AARP Scorecard: Taking a Closer Look at Rhode Island’s Long-Term Services and Support to Older Adults

Published in Woonsocket Call on June 18, 2017

With America’s baby boomers beginning to turn age 80 in 2026, days ago the Washington, DC-based AARP released Scorecards detailing how each state spends its dollars on long-term services and supports (LTSS) to assist older adults and adults with disabilities. The report findings revealed a need for state legislatures to quicken the pace of improving LTSS for their older residents. LTSS include assistance with activities of daily living provided to older adults and people with disabilities who cannot perform these activities on their own because of physical, cognitive, or chronic health conditions. The types of assistance include such things as help with bathing, dressing, managing medications, preparing meals, and transportation, as well as support for family caregivers.

The latest comprehensive state-by-state Scorecard report was funded by AARP Foundation with support of the nation’s leading organizations behind quality long-term care, The Commonwealth Fund and SCAN Foundation. This is the third edition of the Scorecard, initially released in 2011 and again in 2014.

AARP’s 2017 report, “Picking Up the Pace of Change: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers (“Scorecard”), released on June 14, finds that although Rhode Island and most states have taken small steps to make some progress, this pace of change overall remains too slow and has not kept up with demographic demands.

“This Scorecard sounds the alarm, but it also provides a range of tools states can use to spark new solutions and create systems that are aligned with the new realities of aging and living with a disability,” said Susan Reinhard, RN, PhD, Senior Vice President and Director, AARP Public Policy Institute. “The proposed cuts to Medicaid—the largest public payer of long-term assistance—would result in millions of older adults and people with disabilities losing lifesaving supports.”

“This new Scorecard shows that it’s time for all states to accelerate care improvements for older adults and people with disabilities,” said Bruce Chernof, MD, FACP, President and CEO of The SCAN Foundation. “States that consistently rank at the top have strategically planned for their aging population across the main sectors of health, housing, transportation and family caregiving.”

Like previous two LTSS scorecards, states are ranked on their performance in five categories: Affordability and access, Choice of setting and provider; Quality of life and quality of care; Support for family caregivers; and Effective transitions between nursing homes, hospitals and homes. Within the five categories, states are scored on their performance in 25 specific indicators, including such things as Medicaid spending, nursing home cost, home health aide supply, antipsychotic medication use in nursing home residents, long nursing home stays, employment rate of people with disabilities, and support of working caregivers.

But this year, AARP has made changes in LTSS Scores in the way information is presented on its interactive website (www.longtermscorecard.org), making it easier for a user to customize data to suit their specific needs. Visitors to the Scorecard site will be able to access videos, called Impact Stories, that show how improving on the Scorecard can impact the lives of real people.

Users can also download Promising Practices as well as Emerging Innovations (updated throughout the year) that state officials can use as they work to improve their long-term care delivery systems.

Rhode Island Improves in Delivering LTC Services

In the 2017 AARP report, Rhode Island ranks 32nd overall when it comes to meeting the long-term care needs of older residents and people with disabilities, but showed improvement in all but one Scorecard category. AARP warns more must be done, at an accelerated pace, to meet changing demographic demands. Rhode Island ranks 22nd nationally Support for Family Caregivers and 24th in Quality of Life & Quality of Care. The state ranks 35th in Effective Transitions – the only category in decline

“The vast majority of older Rhode Islanders want to live independently, at home, as they age—most with the help of unpaid family caregivers,” says Kathleen Connell, State Director of AARP Rhode Island, which serves more than 138,00 members age 50 and older in the state. “Even facing tight budgets, Rhode Island is making progress to help our older residents achieve that goal. However, this Scorecard shows we have more to do, and we need to pick up the pace.”

According to Connell, today, unpaid family caregivers provide the bulk of care for older Rhode Islanders in part because the cost of long-term care remains unaffordable for most middle-income families. In Rhode Island, more than 134,000 residents help their aging parents, spouses and other loved ones stay at home by helping with bathing and dressing, transportation, finances, complex medical tasks like wound care and injections, and more. The value of this unpaid care totals about $1.78 billion.

“When it comes to helping older Rhode, Islanders live in the setting of their choice, family caregivers take on big responsibilities,” explains Connell. “Many juggle full-time jobs with their caregiving duties; others provide 24/7 care for their loved ones. With every task they undertake, these family caregivers save the state money by keeping their loved ones out of costly nursing homes – most often paid for Medicaid. They have earned some basic support.”

“That’s why AARP Rhode Island has fought for Caregiver, Advise, Record, Enable (CARE) Act; caregiver temporary leave insurance; and caregiver tax credits, adds Connell.

Rhode Island has made progress to improve long-term services and supports for older adults and people with disabilities, as highlighted in this Scorecard. But, proposals in Washington, D.C. to drastically cut federal Medicaid funding would threaten these advancements, likely resulting in our most vulnerable citizens losing the lifesaving supports that they count on,” says Connell.

“The single strongest predictor of a state’s long-term care system is the reach of its Medicaid long-term care safety net,” says Connell, noting that’s why AARP fights to expand services provided at home and in the community, by shifting funds away from and more expensive nursing home care. “While the percent of long-stay nursing home residents hospitalized within a six-month period has decreased, the Scorecard highlights additional serious issues related to institutional care in Rhode Island, such as residents with pressure sores and residents with low care needs],” she notes.

While Rhode Island has improved its rank from 50th to 44th in the percentage of Medicaid long-term care dollars for older adults and people with physical disabilities that support care provided at home and in the community—the care setting that most Rhode Islanders prefer—the Scorecard spotlights areas that call for improvement, including choice of setting and provider; and effective transitions.

