Passage of the health care reform bill will affect millions of Americans in both positive and negative ways, depending on which side of the socioeconomic spectrum they fall on. One of the major groups affected by the bill is senior citizens.

“There are several game changers for the elderly over time,” said Larry Minnix, president and chief executive officer of the American Association of Homes and Services for the Aging.

Minnix was in town last week to speak at the 2010 Rhode Island Association of Facilities and Services for the Aging (RIAFSA) annual meeting at the Crowne Plaza Hotel.

One aspect of the bill that directly affects seniors is the closing of the Medicare prescription drug "donut hole" by 2020.

When a person joins a Medicare prescription drug plan, they may have to pay up to the first $310 of their drug costs. This is known as the deductible. Currently Medicare leaves more than 31,000 Rhode Islanders without prescription drug coverage for parts of the year

During the initial coverage phase, the drug plan pays 75 percent of the covered prescription drug costs after the deductible is met and the consumer pays 25 percent until the total drug costs (including the deductible) reaches $2,830. Once $2,830 in total drug costs is reached, a person will be in the donut hole and must pay the full cost of prescription drugs until the total out-of-pocket cost reaches $4,550. This annual out-of-pocket spending amount includes the yearly deductible and co-pay amounts. When a person spends more than $4,550 out-of-pocket, the coverage gap ends and the drug plan pays most of the costs of the covered drugs for the remainder of the year.

With the new reform bill, seniors who hit the donut hole by 2010 will receive a $250 rebate. Beginning in 2011, seniors in the gap will receive a 50 percent discount on brand name drugs.

“Immediately the most help will go to the children, where it is most needed, and to closing the donut hole because medications are essential,” said Minnix.

The bill is also going to emphasize preventive wellness efforts that have long been ignored. Minnix believes that this will serve as a new mechanism for pilot and demonstration projects relating to managing care and helping people manage transitions.

“A significant number [of] money is wasted in bad transitions,” said Minnix.

There are provisions in the bill for provider groups to get one pot of money based on a patient’s episode. The idea is that this will significantly reduce provider handoff fragmentation.

“This will ensure that the patient gets care where and when they need it,” said Minnix.

Minnix also stressed that no one is losing any of his or her basic benefits as a result of the bill. The goal of the bill is to squeeze exorbitant profits out of companies. Minnix believes that this can be done by cutting salaries and minimizing company benefits to high-ranking employees such as gym memberships.

“Companies can do different ways of business to become more efficient,” said Minnix.

Eighty percent of nursing care in America is done inside of people’s homes, according to Minnix. That amounts to over 10 million people spending an average of $5,500 out-of-pocket on home care. Making patient transitions more productive and increasing funding for preventative care methods will significantly reduce the cost of care.

“There are a lot of things in the bill that address fundamental changes,” said Minnix.

There are some very profitable niches in home health care that are easy for companies to pick out and those that are not profitable usually end up in non-profit care. The bill takes aim at closing that profit-based care plan.

“If it wasn’t good for seniors, Congress wouldn’t do it, the administration wouldn’t do it and we wouldn’t do it,” said Minnix.

He believes that as the dust settles, post passage, the real facts of the bill will appear.

“It is difficult now because accurate and politically spun propaganda are mixed,” said Minnix.

Minnix believes that as a result of the health care efforts Presidents Bush and Obama were able to achieve, historians will look back at this time as the changing decade for health care delivery. Minnix believes that this is a transformational time because the old solutions don’t work anymore.

“If you ain’t the lead dog on the sled team, your view of the world is always the same,” said Minnix.