At this point in our country’s history, aging is becoming a really big deal. Thanks to significant technological, medical and social advances over the course of the last century, people are living considerably longer than ever before.
This increase in longevity, coupled with a boom in babies born after World War II, has led to a dramatic increase in the aging population in the U.S. By 2030, the entire baby boomer generation will be 65 or older. At roughly 73 million people strong, the boomers represent approximately 21% of the population. Lawmakers and policymakers are scrambling to address the public policy implications of such a demographic shift.
Three Overarching Trends
According to Nora Super of the Milken Institute, Center for the Future of Aging, three overarching trends are shaping the politics of aging in the U.S. The first trend is that the government will spend over two-thirds of its budget on those 65 older in the next decade. Spending for Social Security and Medicare is expected to increase not only because more Americans will qualify for benefits, but also because of the escalating cost of healthcare.
Super also believes another trend that will continue to drive aging policy is the fact that the number of caregivers is shrinking at a time when there is a rise in older adults needing care. At the heart of the aging phenomenon is the essential role that friends and family play in the support of aging loved ones. Changes in family size, composition and location are contributing to the shrinking of the caregiver pool. As the first line of assistance for most aging individuals who need care, family caregivers are also vulnerable to serious negative financial, emotional and physical repercussions of providing care.
In addition to family caregivers, the pool of professional caregivers is also shrinking. Direct-care workers provide care to some of the most vulnerable of individuals but receive low wages, experience high turnover and receive little training or advancement opportunities. The pandemic has also played a role in decimating the long-term care workforce. Many direct-care workers have left their jobs due to fear, illness, family responsibilities and economic conditions.
The third trend that Super identifies that will largely impact aging policy is the current geographic concentration of our aging population. The majority of older adults in America reside in just a handful of states. In fact, of the 52 million Americans over the age of 65, 25% live in one of three states: Florida, California or Texas. Therefore, at the local and state level, policies will have to be enacted to address the needs of the specific demographics within a region.
Legislation Seeks to Close Gaps
Because of the economic implications of such a large aging population, policymakers are working to address certain social factors proven to foster positive health outcomes, such as affordable housing, food and nutrition, transportation and access to healthcare. As a result of the pandemic, seniors experienced unprecedented social isolation and a gaping digital divide was revealed. Legislation is being introduced to address these issues and close the gaps that exist in our current societal infrastructure.
In November, the House passed the Build Back Better Act. As the bill currently stands, it would significantly reduce prescription drug costs and expand Medicare coverage to include hearing aids. Additional proposed funding for home and community-based services (HCBS) would improve access to home care and improve wages for direct-care workers. The bill also contains increased funding for the Older Americans Act (OAA), which was initially passed in 1965 and supports services delivered at the local level that allow older adults to live independently and remain part of the community. Some of the programs and services provided under OAA include senior centers, meal programs, job training/placement for older adults, transportation and health programs.
The Build Back Better bill has now moved on to the Senate where it faces some uphill challenges. While there is bipartisan support for the prescription drug and home care provisions, there is concern about some of the other provisions in the bill — which are mostly unrelated to the provisions affecting older Americans. Advocates are hopeful that negotiations on key provisions will resume in April, with a possible vote on the bill in early summer.
Although the Build Back Better bill is getting a great deal of attention, there is other important legislation being introduced. Nearly 110 pieces of legislation have been introduced in Congress since January 2021 that support seniors. Only a handful, however, have been passed in either the House or the Senate and are awaiting their fate in the other chamber.
Here’s just a sampling of the current legislation that addresses the oncoming trends in aging:
Legislation to Promote the Health and Well-Being of Older Americans
- H.R. 6302 (Protecting the Health of America’s Older Adults Act). Introduced by Lois Frankel (D-Fla.), it would establish a program at the Centers for Disease Control and Prevention with respect to healthy aging and authorize grants to health departments to carry out healthy aging programs.
- H.R.5005 (Addressing SILO Act of 2021). Introduced by Linda Sanchez (D-Calif.), it would amend Title XX of the Social Security Act to provide grants and training to support area agencies on aging or other community-based organizations to address social isolation among vulnerable older adults and people with disabilities.
Legislation to Support and Protect the Economic Security of Older Americans
- H.R.982 (Seniors Fraud Prevention Act of 2021). Introduced by Theodore Deutch (D-Fla.), it would direct the FTC to establish an office within the BCP to advise the FTC on preventing fraud targeting seniors and to assist the FTC in monitoring the market for mail, television, internet, telemarketing and recorded message telephone calls (robocalls) fraud targeting seniors.
- H.R.1166 (Retirement Freedom Act). Introduced by Gary Palmer (R-Ala.), it would allow an individual to opt out of Medicare hospital services benefits (Part A) without also having to opt out of Old Age, Survivors and Disability Insurance benefits and without having to repay Medicare hospital services benefits already received. The bill would also allow an individual to opt back in with no penalty.