Specifically, the percent of

• Medicaid and state-funded LTSS going to HCBS;
• Medicaid LTSS users first receiving services in the community;
• People with 90+ day nursing home stays successfully transitioning back to the community;
• Nursing home stays lasting 100 days or more.

“This Scorecard gives us a snapshot of how well Rhode Island serves our older residents, those with disabilities, and family caregivers—and shows us where we must sharpen our focus to better assist hardworking Rhode Islanders,” concludes Connell. “We will continue to work with the governor, legislative leaders and policymakers to take the actions needed now to protect our expanding needs.”

Connell says that of the 25 Scorecard indicators, many may be improved through state policy changes, pointing to the importance of AARP’s multi-state advocacy campaign, launched in 2014, to help older Americans live independently, at home, and the family caregivers that support them.

Director Charles Fogarty, of Rhode Island’s Division of Elderly Affairs, sees the importance of AARP’s Rhode Island’s Scorecard, to evaluate progress in meeting the needs of older Rhode Islanders. “This report reinforces what we already know: while Rhode Island is showing improvements in some areas, there is still much to be done to provide the level of care and services our seniors deserve. Our improved ranking from 50th to 44th in the percentage of Medicaid long-term care dollars spent on home and community care options is a step in the right direction,” says Fogarty.
“We must continue to build upon the success of Reinventing Medicaid and move towards rebalancing of the long-term care system while preserving access and quality of care for older Rhode Islanders,” adds Fogarty.

AARP Scorecard Snap Shot of the National Delivery of LTSS

Washington State and Minnesota are top-ranked states again (followed by Vermont, Oregon and Alaska), but all states lag in helping care for the nation’s growing populations of older persons with people aging and living with disabilities.

AARP’s LTSS Score card noted that the bottom ranking states were Indiana, (No. 51), Kentucky (No. 50, Alabama, (No. 49), Mississippi, (No. 48), and Tennessee (no. 47).

According to researchers, overall, states made incremental LTSS improvements since the previous report in 2014, but the pace of change has been slow and uneven. However, two states—Tennessee and New York—showed the most improvement across measures since the last Scorecard.

States made the most significant progress in reducing inappropriate ‘off label’ use of antipsychotic medications among nursing home residents and increasing support of family caregivers.

In general, states showed the most significant declines in employment rates for people with disabilities and rates of transitioning long-stay nursing home residents back into the community. Notably, the majority of states showed no real change on ‘Affordability and Access,’ meaning that the cost of LTSS over time continues to be much higher than what the majority of families can afford.

Herb Weiss, LRI’12 is a Pawtucket writer covering aging, health care and medical issues. To purchase Taking Charge: Collected Stories on Aging Boldly, a collection of 79 of his weekly commentaries, go to herbweiss.com.

Trump Budget Could Eventually Hurt Seniors

Published in Woonsocket Call on June 4, 2017

Last month, President Donald Trump submitted his Fiscal Year 2018 budget proposal to a GOP controlled Congress. Critics of the Republican president and Democratic lawmakers called the 62-page budget proposal, “Dead on Arrival.” Now, with Congressional recess over, look for the House and Senate to begin drafting their own fiscal blueprint.

Massive Cuts to Entitlements and Discretionary Spending

Trump’s $4.1 trillion spending plan proposes historic, massive cuts by eliminating funding for 19 federal agencies to offset the cost of $54 billion to increase defense spending, to pay for infrastructure and the construction of a border wall between Mexico and the U.S., and to fund school voucher programs and a new paid leave initiative. The Trump budget also slashed funding from the budgets of other executive departments and agencies as well. The Environment Protection Agency, the State Department and Agriculture Department took the biggest funding cuts.

The core philosophy of Trump’s first full budget request, “A New Foundation for American Greatness,” can be described as “Taxpayer First,” says Director Mick Mulvaney, of the Office of Management and Budgets.

Mulvaney, a former Republican Congressman now serving as Trump’s budget director, told reporters one day before the release of Trump’s budget, “This is, I think, the first time in a long time that an administration has written a budget through the eyes of the people who are actually paying the taxes.”
We’re not going to measure our success by how much money we spend, but by how many people we actually help,” added Mulvaney.

Many aging advocates fear that Trump’s budget proposal will fray the nation’s social safety net forcing seniors to fall into poverty.
With the release of the Trump Budget proposal, the Washington, DC-based AARP, representing over 38 million members was quick to issue this statement. Executive Vice

President Nancy LeaMond said “AARP opposes the budget proposed today because it explicitly harms the very people we are counting on the President to protect. Today’s budget proposes to cut Social Security benefits, as well as funding for critical health, hunger, housing, and transportation assistance to low and middle-income seniors. This budget sends a powerful message to older Americans and their families that their health and financial security is at risk.”

“We do want to acknowledge the Administration’s paid leave proposal. Although it must be improved so that it addresses the workplace needs of all family caregivers, we hope that it leads to a national conversation about ways to support family caregivers in the workplace,” adds LeaMond.
The Washington, DC-based National Committee to Preserve Social Security and Medicare (NCPSSM), believes Trump’s released budget proposal “literally leaves seniors in the cold.”

“This heartless budget does not reflect true American values,” says Max Richtman, President and CEO of the National Committee to Preserve Social Security and Medicare in a statement. “In our America, we do not cast seniors into the cold. We do not take food out of their mouths or make it harder to get the healthcare they so desperately need. In short, we do not cut off our most vulnerable citizens at the knees to pay for a massive tax break for the wealthy and big corporations.”

“This budget undermines the President’s promises to seniors. It guts Medicaid, which he promised to protect. The cuts to Social Security Disability Insurance (SSDI), [a program that helps disabled beneficiaries to say at work or return to work] violates his pledge not to tamper with Social Security. It also casts into serious doubt his pledge as a candidate to defend Medicare. No one who is serious about protecting these vital programs would propose a budget so harmful to seniors,” says Richtman.

