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 Trial Balloon Called “Trojan Horse”

Published in Woonsocket Call on April 16, 2017

In previous years, the GOP leadership, now controlling both chambers of Congress, pushed legislative proposals to eliminate Social Security and Medicare by privatizing these programs. These attempts were clearly visible for all to see. But, we are in new political times with a GOP White House seeking the destruction of these programs, too, but as some say through the back door.

According to an Associated Press story, published on April 10, 2017, as the Trump Administration begins to learn from its failed attempt to repeal Obamacare, tax code reform is now on its agenda. One trial balloon, being floated by a GOP lobbyist with close ties to the Trump Administration, would eliminate the mandated payroll tax that all American workers pay to fund Social Security and Medicare.

“This approach would give a worker earning $60,000 a year an additional $3,720 in take-home pay, a possible win that lawmakers could highlight back in their districts even though it would involve changing the funding mechanism for Social Security, according to a lobbyist, who asked for anonymity to discuss the proposal without disrupting early negotiations,” says Writers Josh Boak and Stephen Ohlemacher in their Associated Press story.

Currently, about 163 million American workers pay Social Security taxes and 59 million retired and/or disabled persons collect monthly benefits. About one family in four receive income from Social Security. The nation’s social insurance and welfare program is a “pay-as-you-go-program.” Today’s workers support the program by paying their taxes into the program and the money flows back out to the program’s current beneficiaries.

GOP Stealth Attack on Social Security

Responding to the GOP trial balloon, in her blog post published last Tuesday on the Huffington Post, a politically liberal American online news web site, Contributor Nancy Altman, President of Social Security Works called the GOP trial balloon “a Trojan horse”, noting that “It appears to be a gift, in the form of middle class tax relief, but would, if enacted, lead to the destruction of working Americans’ fundamental economic security.”

If President Trump proposes “the Trojan horse, it would be the newest shot in the ongoing Republican war against Social Security. That war has failed so far. The American people overwhelmingly support Social Security because they appreciate that it provides working families with basic economic security when wages are lost as the result of death, disability, or old age. And it does so extremely efficiently, securely, fairly, and universally,” says Altman in her April 11, 2017 blog post.

According to Altman’s blog posting, after Trump and GOP lawmaker have suffered legislative defeats in their “frontal attacks” against Social Security to eliminate the programs “it appears they are contemplating a “stealth attack instead.” She noted, “In the 1980s, Republicans, who had long tried but failed to cut government programs directly, discovered a new tactic. They realized that they could undermine government and eventually force cuts to spending by cutting taxes and, in their words, starve the beast. Now, Trump is making plans to use that same tactic against Social Security.”

“Not only would the Trump proposal starve Social Security of dedicated revenue, it would ultimately destroy it. Social Security is not a government handout. It is wage insurance that the American people earn, as part of their compensation, and, indeed, pay for with deductions from their pay,” observed Altman.

Altman warns that GOP lobbyist’s proposal to eliminate the payroll tax to fund Social Security is consistent with Trump’s previous actions. “No one should be fooled by Trump’s campaign promise not to cut Social Security. Before he became a candidate, he called it a Ponzi scheme and advocated privatizing it. He chose, as his vice president, Mike Pence, who complained that the Bush privatization proposal didn’t go far enough, fast enough. As President, he has chosen a staunch opponent of Social Security, Mick Muvaney, as his budget director, and another staunch opponent, Tom Price, as Secretary of Health and Human Services (one of Social Security’s trustees.), she said.

In an email urging recipients to sign a petition to protect Social Security’s funding [the payroll tax], Michael Phelan, Deputy Director of Social Security Works noted, “For decades, Republicans in Washington and Wall Street bankers have told us that Social Security is going broke―even though Social Security has a $2.8 trillion surplus and can pay out 100% of benefits for the next 17 years and over 75% of benefits owed after that.” He warns the “Republican’s tax plans might be a self-fulfilling prophecy. By starving Social Security of funding, they could finally receive their wish―replacing Social Security’s guaranteed benefit with unstable Wall Street retirement plans.”

The “Great Wisdom” of a Payroll Contribution Tax

Max Richtman, President & CEO of the National Committee to Preserve Social Security and Medicare, says, “It’s no surprise that the GOP lobbyist who suggested this dangerous idea and remained anonymous. After all, who would want to own up to an idea that would trigger the collapse of the most successful government program in U.S. history?”

