Aging Groups Fear that Deficit May Lead to Attacks on Entitlement Programs

Published in Woonsocket Call on January 21, 2018

In early December, the GOP-controlled Senate passed by a partisan vote of 51 to 49 its sweeping tax rewrite, sending the $1.5 trillion tax package, detailed in a 492 page bill, to the Conference Committee to iron out the differences between the Senate and House bills. The House’s Tax Cuts and Jobs Act (H.R. 1), was passed by a 227-to-205 vote on November 16, 2017. Congress ultimately passed the Conference Committee’s revised tax bill, sending it to President Trump’s desk for signature. While the new tax law has a few positive provisions for seniors, aging groups predict a frontal assault by the GOP-controlled Congress and White House in 2018 to make cuts on Medicare, Medicaid, and Social Security to balance to ballooning federal deficit.

Just days before President Trump signed into law on December 22, 2017, the Tax Cuts and Jobs Act (P.L. 115-97), considered to be the biggest tax reform overhaul in over 30 years, AARP’s Chief Executive Officer, Jo Ann C. Jenkins, sent a letter to Congress raising the Washington, DC-based aging groups concerns with the law’s significant shortcomings as well as highlighting its impact “on the nation’s ability to fund critical priorities.”

Putting Medicare on the Chopping Block

In December 19 correspondence, Jenkins noted that AARP opposed the tax bill because of its negative impact on older adults. She expressed concern that there would be increased calls for greater spending cuts in Medicare, Medicaid and other domestic programs serving older Americans, with the tax legislation increasing the nation’s deficit by $1.5 trillion over the next ten years (with an unknown amount beyond 2027).

“Indeed, the non-partisan Congressional Budget Office (CBO) has confirmed that unless Congress takes action, the reconciliation legislation will result in automatic federal funding cuts of $136 billion in fiscal year 2018, $25 billion of which must come from Medicare,” said Jenkins. With the tax legislation’s repeal of Obamacare’s individual mandate, health care premiums would increase by 10 percent (with 64-year olds paying an average increase of $1,490) and there would be 13 million fewer Americans with health coverage, says Jenkins, citing a CBO’s analysis of the tax legislation.

However, AARP did appreciate that the Tax Cuts and Jobs Act retained the medical expense , deduction and restored the 7.5 percent income threshold for all tax filers for two years, said Jenkins, noting that “almost three-quarters of tax filers who claimed the medical expense deduction are age 50 or older and live with a chronic condition or illness, and seventy percent of filers who claimed this deduction have income below $75,000.”

Finally, Jenkins also said that the Tax Cuts and Jobs Act retained the additional standard deduction for those age 65 and older, as well as rejected proposals to make significant changes to the tax treatment of retirement contributions, which would have negatively affected the ability many tax filers to save for their retirement.

Targeting Social Security, Medicare, and Medicaid

Like Jenkins, the Washington, DC-based National Committee to Preserve Social Security and Medicare also sees Medicare, Medicaid and Social Security becoming more vulnerable to benefit cuts due to the huge $1.5 trillion increase in the public debt resulting from the enactment of the GOP’s tax law.

According to the NCPSSM’s Government Relations and Policy staff in a January 2018 policy brief, key supporters of the Tax Cuts and Jobs Act made it very clear that Medicare, Medicare and Social Security, would be targeted to balance the federal budget immediately after its approval. “For example, Senator Marco Rubio (R-FL) said that the tax bill is just the first step before “…instituting structural changes to Social Security and Medicare…” benefits to reduce the federal deficit. Similarly, House Speaker Paul Ryan (R-WI) said that “we’re going to have to get back next year [2018] at entitlement reform, which is how you tackle the debt and the deficit.” In other words, the majority leadership will seek cuts to Medicare, Medicaid and Social Security benefits as the next step to pay for the deficits this tax bill will create,’ NCPSSM’s policy brief.

In 2018, NCPSSM anticipates that the GOP-controlled Congress will seriously look at privatizing Medicare, raising the Medicare eligibility age, increasing beneficiary out-of-pocket costs, expand means testing of Medicare premiums, and block granting Medicaid, as a way to reducing the huge federal debt.

NCPSSM says that under the GOP’s Medicare privatization plan, when people become eligible for Medicare benefits they would not enroll in the current traditional Medicare program, which provides guaranteed benefits, but would receive a voucher to purchase private health insurance or traditional Medicare through a Medicare Exchange. The voucher’s amount would be determined annually when private health insurance plans and traditional Medicare participate in a competitive bidding process.

Medicare costs could also be cut by gradually increasing the eligibility age of Medicare to correspond with Social Security’s retirement age which is increasing from 65 to 67. Although this GOP strategy would initially save money, it would increase “system-wide health spending for everyone else,” warns NCPSSM.

NCPSSM says that “savings from redesigning the Medicare benefit [to reduce the federal deficit] by combining the Part A and Part B deductibles and making changes to supplemental insurance (Medigap) policies, would likely increase costs for people with Medigap policies.”

