Before you vote, take the time to get to know where the candidates stand on issues that matter the most to AARP members and their families. This guide helps explain more about the top federal voting issues for older adults, as well as some guiding principals when it comes to the future of our health care and economic security. For more information on any of these voting issues, go to www.aarp.org/vote.
Medicare Must Be Preserved and Strengthened
Medicare provides affordable health care for 60 million seniors. Hardworking Americans pay into the program their entire working lives and are guaranteed benefits. It’s a deal that must not be broken. Congress must keep the promise it made a half century ago so the American people may continue to live with dignity and financial security as they age.
That’s why earlier this year AARP successfully fought off drug company attempts to undo the law that closes the Medicare Part D doughnut hole a year early and lowers drug costs for seniors. AARP has also long opposed legislation that would reduce benefits or shift costs onto consumers, such as turning Medicare into a voucher program in which beneficiaries would receive a set amount of money each year for their health care. Vouchers would dramatically increase health care costs and risks for current and future retirees.
Within eight years, Medicare won’t be able to pay full hospital benefits. Rising health care costs stemming from rapidly increasing prescription drug prices, new technology, and inefficient and uncoordinated care threaten Medicare and the entire health care system. Slowing down the rate of growth in costs is especially crucial for Medicare, as the number of enrollees is expected to increase by more than 20 million between 2018 and 2030.
People and their families must remain at the center of health care in partnership with providers, who must be held accountable for the cost and quality of care.
AARP Guiding Principles
As you consider a candidate, keep in mind AARP’s guiding principles on the Medicare program:
- Guarantee coverage to older people and people with disabilities, regardless of their incomes or health status.
- Guarantee affordable benefits that meet the needs of people with Medicare, which means no unaffordable premiums or cost-sharing. It also means exploring ways to expand coverage to important services like dental care and hearing aids.
- Provide high quality and high value care that is right for each person.
- Ensure all people with Medicare have access to health care through an array of enough qualified health care providers that are sufficient to meet the needs of beneficiaries.
- Sustain Medicare for the future by reducing waste and fraud, and ensuring that its resources are spent wisely.
- Enable Medicare to innovate and collaborate with the broader health care system. This means ensuring that Medicare can keep up with new ideas and technologies, and work with the larger health care system to help improve quality of care.
Medicaid: A Lifeline for America’s Seniors and People with Disabilities
Medicaid provides a vital safety net for millions of Americans, including more than 17.4 million seniors and children and adults with disabilities who rely on the program for critical health care and long-term services and support, such as help with daily activities including eating, bathing, dressing, managing medications, and transportation.
The joint federal-state program provides affordable health care for America’s most vulnerable citizens with low incomes and few assets. In many states, Medicaid is also available to hardworking Americans who in 2018 will earn less than $22,715 for a two-person family, or $34,638 for a family of four, and do not have access to health care on the job.
Last year, AARP successfully fought Congress’s proposed $772 billion cut to Medicaid, which would have caused many seniors to lose the services they need to stay in their homes, in their communities and in nursing facilities. Rural hospitals especially count on Medicaid to cover the costs for those in need when an accident or illness strikes. Without that support, rural hospitals are forced to close, depriving area residents of access to care. Medicaid is essential to keeping our rural communities healthy and strong.
AARP has long advocated for quality, affordable services to be available through Medicaid. In particular, AARP has called for more reliable coverage of services at home and in the community, increased quality measures, and health care for more hardworking Americans with lower incomes who have no access to insurance on the job.
Under federal law, Medicaid covers inpatient and outpatient hospital care, physician services, rural health clinic services and nursing home care. States also help pay for some services at home and in the community to help seniors and people with disabilities who require help with daily activities, avoiding more costly nursing home care. However, because these home- and community-based services are not
mandated by federal law, they vary widely across states and are only available at the discretion of state policymakers.