Richtman adds, “Peddling this kind of scheme reminds me of President George W. Bush’s 2005 privatization proposal. Only in this case, the risk factor shifts from the uncertainty of Wall Street to benefit cuts that will almost certainly occur when Social Security is forced to compete for government funding with other discretionary programs. There was great wisdom in President Roosevelt’s plan for funding Social Security through a dedicated payroll tax. As President Roosevelt said, ‘We put those payroll contributions there to give the contributors a legal, moral and political right to collect their pensions…No damn politician can ever scrap my social security program.”

Darrell West, Vice President and Director of Governance Studies at the Washington, D.C.-based the Brookings Institution, sees an uphill battle to formalize the tax policy to eliminate the payroll contribution to fund Social Security. “I don’t think Trump will be able to eliminate or reduce the Social Security tax because of its dire consequences for the program itself. The program is very popular with the general public and many recipients count it as their sole support. Republicans will get killed if they try to do this. It is not a viable option now or anytime in the near future.”

When Trump releases his tax code reform proposal, aging advocates must remember that the devil is in the details. Read the proposal thoroughly with a fine-tooth comb

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.

Search on for GOP Senators to Protect Medicare

Published in Woonsocket Call on January 29, 2017

Since President Donald Trump took the oath of office on January 20, he is making good on some of his hundreds of campaign promises. During his first week in office Trump signed three executive orders declaring new government policies and eight presidential memoranda detailing the priorities of his new administration.

But, for aging groups, with Trumps arrival in Washington, D.C, the skirmish officially begins to protect Medicare in this new session of Congress.

With Trump and Congressional Republican Leadership on record for their support of repealing the 2010 Affordable Care Act, popularly known as Obamacare, President and CEO Max Richtman, of the National Committee to Preserve Social Security and Medicare (NCPSSM), clearly sees the writing on the wall. If successful, Richtman warns that GOP legislative actions will severely damage Medicare impacting 57 million seniors and disabled adults who rely on the program for their health care.

Building A Firewall Against Privatizing Medicare

With the GOP holding a slim majority of the U.S. Senate seats, 52 to the Democrats 48 seats, Richtman sees swaying Republican Senators away from their party’s position on privatizing Medicare to protect the federal health care program.

On January 24, 2017, Richtman urged Senator John McCain (R-AZ), Senator Susan Collins (R-ME), Senator Charles Grassley (R-IA), and Senator Lamar Alexander (R-TN) to be the Senate’s “firewall against Medicare cuts.” His correspondence asked them to vote against proposals to privatize Medicare, raise the Medicare eligibility age from 65 to 67, and repeal provisions in the Affordable Care Act (ACA), President Barack Obama’s landmark health care law, that provided additional benefits to beneficiaries.

Richtman reminded the GOP Senators that the Affordable Care Act (ACA) improved Medicare benefits and extended the solvency of the Part A Hospital Insurance Trust Fund by more than a decade. ACA’s closing of the prescription drug donut hole has put money into the pockets of Medicare beneficiaries. The health care law also added coverage of an annual wellness visit and eliminated copays for preventive services like cancer screenings, he said.

“I am also troubled by “premium support” [GOP] proposals to privatize Medicare,” says Richtman. According the aging advocate who was a former staff director of the U.S. Senate Special Committee on Aging and a 16-year veteran of Capitol Hill, under previous privatization plans, beneficiaries would not enroll in the current program; rather, they would receive a capped payment or voucher to be used to purchase private health insurance or traditional Medicare. Private plans would have to provide benefits that are at least actuarially equivalent to the benefit package provided by fee-for-service Medicare, but they could manipulate their plans to attract the youngest and healthiest seniors. This would leave traditional Medicare with older and sicker beneficiaries whose higher health costs would lead to higher premiums that they and others may be unable or unwilling to afford, reducing the fee for service risk pool even further resulting in a death spiral for traditional Medicare.

GOP Medicare Fix Financially Hurts Beneficiaries

Richtman also told the GOP Senators that NCPSSM opposed the raising of the Medicare eligibility age from age 65 to 67 because the proposal would increase costs for millions of older Americans. Absent the guarantees in the existing ACA, such as requiring insurance companies to cover people with pre-existing medical conditions and limiting age rating, millions of seniors 65 and 66 without Medicare would find private insurance unaffordable. Raising the eligibility age would also increase average costs for Medicare as younger, healthier seniors are eliminated from the risk pool and costs are spread across an older, less-healthy population, he says.

Richtman urged the GOP Senators to oppose efforts underway in the 115th Congress to block grant Medicaid, cap Medicaid payments on a per-beneficiary basis (per capita caps) and/or repeal the ACA’s Medicaid expansion. He noted that these policy changes would “financially hurt states and lead to states cutting services, quality and eligibility for the most vulnerable of our senior population.”