In 2018, the GOP Congress also might even consider expanding means-testing of Medicare premiums to reduce the federal deficit, says NCPSSM. “Expand income-related premiums under Medicare Parts B and D until 25 percent of beneficiaries are subject to these premiums [would reduce costs]. A Kaiser Family Foundation study found that this proposal would affect individuals with incomes equivalent to $45,600 for an individual and $91,300 for a couple in 2013,” says NCPSSM’s policy brief.

Medicaid provides funding for health care to low-income seniors, people with disabilities, children and some families. “We anticipate [GOP] proposals will be made that would end the current joint federal/state financing partnership and replace it with per capita caps (or a block grant, at state option) giving states less money than they would receive under current law,” says NCPSSM’s policy brief, noting that repealing the Medicaid expansion under Obama’s Affordable Care Act would prevent low-income adults from accessing health care services.

Concerns Over Fast-Track Reforming Social Security

Finally, NCPSSM’s policy brief warns that GOP lawmakers might push for a “fast-track” procedure that would lead to cutting social security benefits. This proposal would require the President to submit a plan to be considered in Congress under “expedited procedures” to reform Social Security if the Social Security Trustees determine the Trust Funds do not meet a 75-year actuarial balance. NCPSSM views this proposal “as a way that to circumvent public scrutiny of proposals to reduce Social Security programs.”

NCCPSSM also anticipates a GOP proposal to eliminate concurrent receipt of unemployment insurance and Social Security Disability Insurance (SSDI) for beneficiaries who work, get laid off and as a result qualifies for Unemployment Insurance.

Last month, the GOP-controlled Congress and White House enacted the largest tax reform bill. AARP, NCPSSM and other aging advocacy groups warn that Social Security, Medicare and Medicaid will be targeted by the GOP lawmakers to balance the tax reform law’s $1.5 billion costs. Older voters must now become politically active in protecting and strengthening these programs for both current beneficiaries and future generations” With the looming 2018 mid-term elections, may be Congress might just listen.

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Medicare Takes a Blow Under GOP’s Major Tax Plan Fix

Published in the Woonsocket Call on December 10, 2017

In early December, the GOP-controlled Senate passed by a partisan vote of 51 to 49 its sweeping tax rewrite (with Republican Senator Bob Corker of Tennessee siding with the Democrats and opposing the measure), sending the $1.4 trillion tax package, detailed in a 492 page bill, to the Conference Committee to iron out the differences between the Senate and House bill, Tax Cuts and Jobs Act (H.R. 1), that was passed by a 227-to-205 vote on November 16, 2017.

While Democrats are technically part of the conference committee, Republicans are yet again hashing out the details behind closed doors on a purely partisan basis. Democrats charge that the GOP lawmakers on the conference committee will look to rubber-stamp whatever their leadership comes up with and do not expect to see any changes to the legislation for the better.

The cores of the House and Senate bills are already very similar: tax cuts for the wealthiest and corporations paid for by middle-class Americans. Republicans are rushing to get legislation to President Donald Trump’s desk for his signature before Christmas. While Trump looks forward to the first major legislative accomplishment of his presidency (once signed into law) as a Christmas gift to the nation, those opposing the massive changes to the nation’s US tax code view it as a stocking stuffed with coal.

Congressional insiders expect to see a finalized tax bill in the coming days, and votes in the House mid-next week at the earliest.

Medicare Takes a Blow

U.S. Senator Sheldon Whitehouse, sitting on the Senate Special Committee on Aging, sees the writing on the wall with the passage of the GOP tax bill. “The Republican tax plan would run up huge deficits, trigger immediate cuts to Medicare, and threaten Social Security and Medicaid down the line,” says the Rhode Island Senator.

Adds, Max Richtman, president and CEO of the National Committee to Preserve Social Security and Medicare (NCPSSM), this forces the “the poor, middle class, and elderly to pick up the tab for trillions of dollars in tax breaks that the super-rich and profitable corporations do not need..” If enacted, the GOP tax fix triggers an automatic $25 billion cut to Medicare,” he warns, noting that “it blows a $1 trillion hole in the deficit, inviting deep cuts to Social Security, Medicare, and Medicaid.”

Richtman says, “adding insult to injury” both the GOP Senate and House tax bills repeal the Obamacare mandate, which will raise ACA premiums for older adults (age 50-64) by an average of $1,500 in 2019. He notes that the Senate tax bill uses the “Chained CPI” inflation index for calculating deductions and tax brackets, this “setting a dangerous precedent that could spill over into cost-of-living adjustments for Social Security.”

In her December 7 correspondence to Congressional leadership, AARP Chief Executive Officer Jo Ann Jenkins, representing millions of members who whose health care depends on Medicare, urged lawmakers to work together in a bipartisan fashion to enact tax code legislation that would meet the needs of the older population and arrive at a tax code that is “more equitable and efficient, promotes growth, and produces sufficient revenue to pay for critical national programs, including Medicare and Medicaid.”

