What Happens When Obamacare Gets Repealed?

What Happens When Obamacare Gets Repealed?

Promises to repeal Obamacare (the Affordable Care Act) abound but "replacement" still appears very murky. Many agree that repealing it is warranted (though many disagree) but few can agree on what replacement would entail. Here is a look at some of the real life effects of repeal, focused on the minimum wage worker. The articulated plans for replacement miss these workers who are most likely to lose health insurance coverage altogether when mandates are repealed.

According to the Bureau of Labor Statistics, In 2014 there were 77.2 million workers in the United States paid at hourly rates, representing 58.7 percent of all wage and salary workers. Among those paid by the hour, 1.3 million earned exactly the prevailing federal minimum wage of $7.25 per hour. About 1.7 million had wages below the federal minimum. The average American worker got paid $24.57 per hour, or $850.12 per week. And averages can be deceiving. They lump together those who may be educated with those who have less education and value in the workplace. For this discussion, we focus on those who work full time, at the low end of the wage scales.

Repeal will immediately remove the employer mandate which means that employers who do not care to undertake the expense of insurance coverage for their groups of employees would simply stop covering them. Millions of workers would lose coverage, and be expected to pay for it themselves with so called "health savings accounts" or tax credits.

Those who have announced their positions on this, particularly those most likely to influence what happens after repeal believe that health savings accounts are the answer and that everyone without insurance will then be motivated to save their money and buy coverage themselves.

Reality check: the lowest income workers do not have any money to save. It is not about motivation. It is about living at the edge of poverty. These workers spend every penny of that minimum or low end wage on food, clothing and shelter and there is nothing left to pay for insurance without the existing subsidies. The myth of health savings accounts is that there is, in fact, money available to save so you can pay for insurance yourself. Repeal will mean no health insurance subsidies, which are a controversial feature of Obamacare and one of its main pillars.

Workers who only have coverage through employers who then drop coverage would return to being uninsured. When they get sick or injured, they will not receive treatment, or they will go bankrupt with medical bills they cannot pay. Essential preventive care will not be available as it is now in all insurance policies and minor problems become major health issues, some resulting in death.

Another premise of the as yet undefined replacement plan is that offering tax credits will also motivate people to buy their own insurance when subsidies and the individual mandate, now also main pillars of Obamacare, are gone. As with health savings accounts, the same incorrect assumption applies. Low wage workers do not have enough money to advance for monthly insurance premiums to attain a tax credit at year end. Simply put they can't afford it at all and a benefit at year end does not create a higher monthly salary for them. The politicians and appointees who want to use health savings accounts and tax credits as replacements for health care insurance subsidies are the same people who vehemently oppose raising the minimum wage. The majority in power will succeed in that.

Ask any minimum wage worker: Do you have extra money left after you pay for your rent, transportation, kids' needs and groceries each month? They will say no. Anything left buys a child a pair of shoes, not health insurance. They will take a chance on never getting sick, never being in an accident and never having a family member who has a chronic or life threatening health condition. How realistic is that?

Anyone who is working full time and is not quite poor enough to qualify for Medicaid is not in the world of the cabinet picks and advisors who created the fantasy of how it is supposed to be with tax credits and health savings accounts. Perhaps the bureaucrats cannot imagine what it is like to have zero in the bank account after the most essential costs of everyday life are paid from one's paycheck. Amid that and the force that will keep wages low for the lowest on the wage ladder, where are we leaving so many who work every day but will have no health insurance?

Replacement needs to be thought out in terms of the millions of workers who stand to lose coverage altogether when the law that now helps them buy health insurance is repealed. Keeping coverage for those with pre-existing conditions sounds fine, if you can pay for the insurance premium that is. If you lose your coverage, it matters not whether the insurer would take you with a pre-existing condition. You have to be able to pay for coverage whether there is a pre-existing condition or not. And keeping coverage in place for one's children until age 26 also sounds fine, but only if you, the worker are covered and can pay for the insurance yourself or you are lucky enough to get it through your employer.

The ACA also expanded Medicaid for those living at and below the poverty line. If Medicaid is shrunk, as some politicians want, so as to "cut government spending" it will destroy the only means the least fortunate have to get any coverage at all. Must we let them die in the streets? No charity in existence buys health insurance for anyone. That is the very reason why Medicaid exists--to cover the poorest among us. As flawed as Obamacare is, that is all there is for over 21 million previously uninsured people. My hope is that better solutions can be found than completely obliterating coverage for so many. Note to politicians: get with it and figure it out!