Many seniors would not be able to absorb the loss of coverage and increase in their costs that would occur if these proposals became law. In fact, half of all Medicare beneficiaries in 2014 had incomes below $24,150 and Medicare households spent over two times more than the average American household on out-of-pocket health care costs,” he says.

“If Senate Democrats stand strong, we only need a handful of Republicans to protect the commitment to Medicare,” says Richtman. “We hope Senators McCain, Collins, Grassley, and Alexander to do the right thing for seniors in their states – and across America.”

Richtman correspondence to the four GOP Senators is part of NCPSSM’s pro-active legislative strategy to protect the existing Medicare program. The letters sent quantify the economic impact that proposed Medicare cuts would have on seniors in the four GOP Senators’ states: Arizona (with 1.3 million beneficiaries), Maine (306,000 beneficiaries), Iowa (nearly 572,000 beneficiaries), and Tennessee (1.2 million beneficiaries).

“We know that these four Republican Senators have the wisdom and judgment to protect seniors in their states from legislation that would impose painful Medicare cuts,” says Richtman. “It’s time to slam the brakes on any attempts to pass harmful legislation.”

Senate Democrats Attempt to Block HHS Nomination

Two days before Trump was sworn in as president, the Senate Health, Education, Labor and Pensions (HELP) Committee held confirmation hearing on Rep. Tom Price, (R-Ga), Trump’s nominee to oversee the Department of Health and Human Services, the federal agency that oversees the Medicare program. In confirmed, he is expected to play a key role in the GOP’s efforts to privatize Medicare.

No formal vote was taken at the HELP Committee hearing but the Congressman is scheduled to testify a week later at the Senate Finance Committee, which will vote on his nomination.

During the four-hour heated confirmation hearing, held in 430 Dirksen Senate Office Building, HHS nominee Price dodged questions lobbed by Democrats about the Trump Administrations position on the future of Medicare. They also zeroed in on his personal financial investments in health care companies, calling them conflicts of interest which the denied.

Price, an orthopedic surgeon and a six term congressman, considered to be one of the most vocal critics of Obamacare on Capitol Hill, is expected play a key role in the GOP’s efforts to repeal and replace the Affordable Care Act.

Rhode Island Sen. Sheldon Whitehouse, sitting on the HELP Committee, gave this take on Price after the first of two confirmation hearings: “Price hasn’t been able to win Democratic support for any of his health care legislation [in the House] and today confirmed that he and his allies have no plan that can win support from across the aisle or the millions of Americans who would be affected by tearing down the Affordable Care Act. He conceded that he should not stop Americans under twenty-six from staying on their parents’ insurance, re-open the dreaded prescription drug doughnut hole for seniors, deny coverage to those with pre-existing conditions, and reinstate lifetime limits on care. But he has no plan to make that happen.”

Adds Whitehouse, “Price also failed to reassure the Rhode Islanders I serve who rely on Medicare for their care. He has fought to voucherize the program, which would gradually unload costs onto seniors while eroding their benefits. He needed to tell the American people they could depend on him to faithfully administer Medicare and keep the sacred promise we’ve made to our seniors of a dignified retirement with access to good health care. He did not.”

“Congress must protect Social Security and Medicare, but many Republicans see the latest election results as an opportunity to hollow out these vital programs. President Trump’s pick to oversee Medicare has long championed efforts to privatize Medicare, which I strongly oppose. Cutting benefits and privatizing these programs could hurt millions of Americans and harm our economy,” said Sen. Jack Reed, noting that these programs reduce poverty and improve public health in ways that benefit all Americans.

As NCPSSM’s Richtman continues his effort to sway GOP Senators, rallying the troops at the state-level may well be the path to blocking GOP attempts to privatize Medicare. Voters in states with Republican Senators must send this message to their elected official, “don’t touch my Medicare.” Let the movement to strengthen Medicare in these states begin today.

Can Our Nation Survive Trump and the GOP’s Control of Capitol Hill?

Published in Woonsocket Call on January 8, 2017

Almost two months ago when GOP presidential candidate Donald Trump trounced his Democratic challenger Hillary Clinton and his party took control of both chamber of Congress. Trump’s surprising victory stunned both voters and political commentators and pundits covering the heated presidential race. According to a November 16, 2016 Gallup Poll, 80 percent of Trump’s voters are “excited,” while 76 percent of Clinton’s voters say they are “afraid.” A large majority of the respondents (75 percent) shared one reaction: “surprise.”

Days after the tumultuous election, Darrell M. West, vice president and director of Governance Studies at the Washington, D.C.-based the Brookings Institution, penned his thoughts about how president-elect Trump might govern the divided nation. His posting, “Four Scenarios for a Trump Presidency,” can be found on the Brooking’s FixGov blog, written on November 14, 2016.

