A Doctor from the Leakey, Texas, Area Visiting an Elderly Patient, near San Antonio
A Doctor from the Leakey, Texas, Area Visiting an Elderly Patient, near San Antonio. Photo courtesy U.S. National Archives

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By Thomas Goldsmith

A new president in Washington and new governor in North Carolina — either incumbent Pat McCrory or preliminary general election winner Roy Cooper — will have plenty of public policy issues to address that affect older North Carolinians.

However, answers are yet elusive about specific steps President-elect Donald Trump will take at the national level, or how a new North Carolina governor will approach issues such as community-based care and the situation of people who are eligible for both Medicare and Medicaid.

“Certainly, if one looks at the data, Medicare would be an issue, just like Social Security would be an issue, that demands attention,” said Robert Clark, professor of economics and management, innovation and entrepreneurship at North Carolina State University.

U.S. Congressional House Speaker Paul Ryan (R-WI) has long called for replacing the current Medicare system, which is essentially single-payer health care for seniors and people with disabilities, with “premium supports” for those beneficiaries to buy private insurance. Official Congressional portrait.

With Republicans in charge in the White House, the U.S. Congress and potentially the U.S. Supreme Court, Clark said, there could be an opportunity for the federal government to make changes in the massive programs that help support the health and well-being of millions of older Americans.

Trump has called for maintaining Social Security and Medicare at present levels, but both programs face projected shortfalls especially as Baby Boomers age.  Trump’s policy statements suggest reductions in Medicare fraud and waste, required price transparency from all health care providers, and the chance for consumers to buy “safe, reliable and cheap” drugs from overseas.

“While Trump vowed throughout his campaign to leave Social Security and Medicare untouched, congressional Republicans have targeted both programs and it is not clear whether the new president would resist their efforts to cut benefits,” Howard Gleckman, a resident fellow at The Urban Institute, wrote in Fortune this week.

Bill Lamb, executive director of Raleigh-based Friends of Residents in Long Term Care, said President Barack Obama and his predecessors had made a habit of delaying action on Social Security and Medicare.

“Everyone so far has been kicking that ball down the road and that ‘down the road’ is now,” Lamb said. “You only have two ways to fix it: You’ll have more money coming in or less money going out. You either have to raise taxes on somebody or you’re going to have to hose someone.”

Social Security changes mulled

Cuts in overall spending on Social Security could involve either limiting existing benefits or continued upward movement of the eligibility age. Candidate Hillary Clinton suggested lifting the cap on the amount of income on which earners have to pay Social Security tax, set at $118,500 for 2016.

A Pew Research Center report on Tuesday’s election found 53 percent of older voters preferred businessman Trump, while 45 percent chose former Secretary of State Clinton, a Democrat.

Check out our other stories on the implications of the election on NC health issues:
What the Election Could Mean for NC: Environmental Health
What the Election Means: Health Care in NC

At the state level, changes in Medicaid could also affect older residents, as many are dual eligibles who qualify for both Medicaid, which covers health care costs for low-income and disabled people, and for Medicare, health coverage for people 65 and older.

A state advisory committee on dual eligibles will meet Thursday at the McKimmon Center at N.C. State University to continue its work to determine how this population should be covered under North Carolina’s proposed Medicaid reform plan. (The term “dual eligible” is used in other contexts to describe people who require treatment for both mental illness and substance abuse.)

North Carolina is waiting for a federal response to its application to convert the state’s Medicaid services from a fee-for-service to a managed-care approach.

“It doesn’t matter”

If Cooper emerges as governor when the vote is certified late this month, the Democrat will be able to replace department heads and division leaders throughout state government, including health and human services agencies crucial to services for older people. He would also propose a state budget, although the GOP-led state legislature is under no obligation to adopt it.

“Because Democrats didn’t pick up any seats in the house, it doesn’t matter who’s governor,” Lamb said. “They’ll do some face-saving, lip-service kind of stuff. It’s going to be anti-regulatory.”

The state Coalition on Aging, which represents 45 North Carolina groups, will be pushing for issues including increased spending on programs that allow older people to remain at home longer, such as adult day care and community-based care, said Mary Bethel, president of the coalition.

“I think advocates for aging people want to make sure there’s a robust continuum of care,” Bethel said.

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Thomas Goldsmith

Thomas Goldsmith worked in daily newspapers for 33 years before joining North Carolina Health News. Goldsmith is a native Tar Heel who attended the UNC-Chapel Hill, and worked at newspapers in Tennessee...

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