Bill Overview
Title: Advancing Integration in Medicare and Medicaid (AIM) Act
Description: This bill requires state Medicaid programs to develop strategies for integrating and coordinating Medicaid and Medicare coverage for individuals who are dually eligible for both, including with respect to enrollment, quality measures, and access to care.
Sponsors: Sen. Scott, Tim [R-SC]
Target Audience
Population: Dually eligible individuals for Medicare and Medicaid
Estimated Size: 12000000
- There are approximately 12 million individuals who are dually eligible for both Medicare and Medicaid in the United States.
- The bill directly impacts individuals who are enrolled in both Medicare and Medicaid, focusing on better integration and coordination of their healthcare coverage.
- Global estimates of dual-eligible individuals would be equivalent to U.S. estimates as Medicare and Medicaid are U.S.-based programs.
Reasoning
- The AIM Act is primarily focused on the 12 million individuals who are dually eligible for Medicare and Medicaid, which means the policy is highly targeted. To simulate a range of perspectives, interviews will include those who are directly affected due to their dual eligibility, as well as a few who might perceive themselves unaffected.
- The budget for the initial year, $50,000,000, should ideally cover administrative changes and initial rollouts, affecting scores gradually from year 1. Over a decade, the budget is structured to allow broader implementation potentially improving scores more substantially.
- Variations in the impact will be reflected by factors such as geographical location, current access to healthcare services, quality of existing coordination methods, and personal health conditions.
- Not all dually eligible individuals will be equally affected or aware of the policy due to variances in local governmental implementations and personal health literacy levels.
Simulated Interviews
Retired teacher (New York, NY)
Age: 74 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 15/20
Statement of Opinion:
- I often find the process of managing my healthcare coverage incredibly confusing.
- If my care could be better coordinated, I expect it could also improve my quality of life.
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 | 8 | 5 |
| Year 20 | 8 | 5 |
Retired farmer (Rural Kentucky)
Age: 82 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 5.0 years
Commonness: 10/20
Statement of Opinion:
- The healthcare maze is too complex for me.
- Anything making it simpler is a good move.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 5 | 4 |
| Year 3 | 6 | 4 |
| Year 5 | 6 | 4 |
| Year 10 | 6 | 4 |
| Year 20 | 6 | 4 |
Part-time healthcare worker (Los Angeles, CA)
Age: 68 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 7.0 years
Commonness: 12/20
Statement of Opinion:
- I've learned to navigate the system, but it's exhausting.
- This bill sounds promising if it simplifies things.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 8 | 6 |
| Year 20 | 9 | 6 |
Retired engineer (Chicago, IL)
Age: 75 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 13/20
Statement of Opinion:
- Dealing with my healthcare is like solving a puzzle every time.
- Hopeful for any positive change.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 5 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 6 | 5 |
| Year 10 | 6 | 5 |
| Year 20 | 7 | 5 |
Retired nurse (Miami, FL)
Age: 85 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 0.0 years
Commonness: 8/20
Statement of Opinion:
- I am quite satisfied with my current situation, thanks to my facility.
- Integration would benefit others more than me.
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 | 7 |
| Year 20 | 7 | 7 |
Retired IT professional (Austin, TX)
Age: 65 | Gender: male
Wellbeing Before Policy: 7
Duration of Impact: 10.0 years
Commonness: 7/20
Statement of Opinion:
- Coordinated payments would ease my financial stress.
- I travel frequently, so better interstate provider management is needed.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 8 | 7 |
| Year 3 | 8 | 7 |
| Year 5 | 9 | 7 |
| Year 10 | 9 | 7 |
| Year 20 | 9 | 7 |
Retired librarian (Baltimore, MD)
Age: 79 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 15.0 years
Commonness: 11/20
Statement of Opinion:
- Better integration could help manage my allergies more consistently.
- My in-home service could be better organized.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 8 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 9 | 6 |
| Year 10 | 9 | 6 |
| Year 20 | 9 | 6 |
Retired construction worker (Phoenix, AZ)
Age: 72 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 20.0 years
Commonness: 9/20
Statement of Opinion:
- Seeking better healthcare management around my respiratory condition.
- I’m supportive if it can help me breathe easier.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 6 | 4 |
| Year 5 | 7 | 4 |
| Year 10 | 8 | 4 |
| Year 20 | 8 | 4 |
Retired administrative assistant (Boston, MA)
Age: 70 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 12/20
Statement of Opinion:
- I've adapted to Medicare and Medicaid independently.
- Still, smoother access would ease my volunteer activities.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 7 | 6 |
| Year 10 | 8 | 6 |
| Year 20 | 8 | 6 |
Retired professor (Seattle, WA)
Age: 90 | Gender: male
Wellbeing Before Policy: 8
Duration of Impact: 5.0 years
Commonness: 7/20
Statement of Opinion:
- I feel competent managing my healthcare needs.
- The policy is more beneficial for those with more diverse needs.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 8 |
| Year 2 | 8 | 8 |
| Year 3 | 8 | 8 |
| Year 5 | 8 | 8 |
| Year 10 | 8 | 8 |
| Year 20 | 8 | 8 |
Cost Estimates
Year 1: $50000000 (Low: $40000000, High: $60000000)
Year 2: $70000000 (Low: $56000000, High: $84000000)
Year 3: $75000000 (Low: $60000000, High: $90000000)
Year 5: $80000000 (Low: $64000000, High: $96000000)
Year 10: $90000000 (Low: $72000000, High: $108000000)
Year 100: $100000000 (Low: $80000000, High: $120000000)
Key Considerations
- The initial startup costs for states in developing integration strategies might be high, but long-term savings can mitigate these initial expenditures.
- Variability in state capabilities and existing infrastructure could lead to uneven implementation costs.
- Potential improvements in health outcomes for dual-eligible individuals could indirectly benefit the economy by reducing absenteeism and enhancing productivity.