When I addressed members of the American Geriatrics Society (AGS) at our 2017 Annual Scientific Meeting this past May, I focused on the need to “navigate change in uncertain times.” With the new Congress and Trump Administration having been in office for less than 6 months, it seemed a fitting sentiment as the title for the meeting's public policy update (Hollmann, Malone, Rudolf, & Unroe, 2017).
Only a few months have passed since #AGS17, and the need to keep navigating change is perhaps the only thing that has not changed since then. The sentiment bears repeating—and it certainly warrants deeper reflection if you followed any of the health care action in Congress this summer.
From #AGS17 through September, we saw no less than six proposals (along with multiple revisions to those proposals) pass through the halls of Congress to repeal and replace the Affordable Care Act (ACA). The drama of seeing these plans rise and fall was gripping, and undoubtedly the options up for debate will have changed again by the time this issue of the Journal of Gerontological Nursing goes to print.
At the AGS, knowing what was at stake, we worked to set aside the partisan drama of health reform. We focused instead on action—action grounded in compassion for older adults, their families, and their caregivers. Our North Star must be, simply and always, our patients. This means that our public policy advocacy will always be directed toward achieving high-quality, person-centered care (PCC) (Kane, Saliba, & Hollmann, 2017).
By that metric, we at the AGS agree with other provider and consumer organizations that the ACA can be improved (Lundebjerg, Hollmann, Malone, & the AGS Board of Directors and Public Policy Committee, 2017). We also agree that Congress must develop bipartisan proposals in sufficient detail, and release them far enough in advance, so that all Americans have the opportunity to make informed decisions about how we move toward a better health system. Recent proposals have so far failed to reach toward high-quality PCC, or to include balanced and transparent approaches to health system improvement.
Most of the summer's proposed ACA repeal bills, for example, called for drastic cuts to Medicaid, our nation's largest public payer for long-term care services and supports. These cuts would have wrought serious damage to our health system, ultimately affecting large numbers of older adults, their families, and their caregivers. These cuts would have increased out-of-pocket costs, reduced health and long-term care coverage, and diminished health benefits for millions of Americans, including many older adults and caregivers.
Through the AGS Health in Aging Advocacy Center (access http://cqrcengage.com/geriatrics), AGS members, partners, and expert collaborators made those concerns known by connecting with approximately one half of U.S. Senators during health reform debates. In the days and weeks following the rejection of the last summer proposal in the Senate, we saw our national health care conversation shift toward bipartisan collaboration and away from a focus on partisan victories. This positive development may indicate that citizens and policymakers heard the calm, committed tenor of our insights and those of other engaged health professionals and groups.
In that context, remember that our work in public policy has been about far more than standing in opposition to policies we know would harm older adults—that has been an important priority, but our work has not (and cannot) end there. Our advocacy also has at its core standing for the values and beliefs we see as critical to older adult well-being. Advance practice nurses and all AGS members and geriatrics health care professionals can continue to play a critical role in supporting those values and beliefs by remaining engaged and connected to the legislative process. The AGS's Health in Aging Advocacy Center is a great place to get started: It offers information not only about legislation critical to our field but also about connecting directly to your Senators and House Representatives to make your voice heard. That sustained engagement—for all your legislators and across different channels—goes a long way toward reinforcing the true importance of our priorities.
As noted time and again in our analyses and correspondence with policymakers (Kane et al., 2017; Lundebjerg et al., 2017; Saliba & Lundebjerg, 2017), our values are grounded in our belief that achieving high-quality PCC for all older adults means building federal and state policies that:
- Expand older adults' health care options to include in-home and other care that enable us to live independently as long as possible; help older adults and caregivers better understand health care needs and make the most of Medicare and other benefits; and provide caregivers with adequate resources and support (Lundebjerg et al., 2017).
- Ensure that value-based purchasing and other quality initiatives account for the unique health care needs of all older adults (Lundebjerg et al., 2017).
- Strengthen primary and preventive care and care coordination (Lundebjerg et al., 2017).
- Address the acute and growing nationwide shortage of geriatrics health care professionals; and ensure that other health care providers have training that prepares them to meet the unique health care needs of older adults (Lundebjerg et al., 2017).
- Step up research concerning healthy aging; the prevention, diagnosis, and treatment of age-related health problems; and the cost-effectiveness of various approaches to care; and ensure that older adults are adequately represented in research trials (Lundebjerg et al., 2017).
We remain committed to the core principle that everyone should have access to high-quality, person-centered, and affordable care—especially care that supports our independence (Kane et al., 2017; Saliba & Lundebjerg, 2017). We remain opposed to changes that would detract from that care or unduly burden our communities (Saliba & Lundebjerg, 2017). But most importantly, we look forward to sharing our expertise on priorities that matter to the millions of older adults and caregivers we serve.
- Hollmann, P.A., Malone, M.L., Rudolf, P.M. & Unroe, K.T. (2017, May19). Navigating through uncertain times in public policy [PowerPoint presentation]. Retrieved from https://geriatricscareonline.org/toc/2017-ags-annual-scientific-meeting-handouts/M005
- Kane, R., Saliba, D. & Hollmann, P. (2017). The evolving health policy landscape and suggested geriatric tenets to guide future responses. Journal of the American Geriatrics Society, 65, 462–465. doi:10.1111/jgs.14849 [CrossRef]
- Lundebjerg, N.E., Hollmann, P. & Malone, M.L.AGS Board of Directors and Public Policy Committee. (2017). American Geriatrics Society policy priorities for new Administration and 115th Congress. Journal of the American Geriatrics Society, 65, 466–469. doi:10.1111/jgs.14854 [CrossRef]
- Saliba, D. & Lundebjerg, N.E.on behalf of the American Geriatrics Society. (2017, August7). An open letter to House and Senate leadership in support of bipartisan healthcare reform. Retrieved from http://www.americangeriatrics.org/sites/default/files/inline-files/Letter%20to%20House%20and%20Senate%20Leadership%20in%20Support%20of%20Bipartisan%20Healthcar....pdf