The debate continues on how or if the Affordable Care Act will actually help Americans who need health care. The uncertainty for seniors becomes even more intense with the federal sequestration.

What we can be certain about is the effect these changes are having on Pennsylvania's older and vulnerable citizens.

While it was designed to provide funding for all, the Affordable Care Act does not address severely underfunded senior care services needed by millions here in the commonwealth. In fact, the act cuts Medicare, which is a major funding source of these programs and care settings.

The sequestration has caused anxiety in industries across the country, and senior care is no different. According to estimates, Pennsylvania's Medicare-funded nursing facilities will lose another $37 million due to the sequestration.

Compounding the problem, dollars for Medicaid -- the other major funding source for nursing facilities -- have never been more difficult to find. The strain is so bad that Pennsylvania's Medicaid-participating nursing facilities have received more than $1.5 billion less than state regulations have required since 2005.

The state Department of Welfare (DPW) has very complex and conservative formulas designed to determine the cost of nursing facility services it pays for recipients. If a person is on Medicaid, the facility must accept the Medicaid reimbursement as payment in full. Yet Medicaid, which pays for 65 percent of nursing facility residents, covers only 85 percent of the cost as determined by the DPW. This built-in loss on every Medicaid resident must be made up by either Medicare (which the Affordable Care Act has cut) or by charging a higher-than-equitable rate for privately paying residents.


In other words, the government has indirectly taxed the elderly who pay for their own services.

Pennsylvania has to address these inequities now. The commonwealth's over-85 population has grown 10 times faster than the average population, making us one of the grayest states in the nation. Yet, Pennsylvania continues to operate under and devote billions of dollars to an outdated funding and regulatory model with little consideration for modern programs such as assisted living, personal care, and home- and community-based services.

Pennsylvania seniors and their families prefer these cost-effective, modern programs when they fit their needs. However, when seniors have limited financial means, they must rely on state funding that does not support modern services.

The fact is we're working with a system based on 20th-century funding models, while trying to meet 21st-century care and service needs.

Pennsylvania's seniors need their leaders to take on the challenge of creating a modern system that is centralized, where what drives the care and services is based on need, with the necessary funding to follow.

Our current system prevents those with limited means from getting the choice of services that best meet their needs. Ironically, if seniors had a choice, many times that choice would be less costly. Band-aid fixes no longer work. We need a systemic change in the way we provide and fund senior services, and the time to act is now.

It is our desire to work with state lawmakers and the Corbett administration on building a truly integrated system of senior services that is open to all, not just a few with the ability to pay.

-- Ron Barth is the presi dent and CEO of the nonpro fit LeadingAge PA, which advocates public policy ini tiatives that support individ ual rights, quality care, equitable access and reim bursement for seniors.