Richtman says, “Make no mistake: the $64 billion in SSDI cuts are very real – and would cause real pain for Americans with severe disabilities. These are people deemed by the Social Security Administration to be too disabled to work. The qualification requirements are stringent, and the cases dire. Though SSDI helps younger Americans, too, most of its beneficiaries are 55 or over – meaning any cuts to the program will hit older Americans particularly hard. In fact, an average 1 in 6 men on SSDI die within 5 years of claiming benefits. For women, the figure is 1 in 7.”

Trump Budgetary Cuts Hurt Seniors, Poor

According to NCPSSM’s Government Relations and Policy staff, Trump’s budget proposal would drastically slash or eliminate funding for programs that benefit America’s seniors. Here is a sampling of budgetary cuts they identified.

Trump’s budgetary cuts of SSDI has an impact on older disabled persons. It would limit the retroactivity of applications for disability benefits from 12 months to six months and denies unemployment compensation payments to certain SSDI beneficiaries. Finally, it unreasonably caps the amount of payable to individuals who receive SSDI while living with other Supplemental Security Income recipients.

The president’s budget proposal also slashes more than $600 billion from the Medicaid program, which undermines seniors’ access to long-term care. It also eliminates the Community Services Block Grant ($715 million), the Community Development Block Grant ($3 billion) and the Social Service Block Grant ($1.7 billion) which helps fund some Meals-on-Wheels program, delivering hot meals to needy seniors.

Trump calls for eliminating the Low Income Home Energy Assistance Program (LIHEAP) which assists seniors with heating costs. LIHEAP received $3.39 billion in President Obama’s Fiscal Year 2017 budget. Of the 6.8 million household’s assistance, it is estimated that 2.26 million are over age 60.
Federal funding is also reduced for the National Institutes of Health (NIH) by $5.67 billion (including nearly $300 million for the National Institute on Aging), which will negatively impact research into cancer, Alzheimer’s, Parkinson’s and other diseases affecting older Americans.

With flat-line funding in the president’s budget proposal, we can expect longer waits at the local offices of Social Security Administration (SSA) and even extended waits when calling SSA’s telecommunication centers. The agency has been critically underfunded since 2010 – reducing the quality of service to SSA beneficiaries. This will continue.

Finally, Trump’s budget proposal eliminates funding for the Senior Corps programs, including the Retired and Senior Volunteer Program, Foster Grandparents and Senior Companions. These programs enable older adults to remain act in their homes.

Rhode Island Lawmaker Gives His Two Cents

U.S. Rep. David N. Cicilline notes, who serves as Co-Chair of the House Democratic Policy and Communications Committee “If a budget is a statement of your priorities and values, then Donald Trump’s budget shows he doesn’t understand the challenges facing Rhode Island seniors. This budget would cut Medicaid by up to $1.3 trillion over the next decade, jeopardizing health coverage that more than 18,000 Rhode Island seniors rely on to access high-quality affordable care.”

“Additionally, despite the President’s campaign promise not to touch Social Security, this budget carves out tens of billions in cuts to SSDI. That would have a devastating impact on SSDI recipients – most of whom are over the age of 55 – who have worked their entire lives and are physically unable to earn additional income,” says the Democratic lawmaker.

Cicilline warns, “Trump’s proposal to slash $193 billion – over 25 percent of total funding – over a decade to the Supplemental Nutrition Assistance Program (SNAP) would undermine the health and well-being of more than 16,300 Rhode Island seniors who receive assistance for their basic food and nutrition needs every month.”

“This budget would eliminate the Low Income Home Energy Assistance Program (LIHEAP), which helps low-income people, including thousands of seniors, pay their heating and cooling bills. It also eliminates the Social Services Block Grant and State Health Insurance Program, both of which provide critical federal support to help states meet the individualized needs of their seniors,” adds Cicilline.

“Plain and simple, this is a budget written by the wealthiest Americans for the benefit of the wealthiest Americans. But it’s a setback for the middle class and millions of seniors who have worked hard and played by the rules for their entire lives. Along with my colleagues in the House Democratic Leadership, I will do everything I can to reverse these devastating cuts and shape a budget that invests in the future of our country and puts honest, hardworking families first,” says Cicilline.

AARP, NCPSSM and aging advocates, now turn their attention to the House and Senate to keep Trump’s draconian budgetary vision out of the final FY 2018 budget. But, voters must also oppose huge cuts in Medicare, Medicaid and Social Security entitlement programs and discretionary funding for programs for older Americans at town meetings held by their Congressman and Senators.

Midterm elections will take place on Tuesday, November 6, 2018, All 435 seats in the House and 34 of the 100 senate will be up for grabs. Maybe GOP lawmakers will craft a budget proposal that will benefit their constituents, not support their political party’s policy positions.

CBO Numbers Says GOP Health Plan Benefits Young, Healthy…Not Seniors

Published in the Woonsocket Call on May 28, 2017

Weeks ago, the Trump Administration and GOP House leadership mended fences with GOP moderates and conservatives to hammer out a new version of the introduced legislation, the American Health Care Act (AHCA) of 2017 and replace the Affordable Care Act, called Obamacare Care. The GOP health care proposal with its last-minute changes passed on May 4 by a razor-thin vote of 217-213, a slim margin of four votes. All 193 Democrats opposed passage, along with 20 Republican lawmakers.

With passage, AHCA moved to the Senate for deliberation. Senators considered the House passed health care bill “Dead on Arrival.” But, Senate Majority Leader Mitch McConnell (R-Ky.) quickly appointed 13 Republican Senators to hammer out their chamber’s health care bill. Political observers doubt whether McConnell has enough votes to pass legislation this year.