Jenkins urged Congress to prevent $25 billion in automatic cuts to Medicare in 2018 that would result from the enactment of H.R. 1 and its $1.5 trillion deficit increase (according to the Congressional Budget Office) since it “would have an immediate and lasting impact, including fewer providers participating in Medicare and reduced access to care for Medicare beneficiaries.”

“The sudden cut to Medicare provider funding in 2018 would have an immediate and lasting impact, including fewer providers participating in Medicare and reduced access to care for Medicare beneficiaries,” said Jenkins, who warned that health care providers may choose to stop accepting Medicare patients at a time when the Medicare population is growing by 10,000 new beneficiaries each day.

Jenkins also expressed her concern that Medicare Advantage plans and Part D prescription drug plans may charge higher premiums or cost-sharing in future years to make up for the cuts now.

The Devil is in the Details

On the AARP website, Gary Strauss, an AARP staff writer and editor, posted an article on December 6, 2017, “Your 2018 Taxes? Congress Now Deciding,” that identifies specific GOP tax bill provisions that hit older tax payers in their wallets.

According to Strauss, an AARP Public Policy Institute analysis also found that more than one million taxpayers 65 and older would pay higher taxes in 2019, and more than 5 million would see their taxes increase by 2027. More than 5 million seniors would not receive a tax break at all in 2019, and 5.6 million would not see their taxes decrease by 2027.

The House and Senate tax bills also have differing views on the medical expense deduction, used by nearly 75 percent of filers age 50 and older, says Strauss. The Senate plan allows taxpayers to deduct medical expenses exceeding 7.5 percent of their income rather than a current 10 percent — for the next two years. The House tax plan eliminates this deduction. Some 70 percent of filers who use the deduction have incomes below $75,000.

Strauss says that the House bill eliminates the extra standard deduction for those age 65 and up, while the Senate bill retains it. For 2017, that’s $1,250 for individuals, $1,550 for heads of households or $2,500 for couples who are both 65 and older. .

Both Senate and House versions abolish state and local tax deductions, with the exception of up to $10,000 in property taxes. Residents in high-tax states such as California, Connecticut, New Jersey and New York, would pay higher taxes, adds Strauss.

For home owners, Strauss notes that the Senate plan leaves interest deduction limits at $1 million, while the House bill lowers the mortgage interest deduction limit to $500,000 and no longer allows it to be used for second homes, says Strauss.. Individuals would also continue to get up to $250,000 tax-free from the sale of a home (up to $500,000 for couples). But, both bills require sellers to live in the property five of the eight years prior to a sale, up from the current requirement of two of the last five years,” adds Strauss.

At press time, dozens of newspapers are reporting that Americans across the nation are protesting the passage of GOP tax bill that makes the biggest changes to the U.S. tax code in 30 years, calling it a “scam.” AARP and NCPSSM are mobilizing their millions of members to protect Medicare, Social Security and Medicaid.

While Trump told Senators at a lunch meeting held on December 5 at the White House that the Republican tax plan was becoming “more popular,” two recently released polls are telling us a completely different story. According to a Gallup national poll, a majority of independents (56 percent) join 87 percent of Democrats in opposing the tax plan. Only 29 percent of Americans overall approve of the proposed GOP changes to the nation’s tax code. Reflecting Gallup’s finding, the Quinnipiac University national poll found that 53 percent of American voters disapprove of the tax plan, while only 29 approve.

With mid-term Congressional elections less than a year away, Trump and the GOP-controlled Congress continued push to dismantle Obamacare, leaving millions without health care coverage and creating a tax code that would destroy Medicare, may well bring millions of older taxpayers to the polls to clean house. We’ll see.

GOP Health Care Reform Moves to Senate

Published in Woonsocket Call on May 7, 2017

House Speaker Paul Ryan’s words are now coming back to haunt him and GOP leadership that rammed American Health Care Act (AHCA), without procedural safeguards, through the House chamber days ago. “I don’t think we should pass bills that we haven’t read that we don’t know what they cost,” said Ryan in a 2009 interview on MSNBC when Congress was debating President Obama’s 1990-page Affordable Care Act (ACA), or Obamacare.

Last month, the Trump Administration efforts to repeal and replace Obamacare, with the American Health Care Act (AHCA) went down in flames when so many GOP moderates and conservative House lawmakers opposed the bill that the leadership didn’t dare bring it up for a vote. Successful negotiations of the GOP factions crafted a new version that passed last Thursday 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 House passage, the bill moves to the Senate for deliberation.

Before the House vote on the GOP health bill there were no legislative hearings held to debate its merits and its full text was posted on the Web less than 24 hours before the vote. Ryan did not even wait for the nonpartisan Congressional Budget Office (CBO) to provide an updated financial analysis of AHCA. The CBO’s analysis of the original bill, pulled moments before a scheduled vote on March 24, 2017, found that the GOP health care proposal estimated that if passed 24 million or more Americans could be uninsured by 2026.