- S.337 (Stop Senior Scams Act). Introduced by Robert Casey (D-Pa.), it would establish a Senior Scams Prevention Advisory Group to create model educational materials to educate employees of retailers, financial services companies and wire-transfer companies about how to identify and prevent scams that affect seniors.
- H.R.4289 [Well-Being Insurance for Seniors to Be at Home (“WISH”) Act]. Introduced by Thomas Suozzi (D-N.Y.), it would create a public-private partnership to create a new federal long-term-care insurance trust fund that would pay for the “catastrophic” period of long-term care for those who need many years of it.
- H.R.5237 (Reduced Costs and Continued Cures Act) Introduced by Scott Peters (D-Calif.), it would amend Titles XI, XVIII and XIX of the Social Security Act to lower prescription drug prices in the Medicare and Medicaid programs, to improve transparency related to pharmaceutical prices and transactions, to lower patients’ out-of-pocket costs, to ensure accountability to taxpayers, and for other purposes.
- H.R.5514 (Choose Home Care Act of 2021). Introduced by Henry Cuellar (D-Texas), it would amend title XVIII of the Social Security Act to improve extended care services by providing Medicare beneficiaries with an option for cost-effective home-based extended care under the Medicare program.
- H.R.5531 (Supporting Older Workers Act). Introduced by Marie Newman (D-Ill.), it would amend the Workforce Innovation and Opportunity Act to promote the employment of older individuals and also serve other purposes.
Legislation to Support Family Caregivers
- H.R.258 (To amend the Internal Revenue Code of 1986 to provide a tax credit for household and elder care services necessary for gainful employment.). Introduced by Barbara Lee (D-Calif.), it would allow for a tax credit for a taxpayer’s employment-related expenses necessary to care for a dependent who has attained age 50. Employment-related expenses include expenses for household services and expenses for the care of the dependent, including respite care and hospice care. The expenses must be incurred to enable the taxpayer to be gainfully employed for any period for which there are one or more dependents that qualify for the credit. The bill limits the amount of such credits to $3,000 for the care of one dependent and $6,000 for the care of two or more dependents of the taxpayer in a taxable year.
- H.R.1474 (Alzheimer’s Caregiver Support Act). Introduced by Maxine Waters (D-Calif.), it would authorize grants to expand training and support services for families and caregivers of individuals living with Alzheimer’s disease or related dementia. ]
- S.1885 (Family Medical Leave Modernization Act). Introduced by Richard Durbin (D-Ill.), it would expand who is permitted to take qualifying family and medical leave and provide additional leave for parents and family caregivers. The bill grants leave to employees to care for a domestic partner and any individual whose close association with such employees is like a family relationship, regardless of biological or legal relationship.
- H.R.3644 (Expanding Access to Retirement Savings for Caregivers Act). Introduced by Jackie Walorski (R-Ind.), it would allow an individual to make annual catch-up contributions to a retirement account before reaching age 50 if the individual leaves the workforce to provide dependent cares services.
Legislation to Improve Long-Term Support and Services and Support the Direct-Care Workforce
- S.2694 (Nursing Home Improvement and Accountability Act of 2021). Introduced by Ron Wyden (D-Ore.), it would establish reporting, staffing and other quality control requirements for Medicare skilled nursing facilities and Medicaid nursing facilities.
- S.3431 (Revitalizing the Aging Network Act). Introduced by Mark Kelly (D-Ariz.), it would seek to modernize and innovate the programs and services delivered under the Older Americans Act of 1965.
- H.R.6530 (SENIOR Act of 2022). Introduced by Lori Trahan (D-Mass.), it would amend the Public Health Service Act to sustain senior congregate care operations in the wake of ongoing COVID–19 financial burdens.
- S.2210 (Better Care Better Jobs Act). Introduced by Robert Casey (D-Pa.), it would establish programs and provide funds for state Medicaid programs to improve home- and community-based services (HCBS), such as home healthcare, personal care, case management and rehabilitative services.
A Basic Human Right
Legislating during these politically divided times is not an easy task, even for issues that most find worthy, such as taking care of America’s seniors. As is often the case, worthwhile legislation gets included in a bill with unrelated or controversial legislation that causes it to stall.
It is a complex time and there are many issues that need to be addressed on a policy level.
As a gerontologist, I want to caution against the idea that funding policy initiatives for America’s seniors is somehow selfish or depletes vital resources available for future generations. The ability to live our lives to the fullest throughout our entire life is a basic human right. Positive aging policies will impact all of us if we are lucky enough — either through the lives of our loved ones or our own. It is imperative to look ahead and prioritize the policies that will be necessary to allow seniors and their families to live and thrive in their communities.
Molly Prues, a gerontologist, is CEO and founder of VistaLynk, a company that provides education on the issues that impact older age and caregiving clients. VistaLynk’s ground-breaking programs provide the building blocks to reimagine aging and empower caregiving.