Speculating on Trump’s White House Governance

In his 1,286 word blog, West, an American author, political scientist, pollical commentator who formerly taught political science at Brown University for 26 years, says that Trump might choose to govern as a traditional Republican endorsing tax cuts, deregulation and repealing Obamacare. Like other GOP politicians he would call for reinstituting law and order, fighting ISIS and other extremist militant groups, and controlling illegal immigration from coming into this country. “These typical GOP positions might resolve his philosophical differences on “entitlement reform and free trade,” says West, an author or co-author of 22 books.

Trump just might even turn over the reins of the presidency to Vice President Mike Pence, House Speaker Paul Ryan, and Chief of Staff Reince Priebus, says West, these individuals “becoming the de facto prime minister.”

According to West, like president-elect Trump did during the presidential campaign, he might take on the role of a “popular rogue.” A “populist Trump could break conventional political rules and “attack the political establishment to represent the little guy,” notes West’s blog posting.

West also suggests that Trump might ultimately fail as president. After all he lost the popular vote by 2 percentage points or nearly three million votes and alienated women, millennials, minorities and immigrants with his insulting comments. Scandals and disclosures about his personal behavior and continuing concerns about serious financial conflicts of interest could derail his “honeymoon” phase at the beginning of his presidential term and negatively impact his popularity ratings, he says.

West also speculates in his blog that policy backlashes due to millions losing health care coverage by his push to repeal Obamacare, privatizing Medicare or gutting Social Security, a slow-down in the economy or even Trump’s continued liking of Russian President Vladimir Putin, might make him a one term president, like President Jimmy Carter.

Finally, public outcry and violent protest may turn Trump into an authoritarian leader. If this happens West expresses concerns smear campaigns (waged by White House Strategist Steve Bannon), the use of federal agencies to “attack adversaries” and the use of local police to “crack down” on protestors. “Firing top intelligence officials would suggest that Trump wants compliant people who will do his bidding against foreign and domestic adversaries,” he says.

Big Changes with the GOP in Charge

“It is a scary time in American politics,” says West, who expects to see big changes on Capitol Hill in 2017. The Brookings political pundit predicts that a Trump White House with a GOP controlled Congress will tackle large tax cuts, corporate tax reform, repealing Obamacare (but not having anything to replace it with), and reversing the Dodd Frank financial regulation bill. With the Republicans controlling both chambers of Congress he does not expect gridlock during the first six months of the 115th Congress.

West predicts that in the long-run many of the GOP president and Republican Congressional leadership policy initiatives will be problematic. “They are governing as if they have a clear mandate even though they lost the popular vote, he says.

West, like some political observers, expect many of the GOP’s conservative policy proposals to hurt the people who voted for Trump. The tax cuts go disproportionately to the top one percent and proposed changes in Medicare and Medicaid will limit medical care, he said.

“In a couple of years, the economy probably will be much weaker than it is today, which will undermine the very rationale of Trump’s candidacy,” says West, noting that if this happens the newly elected president could have a 30 percent job approval rating by 2018. “Of course, that is when he really will become dangerous! The risk is he may try things to improve his poll numbers, such as identifying scapegoats or confronting adversaries,” warns West.

“GOP Congressional leaders have plans to privatize Medicare and block grant Medicaid to the states. This will impose limitations on medical care and make it more difficulty for needy people to get the help they need,” adds West, who also sees Republicans moving to reduce home care and medical assistance to America’s elderly.

West sees the “GOP legislative initiatives as being very contentious politically, and will reinforce perceptions of the GOP as cold and heartless [to Americans].”

“Democrats will not be able to pass legislation. Their main power will be trying to block things they don’t like or stop nominations at confirmation hearings that they find problematic,” says West, noting that they will be put in a defensive posture. “They will seek to protect certain gains made during the Obama administration. However, Congressional Democratic leadership may well be able to work together on infrastructure investments,” he says.

West believes that Trump’s fix for the economy will not work. “In the longer-run, there is a risk that inflation will go up. Interest rates already have risen in anticipation of this,” he says.

“The market is expecting Trump to spend a lot of money and not be able to corral spending by the same amount. That will increase deficits and drive up inflation. It will be hard to blame this on Democrats since there has been low inflation for years now. It will be pretty obvious that GOP policies are responsible for the rate increases,” West adds.