Opposition Mounting to GOP Health Care Proposal

With the passage of AHCA, Democratic Policy and Communication Committee Co-Chair David N. Cicilline (D-RI) issued the following statement, saying “This is the cruelest and most immoral thing I’ve seen the Republican Party do to the American people. They just passed a bill that they know will result in the deaths of thousands of working people each year. I don’t know how they sleep at night.”

“All you need to know about this bill is that Republicans tried to exempt themselves from coverage [of the GOP health care proposal]] before they got caught. That’s because they know it’s a raw deal,” says Senator Sheldon Whitehouse. This legislation sets us on a path to the bad old days when insurance companies could refuse coverage to those with preexisting conditions and deny people health benefits that should be in every plan – like ‎maternity and mental health care, he says.

Whitehouse warns that AHCA’s passage will leave millions of Americans without access to affordable health insurance. “Rhode Islanders rely on the Affordable Care Act and it’s working here. If they want to improve it, that’s one thing, but this House bill will hurt Rhode Islanders,

Within hours of the House vote on AHCA, a joint statement was issued by six prestigious national medical organizations (American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American Congress of Obstetricians and Gynecologists, American Psychiatric Association American and the American Osteopathic Association), representing over 560,000 physicians and medical students, denouncing the GOP health bill. Dozens of other state and national health care organizations, including the American Medical Association, American Nurses Association and American Hospital Association (and this number grows daily) also gave a thumb down on the Republican health bill that is considered “unworkable and flawed.”

Aging advocacy groups came out swinging, too.

AARP, representing 38 million members and considered to be one of the nation’s most powerful aging lobbying groups, plans to hold GOP House lawmakers accounting for their support of AHCA while gearing up to oppose the Republican health care proposal in the Senate.

In a statement, AARP Executive Vice President Nancy LeaMond reiterated AARP’s opposition to the GOP health bill passed in the U.S. House of Representatives, calling it “flawed” and warning that the legislative proposal “would harm American families who count on access to affordable health care.”

LeaMond says, “the bill will put an Age Tax on us as we age, harming millions of American families with health insurance, forcing many to lose coverage or pay thousands of dollars more for health care. In addition, the bill now puts at risk the 25 million older adults with pre-existing conditions, such as cancer and diabetes, who would likely find health care unaffordable or unavailable to them.”

According to LeaMond, AARP will continue its opposition of AHCA as it moves for Senate consideration because it “includes an Age Tax on older Americans, eliminates critical protections for those with pre-existing conditions, puts coverage at risk for millions, cuts the life of Medicare, erodes seniors’ ability to live independently, and gives sweetheart deals to big drug and insurance companies while doing nothing to lower the cost of prescriptions.

LeaMond warns, “We promised to hold members of Congress accountable for their vote on this bill. True to our promise, AARP is now letting its 38 million members know how their elected Representative voted on this health bill in The Bulletin, a print publication that goes to all of our members, as well as through emails, social media, and other communications.”

Medicaid Takes a Major Blow

“The bill threatens the very heart of the Medicaid program, taking away the guarantee that Medicaid will be there when seniors need it most. By slashing Medicaid funding by over $800 billion, the AHCA will place tremendous strain on state budget, says Kevin Prindiville, Executive Director of Justice in Aging, a nonprofit advocacy group for low-income seniors. “States will be forced to cut services, restrict eligibility, and reduce benefits for seniors, children, people with disabilities, and low-income older adults, he says.

“Congress is forcing families to pay more out-of-pocket when grandparents and other loved ones need nursing home care or home care. Two-thirds of all Medicaid spending for older adults pays for long-term services and supports. The AHCA puts this vital care for seniors in jeopardy,” says Prindiville. “By passing the ACHA, the House chose to cut taxes for the wealthy and pharmaceutical companies while harming Medicare beneficiaries by increasing Part B premiums and reducing the life of the Medicare Trust Fund, he says.

Max Richtman, President and CEO of the National Committee to Preserve Social Security and Medicare calls the AHCA vote “appalling” for retirees and views the “raid of Medicare, cuts to Medicaid among the most problematic parts of the AHCA.”

“Despite the bill’s name, risking the health of our nation’s most vulnerable citizens to give the wealthy an $ 600 billion tax cut is tremendously uncaring — and does not reflect real American values,” says Richtman. In modifying the original AHCA bill to give reluctant Republicans political cover, the House leadership made a bad piece of legislation even worse,” he says.

No Protection for Pre-existing Conditions

“Recent amendments to this cruel, ill-advised bill could put coverage for older Americans with pre-existing conditions like cancer and diabetes out of reach. The $8 billion (over 5 years) added to the legislation at the last minute to defray the cost of higher premiums is woefully inadequate. It’s a thin veil that covers a head of snakes,” notes Richtman

“Equally inadequate are the meager tax credits that the GOP bill offers older Americans to buy insurance. A $4,000 annual tax credit doesn’t come to close to covering premiums for seniors ages 60-64, meaning millions of older Americans will lose coverage altogether,” says Richtman.

