Bill Overview
Title: Improving Access to Advance 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: Sen. Warner, Mark R. [D-VA]
Target Audience
Population: Medicare beneficiaries and their families
Estimated Size: 63000000
- Medicare primarily serves people aged 65 and over, so the bill directly impacts older adults who are eligible for Medicare.
- There are also disabled individuals and people with certain conditions under 65 who are eligible for Medicare, enlarging the impacted population slightly beyond just seniors.
- Clinical social workers are now recognized as providers of these services, expanding the workforce capable of delivering advance care planning.
- Waiving coinsurance and deductibles reduces financial barriers for accessing these services, affecting all Medicare beneficiaries interested in advance care planning.
- Advance care planning has broader implications for family members and caregivers, as it helps in making informed decisions about a patient’s future care.
- Globally, the concept of advance care planning is relevant and can indirectly influence policy or individuals, but the bill's direct legislative impact is on U.S. legislation.
Reasoning
- The primary target population for this policy are older adults over 65 who are Medicare beneficiaries and potentially a significant percentage of those under 65 with disabilities or certain conditions covered by Medicare.
- The policy will likely have a direct impact on those who are proactive about their healthcare planning and are interested in reducing future uncertainty regarding medical treatment decisions.
- There is an indirect, more diffuse benefit to families and caregivers who may be relieved of the burden of making critical healthcare decisions for their loved ones.
- Including clinical social workers in the offering expands the reach and makes it more feasible to cover the demand without overwhelming existing providers.
- Waiving coinsurance and deductibles removes financial disincentives for seeking these services, potentially increasing uptake among lower-income beneficiaries.
- Given the policy's budget constraints, not all Medicare beneficiaries who might benefit will engage in advance care planning, but even a moderate uptake can have ripple effects towards better healthcare outcomes and resource utilization.
Simulated Interviews
Retired teacher (Ohio)
Age: 68 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 15/20
Statement of Opinion:
- I find it challenging to think about my healthcare future, but it's a relief this service is now provided by Medicare.
- Not having to worry about additional costs means I'm more likely to pursue advance care planning.
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 | 9 | 5 |
| Year 20 | 8 | 4 |
Retired engineer (Florida)
Age: 72 | Gender: male
Wellbeing Before Policy: 7
Duration of Impact: 5.0 years
Commonness: 17/20
Statement of Opinion:
- This policy gives me assurance that my medical preferences will be respected without burdening my family financially with the planning costs.
- Advance care planning should be part of the normal healthcare process.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 7 |
| Year 2 | 8 | 7 |
| Year 3 | 9 | 7 |
| Year 5 | 9 | 7 |
| Year 10 | 8 | 6 |
| Year 20 | 7 | 5 |
Disability advocate (California)
Age: 55 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 5.0 years
Commonness: 7/20
Statement of Opinion:
- Access to advance care planning should have been available a long time ago, especially for people with disabilities.
- Knowing that clinical social workers can assist makes me feel this is more tailored to my needs.
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 | 6 | 4 |
Retired military (Texas)
Age: 70 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 8.0 years
Commonness: 10/20
Statement of Opinion:
- I've been meaning to sort out my healthcare plans, and now is the right time without worrying about the extra costs.
- Veterans deserve comprehensive care planning and this aligns well with those benefits.
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 | 7 | 5 |
| Year 20 | 6 | 5 |
Retired artist (New York)
Age: 80 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 12.0 years
Commonness: 12/20
Statement of Opinion:
- My daughter helps me with everything, but having this planning in place helps make difficult decisions easier.
- I like that costs are no longer a barrier.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 7 |
| Year 2 | 8 | 6 |
| Year 3 | 9 | 6 |
| Year 5 | 9 | 5 |
| Year 10 | 9 | 4 |
| Year 20 | 8 | 4 |
Retired nurse (Arizona)
Age: 90 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 5.0 years
Commonness: 3/20
Statement of Opinion:
- This policy allows me to ensure my end-of-life care aligns with my own values without stressing about costs.
- It's crucial for nurses and social workers to be part of the conversation as trusted professionals.
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 | 3 |
| Year 10 | 6 | 3 |
| Year 20 | 5 | 3 |
Retired factory worker (Michigan)
Age: 66 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 8.0 years
Commonness: 10/20
Statement of Opinion:
- Living in a rural area means services often feel out of reach, but involving social workers could change that.
- No deductible is a big consideration for someone on a fixed income.
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 | 4 |
| Year 20 | 5 | 4 |
Non-profit director (Illinois)
Age: 64 | Gender: other
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 8/20
Statement of Opinion:
- Attention to advance care planning is indicative of a compassionate healthcare system.
- Removing coinsurance barriers aligns medical decisions with personal values without financial stress.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 5 |
| Year 5 | 8 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 7 | 5 |
Homemaker (Mississippi)
Age: 63 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 20.0 years
Commonness: 3/20
Statement of Opinion:
- This provides peace of mind that our plans are financially feasible and in place before his condition worsens.
- Caregiver roles are challenging enough without healthcare financial considerations.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 8 | 4 |
| Year 5 | 8 | 4 |
| Year 10 | 9 | 3 |
| Year 20 | 7 | 3 |
Retired professor (Oregon)
Age: 74 | Gender: male
Wellbeing Before Policy: 7
Duration of Impact: 10.0 years
Commonness: 11/20
Statement of Opinion:
- Policy is a step in the right direction for a comprehensive view of healthcare and aging.
- Access to social workers bolsters trust in the system.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 7 |
| Year 2 | 8 | 7 |
| Year 3 | 9 | 7 |
| Year 5 | 9 | 6 |
| Year 10 | 8 | 6 |
| Year 20 | 7 | 6 |
Cost Estimates
Year 1: $250000000 (Low: $150000000, High: $400000000)
Year 2: $150000000 (Low: $100000000, High: $300000000)
Year 3: $150000000 (Low: $100000000, High: $300000000)
Year 5: $200000000 (Low: $100000000, High: $350000000)
Year 10: $300000000 (Low: $200000000, High: $450000000)
Year 100: $1000000000 (Low: $500000000, High: $1500000000)
Key Considerations
- Potential savings from reduced emergency interventions might offset some of the initial costs over time.
- Increase in the number of providers through inclusion of clinical social workers could enhance outreach and effectiveness in utilization.
- Coinsurance waivers are expected to increase immediate outlays but could reduce long-term costs by aligning treatments with patients' desires.