Democratic lawmakers and critics of the House’s passed AHCA legislative proposal expressed outrage that House Speaker Paul Ryan (R-WI) called for a vote, not even waiting for the nonpartisan Congressional Budget Office (CBO) to provide an updated financial analysis of the new version of AHCA. The CBO’s cost analysis of the original bill, pulled moments before a scheduled vote on March 24, 2017, found that the GOP health care bill estimated that if passed 24 million or more Americans could be uninsured by 2026.

Now the long-awaited CBO new numbers are finally in for the House GOP passed health care bill.

According to the CBO analysis released on May 24, 2017, 23 million people will lose health insurance in the next decade under the House GOP’s recently passed health care proposal. The CBO analysis concludes that the AHCA benefits the young and healthy at the expense of older and sicker Americans. The report indicates that “near seniors” (aged 50-64) will be hit particularly hard by the GOP healthcare bill. Specifically, net insurance premium costs for low-income seniors would rise by 700 to 847 percent over the next 10 years under House-passed bill. A 64-year-old with an income of $26,500 per year who paid $1,700 annually for an Obamacare policy would now pay a whopping $13,600 under the Republican plan.

Aging Groups Rally Against Flawed GOP Fix to Nation’s Health Coverage

Aging advocates says that CBO’s analysis of the newer version of AHCA again brings to the forefront the flaws of the GOP’s health care coverage fix.

In a statement, AARP Executive Vice President Nancy LeaMond says the new CBO analysis serves as another example that the House legislation would make harmful changes to the nation’s current health care system. The bill would also hurt older Americans by decreasing the solvency of Medicare, hiking costs for those who can least afford them, eroding seniors’ ability to live independently, and giving tax breaks to big drug companies and health insurance companies, she said.

“AARP reiterates our strong opposition to the harmful bill passed by the House and calls on the Senate to take action by starting a bill from scratch. The CBO analysis found that premiums would go up to unaffordable levels by inflicting an Age Tax and removing current protections for people with common conditions including diabetes and weight gain. Putting a greater financial burden on older Americans is not the way to solve the problems in our health care system,” says LeaMond.

“The CBO report was no surprise to those of us who are looking out for the best interests of older Americans. The GOP leadership was so focused on passing repeal and replace legislation that they failed their due diligence by ignoring an ominous flaw: their bill will drive up seniors’ out-of-pocket costs by repealing subsidies that help defray the cost of premiums,” says Max Richtman, President and CEO of the National Committee to Preserve Social Security and Medicare in a statement.

The report also confirms that the House bill will only compound the problems faced by near seniors with pre-existing conditions. While an amendment by Rep. Fred Upton (R-MI) adds $8 billion over five years to fund high-risk pools for patients with pre-existing conditions, that will not be nearly enough to offset the extra costs to seniors, warns Richtman.

According to CBO, “People who are less healthy (including those with pre-existing or newly acquired medical conditions) would ultimately be unable to purchase comprehensive non-group health insurance at premiums comparable to those under current law, if they could purchase it at all.”

Seniors who rely on Medicaid will suffer under the GOP’s passed health care bill, said Richtman, noting that the CBO report calculates that the AHCA slashes Medicaid spending by $834 billion. Medicaid currently helps pay for long term care for millions of seniors nationwide.

The CBO estimates that some 14 million Medicaid recipients would lose coverage under the AHCA – or not be able to attain it in the first place – within the next 10 years. In fact, more than half of the increase in uninsured Americans under the AHCA would come from this vulnerable population. In addition, changes to the ACA’s individual market reforms will increase the number of uninsured Americans age 50 to 64 from just over 10 percent under current law to nearly 30 percent, says Richtman.

Richtman charges that the GOP healthcare bill also weakens Medicare by repealing a tax on high wage earners, which would decrease the solvency of the Medicare Part A Trust Fund by three years. Accelerating the exhaustion of the Part A trust fund would likely lead to cuts in Medicare, including privatizing the program, that would be detrimental to current and future beneficiaries.

“The amended American Health Care Act is an assault on the health care of all seniors,” says Richtman. “We can only hope that the Senate will take the CBO’s new figures into consideration – and reverse the provisions that are so demonstrably harmful to our nation’s seniors.”

GOP Defends its Health Care Coverage Fix

As expected, with the release of CBO’s new numbers, the GOP moved quickly to dispute the federal agency’s findings. Republican National Committee Chairwoman Ronna McDaniel stated “The CBO has a history of being way off in their predictions, often giving a different forecast from actual reality.”

Even former House Speaker Newt Gingrich (R-GA) got into the verbal fray, blasting the new CBO analysis on FOX Business’ Lou Dobbs Tonight, calling for “the abolishment of the federal agency.” Gingrich called CBO “a dishonest bureaucratic organization,” suggesting that money might be saved by hiring “outside professional firms, get three to five major scores on bills.”

The Battle on Health Care Reform Moves to the Upper Chamber

On May 22, 2017, more than 75 national organizations recently sent a letter to Senate Majority Leader Mitch McConnell and Ranking Minority Leader Chuck Schumer, calling on the Senators to reject AHCA and to engage in “a transparent, bipartisan dialogue on needed reforms to enhance health care access and affordability.” The correspondence gave notice that these organizations strongly opposed provisions in the AHCA that undermined Medicare’s financing and risk access to essential care for Medicare and Medicaid recipients.

