The coronavirus has upended the daily lives of seniors, creating an urgent threat to their health and new challenges for how they meet their basic needs and receive long-term care services and supports.  Congress has already enacted several initial relief packages.  But more will be needed to prevent seniors from contracting the disease, provide access to testing and treatment to those infected, bolster the health care system, keep seniors in nursing homes safe, and provide services to seniors living in the community.

Preventing and Treating Infection

Because of early failures by the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA), the United States is well behind other countries in testing for COVID-19 infection.  This means we don’t know the scope of the infection rate and have limited tools to identify individuals who may be at risk of transmitting the disease.  As more tests are made available by the CDC and are fabricated by commercial manufacturers, the U.S. must test more individuals to identify infected people so they can isolate themselves and make sure that others that they have been in contact with are also identified and tested.

Congress has provided additional funding to states to help them contain the spread of COVID-19 in nursing homes.  The Coronavirus Aid, Relief and Economic Security (CARES) Act (P.L. 116-136) that became law on March 27, provides $2 trillion in economic and medical relief.  The Centers for Medicare and Medicaid Services (CMS) has received $200 million to prevent the spread of the virus in nursing homes.  But CMS must provide more oversight of nursing homes that take Medicare and Medicaid payment to ensure that facilities have in place, and comply with, infection control plans.  Toward that end, Congress has provided a much-needed infusion of resources to nursing homes and hospitals to help them improve staffing, training and acquire needed equipment.

Congress and states must ensure that free testing is easily accessible to everyone in the U.S.  More progress must be made to make sure drive-by testing sites are accessible throughout the country and that homebound individuals have access to testing.  Medicare Part B pays for COVID-19 testing and also covers telehealth visits with doctors if seniors need guidance on whether they should be tested.  The Families First Coronavirus Response Act (P.L. 116-127) enacted on March 13 requires private insurers to waive cost sharing for coronavirus testing.  Under the CARES Act, Medicare beneficiaries would pay nothing out of pocket for the COVID-19 vaccination under Medicare Part B.  And the new law provides a 20 percent Medicare add on payment to hospitals for COVID-19 related treatment.

Incentivizing the Development of Vaccines and Treatments While Preventing Price Gouging

Congress and the Administration must ensure that vaccines and treatments for coronavirus are accessible and affordable as they are developed.  That’s why they should say no to pharmaceutical manufactures when they use the crisis to seek expansive patent and regulatory monopolies to gouge taxpayers and patients.  There is no reason to give into their demands when the worldwide pandemic will enable drug manufacturers to make huge profits from fairly priced products on volume alone.  In addition, the FDA should not provide additional marketing monopolies to existing drugs that may be useful for treating COVID-19.

To the extent policy makers believe additional inducements are needed to incentivize development of vaccines or treatments for COVID-19, they should be targeted narrowly to reward speedy development of effective treatments or to fairly pay for the price of altering an existing drug or getting it approved for a new use.  The government should require reasonable pricing in return for public funding of any of the research used in developing treatments or vaccines.

Covering the Uninsured

While Congress provided much needed emergency assistance to the health delivery system in its initial relief efforts, it missed a chance to fill crucial gaps in our health care system that leave many uninsured.  As many people lose their jobs, they will become uninsured and won’t have access to coverage for COVID-19 testing or treatment.  The uninsured are themselves vulnerable to coronavirus and if they remain untested and untreated pose a threat to others, particularly seniors and individuals with other underlying health conditions.

Many uninsured individuals will receive health care coverage if they live in states that have expanded Medicaid.  But 15 states have not expanded the program.  In those states, subsidies to help pay for health insurance through Affordable Care Act marketplaces are available only to individuals with income between 100 and 400 percent of the federal poverty line.  States who have not yet done so should expand their Medicaid programs and Congress should allocate resources to allow states to receive a full federal Medicaid subsidy for the initial years of implementation, as it did for states that already expanded Medicaid.

The CARES Act delays scheduled reductions to Medicare payments made to hospitals which help the uninsured.  It is critical that proper oversight of these funds be maintained in order to be sure that hospitals that receive payments to help the uninsured are doing so.

Bolstering the Health Delivery System

In addition, Medicaid will need to be bolstered to meet the needs of the existing program.  Medicaid accounts for approximately half of all long-term care spending.  Congress has already authorized a 6.2 percent increase to the federal match rate to assist states during the emergency, but many Medicaid experts think a boost of 10-12 percent will be necessary to help states deal with the impact of COVID-19.

The CARES Act provides $4.3 billion to support federal, state and local public health agencies prepare for the coronavirus.  And the new law allocates $150 billion to a relief fund for states and territories and $100 billion to hospitals to help them respond to the pandemic.

The CARES Act reauthorized programs to provide training and education for health care providers including those in geriatrics.

It is imperative that distribution of CARES funds be monitored to make sure caregivers working in nursing homes and providing in-home care have the adequate training and equipment to keep seniors and themselves healthy.  Advocates for homecare workers report that with limited equipment, hospital workers are being prioritized.  Without adequate protection, home care workers will reasonably fear going to work.

Providing for seniors in their homes

Now that many seniors will be confined at home, there is an urgent need to provide new funding for home and community-based services including wage and benefit increases for home care workers to reward workers who go to work.  Benefits like paid sick leave and paid medical leave are important to protect the safety of workers and the vulnerable individuals they care for.

The CARES Act provides $955 million to Older Americans Act programs such as meals on wheels to make sure seniors who are homebound are properly fed, and the family caregiver support program that helps individuals who are caring for homebound loved ones have access to respite care.

While more funding for home-delivered meals will help older Americans staying at home, Congress’s decision not to improve Supplemental Nutrition Assistance Program (SNAP) benefits will deprive low income seniors of food.  Improved SNAP benefits would help many low-income seniors who will not have access to meals at adult day programs and a variety of charitable meal programs while they shelter in place.

The CARES Act has loosened home care requirements under Medicare to allow physician assistants, nurse practitioners, and other professionals to order home health services for beneficiaries.  This will reduce the burden on already overwhelmed physicians allowing beneficiaries to get access to care in their homes more quickly.

To ease access to medications for homebound seniors, Medicare and Medicaid should make it easier to fill prescriptions.  The CARES Act gave seniors access to 90-day refills under Medicare Part D.  Further efforts should be made to streamline the appeals process to make sure that Medicare Advantage plan’s utilization management tools such as prior authorization, step therapy and restrictive formularies do not provide a barrier to seniors accessing medications.

One area the National Committee thinks is especially important for Congress to address in further COVID relief bills is more funding for home and community-based services.  It is vitally important for seniors to remain in their homes to avoid infection.  For this reason, we support S. 3544 and H.R. 6305, the Coronavirus Relief for Seniors and People with Disabilities Act, which creates a Medicaid grant for states to bolster their home and community-based services.  Grants could be used to improve compensation and to provide paid sick leave and paid medical leave for home care workers, important steps to boost the homecare workforce and keep workers and seniors safe from infection.