The November 2012 election is being referred to as the “groundhog day” election. President Obama was re-elected. Democrats retained control of the Senate. Republicans maintained control of the House and all respective congressional leaders remained the same (technically the Democrats increased their majority in the Senate and the Republicans saw their majority decrease in the House).
The new 113th Congress includes 20 women in the Senate. The election saw the defeat of a longtime champion of healthcare, Rep. Pete Stark, and two strong champions for older Americans, senators Herb Kohl and Olympia Snowe, who did not seek re-election.
But most leadership on key committees will remain the same. Exceptions include the Senate Budget Committee with Sen. Patty Murray as its new chair and Sen. Bill Nelson as the expected new chair of the Senate Special Committee on Aging. Sen. Lamar Alexander is expected to be the new top Republican on the Senate Appropriations Committee.
Although this will all be sorted out by the time this newspaper hits mailboxes, the road to the new 113th Congress had to go through the remaining work of the 112th Congress. Those nearly 100 lame-duck members still stood in judgment over issues, which will impact the new Congress. The most significant of these was the so-called fiscal cliff and how to avoid it.
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Complications of the Fiscal Cliff
The fiscal cliff was the combination of tax increases and spending cuts expected at year’s end unless alternative actions were taken by Congress and signed by the president. The cliff also meant a sharp decrease in reimbursement rates for physicians under Medicare.
Medicaid, the SNAP (food stamp) program and most support programs for veterans were exempt, and Medicare cuts were limited to 2 percent at the provider level. However, funding for hundreds of key social and human service programs was to be slashed by more than 8 percent. Estimates provided by the Leadership Council of Aging Organizations point to losing 17 million meals for elders, 3.5 million community service hours and several thousand jobs. The National Institutes of Health would suffer a $2.4 billion cut, eliminating 700 new research projects.
To avoid the cliff, most observers agree that new revenues from tax increases or reforms must be found. Deficit reduction only through spending cuts cannot be sustained. Additional spending will be needed to pay for the Medicare doc ‘fix’—which could keep Medicare reimbursement levels where they are—and for victims of Superstorm Sandy and the ongoing drought.
If an agreement on new revenues is reached, then the balance of the so-called grand bargain will come from compromises from both sides—mostly on the spending side. This could include some concessions from the Obama Administration related to entitlements and the Affordable Care Act (ACA).
Prognosis for the Year Ahead
The election produced one clear outcome: the ACA will go forward. Efforts to repeal it are over. The Obama Administration is working to ensure the law is implemented on schedule between now and 2015. The most immediate deadlines relate to establishing healthcare exchanges and the essential health benefits they will provide. Between December and February, states must decide if they will run a state-only exchange, partner with the federal government or have the federal government assume full responsibility. A proposed package of essential health benefits to be offered was issued as proposed rules in November.
The year ahead should also see progress on promoting good care transitions to lower hospital re-admissions, and further movement on care coordination through medical homes, accountable care organizations and related initiatives. The Elder Justice Act, also part of the ACA, will see new efforts to secure further funding and implementation.
Expired laws, including the Farm Bill, the Workforce Investment Act and the Violence Against Women Act, need to be addressed in 2013. Also there’s the reauthorization of the Older Americans Act, which is now two years late. Its renewal must be a primary advocacy goal. The Act could be on the threshold of helping to transform care options for millions of older persons through closer integration with the ACA around care transitions and greater support for home- and communitybased care. This is needed for the long-term sustainability of the ACA.
Also up for review in 2013 is the creation in 2012 of the Administration for Community Living, which combines the Administration on Aging with two existing disability offices.
Here is the enduring question for 2013: Does this election, which preserved the status quo in the electoral sense, also preserve the status quo of partisan gridlock and solution avoidance on key issues? One detects a more impatient American voter looking for leadership and solutions. They will vote again in 2014, when the full House and a third of the Senate are up for re-election.
That election, and the presidential election to follow in 2016, may produce the changes that the 2012 election did not.
Robert B. Blancato is president of Matz, Blancato & Associates in Washington, D.C. He serves on the ASA Board of Directors and Executive Committee and is co-chair of ASA’s Public Policy Committee.
Editor’s Note: This article appears in the January/February 2013 issue of Aging Today, ASA’s bi-monthly newspaper covering issues in aging research, practice and policy nationwide. ASA members receive Aging Today as a member benefit; non-members may purchase subscriptions at our online store.
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