AARP Guiding Principles
As you consider a candidate, keep in mind AARP’s guiding principles on the Medicaid program:
- Medicaid shouldn’t force seniors and people with disabilities in need from their homes and into nursing homes. Instead, Medicaid should also offer services that help seniors and people with disabilities who are eligible stay in their homes where they want to be. This is not only more cost effective — care at home costs much less on average than in nursing homes — but it is also the right, commonsense policy.
- America’s most vulnerable citizens with low incomes who are eligible for Medicaid should be able to access the program when and where they need it, for as long as they need it.
- Arbitrary changes to Medicaid, like block grants (lump sums to states) and caps, are just Washington code for cuts. Such reductions would mean seniors and people with disabilities could lose access to the vital services that help them remain in their homes, hardworking Americans could lose their health insurance, people could lose their jobs and state economies would be threatened.
Social Security: Keep It Strong for Future Generations
Social Security has remained strong over its 83-year history largely because of its dedicated financing and the commitment of past congresses and presidents to work together to make the changes needed to secure its financial future.
AARP has been fighting for 60 years — and will continue to lead the charge — to keep Social Security viable for current and future generations. When the president proposed turning Social Security into private accounts in 2005, AARP mobilized the power of millions of its members to defeat that harmful plan. In 2010 and again in 2013, after the president’s deficit commission recommended cutting the cost of living adjustment (COLA), AARP fought and won.
While the program remains secure today, it needs modest changes to ensure that future generations will get the benefits they’ve earned. Currently, Social Security can pay full benefits for just over 15 years. But if nothing is done to make the program financially sound for the long term, benefits will be cut by about 25 percent in 2034, according to the latest Social Security Board of Trustees report.
In addition, Social Security must be updated to meet changing realities. Life expectancy is increasing, people are having fewer children and there are more women in the workforce than when the program was created. Policymakers also need to be aware that current benefit levels are modest and that people rely heavily on their Social Security benefits. In addition, the retirement landscape has changed, with fewer people guaranteed pensions.
With modest adjustments, we can better preserve, protect and ensure adequate benefits for both current and future generations.
AARP Guiding Principles
As you consider a candidate, keep in mind AARP’s guiding principles on the Social Security program:
- Achieve long-term solvency and adequacy. Social Security should be sufficiently financed to ensure solvency for the long term. Any changes must ensure meaningful benefits for future generations.
- Reaffirm Social Security’s fundamental character. Social Security should continue to provide a stable foundation for retirement income. It should remain a partnership among individuals, employers and the federal government. It should also maintain its role in providing protection for workers and families affected by death or disability. All covered workers should contribute equitably to the program and receive benefits.
- Ensure protections for those most in need. Reforms should consider the needs of those most reliant on Social Security and those who have difficulty postponing retirement.
- Recognize the value of Social Security’s core elements. Social Security should continue to reward work. The key elements of Social Security’s successful structure should be preserved: progressive, defined benefits that cannot be outlived; inflation protection; and benefits based on earnings.
- Make improvements to reflect today’s workforce. An updated Social Security program must address economic and demographic changes to be able to respond to the needs of future beneficiaries and their families.
- Ensure fairness. Changes to the program should be implemented gradually and should protect current beneficiaries and near retirees.
Family Caregivers Need More Support
More than 40 million Americans care for older parents, spouses, children and adults with disabilities or other loved ones, helping them to live independently in their homes and communities — where they want to be.
AARP advocates for family caregivers — and the loved ones who count on them — on Capitol Hill and in state capitals across the country. This year, AARP fought successfully to enact the federal bipartisan Recognize, Assist, Include, Support and Engage (RAISE) Family Caregivers Act, which creates a multidisciplinary task force to recommend how to provide better, more coordinated support for America’s family caregivers.
At the state level, AARP state offices have worked to pass hundreds of new laws to provide family caregivers access to care at home, workplace flexibility, training, relief and much more. In addition, in about 40 states and territories, the AARP-authored CARE (Caregiver Advise, Record, Enable) Act is now law, supporting family caregivers when their loved ones go into the hospital and as they transition home.
