Senate Republicans Pushing to Vote on Latest Health Care Proposal

Published in the Woonsocket Call on September 24, 2017

With the September 30 expiration of its special Senate budget reconciliations status that allows the chamber to repeal and replace Obamacare with just a simple majority, Senate Republicains are rushing to bring their latest health care fix up for vote by the end of next week. The GOP’s last attempt failed by a razor thin margin.

Critics charge that the Senate Republicans push to quickly vote on their latest health care bill, crafted by Republican Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, comes before the issuance of a complete analysis of the Congressional Budget Office (CB)) that would detail the legislative proposal would impact coverage nationwide.

AARP, the National Committee to Preserve Social Security and health care provider groups say that Graham-Cassidy’s fix to put the brakes to rising health care costs will increase premium and out-of-pocket costs for millions. They say that the nonpartisan CBO would give the details to its negative impact.

Even Gov. Chris Christie came out opposing the GOP health care over haul bill that Senate Republicans are pushing. “I can’t support a bill that takes $3.9 billion away from the people of the state of New Jersey,” said the New Jersey Governor, reported last Wednesday by the Trentonian News. Democratic Colorado Gov. John Hickenlooper and Gov. Republican Governor John Kasich, of Ohio, held a bipartisan news conference this week calling for a bipartisan approach to reforming health care.

Talk Show Host Jimmy Kimmel also came out swinging against the Graham-Cassidy proposal, calling Sen. Cassidy, a co-sponsor of the bill, a liar. Earlier this year the Republican Senator had appeared on his show and after hearing that Kimmel had an infant son with a heart condition, he assure Kimmel that any GOP proposal would protect those with pre-existing conditions. It does not, at least to Kimmel’s satisfaction.

For days, aging and provider groups and even Democrats on cable shows expressed concern that the Graham-Cassidy Bill would allow states to permit insurance companies to charge people with preexisting conditions (an estimated 25 million Americans age 50 to 64) just because they have cancer, diabetes, high blood pressure, asthma, etc.

Age Tax Hits Seniors Right in their Wallets

On September 20, 2017, AARP writer Dena Bunis, charges in a blog posting, “Latest Senate Health Care Bill Revives Age Tax for Older Americans,” the GOP’s latest effort to repeal President Obama’s landmark Affordable Care Act (ACA), imposes an “age tax” on older Americans by eliminating premium tax credits and cost sharing payments that helped low-income persons afford deductibles and copayments for medical services.

The Graham-Cassidy bill would also allow states to get federal waivers for insurers to charge older Americans more so as to lower the cost for younger policyholders. The ACA limits the expense for older policyholders at three times the amount younger ones pay, says Bunis.

To illustrate the “age tax” Bunis, citing an AARP analysis, notes, that for a 60-year-old earning $25,000 a year, premiums and out-of-pocket costs could increase by as much as $16,174 a year. If that 60-year-old lives in a state that allows insurers to charge older individuals dramatically higher premiums, he or she would face an additional $4,124 increase in premiums,” she says.

The Graham-Cassidy bill takes away the premium tax credits that help older adults pay for their health care coverage, notes Bunis. . “About 6 million 50- to 64-year-olds buy their health coverage in the individual market, and about half of those individuals receive tax credits to help pay their premiums, she says, citing an analysis by the AARP Public Policy Institute.

The Graham-Cassidy bill would also eliminate vital cost-sharing payments that help low-income persons — especially those over age 50 — afford deductibles and copayments for medical services, too, adds Bunis, noting that “about 58 percent of adults enrolled in ACA marketplace plans get cost-sharing assistance, and 35 percent of those individuals are between 50 and 64 years old.”

Bunis notes that the latest Senate health care proposal would shift federal funds to the state through block grants that would allow each state to develop their own specific health care coverage initiatives to reduce costs. But, she says that Medicaid per capita cap or block grants funding proposals, “fundamentally change the Medicaid program [covering 17.4 million older Americans and people with disabilities], which has been a safety net for millions of poor Americans and people with disabilities.