The correspondence cosigners noted that Obamacare imposed a small tax increase on the highest earners that helped” put Medicare on stronger financial footing. The GOP health care bill’s repeal of this tax would result in lost revenues, causing the Medicare Hospital Insurance (Part A) Trust Fund to become insolvent two years earlier than anticipated. The correspondence also expresses alarm that Congress would knowingly vote to undercut the Trust Fund.

The correspondence also charges that the GOP’s AHCA advances devastating Medicaid cuts—per-capita caps—that threaten access to needed care for the 11 million people with Medicare who also depend on Medicaid. One in five people with Medicare rely on Medicaid to cover vital long-term home care and nursing home services, to help afford their Medicare premiums and cost-sharing, and more.

“Federal cuts to Medicaid…would drive states to make hard choices, likely leading states to scale back benefits, impose waiting lists, implement unaffordable financial obligations, or otherwise restrict access to services,” says the correspondence.

Joe Baker, president of the Medicare Rights Center, said, “A Medicaid cut is a Medicare cut. One in five people with Medicare rely on Medicaid to access home and community-based services and nursing home care that they would otherwise go without. Medicaid is also the lifeline that helps millions of older adults and people with disabilities afford their Medicare premiums and cost-sharing. Per-capita caps are not a viable path forward to support our aging nation; the Senate must start from scratch.”

Adds, Kevin Prindiville, executive director of Justice in Aging. “The AHCA risks the health and financial security of millions of older adults in our families and communities. Slashing the program’s funding by over $800 billion eliminates Medicaid’s 50-year guarantee that older adults can count on Medicaid when they need it the most. We call on the Senate to protect seniors and Medicaid.”

“Simply put, this legislation is not a health care bill,” says Judith Stein, executive director of the Center for Medicare Advocacy. “A health care bill would strengthen coverage and delivery programs. AHCA gratuitously weakens Medicare, decimates Medicaid, and guts insurance for 24 million people. We urge the Senate to reject this charade and develop a real health care bill that improves coverage and enhances the Affordable Care Act.”

House GOP Leadership Puts its Health Care Proposal on Fast-Track

Published in Woonsocket Call on March 12, 2017

After years of calling for the dismantling of Obama’s signature health care law, the 2010 Affordable Care Act (ACA), dubbed Obamacare, an emboldened GOP controlling both the White House and two chambers of Congress, began legislative efforts to substantially change the way the federal government subsidizes health coverage for millions of Americans and puts the brakes on Medicaid expansion that extended coverage to millions more.

On March 6, House Speaker Paul Ryan (R-Wis), with the blessing of President Donald Trump, began his legislative efforts to enact the House GOP’s 123 page health care proposal, the new American Health Care Act (AHCA). Democratic lawmakers and aging groups charge that the AHCA lacks a fiscal estimate from the bipartisan Congressional Budget Office as to how many people will lose their health insurance coverage as a result of the bill or how much it will cost.”

According to rating agency S&P Global Ratings, between 6 million and 10 million people could lose health insurance coverage if the GOP’s health care proposal to “repeal and replace” Obamacare passes. Specifically, there would be a decline in enrollment in the individual health insurance plan market of between 2 million and 4 million people. There would also be a decline of between 4 million and 6 million people in the nation’s Medicaid system after 2020 to 2024, says the recently released analysis.

GOP Health Proposal on Fast-Track

Just hours after AHCA was introduced early in the week, the House Energy and Commerce Committee and Ways and Means Committee began holding markups on their specific portions of the GOP’s health care proposal. After deliberating for almost 18 hours the Ways and Means approved its portion by a vote of 23-16, along party lines. After a marathon 27-hour markup session, the AHCA proposal was approved by the second House panel, Energy and Commerce Committee, by voted 31 to 23, by party line, too. Next week, the House Budget and Rules committees is expected to take up the GOP health care proposal, with a full House floor scheduled for the week of March 20. It has been reported that Ryan hopes to have a bill to President Trump for signature before April recess.

“Obamacare is rapidly collapsing. Skyrocketing premiums, soaring deductibles, and dwindling choices are not what the people were promised seven years ago. It’s time to turn a page and rescue our health care system from this disastrous law,” said House Speaker Ryan in a statement released when AHCA was thrown into the legislative hopper.

Ryan asserted that the GOP health care proposal would “drive down costs, encourage competition, and give every American access to quality, affordable health insurance. It protects young adults, patients with pre-existing conditions, and provides a stable transition so that no one has the rug pulled out from under them.”

The GOP health care proposal would keep two of the most popular provisions of Obama’s ACA, specifically providing health care coverage to people with pre-existing conditions (though insurers would be allowed to charge higher premiums to individuals with lapsed health care coverage) and allowing children to stay on their parents’ health plans until the age of 26.

But, the GOP’s efforts to repeal and replace Obama Care has brought aging groups together to put the brakes on House passage.

Aging Groups Come Out Swinging

Seniors’ advocates object to the ACHA’s impact on federal programs that provide both healthcare and long-term care to retirees. The bill rescinds an 0.9% tax on upper income earners’ wages, which had been used to extend the solvency of Medicare until 2028. Removing the tax decreases Medicare’s solvency by four years, which could lead to benefit cuts down the road. Advocates also decry the age-rating provisions in the repeal bill, which would allow insurers to charge older Americans up to five times as much for premiums as younger enrollees pay. The $4,000 tax credits for near seniors (aged 50-64) which replace Obamacare subsidies won’t make a dent in the premiums that this age group will pay under the GOP plan. Older Americans who can’t afford insurance will then arrive at the threshold of Medicare less healthy, putting additional strain on the system.

“This legislation is a triple whammy for seniors. It’s bad for Medicare beneficiaries, bad for near seniors, and bad for the Medicare program,” says Max Richtman, President and CEO of the Washington, D.C.-based National Committee to Preserve Social Security and Medicare.”

