Bill Overview
Title: Improving Access to Advanced Care Planning Act
Description: This bill provides statutory authority for Medicare coverage of advance care planning services. It also (1) allows such services to be provided by clinical social workers, and (2) waives the coinsurance and deductible for such services (regardless of whether the services are provided as part of an annual wellness visit). The Centers for Medicare & Medicaid Services must conduct outreach about Medicare coverage of advance care planning services; the Medicare Payment Advisory Commission must study and report on the provision and utilization of such services.
Sponsors: Rep. Blumenauer, Earl [D-OR-3]
Target Audience
Population: Medicare beneficiaries
Estimated Size: 64000000
- The bill directly impacts Medicare beneficiaries by improving access to advanced care planning services.
- Medicare is the U.S. federal health insurance program primarily for individuals aged 65 or older, but also covers some younger individuals with disabilities and those with End-Stage Renal Disease.
- In 2023, there are approximately 64 million enrollees in Medicare.
- Advanced care planning is particularly relevant for older adults as they are more likely to require medical decision-making support due to complex health conditions.
- By waiving coinsurance and deductibles, the bill may increase utilization of these services among Medicare beneficiaries.
- Clinical social workers, as potential providers of these services, will also be impacted by this legislation.
Reasoning
- The policy is likely to affect older individuals, primarily aged 65 and above, who are enrolled in Medicare. This constitutes a significant portion of the population given the total number of Medicare beneficiaries.
- The policy will have differing impacts depending on individuals' health care needs and financial situations. Those with complex health conditions who require advanced care planning will be more affected.
- Clinical social workers will see an increased role in providing these services, which might impact their job satisfaction and workload.
- Some people may not perceive immediate changes but will benefit long-term by having access to planning services without financial barriers.
- Healthcare providers, including social workers, will need to undergo training and adjustments to integrate these services into their practices. This may pose a short-term burden but should stabilize over time.
- People already planning for advanced care may experience higher well-being due to reduced financial stress.
- Given the budget, not all 64 million beneficiaries will be directly influenced in year 1, suggesting targeted outreach and service provision.
Simulated Interviews
Retired teacher (Florida)
Age: 70 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 14/20
Statement of Opinion:
- The policy is fantastic because it takes away the financial stress of planning for future care needs.
- I worry about medical decisions if I can't speak for myself, so having a plan is comforting.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 8 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 7 | 5 |
Retired engineer (California)
Age: 82 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 6/20
Statement of Opinion:
- Having access to planning without cost is a relief given my wife's condition.
- It helps me feel prepared for the future, although I hope I don't have to use it.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 4 |
| Year 5 | 7 | 4 |
| Year 10 | 6 | 3 |
| Year 20 | 5 | 3 |
Clinical social worker (Texas)
Age: 63 | Gender: female
Wellbeing Before Policy: 8
Duration of Impact: 5.0 years
Commonness: 2/20
Statement of Opinion:
- Excited to play a bigger role in helping patients plan for their future care.
- There will be challenges with increased workload but overall rewarding work.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 8 |
| Year 2 | 9 | 8 |
| Year 3 | 9 | 8 |
| Year 5 | 9 | 8 |
| Year 10 | 8 | 8 |
| Year 20 | 7 | 8 |
Retired policeman (New York)
Age: 78 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 15.0 years
Commonness: 10/20
Statement of Opinion:
- I can’t really afford extra health expenses, so this change is critical for my budget.
- After recent surgery, I've realized the importance of having a care plan.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 7 | 4 |
| Year 5 | 7 | 4 |
| Year 10 | 7 | 4 |
| Year 20 | 6 | 4 |
Retired nurse (Ohio)
Age: 67 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 5.0 years
Commonness: 4/20
Statement of Opinion:
- This policy aligns with what I've always practiced as a nurse. It seems sensible to remove cost barriers.
- I'm glad to know my future care plans are secure at no extra cost.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 8 | 7 |
| Year 5 | 8 | 7 |
| Year 10 | 8 | 7 |
| Year 20 | 7 | 7 |
Disability benefits recipient (Illinois)
Age: 58 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 8/20
Statement of Opinion:
- It's a proactive step, I get nervous thinking about this, but glad the option is freely there for when I need it.
- Will likely use the service within the next year due to worsening symptoms.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 6 | 6 |
| Year 10 | 6 | 5 |
| Year 20 | 5 | 5 |
Retired chef (Washington)
Age: 74 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 8.0 years
Commonness: 12/20
Statement of Opinion:
- Removing the financial burden makes it practical for me to consider my future care.
- It's necessary to have someone designated for making care decisions.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 6 | 5 |
Retired farmer (Ohio)
Age: 81 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 9/20
Statement of Opinion:
- It's reassuring to have a clear plan as part of my ongoing health care, and financially I won't feel it.
- My family was concerned; this offers peace of mind.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 6 | 5 |
| Year 20 | 5 | 5 |
Retired librarian (Georgia)
Age: 85 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 3.0 years
Commonness: 14/20
Statement of Opinion:
- Given my age, planning ahead with clear financial options makes life easier.
- Unsure about the specifics, but trusting healthcare providers is key.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 6 | 6 |
| Year 3 | 6 | 6 |
| Year 5 | 6 | 5 |
| Year 10 | 5 | 5 |
| Year 20 | 4 | 4 |
Retired dentist (Arizona)
Age: 76 | Gender: male
Wellbeing Before Policy: 7
Duration of Impact: 4.0 years
Commonness: 3/20
Statement of Opinion:
- I appreciate steps to prepare for healthcare needs in my later years without added costs.
- Though I'm healthy now, it's wise to plan.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 7 | 7 |
| Year 5 | 7 | 7 |
| Year 10 | 7 | 6 |
| Year 20 | 6 | 6 |
Cost Estimates
Year 1: $500000000 (Low: $300000000, High: $700000000)
Year 2: $525000000 (Low: $315000000, High: $735000000)
Year 3: $551000000 (Low: $331000000, High: $770000000)
Year 5: $603000000 (Low: $362000000, High: $843000000)
Year 10: $741000000 (Low: $445000000, High: $1037000000)
Year 100: $1238000000 (Low: $743000000, High: $1733000000)
Key Considerations
- The policy is focused on improving access for a targeted group, which limits its wider economic implications but emphasizes its targeted social benefits.
- The use of clinical social workers can contain some costs yet broaden the range of providers.
- Advanced care planning can lead to improved alignment of medical treatments with patient wishes, potentially reducing expensive unwanted treatments.
- With the policy's focus on waiver of costs to beneficiaries, an increase in service demand and utilization is expected.