According to Richtman, AHCA slashes nearly $1 trillion from the Medicaid by converting the social health care program into a block grant program or imposing per capita caps. “This would make it harder for impoverished seniors to access long term skilled nursing care and community or home care. Overall, the Congressional Budget Office estimates that 14 million people will be kicked off the Medicaid rolls in the next 10 years if this bill becomes law,” he says.

Richtman observes that the enactment of AHCA would reduce Medicare’s solvency by repealing Obamacare’s 0.9 percent payroll tax on wages above $200,000. This could lead to cuts in Medicare, including privatizing the program — harming current and future beneficiaries, he says.

“Under the GOP bill, insurers can charge older enrollees five times more than younger ones. The Congressional Budget Office predicts that by 2026 this provision will substantially raise premiums for older people by as much as 25 percent,” notes Richtman.

Senate Becomes New AHCA Battle Ground

After the politically decisive House vote to pass AHCA, President Donald Trump and House GOP lawmakers celebrated their major political victory at the White House Rose Garden claiming that they had fulfilled a promise made 7 years ago to repeal and replace Obamacare. But this celebration was short lived. Like House Democratic lawmakers, Democratic and Republican Senators began voicing their skepticism and strong opposition to the House’s passed health bill. Holding a slim 52-to-48 advantage in the upper chamber, GOP Senate Leadership must craft a bill that can win the support of at least 50 of their caucus members.

Washington insiders are now reporting that the House’s unpopular AHCA is “Dead on Arrival” in the Senate. Senate Republicans say they will not vote on the House passed bill and the upper chamber is expected to move slowly in crafting its health bill, starting from scratch. Many GOP Senators opposed AHCA, especially those who want to protect their constituents with pre-existing conditions and others who represent states that have expanded their Medicaid program under Obamacare.

A group of 13 Republican Senators (all men) have begun the process of hammering out their own health bill. Senate rules do not allow a review of the legislation or the determination of the rules of the debate until the CBO provides its official fiscal impact estimate. Because of this the health policy debate may not begin until summer.

Hopefully, Senate Majority Leader Mitch McConnell, a Republican from Kentucky, and his partisan working group will reach across the aisle to Democratic Senators to assist in crafting a bipartisan solution. Won’t that be refreshing.

GOP Health Care Proposal Pulled at Last Moment

Published in Woonsocket Call on March 26, 2017

Days ago, unified Democratic lawmakers combined with a deep philosophical wedge between the conservative House Freedom Caucus and moderate Republicans over policy details of the American Health Care Act (AHCA), forced the Trump Administration and House Speaker Paul Ryan to pull the AHCA proposal minutes from a floor vote to steer it away from a humiliating legislative defeat last Friday. Interestingly, the seventh anniversary of President Barack Obama signing the Affordable Care Act (ACA), his signature health care law, took place one day before the House vote.

A day before Friday’s scheduled vote to dismantle and repeal Obama’s ACA, President Donald Trump taking a high-risk negotiation tactic straight out of his bestselling book, “The Art of the Deal,” gave a late-Thursday night ultimatum to the House GOP lawmakers. Trump told to them to vote up or down on AHCA or he would be prepared to move on to other legislative agenda items.

As to Trump’s ultimatum to GOP House lawmakers, CNN Presidency Historian Timothy Naftali noted on CNN Newsroom with Fredricka Whitfield, “He played chicken and he blinked.”

House GOP Making Legislative Sausage

In a report issued on March 13, the Congressional Budget Office (CBO), detailed the drastic impact of the initial AHCA legislative proposal. CBO, a federal agency that provides budget and economic information to Congress, found that AHCA would result in 24 million losing health insurance coverage by 2026, Medicaid would be cut by $880 billion over the next ten years, and premiums and out-of-pocket costs would skyrocket increase, particularly for older adults and individuals with lower incomes.

Earlier this week, on Monday, Ryan and his House GOP Leadership team made eight amendments to AHCA to pull in skeptical GOP moderate and conservative lawmakers, including the controversial speeding up tax cuts while whittling down the Medicaid program. Later, on March 23, CBO confirmed that these amendments would lead to essentially the same level of coverage losses, about 24 million people and cost increases for individuals and would yield $187 billion less in savings than the original GOP health care proposal.

Meanwhile, on Wednesday, Senator Wyden and Congressman Pallone revealed that the Center for Medicare & Medicaid Services’ independent Actuary “estimated that the repeal of the tax on prescription medications, known as the ‘pharma fee,’ beginning January 1, 2017 would increase Medicare Part B premiums by $8.7 billion through fiscal year 2027.” noted the Center for Medicare Advocacy.

On Thursday, three more amendments were offered to sway GOP House critics. One would strip the requirement that insurance companies cover essential health benefits (EHB). This amendment would effectively eliminate annual out-of-pocket caps, reinstate annual and lifetime coverage limits, and gut protections for pre-existing conditions. Another would delay – but not remove – the Medicare payroll tax cut that will undermine Medicare’s financing and its future stability.

