This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.

Alongside climate change and deficit reduction measures, the broad-ranging provisions in the Inflation Reduction Act of 2022 (IRA) include several game-changing developments for older adults' health costs. Starting in 2023, the act will lower prescription drug costs for people with Medicare, cap out-of-pocket costs for insulin at $35 a month, and allow over-the-counter (OTC) sales of hearing aids for the first time.

"Because of the exorbitant cost of medications, quite a few individuals, especially seniors, do not actually take their medications like they're supposed to. They either take a lower dose of insulin, cut pills in half, and are taking less than what’s prescribed," says Nathaniel Bergman, pharmacist with Michigan’s Region VII Area Agency on Aging (AAA), which serves seven counties in and around the Thumb area. "When we're able to lower the cost for insulin and other medications, we are much more likely to see these individuals actually take their medications like they're supposed to."
Nathaniel Bergman.
Being able to afford prescribed medications will, of course, help these older Michiganders to better manage chronic medical conditions such as diabetes, hypertension, and heart disease. According to Bergman, the result will be not only improved health and quality of life for thousands of individuals, but also reduced overall costs in the long term for the state’s public and private health care systems.

"There are also going to be mental health benefits. The high cost of medication is a mental health stressor," Bergman says. "Patients are having to stress over, ‘Do I put food on my table or do I take my medication?’ If we're removing that mental anguish, we can better help their mental health."

According to Melissa Seifert, AARP Michigan associate state director for government affairs, one in three Michiganders are not taking prescribed, sometimes life-saving medications to control chronic conditions.
 
"The main reason they keep citing is cost. They can't afford the prescriptions," she says. "These prescription drugs don't work if you can't afford to take them. We want these individuals to be living a happy, fulfilled, engaging life so that they can contribute to the economy and be healthy while they're doing it."
Melissa Seifert.
AARP has been advocating for lowering prescription drug costs since 2018 at state and federal levels. In Michigan, tele-townhalls allowed residents to share concerns with members of Congress. Some told stories of traveling to Canada to find better prices. Others admitted to cutting their insulin doses in half to make ends meet.

"This is a monumental win for Michigan residents who are on Medicare," Seifert says. "I want us to all take a moment and give everyone who had a hand in this a big high five and a slap on the back because this was not for the faint of heart."

Affordable insulin a big win for Michiganders living with diabetes

When diabetes is not managed with the right combination of prescribed medication, physical activity, and diet, the results can be heart disease, stroke, amputation, kidney failure, blindness — and death. According to the American Diabetes Association, approximately 11.5% of Michigan’s adults — more than 900,000 people — live with diagnosed diabetes. An additional 239,000 Michiganders have diabetes but don’t know it. Another 2.7 million Michiganders have pre-diabetes. Diagnosed diabetes costs an estimated $9.7 billion in Michigan each year. 

"Michiganders that are diabetic and need this life-saving medication were paying three times higher than other countries for the exact same medication," Seifert says. "We have a lot more work to do on lowering the cost of prescription drugs for older adults, and for all Michiganders, so that we can all age with dignity and purpose, and be healthy and happy as we do that."

Building on the IRA, Michigan Gov. Gretchen Whitmer signed an executive directive in October 2022 to determine how the state can further lower insulin costs, including by developing insulin manufacturing capabilities within the state. 

"Our neighbors, family, and friends with diabetes need insulin to survive and for too long, drug companies have been jacking up prices, forcing them to make impossible choices between medication, food, rent, or other bills," Whitmer said when the directive was released. "The American people pay 10 times more for insulin than citizens of other comparable nations and costs have tripled over the last decade alone … together, we will lower the cost of insulin, hold drug companies accountable, and save lives."

Financial relief for the hearing impaired

The IRA's provision for OTC hearing aid sales is another cost savings measure that will help older adults. The National Institutes of Health have determined that nearly 30 million Americans could potentially benefit from hearing aids, but only 30% of people ages 70 and older currently use them. For those going without, cost is the main reason. Prescription hearing aids range in price from $1,000 to $4,000 per ear — and are not typically covered by insurance. Dr. Devin McCaslin, director of audiology and professor of otolaryngology at Michigan Medicine, says OTC hearing aids will be available at retailers and medical provider offices, including Michigan Medicine facilities, for approximately $800 a pair.
Dr. Devin McCaslin.
"The underlying driver of this new category [of hearing aids] is to help provide access to individuals with mild to moderate hearing loss," McCaslin says. "The big take-home [is that] more and more people are going to have access to affordable hearing care and it's exciting."

However, McCaslin emphasizes the importance of having a medical professional test hearing before purchasing hearing aids over the counter – to determine that hearing loss falls within the mild-to-moderate range, and to rule out medical causes for hearing loss, which could be as simple as a buildup of earwax or as serious as a tumor.

"Typically, people with a mild to moderate hearing loss [are] going to experience difficulty understanding quietly spoken words, soft-spoken people, and have problems with background noise," McCaslin says. "A hearing test performed by a hearing health care professional is really the only way to understand whether or not they are actually a viable candidate for one of these devices."

Because operating an OTC hearing aid will most often require using a smartphone and bluetooth technology, people using them will require a level of comfort with technology. For others, even an $800 price tag will prevent them from getting the hearing help they need. But those who can afford it will experience significant benefits.

"There are a lot of negative consequences to not keeping your hearing," McCaslin says. "Being able to hear appropriately is not only beneficial socially, but it's also a safety issue. There's also a lot of emerging evidence coming out that hearing aids may actually help decrease cognitive decline … and reduce fatigue."

Getting the word out

Now, the challenge for health providers is to ensure that Michigan's older adults know about these money- and hassle-saving changes. Michigan’s Area Agencies on Aging, like Region VII AAA, are taking the lead by informing clients of the lower costs when they come in to discuss their Medicare options.

"The Medicare/Medicaid Assistance Programs that are done through your local Area Agency on Aging are a wealth of information," Seifert says. "They set up appointments with individuals to talk through what their health care needs are, how Medicaid or Medicare can benefit them, and what plans would be the best fit for them."

"It’s a very, very complicated system," Bergman adds. "I encourage any older adult, and even family members of older adults, to reach out to their local Area Agency on Aging and request that assistance with Medicare or Medicaid."

AARP has information about the IRA and cost savings on its website. AARP Michigan plans on hosting tele-townhall events to help older adults understand and benefit from the savings being made possible by the IRA.

"There's a lot of excitement around this monumental victory, but also a lot of confusion as to what this will look like," Seifert says. "Now that we got it passed, we have to make sure that we're educating and reaching out to our membership to know what their benefits are in this new world."

Estelle Slootmaker is a working writer focusing on journalism, book editing, communications, poetry, and children's books. You can contact her at Estelle.Slootmaker@gmail.com or www.constellations.biz.

Nathaniel Bergman photos by Crystal Gwizdala. All other photos courtesy of the subjects.