Carolyn Rosenblatt, RN, Attorney, AgingParents.com and AgingInvestor.com

Podcast Interview: Common Challenges in Helping Aging Parents

Podcast Interview: Common Challenges in Helping Aging Parents

Interview: Common Challenges in Helping Aging Parents

Hello everyone. Welcome to better health while aging, a podcast that gives you strategies and tips about improving the health and well-being of older adults. We discuss common health problems that affect people over age 60, the best ways to prevent and manage those problems and we also often address common concerns and dilemmas that come up with aging parents and other older loved ones, like what to do if you're worried about falls or safety or memory or even the quality of a seniors healthcare.

I'm your host Dr. Leslie Kernisan. I'm a practicing geriatrician, so that means I'm a medical doctor specialized in geriatrics, which is the art and science of modifying healthcare so that it works better for older people, and for their families.

Today’s episode features a special guest and we are going to be talking about common challenges related to aging parents. My guest is Carolyn Rosenblatt. She is an attorney and a registered nurse, and for the past several years she and her husband Dr. Mikol Davis, who is a geriatric psychologist, have specialized in helping families resolve difficult issues related to older parents. They have a website at AgingParents.com.

Carolyn is the author of “The Family Guide to Aging Parents” and several other books about assisting older adults with legal, financial, and life issues. She also write a column about aging for Forbes.com.

I have read many of Carolyn’s Forbes columns over the past few years and also read her book recently as I was writing one of my own articles about advance planning for legal and financial issues. So I’m thrilled that she was able to join me today to share some of her insights on how to manage some of the common challenges and dilemmas that families often struggle with.

Carolyn, welcome to the show.

Questions:

  • Tell us about your practice and how did you come to specialize in families and aging parents?
  • What are the most common types of problems that people ask you to help them with?
  • Some common scenarios we can discuss:
    • People are sometimes concerned that their parent is losing mental abilities, or becoming “incompetent.” They also often complain that their parent is refusing to talk about the issues and refusing to go see a doctor. What are some of your suggestions to help families resolve this?
    • People worried about how their parents are spending money, and/or worried that someone else is influencing the spending (e.g. a sibling)
    • People worried about their parents driving
    • People who want their parents to plan for decline in the future but the parents refuse or avoid the subject
  • How can older adults and their adult children plan ahead to avoid many of these difficult situations? Can you share some favorite resources that are effective in helping people through this?
  • For families that have set up springing powers of attorney, there is often a requirement that a doctor or other clinician say the older person no longer has capacity to manage finances or whatever power is in question. But families often say they can’t get the person to the doctor/psychologist to obtain this assessment. Suggestions?
  • There is really a lot that families could and should do to plan ahead. If people are feeling really limited in time and energy, what do you think are the most important or high-value things to do, when it comes to older parents who are doing ok now.
    • Another angle on this: what are the things that people end up regretting not doing the most often?
  • You’ve written a lot about preventing financial abuse of older adults. What are some useful steps you recommend to prevent this from happening, or from causing serious financial losses?
  • You have a chapter on helping older parents from a distance, and you write about how you and your husband eventually hired a care manager, in order to have someone close to your mother-in-law. What do you recommend for people who feel they can’t afford to hire a care manager?
  • How can families deal with declining abilities, dementia, and physical dependency if there isn’t family to provide care or money to hire someone?
  • How have you and your husband planned for your own future? (We can skip this if it’s too personal.)

At the end I will tell people they can learn more about you and your special consultation practice at AgingParents.com.

Financial Advice Your Boomer Clients May Need

Financial Advice Your Boomer Clients May Need

Are you considering the issue of Boomers having to care for their aging loved ones in retirement? You've probably done a good job with helping clients be ready for retirement age, but every financial professional needs to consider a massive problem we now face. Our oldest old are living longer than anyone expected and they can run out of resources. Their adult children might have to care for, pay for or take in their aging parents.

Years before, the parent probably extracted a vow from the adult child your client, (typically a daughter) "promise you'll never put me in one of those homes".  And the daughter, without much thought replied, "Of course Mom. I'd never do that".  How time changes things.

