This week, all the talk in Washington has been about handicapping the outcome of the Supreme Court health reform cases, and identifying winners and losers. What did the justices mean with each question? Which way are the potential swing votes leaning? Will the Court reach consensus of any kind? What are the likely political/electoral consequences of the upcoming rulings?
There's been painfully little attention to the impact of the rulings for patients, and one group has been just about totally ignored throughout this debate: older women. But as one of the most vulnerable segments of our population, older women have a tremendous amount at stake as the future of reform is decided.
Why, when most seniors are covered by Medicare? Because older women tend to have low incomes and poor health -- and because nobody suffers more in our fragmented, incoherent health care system.
Let's get specific. Older women are more likely than others to have chronic conditions and, consequently, they bear the brunt of shortcomings in our health care system -- among them high cost, poor quality and uncoordinated services that often generate additional cost, burden and sometimes serious harm. Older women also are more vulnerable than men to high costs, due to the lower wages and savings that result from time spent out of the workforce to meet family caregiving responsibilities.
That means older women gain a lot from the Affordable Care Act, because the law does so much to improve both the affordability and quality of health care.
It is closing gaps in Medicare coverage. Annual wellness visits are now covered, as are some preventive benefits older women need, such as mammograms and bone density tests, without co-pays. This benefit includes time for health care providers to conduct comprehensive health risk assessments and create personalized prevention plans for their patients.
Older women will save millions of dollars as reform closes the current gap in Medicare prescription drug coverage known as the "donut hole." Beneficiaries who fell in this gap have already received a $250 rebate. Beginning last year, they benefited from 50 percent off brand-name drugs in the "donut hole." By 2020, the donut hole will be closed, and beneficiaries will only have to cover 25 percent of the cost of their drugs until they hit the catastrophic cap, after which they will only have to pay 5 percent.
Health reform also created the Center for Medicare and Medicaid Innovation, to test, evaluate and rapidly expand new care delivery models that improve quality and care coordination. It encourages the use of health information technology in these models to help improve coordination and communication among health care providers and patients. It puts more resources into making sure older women get the follow-up support they need when they transition from a hospital stay back to the community. It supports new medication management services that will help patients and caregivers understand their medications and avoid dangerous interactions and medical errors. It supports better primary care and a team-based approach that will help older women avoid unnecessary hospitalizations and link them to community services that can help them maintain their health and live better quality lives. And the reform law establishes Geriatric Education Centers to support training in geriatrics, chronic care management and long-term care issues for family caregivers, as well as for health professionals and direct care workers. Read even more about the benefits for older women in health reform here.
Health reform is the greatest advance for women's health in a generation. Access to affordable, quality health care is central to the well-being of older women. It is a key determinant of their quality of life, their economic security and their ability to thrive, prosper and participate fully in our society. Losing reform would have grave consequences for women and families, and older women have a particular stake. Nobody wins when we lose sight of that.