The unpaid assistance America’s family caregivers provide — valued at about $470 billion annually — ranges from bathing and dressing to transportation and complex medical tasks. They are the first line of assistance for older Americans and people with disabilities, helping to delay and prevent more costly nursing home care and unnecessary hospitalizations, saving taxpayer dollars.
Family caregivers are the backbone of America’s care system, yet they continue to face physical, emotional and financial challenges as they care for loved ones. Most juggle caregiving duties while also working full- or part-time jobs. They also use on average about 20 percent of their own income, about $7,000 a year, on necessities like home modifications, assistive technology and adult day care. Some are still raising their own families.
Family caregivers will only face greater strains in the future as the number of potential family caregivers per loved one in need of assistance shrinks. In 2010, the caregiver
support ratio was about seven potential caregivers for every person 80 or older. By 2030, this ratio is projected to decline sharply to 4 to 1; by 2050, less than 3 to 1.
AARP Guiding Principles
As you consider a candidate, keep in mind AARP’s guiding principles on advancing policies to support family caregivers:
- Helping family caregivers navigate financial challenges. This includes updating state guardianship laws and passing the Uniform Power of Attorney Act in states, as well as a modest tax credit for caregivers.
- Protecting and increasing access to care at home and in the community.
- Breaking down the barriers that prevent use of telehealth, including access to the technology that can help family caregivers manage their own or their loved one’s health.
- Helping family caregivers balance responsibilities at home and work through paid and unpaid leave policies.
- Modernizing laws to allow nurse practitioners and all advanced practice registered nurses to provide the quality health care that patients and their family caregivers depend on. And allow nurses to delegate authority for certain tasks to trained home care professionals, as opposed to only family caregivers.
- Expanding respite care services that allow family caregivers to take a hard-earned break.
Demanding Lower Prescription Drug Prices
AARP is calling on Congress to protect seniors and all taxpayers from price gouging by big drug companies. There is no reason Americans should continue to pay among the highest prescription drug prices in the world.
Last year AARP successfully kept drug company lobbyists from breaking a deal to close the Medicare Part D doughnut hole a year early, which would lower drug costs for seniors. AARP also supports the Creating and Restoring Equal Access to Equivalent Samples (CREATES) Act, which would prevent pharmaceutical firms from delaying entry of affordable generic drugs in the marketplace.
The simple answer to why drug prices are so expensive is because no one is stopping pharmaceutical companies from charging such high prices. The United States allows drugmakers to set their own prices with no transparency. And pharmaceutical firms, which spend billions of dollars on marketing and lobbying, are publicly owned and concerned about their bottom lines. They often focus on drugs that will bring in the most profit, and drug companies are among the most profitable public businesses in America.
Other contributing factors include pharmaceutical companies extending patents so they have longer monopolies, doctors writing prescriptions for medicines familiar to them — thanks to the concerted marketing by drugmakers to health care professionals — and the inability of Medicare to negotiate prices.
Skyrocketing prices are pushing important prescription drugs out of reach for the older Americans who need them. People with cancer, asthma and diabetes are having trouble affording life-saving medications.
In addition, costly prescription drugs could lead to higher health insurance premiums, deductibles and cost-sharing for all Americans. High prices also increase costs for taxpayer-funded programs such as Medicare and Medicaid. This translates into higher taxes and cuts to public programs that affect all Americans.
AARP Guiding Principles
As you consider candidates, keep in mind AARP’s guiding principles on prescription drug prices:
- Medicare should be allowed to negotiate prescription drug prices, which it is now prohibited by law from doing. The Secretary of Health and Human Services should be authorized to allow Medicare to use the bargaining power of its 60 million beneficiaries to negotiate lower prices, particularly for high-priced brand-name drugs.
- Allow the importation of drugs. Americans pay the highest brand-name drug prices in the world. We should increase competition by allowing for the safe importation of less expensive but equally safe and effective drugs from abroad.
- Increase price transparency. Drug manufacturers are charging whatever they want for their products with no explanation. This must stop.
- Speed generic drugs to market. Brand-name drug manufacturers game the system to extend their patents or exploit loopholes to prevent generic drugs from coming to market. We need to end those practices.