After the defeat of AHCA, Trump blamed the Democrats for the House GOP’s failure to pass its health care proposal to scrap Obamacare. “The Democrats were not going to give us a single vote,” he said, warning that “Obamacare will explode” forcing the opposition party back to the negotiation table to craft a better health care law.

House Speaker Ryan also noted that “We are going to be living with Obamacare for the foreseeable future.”

“We just really did not get a consensus today,” say Ryan. “That’s why I thought the wise thing to do was not proceed with a vote but to pull the bill. When asked if he was going to try “to prop it up, Ryan responded by saying “it is so fundamentally flawed, I don’t know that that is possible.”

Sighs of Relief from Aging Groups, Democrats

“The American Health Care Act is not American in spirit or health care in substance. In fact, it’s a tax cut bill for the wealthy, not a health care bill for the people. It will make America sicker. Congress should reject this charade and this disaster of a bill today,” states Judith Stein, Executive Director of the Center for Medicare Advocacy.

“The House Congressional leadership was destined to lose on their disastrous American Health Care Act, which would have effectively repealed Obamacare and hurt seniors, including beneficiaries of Medicare and Medicaid. It doesn’t matter whether they pulled or failed to pass the bill,” says Richtman, President and CEO of the National Committee to Preserve Social Security and Medicare in a statement. “It needed to go down and we thank the millions of National Committee members and supporters – and those of other senior advocacy organizations – whose protests were loud, numerous, and furious.”

“No one knew’ that health care could be so complicated. Hopefully, he has learned a lesson… that health legislation is built on a complex foundation that considers the real human needs – and costs – of changes to the system. A common refrain from Donald Trump during the campaign was, ‘What do you have to lose by electing me?’ Now we know what’s at stake: affordable health care for older Americans, Medicare, and Medicaid,” says Richtman.

“The leadership’s decision to withdraw the bill from consideration proves that the voices of Americans are very powerful. This harmful legislation would have added an Age Tax on older Americans and put vulnerable populations at risk,” says AARP Executive Vice President Nancy LeaMond, in a statement.

LeaMond calls on Congress to focus on the issues important to older Americans and their families, including: protecting and improving Medicare’s benefits and financing; providing access to affordable quality coverage; preventing insurers from engaging in discriminatory practices; lowering prescription drug costs; providing new incentives to expand home and community based services; and strengthening efforts to fight fraud, waste, and abuse.

Adds, Justice in Aging Executive Director, Kevin Prindiville, “Congress tried to rush this disastrous bill through Congress without regard for the health and safety of older Americans and their families, and such a bill cannot and should not be revived. Older adults and their families rely on Medicaid and Medicare and these programs must be protected.”

Compromise might well be the way to make sound changes to the nation’s health care law, says Rep. David N. Cicilline (D-RI), who serves as House Democratic Policy and Communications Committee. “The Affordable Care Act is a good law, and Republicans and Democrats should be working together to make it even better. If Republicans ever decide to come to the table, we should work together to increase competition, expand coverage, and bring down premiums. That’s a decision that Republicans have to make – whether to work with Democrats or continue down the path they’re on,” he says.

Rep. James Langevin (D-RI) also stresses the importance of reaching over the aisle to create a better health care law and getting away from partisan bickering. “It’s time for Republicans to move on from their misguided crusade to dismantle the ACA. The health care law has brought insurance coverage to millions of Americans. Its consumer protections, premium assistance, essential health benefits, and countless other provisions that were at risk of elimination have improved our nation’s health and saved lives. We must work together in a bipartisan manner to strengthen and improve the ACA, not risk the health and wellbeing of everyday Americans for an empty, partisan victory,” he says.

Cicilline: Let’s Bring Back the House Permanent Select Committee on Aging

Published in the Woonsocket Call on March 5, 2017

Twenty-three years after the House eliminated the House Permanent Select Committee on Aging, Rep. David N. Cicilline (D-RI) introduced a House resolution days ago to reestablish the House select committee, once charged with investigating and putting a spotlight on aging policy, spurring legislation and other actions. During the last Congressional session, Cicilline, attracting 63 cosigners (no Republicans) out of 435 lawmakers, threw his simple resolution into the House legislative hopper only to see no action taken.

During the 115th Congress, on March 1, 2016, Cicilline introduced House Resolution 16, which would bring back the House Permanent Select Committee on Aging. Its charge would be to conduct a continuing comprehensive studies on specific aging policy to identify issues, problems and trends. Like the former House Select Committee, its work would not be limited by narrow jurisdictional boundaries of the standing committees but broadly at the targeted aging issue.

According to Cicilline, all standing and select committees of the House (except Appropriations) are authorized by a simple House resolution, detailing purpose, defining membership and any other issue that needs to be addressed, and funding is then provided through appropriations.

House Aging Panel to Play Important Role in Today’s Congress

It is extremely obvious to Cicilline and his 24 Democratic cosigners that included Rep. James R. Langevin (D-RI), about the important role the House Permanent Select Committee on Aging would play in today’s Congress. In explaining why he introduced the simple resolution, Cicilline tells this writer that, “Our nation’s seniors deserve dedicated attention by lawmakers to consider the legislative priorities that affect them, including Social Security and Medicare, the rising cost of prescription drugs, poverty, housing issues, long-term care, and other important issues.”