Richmond is especially alarmed that the AHCA also makes radical changes to the Medicaid program. The bill cuts $370 billion from Medicaid over 10 years by imposing “per capita caps,” meaning that states will get a fixed federal payment per beneficiary instead of the guaranteed match they now receive. Those fixed payments will not be able to keep pace with rising healthcare costs, leaving the states with significant shortfalls. “Millions of seniors rely on Medicaid for skilled nursing care, both in the home and at community-based facilities. The cut in federal payments will compel states to remove seniors from Medicaid rolls or radically reduce benefits, forcing them and their families into poverty.”

Following the release of the GOP’s AHCA, the Washington, D.C.-based AARP, the nation’s largest advocacy group representing over 37 million members, came out swinging. The GOP legislative proposal would weaken Medicare, leaving the door open to a voucher program that shifts costs and risks to seniors, warned AARP Executive Vice President Nancy LeaMond in a statement.

“Before people even reach retirement age, big insurance companies would be allowed to charge them an age tax that adds up to thousands of dollars more per year. Older Americans need affordable health care services and prescriptions. This plan goes in the opposite direction, increasing insurance premiums for older Americans and not doing anything to lower drug costs, noted LeaMond.

LeaMond charged, “On top of the hefty premium increase for consumers, big drug companies and other special interests get a sweetheart deal. “Finally, Medicaid cuts could impact people of all ages and put at risk the health of 17.4 million children and adults with disabilities and seniors by eliminating much needed services that allow individuals to live independently in their homes and communities.”

“Although no one believes the current health care system is perfect, this harmful legislation would make health care less secure and less affordable,” says LeaMond, noting that her nonprofit aging group will work with either political party to hammer out a health plan that “puts Americans’ health care first, not the special interests.”

Adds Judith Stein, executive director of the Center for Medicare Advocacy in a statement, “the proposed AHCA would also gut key financing mechanisms of the Affordable Care Act that would amount to tax cuts for the wealthy – by some estimates, by hundreds of billions of dollars. Regrettably, these tax cuts include provisions that would jeopardize Medicare’s financial stability. “We fear such cuts will lead to renewed calls to ‘save’ Medicare by privatizing it for future generations,” says Stein.

According to the Center for Medicare Advocacy’s statement, the proposed GOP legislative proposal would dismantle key structural supports of ACA, including eliminating the employer coverage mandate and the individual mandate to obtain health coverage, and instead would impose a 30 percent penalty for lapses in coverage. Instead of the ACA’s subsidies that make health coverage more affordable for millions, the new legislation would offer age-based tax credits ranging from about $2,000 to $4,000 – likely insufficient to pay for meaningful insurance coverage.

The Medicare Advocacy Group also warns that older Americans needing health insurance coverage before becoming Medicare eligible would also be hit hard by the proposed AHCA. The ACA’s protection of older adults that prevents insurance companies from charging no more than three times the premium amount charged of younger individuals (a 3:1 ratio) would be replaced by a higher 5:1 ratio – this dramatically increasing the premium amount insurance companies can charge older adults. Critics call this change an “age tax.”

Finally, the Republican’s AHCA would also phase out ACA’s expansion of Medicaid starting in 2020, structurally reforming virtually the entire Medicaid program (including Medicaid expansion). These changes would have a devastating impact on providing health care by capping federal Medicaid payments to each state to a limited, preset amount per person (often referred to as a “Per Capita Cap”).

Could Political Backlash Happen with Passage of AHCA?

Last Thursday, Ryan, with sleeves rolled up, urged GOP lawmakers to back AHCA, promising tweaks to address Republican conservatives’ concerns. At the 23 minute news conference, Ryan said: “This is the closest we’ve been to repealing and replacing Obamacare and it’s the closest we will ever get to repealing and replacing Obamacare.” It is either voting for the House bill, or let ACA survive, he said.

President Trump also chimed in to the AHCA debate, too, by calling for the controversial health care proposal’s enactment in an afternoon tweet. “Despite what you hear in the press, health care is coming along great. We are talking to many groups and it will end in a beautiful picture!,” he tweeted.

As the Congressional April recess approaches opposition to AHCA is building as physician, nurse and hospital groups warn that the legislative proposal’s enactment will take health care coverage away from millions of Americans. While Democratic and progressive organizations oppose ACA’s passage, too, a growing number of GOP lawmakers and conservative groups, from the Cato Institute, Americans for Prosperity and Tea Party Patriots, are expressing their concerns.

Days ago, Andrev Ostrovskv, chief medical officer for Medicaid at the Baltimore, Maryland-based Centers for Medicare and Medicaid based, risking the wrath of Trump’s political appointees in his federal agency, tweeted his displeasure and opposition. “Despite political messaging from others at HHS [Health and Human Services], I align with the experts from @aafp @AmerAcadPeds @AmerMedicalAssn in opposition to #AHCA,” he tweeted. Dr. Ostrovskv’s agency oversees the administering of Obamacare.

Even if the GOP House Leadership are able to address conservative lawmaker concerns, one being AHCA does not require an earlier halt to Medicaid expansion enrollment, the GOP’s health care proposal appears to have a rocky road to travel in the upper chamber. Senate. Republications, having just a 52-48 slim majority, can only lose two votes.

Says Senator Tom Cotton (R-Arkansas) in a tweet to House GOP Leadership: “ House health-care bill can’t pass Senate w/o major changes. To my friends in House: pause, start over. Get it right, don’t get it fast.”

With the popularity of Obamacare the GOP’s death wish to repeal and replace the law may well be hazardous to the Republican Party’s political health. We’ll find out for sure in the mid-term elections.

