Age Discrimination - PPACA | LabourBlawg

Age Discrimination – PPACA

by Andrew Miller on January 3, 2013

Broken Bank

With the economic meltdown and the failure of raided pension funds to provide an adequate retirement income to many older American adults, the number of retired people still working – or working again – becomes increasingly important to the subject of age discrimination in the workplace.

Let’s talk about that workplace, where those over retirement age continue to work, if possible, or go back to work for wages that seem parsimonious compared to pre-retirement employment.

In spite of being offered wages that represent slow starvation, at least figuratively speaking, many older Americans are now working in the sorts of jobs formerly taken by students on summer vacation or immigrants whose language skills (and, possibly, citizenship status) make hoping for better temporarily superfluous.

The situation for the elderly is further worsened by proposals like a Medicare/Medicaid payment parity cut to offset what many imagine as the insolvency of that program if sustainable growth rate (SGR) formulas are not instituted.


The Patient Protection and Affordable Care Act (PPACA), ordinarily referred to as Obamacare, contains a provision that would pay Medicaid-participating health groups and individuals at Medicare rates through 2014. Removing that provision is viewed by many as the only way to subvert a potential $25 billion reduction in Medicaid funding, leaving many system providers holding the proverbial short end of the stick. Alternatively, states like Texas may reduce Medicaid eligibility, or the federal government could redraft pharmacy payments, which total the exact amount needed to keep Medicaid solvent (in 2011 dollars).

Medicaid, which provides limited medical protection and services to those below the federal poverty level, as well as the elderly, pregnant women, children and the disabled, benefits 60 million Americans.

Once the standard of medical insurance to those who couldn’t get standard medical insurance (e.g., Blue Cross Blue Shield and the like), Medicaid has evolved to a program for which very few now qualify, and those who do are grandfathered in only if they now pass some very stringent qualifications. In other words, this branch of Medicare aimed at those who are not necessarily old but need healthcare as much as retired people without pensions, is failing to serve the very people for whom it was designed.

The proposed cut to Medicaid, if allowed to exist, would cut physicians’ reimbursements by 26.5 percent, beginning January 1, 2013 unless Congress acts. The result of this – since most physicians are self-employed and not bound to honor Medicaid or Medicare – will be to create a swathe of denial-of-service claims for those who have few or no medical resources. The only exemptions will be hospitals and medical centers (and their physicians) which depend on federal funding to keep their doors open.

The Results

The effect of that will be to further overcrowd emergency rooms already crowded to sardine status by indigent, aged and handicapped individuals who have nowhere else to go. And some of these will never be seen, as happened in the UK when a man left in the waiting room of a National Health Service hospital died and was only discovered to have done so several days later.

As less than eight percent of UK residents use private hospitals, and that system is also going broke thanks to rising populations and falling employment, one can almost expect that sort of thing occurring more rather than less regularly in the future.

The Medicare Payment Advisory Committee also recommends removing the provision, which in that instance may well signify incipient insolvency in a program first instituted in 1965 at the behest of former U.S. President Harry Truman.

Once Congress has removed the provision, expect them to begin cutting food-based programs like WIC (a nutrition program for women and children) and Meals on Wheels, the latter of which guarantees at least one hot and nutritious meal per day to the elderly and housebound.

Removing the provision is opposed by the American Academy of Family Physicians, the American College of Physicians, the American Academy of Pediatrics, the American Medical Association and the American Osteopathic Association at national, state and local levels.

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