Receiving Medicaid eligibility for coverage and services would leave fewer doctors and other providers willing to take Medicaid patients or provide needed care because reimbursement is too low.

Block grants, mandated by the Graham-Cassidy bill, would only last through 2026, offering no replacement health care plan, says Bunis. “Over 20 years, Graham-Cassidy would slash Medicaid funding by $1.2 trillion to $3.2 trillion, turning control of the program to the states and shifting costs over time to states and Medicaid enrollees,” she says.

“Americans have a right to know how this bill would impact them. Regretfully, the Majority Leadership is rushing the Senate to blindly consider Graham-Cassidy without fully vetting this proposal in committee hearings and mark-up, where amendments could be considered, and without a full Congressional Budget Office (CBO) score. CBO previously estimated that repeal-without-replace would cause 32 million people to lose health coverage,” said Max Richtman, President and Chief Executive Officer of the National Committee to Preserve Social Security and Medicare (NCPSSM), in a statement to Senate Finance. The Senate panel is scheduled to hold a hearing on the Graham-Cassidy bill next week.

“Senate consideration of any bill that would change the accessibility and affordability of essential health care for millions of Americans without a complete CBO analysis and committee debate would be the height of legislative malpractice,” says Richtman.

NCPSSM calls the latest GOP Senate Health care proposal “deeply flawed” and suggests that it be referred to the Senate Committee on Health, Education, Labor and Pensions where Chairman Lamar Alexander and Ranking Member Patty Murray are attempting to hammer out a bipartisan solution to strengthen the ACA’s individual health insurance market reforms.

A Final Take

A press time, Republican Sens. Ron Paul (Kentucky) and John McCain (Arizona) give thumbs down to the Graham-Cassidy bill with the Portland Press Herald reporting that Sen. Susan Collins of Maine, saying “I’m leaning against the bill.” Fifty Republican Senators must give their thumbs up, with Vice President Mike Pence casting the tie-breaking vote, to get a simple majority for passage. Now, the votes are just not there for passage.

But, one long-time Republican Senator speaks honestly on the record why President Donald Trump his fellow Senate caucus members are pushing so hard for passage of the latest Senate health care proposal. “You know, I could maybe give you 10 reasons why this bill shouldn’t be considered,” Iowa Republican Senator Chuck Grassley. “But Republicans campaigned on this so often that you have a responsibility to carry out what you said in the campaign. That’s pretty much as much of a reason as the substance of the bill.”

Sadly, if true the Republican-controlled Congress has put millions of Americans at risk of losing their health care coverage and at risk for the sake of a political promise. Our lawmakers must become statesmen and vote on legislative proposals because it is the right thing to do, not politicians who vote by party-line.

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Unpaid Caregiver Care Saves State Money

Published in Woonsocket Call on July 26, 2015

With the graying of state’s population, Ocean State caregivers provided 124 million hours of care—worth an estimated 1.78 billion —to their parents, spouses, partners, and other adult loved ones in 2013, according to a new AARP Policy Institute’s report.  The total estimated economic value of uncompensated care provided by the nation’s family caregivers surpassed total Medicaid spending ($449 billion), and nearly equaled the annual sales ($469 billion) of the four largest U.S. tech companies combined (Apple, Hewlett Packard, IBM, and Microsoft) in 2013, says the 25 page report.

AARP’s report, Valuing the Invaluable: 2015 Update, noted that family caregiving for relatives or close friends with chronic, disabling, or serious health problems – so they can remain in their home – is nearly universal today.  In 2013, about 134,000 family caregivers in Rhode Island helped another adult loved one carry out daily activities (such as bathing or dressing, preparing meals, administering medications, driving to doctor visits, and paying bills), says the report issued on July 16.

Log on to AARP Rhode Island’s caregiving Web page (www.aarp.org/ricaregiving) to download the report as well as access information on recent caregiver legislation passed by the General Assembly and other resources: www.aarp.org/ricaregiving.