“As you know, the House Permanent Select Committee on Aging was active in the House of Representatives between 1974 and 1993 with the purpose of “advising Congress and the American people on how to meet the challenge of growing old in America,” noted Cicilline, who represents the state’s First Congressional District. “ The select committee did not have legislative authority, but conducted investigations, held hearings, and issued reports to inform Congress on issues related to aging,” he said.

Cicilline says, “The reestablishment of this Select Committee would emphasize Congress’ commitment to our current and future seniors and would allow us to focus our energy to ensure that they are able to live with dignity and enjoy a high quality of life,”

A newly operational House Permanent Select Committee on Aging would be charged with conducting ongoing comprehensive studies to examine the myriad of problems that older Americans face, taking a look at income maintenance, poverty and welfare, housing, health (including medical research), employment, education, recreation, and long-term care.

The newly established House Select Committee would also study ways that would encourage the development of public and private sector programs and policies that would keep older Americans active in their community. Finally, hearings would generate federal policies to encourage coordination of both governmental and private sector programs designed to deal with problems of aging. House Lawmakers and staff on this Select Committee would also review any policy recommendations made by the President or by the White House Conference on Aging that impact the nation’s older population.’

Hammering the Nail in the Casket

Claude Pepper’s death in 1989, who had served as a former Chairman of the House Permanent Select Committee on Aging, might have been an omen to aging groups of the bleak future of the House Aging panel. In 1993, Congress moved to tighten its belt to match President Clinton’s White House staff cuts. Democratic House leadership’s efforts to streamline its operations by slashing $1.5 million from its budget jurisdictions over aging policy would lead to its elimination in that year.

If alive in 1993, Rep. Pepper (D-Florida), serving as the House Permanent Select Committee on Aging, its chair for six years and considered by many to be the nation’s most visible Congressional advocate for the nation’s seniors, would have fought tooth and nail to save his beloved Select Committee.
House lawmakers who opposed the elimination of this Select Committee warned that standing committee staff did not have the time nor resources to thoroughly investigate aging policy but this select committee did. Even with these arguments and the intense lobbying of aging groups, including AARP, National Council on Aging, National Council of Senior Citizens, and Older Woman’s League, the House Permanent Select Committee on Aging could not be saved. No vote was scheduled to continue its existence on March 31, 1993 when its authorization automatically expired.

The former House Permanent Select Committee on Aging did have an impact on crafting national aging policy. In 1993, with the demise of this select committee staff, writer Rebecca H. Patterson reported on March 31, 1993 in the St. Petersburg Times that Staff Director Brian Lutz said that during its 18 years, the House Aging panel “has been responsible for about 1,000 hearings and reports.”

Throughout its existence, the House Permanent Select Committee on Aging prodded Congress to abolish forced retirement, reform nursing home operations and reduce abuse against patients, to increase home care benefits, cover breast screening for older women, combat elder abuse, improve elderly housing as well as establish research and care centers for Alzheimer’s Disease.

Support from the Trenches

It’s about time that Congress brings back the House Permanent Select Committee on Aging, say long time aging advocates.

As a former Staff Director of the Senate Select Special Committee on Aging, Max Richtman, CEO and President of the Washington-DC based National Committee to Preserve Social Security and Medicare, says bringing back the House Permanent Select Committee on Aging is “long overdue.” The House Aging panel will once again provide serious oversight and lay the ground work for House legislative proposals impacting Social Security, Medicare and Medicaid, he says.

According to Richtman, the Rhode Island Congressman is highly regarded by House Democratic lawmakers and was recently appointed to a Democratic leadership position,” he says. “America’s seniors have been looking for “a champion in the mold of the late Rep. Claude Pepper for a very long time, he says, noting that Cicilline “may well be just the person to fill his shoes.”

Fernando Torres-Gil, M.S.W., Ph.D., Director of the Center for Policy Research on Aging at the UCLA Luskin School of Public Affairs, says “The U.S. House Select Committee on Aging was a leading voice for older persons and an aging society and with illustrious champions for the elderly. Claude Pepper and Edward Roybal were examples of congressional leadership on protecting Social Security and enhancing nursing home protections.” As a former staff director of this select committee during the l980s, Torres-Gil remembered how important it was to have this committee “gerontologize” Congressional lawmakers. “It became in its time the largest committee in the Congress with members on both sides of the aisle vying to be appointed to this committee,” he said.

After the elimination of the House Permanent Select Committee on Aging in 1993, a brief effort was undertaken by Rep. Nancy Pelosi (D-California) when she became House Speaker to bring back the Aging panel but this attempt was not successful. It’s time for Pelosi and her Democratic lawmakers to make a full court press to make it happen in 2017.