The concept of "being put in a home" is vague, based on largely outdated notions our elders have of ugly warehouses for the poor, something conjured not just out of an English novel, but out of the way things once actually were in some places, long before Medicare and Medicaid existed to ensure at least some care for our elders. We did neglect older impoverished people and place them in poorly regulated homes.

Things are supposed to be better now, with the rise of public benefits, and government regulations over skilled nursing facilities, all designed to keep residents safe and in a somewhat dignified existence. The intended outcome of these regulations does not always meet reality. The cost of caregiving for all but the lowest income in our society is borne by the elders themselves if they have the funds or by their families if the parent has limited means.  .

Advisors may discuss with retirement-age clients that Medicare doesn't cover all the costs of medical treatment that clients themselves may need as they age. But few advisors have the foresight to ask their clients if they anticipate also having to pay the cost of care and out of pocket medical expenses for their parents too.

We have a 94 year old mother in law. She's in decent health, and has the means to cover what she needs now and in the future. We're among the fortunate ones. Years ago, we and my husband's parents made a joint investment that pays enough income for her, now widowed, to live on. She can cover health emergencies, home care, expensive medications and whatever downturns her health may bring. She has savings as well. This is not how it works for the average person in our country. Perhaps your clients are wealthy but their parents might not be.

Some folks solve the issue of what to do by bringing the aging parent into their homes and providing or paying for care themselves. This multi-generation household approach is a cost effective way to house an aging parent with limited resources and cover many expenses that would otherwise have to be borne by the elder who just might be low income by the time they reach the age of 94, like she did in my family.

Bringing in the aging parent to live with you is not a solution for everyone, but one worth considering. If you broach the subject with your Boomer clients, you can get them thinking about this. Longevity is increasing steadily and it is going to affect those whose parents live longer than anyone thought they would. The takeaway here is for you, the financial professional to ask them about it.

Here are some basic questions you should ask:

"Do you anticipate having to pay for support for anyone else during your retirement years? Are your parents living? How is their health these days? What would you do if they got low on funds and needed care? Have you thought about what it would cost to care for them?"

Learn more about how your clients need to discuss finances with their own aging family members at AgingInvestor.com in Succeed With Senior Clients, A Financial Advisor's Guide to Best Practices. You'll be doing a great service and prudent planning when you initiate the discussion they need to have.

Can Brain Images Tell You If Your Aging Client Can’t Handle Money Any More?

Can Brain Images Tell You If Your Aging Client Can’t Handle Money Any More?

The National Institute on Aging reports that scientists are using magnetic resonance imaging (MRI) of the brain to explore the parts associated with money managing abilities. Can we actually see a picture of this?

The report cites neuropsychologist and lawyer, Dr. Marson. “It’s the $18.1 trillion problem,” said Daniel Marson, J.D., Ph.D., professor of neurology at the University of Alabama at Birmingham, citing an estimate of household wealth held by U.S. adults age 65 and older. “That money is at risk in part because of the cognitive disorders of aging.”

We don't have a way to pinpoint an exact spot in the brain that would tell us that a person is or is not competent with finances, but the report describes novel efforts using MRIs to find out more than ever about the brain and financial capacity. Changes in certain parts of the brain are linked to loss of financial capacity.

New techniques are providing intriguing data on why older adults—even those who were previously quite savvy about finances—may lose their money-managing abilities,” said Nina Silverberg, Ph.D., program director of the Alzheimer’s Disease Centers at NIA’s Division of Neuroscience.

What does this mean for you and your aging client?  It may be one more objective way to verify what you already suspect: that an older client is not savvy anymore when it comes to handling finances. The trick would be persuading a client to get this brain image if you and the family suspect that the client is in cognitive decline. We don't have the MRI techniques nailed down to verify loss of money making decisions, but that seems to be on the horizon.

Meanwhile, every advisor needs to be aware of the subtle signs of impairment in your client. An aging client who is in the earliest stages of Alzheimer's for example, is already moderately impaired for making safe money decisions. That means that you, a responsible advisor have in place a clear path to bringing in a surrogate decision maker to help that client. Part of that $1.8 trillion Dr. Marson mentions as being at risk is what is paying your fees. Take prudent steps to protect it.

Learn fast about spotting diminished capacity with our downloadable free checklist at AgingInvestor.com.