The Difficulty of Caregiving

The AARP report detailed how caregiving can impact a person’s job, finances and even their health, says the researchers.   More than half (55%) of family caregivers report being overwhelmed by the amount of care their family member needs, says the report.  Nearly 4 in 10 (38%) family caregivers report a moderate (20%) to high degree (18%) of financial strain as a result of providing care. In 2014, the majority (60%) of family caregivers had full- or part-time jobs, placing competing demands on the caregivers’ time.

According to AARP Rhode Island State Director Kathleen Connell, AARP’s study on caregiving affirms the state’s record as a trailblazer in the field of caregiving. In 2013, Rhode Island became just the third state to enact paid family leave, which is known as Temporary Caregiver Insurance (TCI). Also in 2013, Rhode Island enacted the Family Caregivers Support Act, which requires a family caregiver to receive an assessment,” she said.

Connell said that this year the Ocean State remained in the forefront of helping caregivers with passage of the Caregiver Advise, Record, Enable (CARE) Act, which calls for hospitals to provide instruction to designated caregivers. Additionally, Rhode Island became the 42nd state to enact the Uniform Adult Guardianship and Protective Proceedings Jurisdiction Act. In Rhode Island, a court-appointed guardian can make important decisions across state lines.

“This new report, however, does demonstrate that we need and can do more to assist the many caregivers in our state,” said Connell. “Some of the ways we can help family caregivers include continuing efforts to improve workplace flexibility, respite care, tax credits and home care services,” she says.

Adds Charles Fogarty, Director of the state’s Division of Elderly Affairs (DEA), “This study demonstrates that the backbone of long-term services and supports are family members and informal caregivers.  Quantifying the hours and economic value of caregiving provided by Rhode Island families and informal caregivers raises public awareness of the impact these services have upon Rhode Island’s health system and economy.  It is clear that there is a significant need to support caregivers who, at a cost to their own health and economic well-being, work to keep their family members in the community.”

DEA works with the state’s Aging Disability and Resource Centers and local nonprofits and agencies such as the RI Chapter of the Alzheimer’s Association, Office of Catholic Charities of the Diocese of Providence, local YMCAs and Adult Day Care programs, to provide programming, support groups and information to Rhode Island’s caregivers, according to Fogarty.  “Rhode Island also requires that a caregiver assessment be conducted when a recipient of Medicaid-funded Home and Community Based Services has a caregiver providing support in the home,” he says.

Improving State Support for Caregiving

            Although Maureen Maigret, policy consultant for the Senior Agenda Coalition of Rhode Island acknowledges Rhode Island as being a leader with progressive laws on the books supporting caregivers, specifically the Temporary Caregiver Insurance Program, more work needs to be done.

Maigret calls for better dissemination of information to caregivers about what services and programs are available.  “In this day and age we should have a robust Rhode Island specific internet site that offers caregiving information about state specific resources,” she says, noting that too often caregivers “just do not know where to turn to find out about programs like DEA’s co-pay program.”  This program pays a share of the cost for home care and adult day care for low-income persons whose incomes are too high to meet Medicaid eligibility.

          Rhode Island also falls short in providing subsidies to caregivers of frail low income elderly to keep them out of costly nursing homes, says Maigret, noting that the program’s funding was cut by 50 percent in 2008, creating waiting lists which have occurred over the years, It’s “short sided” to not allocate adequate resources to this program. The average annual cost of $ 1,200 per family for the caregiver subsidy program can keep a person from going on Medicaid, at far greater expense to Rhode Island taxpayers, she says.

          This AARP report must not sit on a dusty shelf.  It gives an early warning to Congress and to local lawmakers.  As Americans [and Rhode Islanders} live longer and have fewer children, fewer family members will be available for caregiving duties. Researchers say that the ratio of potential family caregivers to the growing number of older people has already begun a steep decline. In 2010, there were 7.2 potential family caregivers for every person age 80 and older. By 2030, that ratio will fall sharply to 4 to 1, and is projected to drop further to 3 to 1 in 2050.

