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Making Light of Our Mortality

What's at Stake for Elders with the SCOTUS Health Care Decision

category_bug_journal2.gif Within a few days - it might even be today - The Supreme Court of the United States will deliver its ruling on the Affordable Care Act (ACA), known to its opponents as Obamacare.

In general, Republicans want the ACA overturned, Democrats want it upheld and speculation tells us that the Court might strike down only parts of the legislation, particularly the mandate.

The ACA contains some excellent health care improvements for elders but many don't know about them. Some examples:

• A free, annual wellness examination

• Elimination of cost-sharing for such preventive screenings as mammograms, bone-density measurements, diabetes, HIV and obesity screenings among others

• Gradual reduction of cost-sharing of prescription drugs for Medicare enrollees who fall into the doughnut hole

• Prevents Medicare Advantage plans from charging enrollees more for chemotherapy, dialysis and some other procedures than allowed under Medicare Parts A and B

• Prevents states from cutting elders from Medicaid

• Expands Medicaid to certain individual under age 65, providing 3.3 million uninsured with health coverage

• Creates provisions to combat exploitation of elders through financial, physical and mental abuse

And a whole bunch more. But they could be gone before many elders have had the opportunity to use them.

According to the National Association to Preserve Social Security and Medicare (NCPSSM), these are the four questions before the Supreme Court:

  1. Is the minimum coverage provision (individual mandate) a constitutional exercise of Congressional power under the Commerce Clause?
  2. If the individual mandate is not constitutional, is it severable from other parts of the law?
  3. Does the Medicaid expansion create conditions on state participation so coercive as to violate Congress' power to impose such conditions under the Spending Clause?
  4. Does the Anti-Injunction Act (providing that taxes can only be challenged after assessed) apply?

I know, I know. The wording of these things makes your eyes cross – well, mine anyway, but I can work through it.

Plus, the NCPSSM yesterday provided a nifty, 12-page document [pdf] explaining How the Supreme Court Decision Could Impact America's Seniors.

According to their analysis, the best possible outcome for elders is for the Court to uphold the individual mandate and the Medicaid expansion. If so, everything for elders in the ACA remains in place.

The worst scenario for elders is if the individual mandate is struck down and not severed from the rest of the ACA. This would mean that the entire law is overturned and all provisions for elders (and everyone else) are stripped away.

There are a couple of other possible outcomes, intermediate in their effect on elders which you can read the NCPSSM analysis. Since you cannot count on all reporters to get anything about Medicare straight, you might want to bookmark this document to help you find out where you stand when the Court decision comes down.

As I mentioned, many elders have not taken advantage of the health improvements available to them in the ACA.

So if the Court upholds the mandate and Medicaid expansion leaving all provisions for elders in place (an old woman can hope, can't she?), you can find out what preventive services are available in the Medicare Guide to Preventive Services [pdf] booklet.

At The Elder Storytelling Place today, Marcy Belson: Personality, or the Lack Thereof


I trust you will let us know what happens.

Thank you so much for writing about this. It is important to share this information with everyone sane in the USA. Sometimes I feel as if our country has been hijacked.

Thank you very much for this.

Even though I thought I was aware of all of the ramifications of the Affordable Health Care Act your post showed me that I was far from knowledgeable.

Thank you for your excellent research and for putting it all together for your followers. I just wish that all those elders that watch Fox news knew about this.

Hope is what you have when you have no power. If we can't beat back the richie-riches on this one we are doomed.

My guess is that this court will decide to take this beyond the question that is before it about the mandate. They have expanded many decisions in this manner - citizens united is one. It wouldn't surprise me a bit if they were to decide that health care is not a right based in the constitution and that the government should keep its nose out of the health care industry.

I'll apologize for being so cynical if I'm wrong.

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