Save the Roses and Try These Tips: Six Ways to Improving Communication at Home

Published in the Woonsocket Call on February 5, 2007

Effective Communication at home with your husband, wife, or partner is key to maintaining a meaningful, healthy, environment and thriving family. With Valentine’s Day fast approaching, Author Donna Mac, a well-known corporate trainer, based in South Eastern, Massachusetts, with 25 years of experience in the broadcasting industry, translates effective corporate communication into tips for use in enhancing communication with your loved ones.

According to Mac, sexual infidelity, commonly linked to divorce, is not the leading cause for couples separating. The corporate communications expert notes that a recent article in Psychology Today says that whether a partner’s communication “lifts you up or brings you down” is the single largest predictor of divorce.

So, mastering your communication skills may be the best Valentine’s Day gift you can give, much better than a dozen roses. Mac, founder & president of Rehoboth, MA-based DMacVoice Communications, explains her Six Pillars Of Effective Communication which can bring healthy energy into an ailing relationship and bring you closer together with your loved one.

Six Pillars of Effective Communication

“The first pillar in becoming a more effective communicator,” says Mac, noting this “is tied to ‘knowing and owning who you are.’ That means your strengths and vulnerabilities. You must be comfortable with who you are and understand that you have a right to communicate what you are thinking and feeling.” She cautions us to be careful to always communicate as calmly and respectfully as possible. Don’t wait to communicate until emotions build up to the point where that is not possible.

“Also, get a sense for whether you are you an extrovert or an introvert”. Mac notes that this will influence how you interact with your partner. According to Mac, communication tends to flows more easily for extroverts. Introverts need more time to process before they speak, but they are usually better listeners.

She also cautions against being a passive, or even a passive-aggressive communicator. Both of these styles are non-productive but they are easy to fall into. Often times it feels easier to be a passive communicator because being an effective communicator take courage and work. “These days, it’s easy to hide behind our computer screens,” she says.

The second Pillar calls for the need to understand your partner. “Understand how your personality and communication style differs from that of your loved one,” suggests Mac, who says that there are differences as well as varying points of view in every relationship. “When you disagree, be open to the possibility that either of you may be “right” or “wrong” or a bit of both. Be open to learning something new. It is also important to make it easy for your partner to share his or her vulnerabilities and ask for your help. “Create a safe space for communications by allowing and encouraging your partner to communicate often and to be authentic,” she adds.

To use a phrase from her book, you can continue to “understand your audience” over the years by listening intently and often.

Pillar three encourages you to “master the content of the conversation” you are about to have. She stresses the need to be clear on what it is you would like to say especially if you have to have a challenging conversation.

Mac says, “You may need to practice how you are going to broach an extremely difficult topic. Do your best to speak in a way that is compelling but concise and has the best interest of both of you. Instead of accusing your partner of something, talk about the way that issue has affected you. Remember, they might not know if you don’t’ tell them. Also, try not to ramble. Instead, state your case with clarity and the most positive energy you can muster. If their actions are unacceptable, know where your boundaries lie and clearly and calmly state them.”

Put Yourself Into Their Shoes

Pillar four calls for you to “anticipate questions and reactions” to conversations.” Mac recommends, while you want to make sure you get your point across, ensure that you’ve taken time to put yourself into your partner’s shoes. “Life isn’t easy for anyone. But if you take time to think about and anticipate how they may feel or react to your topic you won’t be so quick to react emotionally and with harsh words and energy.

By anticipating reaction you will be able become more proactive in your relationship, she says, noting that, “your partner will appreciate it.”

“Remember, effective communication in a trusted relationship takes time, thought and occasional discomfort,” says Mac.

Pillar five suggests that you “speak to serve” in your conversations. “When you ‘serve’ the person you’re speaking with, you are taking time to make sure that the conversation is not “all about you”. It’s for the benefit of you, for them and for the greater good of the relationship or even the entire family!” says Mac. “When you serve while speaking, you are making sure that understanding is taking place. If you’re not sure that it is, you might want to say something like, “is this making sense to you?”

Finally, Pillar six calls for you to “detach from the outcome” of the conversation. “If you follow the first 5 Pillars of Effective Communication you will be well on your way to becoming a highly effective communicator. But you aren’t quite there yet!” states Mac. It is very important that you don’t try to control your partner’s reaction.

Instead of concerning yourself with perfection, remain flexible and detached, knowing that total agreement is never possible. Plus, it’s really unimportant. What is important is the health and strength of your relationship and two powerful voices, even if they don’t always see eye to eye,” she adds.

Don’t Try to Change Others, Change Yourself

Mac suggests that if you want to become an effective communicator, don’t focus on changing the other person. We have no control over other people, only ourselves. “So work on changing what you can change in your communication style so that you can communicate in compelling and influential ways”.

While Mac’s Six Pillars Of Effective Communication can be directed to couples, look at the recommendations and try replacing “romantic” partner with “business” partner or someone you’re collaborating with at work. And replace “the entire family” with “the entire department or company in Pillar five.

“These communication tips are universal and are the foundation for healthy professional AND personal relationships. The are not easy to integrate into our lives, but the more you use them, the quicker they’ll become part of who you are and how you communicate.”

Donna Mac is author of Guide to a RICHER LIFE–Know Your Worth, Find Your Voice & Speak Your Mind and The Six Pillars of Effective Communication. She is also a keynote speaker and private coach. For more details, go to http://www.dmacvoice.com.

Rotary Gears Up to Eradicate Polio

Published in the Woonsocket Call on October 16, 2016

Just days ago, Louis A. Marciano came to St. Paul’s Church on a mission to get his fellow Pawtucket Rotarians more involved in Rotary International’s efforts to create a polio-free world. Marciano, a former Mount Pleasant High School football player, a coach, a World War 11 veteran who fought in the Pacific Theater and a Rotarian for over 44 years, came to publicize the upcoming World Polio Day on October 24 and give an update on the international service organization’s efforts to eradicate Polimyelitis (polio).