With less caregivers in the trenches providing unpaid care to keep their loved one at home, the state will have to step in to provide these programs and services – for a huge price tag to taxpayers.  State lawmakers must not be penny wise and pound foolish when it comes to caregiver programs.  Funding should not be slashed in future budgets, rather increases might just make political sense especially to tax payers.

Herb Weiss, LRI ’12 is a Pawtucket writer covering aging, health care and medical issues.  He can be reached at hweissri@aol.com.

AARP Report Says Older Americans Value Livable Communities

Published n Pawtucket Times, May 16, 2014

If they had their druthers, the vast majority of people age 50 and older plan to remain living independently right at home in their communities “aging in place”, concludes a new report released last month by the AARP Public Policy Institute. The 43 page report which surveyed boomers and seniors found that both value secure neighborhoods, safety, good schools, safe streets for walking, access to transportation, parks and affordable housing as community amenities. With these resources in place, communities enhance personal independence and foster resident engagement in civic, economic and social life, qualities that AARP has traditionally used to describe the livability of a community.

“What older Americans and Millennials want in terms of their community is not all that different.” said AARP Executive Vice President for Policy, Debra Whitman. “What is livable differs for each of us, whether we want a warm climate or a dense city, for example,” she said. “But this report tells us that the fundamental elements of a community that will please America’s aging population will equally serve future generations [as well].”

Maintaining Independence in the Community

The new report, “What is Livable? Community Preferences of Older Adults,” unveiled April 25, 2014, is based on focus groups and a survey of more than 4,500 participants. These findings reaffirm the historic trend that most people ages 50 and older want to age in place. Adults ages 65 and older are even more likely (87 percent) to say they want to age in their current home or community than those ages 50 to 64 (71 percent).

A small portion of adults age 50 and older – about one in six – say they plan to move in the next three years. This thought is more common for members of minority groups, those with low-incomes, those who don’t drive, or those living in metropolitan areas, notes the report.

According to the AARP report, many factors play into the hierarchy of a person’s community preferences. Specifically, household income influences the importance of local government spending priorities on local schools, transportation, personal safety, and proximity to various amenities. Race and ethnicity also play a role as do health and one’s life stage. African-American and Latino respondents ranked affordable housing more highly than respondents in general, for example, while caregivers and people with disabilities rate the availability of specialized transportation more highly than those who are not in those categories.

Participants were also asked, “What community amenities do you want close to home?” Access to public transportation, food and green space topped the list, the researchers say.

Effectively Planning for Livable Communities

Jeff C. Davis, Principal Planner at the Rhode Island Division of Planning, notes that AARP’s report mirrors his state agency’s views as what is a livable community. State planners’ strategy is to identify and promote areas where Rhode Island should grow – places in the state that already have a core of residential and commercial development or are well suited to planned, future development; they are the places that will accommodate and nurture Rhode Island’s future growth while protecting its natural and cultural resources.

According to Davis, livable communities can be found in downtown places like Providence, Westerly, Newport and Warren and in villages like Wickford, Harrisville, Wakefield and Pawtuxet. “These places offer a mix of homes, shops, community services, jobs, and public open space, connected not just by roads, but bus routes, bike paths, and in some cases trains,” states Davis, stressing that the Ocean State is also “very fortunate that a lot of these places have beautiful architecture and access to water, whether rivers, ponds, or the ocean.”

Davis believes that zoning ordinances through the state make it difficult to recreate livable places, or to enhance existing centers with sensitive development. “Many of our older urban communities have the bones of a livable, walk able place, but need targeted reinvestment to come alive again with a mix of uses and housing,” he says.

“The state and our cities and towns need to continue to work together to make sure local zoning allows and encourages center development, finds ways to prioritize funding and other supports for these areas, and makes sure that we are planning physically and financially for inclusive and accessible places,” adds Davis.

Davis is seeking public input to make Rhode Island’s communities more livable. “We are currently working on a planning campaign called RhodeMap RI, and need feedback on ideas for growing Rhode Island’s economy and providing for healthy homes and great communities.”