Cicilline’s legislative efforts to resurrect the House Permanent Select Committee on Aging is in the hands of GOP House Speaker Paul Ryan who controls the chamber. The Washington, DC-based Leadership Council of Aging Organizations, a coalition of 72 national nonprofit aging advocacy groups, could play a key role in advocating for and supporting the Resolution that would establish, once again, a House Select Committee focused on the issues of aging in America.

Kleyman Gives Post Mortem Report on 2015 WHCoA

Published in Woonsocket Call on January 17, 2016

In 1958, Rhode Island Congressman John E. Fogarty, a former bricklayer, introduced legislation calling for a White House Conference on Aging (WHCoA) to “promote the dignity, health and economic security of older Americans.” President Dwight D. Eisenhower signed the enacted legislation and the first conference was held in 1961, with subsequent conferences in 1971, 1981, 1995, 2005 and 2015.

Looking back, the 1961 WHCoA played a major role in the creation of Medicare and Medicaid, even the Older Americans Act. Ten years later, the conference’s recommendation’s for automatic cost-of-living adjustments for Social Security ultimately became law in 1975. The founding of the Senate Aging Committee came from recommendations at the 1971 WHCoA.

A Year Marked with Anniversaries

The one-day 2015 WHCoA (usually three days) was actually held at 1600 Pennsylvania Avenue, but with a much smaller assembly than in previous years at Washington hotels, such as in 1995, which had 2,221 delegates and 2005, where about 1,100 selected delegates gathered. But his time, new technologies allowed others to tune in. The White House could only accommodate a few hundred dignitaries.

Over 700 watch parties were held in every state and thousands of people tuned in on Monday, July 13, 2015, to watch the day-long proceedings by live webcast. Over 9,000 people participated, too, through social media on Twitter and Facebook.

But, Paul Kleyman, editor of the Generations Beat Online (GBONews.org), a E-Newsletter for age beat journalist, noted in the Jan. 17, 2016 issue, that this year’s aging conference had no delegate selection process like previous ones. “As we’ve noted previously, though, more than one expert expressed disappointment that the Obama Administration made little effort to muster bipartisan support among GOP congressional members who might well have wanted some representation on the issue going into the 2016 election season. Historically, governors and members of Congress got to pick local constituents in fields from retirement finance to health services with a prestigious delegate appointment to the conference,” says the seasoned journalist who served as a delegate at the 1995 WHCoA.

A Call for an Expansion of Social Security

The WHCoA’s scheduled date in 2015 fell in the year where advocates in aging celebrated the 50th anniversary of Medicare, Medicaid and the Older Americans Act as well as the 80th anniversary of Social Security. Kleyman notes that the newly released 34 page WHCoA report (with 49 pages of appendices) says, “The 2015 White House Conference on Aging (WHCOA) provided an opportunity to recognize the importance of these key programs as well as to look ahead to the next decade.”

President Obama was sent a letter with 74 Congressional cosigners reminding him that over half of today’s older workers are not expected to be able to have sufficient resources upon their retirement to maintain their current standard of living. Although they called for an expansion of Social Security, Kleyman says discussion was “barely audible” at the aging conference.

In addressing the WHCoA attendees, Obama called for “keeping Social Security strong, protecting its future solvency,” pledging to fight “privatization of the program. Kleyman observed that proposed new rules to help workers increase their retirement “stopped short of supporting stronger benefits that they need.”

It’s a Mixed Bag

But, Kleyman says that aging advocates consider the WHCoA’s recommendations a mixed bag. In his E-newsletter article, he references a Jan. 6, 2015 blog penned by Kevin Prindiville who serves as executive director of Justice in Aging. “The report details piecemeal public actions and private initiatives, but ignores the opportunity to lay out an ambitious policy proposal to address pressing systemic challenges,” he says.

Kleyman also zeros in on Prindiville’s observations as to why this year’s WHCoA was of the scaled down. He observed, “To those who followed the WHCOA closely, this was not a surprise. Congress’ failure to reauthorize the Older Americans Act, and the lack of appropriate funding for the conference, meant WHCOA organizers had to produce a conference without a budget. With little infrastructure and support, the White House did not propose any new big, bold ideas to prepare for a population that is literally booming.”

Kleyman says that attendees were pleased to see a recommendation calling for improving the quality and safety requirements in the nation’s 15,000 long-term care facilities and a proposal to allow low-income and frail home bound elders and people with disabilities to use food stamps for meals on wheels.

Meanwhile, attendees were told at this event that physicians would be paid starting in 2016 to counsel patients about their end-of-life care, adds Kleyman, noting that recommendations did not address the nation’s increasing diversity.  Yet, there was no discussion on hospice and palliative care, affordable senior housing issues, and little discussion of elder abuse, the need for adequate transportation and long-term care, he says.

See You in 2025

According to the Census Bureau, in 2050, the 65-and-older population will be 83.7 million, almost double of what it was in 2012. The 2015 WHCoA conference has taken place with a skyrocketing older population, referred to as the “Graying of America.” Can this year’s conference provide policy makers with a road map to shape the delivery of services for years to come? As Kleyman says, probably not. “So it goes, at least until 2025,” he says.

 

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.