The last White House Conference on Aging was held in 2015. It commemorated the 80th anniversary of Social Security and the 50th anniversary of Medicare, Medicaid, and the Older Americans Act. Those landmark laws have improved the lives of countless older Americans. 

At the time the Conference was held, the Older Americans Act (OAA) was unfunded. Congress reauthorized the OAA in 2016 for a five-year period. In 2020, funds were appropriated for OAA programs through 2024. As Congress again struggles to pass appropriations to continue funding the government, it is important to look back on legislation that is important to older adults and to consider how those laws can be improved.

History of Medicare

The original Medicare program, consisting of hospital insurance (part A) and medical insurance (part B), took effect in 1965. While earlier proposals for comprehensive health insurance coverage for seniors faltered, public demand grew in the early 1960s, when it became clear that more than half of the nation’s older adults were uninsured.

President Johnson signed Medicare into law on July 30, 1965. During the signing ceremony, the nation’s first Medicare card was issued to former President Truman.

The original Medicare program expanded in subsequent years. In the 1980s, Congress added hospice services to Medicare coverage. Options for private health plan coverage (part C) and prescription drug coverage (part D) were added in subsequent decades.

More recent changes to Medicare were implemented in 2010 as part of the Affordable Care Act (also known as Obamacare). Medicare reforms reduced costs, improved delivery of services, and boosted enrollment in Medicare Advantage programs while lowering premiums. Obamacare also lowered the cost that Medicare part D enrollees pay for prescription drugs.

A recently enacted law caps out-of-pocket spending on prescription drugs under Medicare Part D at $2,000 per year. That cap will take effect in 2025 and is expected  to save seniors an average of $400 per year in out-of-pocket expenses.

History of Medicaid

Medicaid, also enacted in 1965, is a means-tested program that provides health insurance to low-income and other needy individuals. Administered by state governments in partnership with the federal government, Medicaid currently provides health coverage to 7.2 million low-income seniors.

While coverage details and eligibility differ from state-to-state, Medicaid benefits available to seniors who are covered by Medicare typically include expanded nursing facility care and payment for eyeglasses, hearing aids, and prescription drugs. Most states have adopted programs that fund at least some level of in-home or community care for seniors who might otherwise need to live in nursing homes.

History of OAA

The Older Americans Act took effect in 1965. The OAA uses federal grants to assist states in establishing community-based programs that provide services to people over the age of 60. Those services include elder abuse protection programs, family caregiver support, home-based nutrition (meals on wheels) programs, transportation services, preventive health services, and “healthy aging” programs.

The OAA also created the Administration on Aging to advocate for older adults. The Administration on Aging oversees regional agencies that work locally to deliver services to older adults.

Meeting Future Challenges

Older adults were represented at the 2022 White House Conference on Hunger, Nutrition, and Health. That conference created a national strategy to end hunger in the United States before 2030. The strategy includes a call for increased funding for OAA nutrition programs. The private sector pledged to donate meals and provide free food delivery for vulnerable populations, including low-income older adults.

A proposed update of OAA regulations will encourage innovation in nutrition and meal delivery programs, add rules to implement the National Family Caregiver Support Program, and strengthen programs that provide legal assistance and elder abuse prevention

Achieving the goals of the OAA is hampered by the underfunding of programs that are essential to the law’s mission. Annual funding increases have fallen well short of inflation. Because meal programs lack sufficient resources, only 10% of older adults who are eligible for meal services receive them.

Medicare is essential to the health of older adults. Still, Medicare fails to deliver most dental, hearing, and eye care services that are important to a senior’s quality of life. Proposals to add those services to Medicare have not been enacted into law. 

Opponents of improvement in Medicare services complain that they would hasten the insolvency of Medicare. That objection that could easily be resolved by increasing the cap on FICA taxes so that high-income workers would be taxed on the same percentage of their income as workers earning an average income.

Medicaid covers nursing home expenses for the poorest seniors but coverage for in-home services varies from state to state. Expanding Medicare coverage to include nursing home care and in-home caregiving services would allow unpaid family caregivers to return to work. 

A White House Conference on Aging has been held in each decade since the 1960s. It is not clear when another conference will be convened. It is time for another Conference on Aging to address issues facing a growing population of elders in the 2020s.