

Require adequate staffing, regular coronavirus testing and personal protective equipment for residents and staff in long-term care facilities.

• Make virtual visitation an option for communication between families and residents, even after in-person visits resume.

• Reject proposals to grant blanket immunity related to COVID-19 for nursing homes and other long-term care facilities.

• Make it easier for older Americans to age in their homes and communities, and provide greater support to family caregivers.

The issue: Even though fewer than 1 percent of Americans live in nursing homes, these facilities represent more than 40 percent of the deaths from the coronavirus. During the pandemic most families have been unable to visit loved ones in nursing homes, and there's been a lack of virtual visitation. Testing in these facilities has been erratic; staffing, in too many cases, has been inadequate; and there hasn't been enough personal protective equipment for workers.

Even before the pandemic, according to a recent report, 8 out of 10 nursing homes were cited for poor infection-control practices in the past few years.

Many older Americans are unable to get ongoing care in their homes because Medicaid is required to pay only for institutional care for eligible lower-income older adults.

The players

President: The candidate who takes control of the White House will have the power to establish federal health and safety guidelines for long-term care facilities and services. He also will have the power to sign or veto any nursing-home-related legislation that Congress passes.

Senators and members of the House of Representatives: They will decide whether to enact legislation to protect residents and improve oversight and conditions in U.S. long-term care facilities.

Governors and state legislators: States inspect nursing homes on behalf of the CMS to see if they comply with federal standards for quality, health hygiene, record-keeping and overall residential care. States also have the power to regulate assisted living facilities.

What voters think: According to a June AARP public opinion poll, 78 percent of voters over 50 say that to win, candidates must address how they will protect nursing home residents from the coronavirus and future pandemics. In the same survey, 68 percent of respondents said they want AARP to demand more action from leaders to protect seniors in nursing homes and assisted living facilities.

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