“It’s All in Our Backyard”

“The one surprise in the AARP report is that health care was not a major concern,” says President and CEO Neil Steinberg, of the Rhode Island Foundation, the state’s largest and most comprehensive funder of nonprofit organizations. “We hear about it all the time. In fact, access to quality, affordable health care is one of our strategic priorities,” he says.

“Almost everyone probably can agree on what makes a livable community. They have vibrant arts and culture, concern for children and families, economic opportunity for all, a great educational system, a sound environment, quality health care, housing that doesn’t break the bank and programs that meet basic human needs,” states Steinberg..

“The fact that we do have livable communities is what keeps Rhode Islanders here generation after generation,” says Steinberg, noting that the state’s small size gives its residents a “statewide feeling of connectedness.”

“This sense of belonging may be the most important factor in defining a livable community,” adds Steinberg.

The Rhode Island Foundation which awarded more than $ 31 million in grants last year to help nonprofits tackle critical issues in the state, has implemented a very visible public awareness campaign that reminds people that the Ocean State is a special, very livable place, notes Steinberg. “It’s All in Our Backyard” is about pride of place. It is an effort to help Rhode Islanders connect with our state’s rich resources, he says.

“There are plenty of success stories right here,” Steinberg says, noting that Rhode Island has “global industry and cutting-edge innovation, thriving entrepreneurship and world-class universities, breathtaking landscapes and a major arts scene.”

Steinberg urges, “Let’s celebrate Rhode Island as the vibrant, stimulating place where we work and live.”

It’s a Mixed Bag

AARP Rhode Island State Director Kathleen S. Connell observes that neighborhoods widely differ in the state’s 39 towns and cities, and within larger cities. “That said, a fair assessment would be that there are examples of great strides toward more livable communities as well as places in Rhode Island that are in a state of neglect.”

“The good news is that where improvements are being made today the process is much different when it was a decade ago as far as taking into consideration the interests of a broader range of stakeholders,” Connell adds.

Connell says that “many of the state’s older neighborhoods qualify as “livable” insofar as they are blessed with open space, sidewalks, are near parks and bike paths and feature transportation infrastructure that is designed with consideration for all types of users and people of all abilities.” Many planners and members of zoning boards understand the concept of livable communities and work hard to maintain and expand livable features,” she notes.

“But as the AARP survey revealed, livable also [also] means good schools, responsive local government, safety, convenient public transportation and affordable housing,” adds Connell, noting that there are still “parts of the state where these things have yet to come together that can be improved and communities made more livable.”

Connell warns that making a community livable should not be just to benefit the older population. “It’s really about people of all ages who want to live comfortable, healthy and environmentally responsible lives,” she says, detailing examples that include more public, park-like space in a retail/business district. These are assets for Rhode Islanders of all ages.

“A greener environment can enhance the business climate and local economy and works for all citizens on that level, too,” states Connell. Bike paths benefit all age groups and curb cuts benefit young moms with baby strollers as much as they are helpful to folks who get around with the aide of walkers,” she says.

The AARP study’s findings show that both young and old gravitate to livable communities. These localities allow persons to be more active, stay fit, even connected, allowing aging boomers and seniors to live independently at home. Rhode Islander’s might just think about The Rhode Island Foundation’s message, “It’s All in Our Backyard.” While we have a little ways to go to be a completely livable state, we’re closer to that goal than some naysayers believe.
The full report “What is Livable? Community Preferences of Older Adults” can be found at http://www.aarp.org/research/ppi/liv-com2/policy/Other/articles/what-is-livable-AARP-ppi-liv-com.

For more information about the Rhode Island Foundation’s “It’s All in Our Backyard,” go to http://www.ourbackyardri.com.

For details about RhodeMap RI, and to take the State’s surveys on housing and economic development, go to http://www.rhodemapri.org/rhodemap-virtual-open-house.

Herb Weiss, LRI ’12, is a Pawtucket-based writer covering aging, health care and medical issues. He can be reached at hweissri@aol.com.