Polio is a paralyzing and potentially fatal infectious disease that still threatens children in some parts of the world. The poliovirus invades the nervous system and can cause total paralysis in a matter of hours. It can strike at any age but mainly affects children under five. Polio is incurable, but completely vaccine-preventable. The infectious disease is found mostly in lower-income countries where poor sanitation and limited access to clean water facilitate the spread of the virus.

A Call for Action at
the Pawtucket Rotary Club

Marciano’s calls for assistance in raising funds to pay for polio inoculations for children and ratcheting up the awareness for Rotary’s efforts is not new. For over four decades, the former Rotary club president District 7950 Governor, has taken his fund raising campaign to end polio to 66 clubs in Rhode Island and southern Massachusetts. His efforts has received attention from his national headquarters, too. The North Providence Rotarian cherishes the Soccer Ball award “Kick Polio out of Africa” presented to him in 1998 for his efforts to eradicate Poliomyelitis

Some say that it may well “Takes a Village” to marshal the resources needed to make a world-wide impact. Over 1.2 million Rotary members belonging to 34,000 clubs world-wide work together to raise funds, advocate for government support, serve as volunteers to help immunize children, and raise awareness in their communities, said Marciano to his audience of Pawtucket Rotarians.

At the podium, the Cranston resident rattled off specifics as to why this global effort is important and is succeeding. Ending polio will save lives, is a very good investment, and most important is achievable, says Marciano.

Marciano notes, India is a prime example of one of the greatest Rotary International’s achievements in wiping out polio. “There were zero cases of polio in 2010 in India and they have been polio-free for nearly six years,” he says, noting that the World Health Organization has officially certified India polio-free in 2014. [According to Devin Thorpe in his March 15, 2014 article published in Forbes, in the 1980s there were approximately 150,000 cases of polio every year in India]

Marciano also announced the upcoming fourth annual world Polio Day event, co-hosted with the U.S. Centers for Disease Control and Prevention, to be held on Oct. 24. The event streaming live from CDC headquarters in Atlanta, Georgia, is expected to bring together more than 50,000 viewers around the world to learn from celebrities and experts about the progress to eradicate polio. For information about World Polio, go to http://www.endpolio.org.

While winding down his talk, Marciano acknowledges that there is still work to do but Rotary is moving closer to its goal of finally wiping polio from the face of the earth.

Carol Pandak, Director of Rotary’s PolioPlus program, agrees with Marciano’s assessment. “For more than 30 thirty years, Rotary has harnessed the dedication of community leaders around the world in support of polio eradication. When we started this effort, nearly 1,000 children a day were paralyzed by this disease. Today, there have been only 27 cases [Afghanistan (8); Nigeria (4); Pakistan (15)] in the whole world. Rotary remains fully committed to this important effort until every child is protected from this disease.”

From the Beginning

Rotary’s effort to eradicate polio began in 1979, with a multi-year project to immunize six million children in the Philippines. The international service organizations, “PolioPlus program, was established in 1985.

As indicated by the “plus” in PolioPlus, Rotarians also provide support for related health services, such as distributing Vitamin A and zinc tablets, providing bed nets to prevent malaria, assisting with preventative inoculations for other diseases, including measles, rubella, mumps, tuberculous, and other childhood diseases. The “plus” also means a system of advocacy and fundraising, and infrastructure and partnerships that will support the fight against infectious disease long after polio is gone.

Rotary also works closely with partners in the Global Polio Eradication Initiative (GPEI), including the World Health Organization (WHO), the US Centers for Disease Control (CDC), UNICEF, the Bill & Melinda Gates Foundation, and the governments of the world in this public health initiative.

Today, Rotary has given more than $1.6 billion to immunize more than two billion children against polio in 125 countries to wipe the infectious disease from the face of the earth. It is estimated that Rotary’s advocacy efforts have played a role in decisions by countries to contribute more than $7.2 billion to the effort.

Rotary’s polio initiative has also caught the attention of others. As far back as 2008, one of America’s biggest philanthropists came to the table to fight the war against polio. The Bill & Melinda Gates Foundation announced that every dollar Rotary committed to polio eradication would be matched two-to-one by the Foundation up to $35 million a year through 2018. Since this Foundation began its partnership with Rotary more than $2 billion has been contributed to Rotary’s polio eradication effort.

These funds help to provide much-needed operational support, medical personnel, laboratory equipment.

Public figures and celebrities have also joined Bill & Melinda Gates as ambassadors to help educate the public about polio through public service announcements, social media and public appearances. They include: Kristen Bell and Archie Panjabi; WWE superstar John Cena; supermodel Isabeli Fontana; Nobel Peace Prize laureate Archbishop Emeritus Desmond Tutu; action movie star Jackie Chan; boxing great Manny Pacquiao; pop star Psy; golf legend Jack Nicklaus; conservationist Jane Goodall; premier violinist Itzhak Perlman; Grammy Award winners A.R. Rahman; Angelique Kidjo and Ziggy Marley; and peace advocate Queen Noor of Jordan. These ambassadors help educate the public about polio through public service announcements, social media and public appearances.

Until polio is eradicated, all countries remain at risk of outbreaks, says Marciano.

Experts say that $1.5 billion is urgently needed to sustain the polio eradication initiative. Without full funding and political will power, polio could return to previously polio-free countries, putting children at risk contracting this paralyzing disease. From every corner of the globe Rotarians are gearing up on October 24 to garner support to wipe polio out, once and for all.