Democrats Mobilize, Video Sends Message to Congress

As president-elect Trump’s inauguration approaches, President Obama traveled to Capitol Hill last week to urge Congressional Democrats to block the GOP president and the Republican Congressional leadership’s efforts to dismantle Obamacare, the outgoing president’s signature healthcare reform law and to fight their legislative policy initiatives. Behind closed doors Obama urged Democratic lawmakers to not “rescue” the Republicans by passing replacement measures. He suggested calling the GOP’s new plan, “Trumpcare,” to ensure that they are held responsible for any disruptions in health coverage. At press time there seems to be no GOP health care plan to consider.

After Obama’s meeting Democrats lawmakers have begun using the phrase, “Make America Sick Again, tying into Trump’s wildly recognized campaign slogan, “Make America Great Again.”

Hollywood is moving to block Trump’s policy initiatives. Almost a week ago documentarian Liz Garbus unveiled her one minute and 49 second video (#StandUpForUS), released by Humanity for Progress, to urge Congress to block any legislative initiatives pushed by Trump and his GOP allies that attack groups he marginalized during last year’s presidential campaign. Celebrities and activists lined up to participate in this video. They included Rosie Perez, Keegan-Michael Key, Tavi Gevinson, Lea Delaria, Sally Field, Steve Buscemi, Zoe Kazan, Jeffrey Wright, and Janet Mock, among others.

“The majority of Americans, regardless of who they voted for, did not vote for racism, for sexism, or for xenophobia. And yet Donald Trump won,” notes the video. At the end of the video, viewers are asked to email the video to members of Congress, as well as to sign a petition on http://www.MoveOn.org, to resist Trump and the GOP agenda,

Stay Tuned

The aftermath of the 2017 presidential election has politically split our nation. Although Trump won the Electoral College, Clinton, the former secretary of state, pulled in over 64 million votes. Even without a clear legislative mandate President-elect Trump and Republican Congressional leadership are moving at a quick pace to make major policy and systemic changes during the first 100 days of the 115th Congress. Democrats are now forced to play the loyal opposition for the next four years and fight against GOP policies rammed through the legislative process. Will GOP legislative fixes push American in the right direction? Or will the nation survive these changes? Stay tuned.

Whitehouse Pushes for Medicare to Pay for Person-Centered Care

Published on July 11, 2016 in Pawtucket Times

At a June hearing of the U.S. Senate Special Committee on Aging, Senator Sheldon Whitehouse calls for improving care for over 90 million Americans with advanced illnesses like Alzheimer’s disease, cancer, and heart disease. On the day of this Aging panel hearing, the Rhode Island Senator unveiled his legislative proposal, “Removing Barriers to Person-Centered Care Act,” at this panel hearing that would promote better coordination between health care providers, and place greater emphasis on the care preferences of Medicare beneficiaries with advanced illnesses.

The hearing, titled “The Right Care at the Right Time: Ensuring Person-Centered Care for Individuals with Serious Illness,” explored ways to improve the quality and availability of care and examined care models that are helping people with serious illness and their families.

Having Important Life Conversations

The June 23 hearing pulled together witnesses who called for “about the need for families and health care providers to prioritize these important life conversations, so that individuals’ wishes are known and person-centered care is prioritized,” noted U.S. Senator Susan Collins, who chairs the Senate Special Committee on Aging. In her opening statement the Maine Senator called for federal policies to “support efforts to relieve suffering, respect personal choice, provide opportunities for people to find meaning and comfort during serious illness, and – most important – remain in control of their own care.”

Advance care planning conversations to a patients’ physical, emotional, social and spiritual well-being are important in the care of a patient, says Collins. However, studies reveal that less than one-third of physicians have reported that their practice or health care system has a formal program in place to assess patients’ goals or preferences, she notes.

Collins also shared a personal story of a close friend who benefited from the person-centered care she received while she was a patient at the Gosnell Memorial Hospice House in Scarborough, Maine. “Despite her serious illness, because of hospice care her days were filled with visits from friends and families and many joyful moments, and she was surrounded by her family when she died peacefully,” she said.

“I’ve heard from Rhode Islanders about how difficult it can be for patients battling serious, advanced illnesses to get the care and respect they want,” said Whitehouse.

Whitehouse noted that “We can do better by these patients. Because so many of the rules and incentives in our health care system are tied to the payment structure, we should design payment systems that support models of coordinated care that focuses on the full person. Payment systems should reward providers for honoring patients’ own preferences for their care.

As Dr. Atul Gawande, surgeon and author of the New York Times best-selling book, “Being Mortal, mentioned in his testimony, “people with serious, potentially life-limiting illnesses face substantial and increasing suffering, particularly during the last year of life. Medical care today typically exacerbates this suffering, often without any benefit of lengthened life. We have an opportunity to change this.”

“The goal is not a good death. Instead, the goal is to have as good a life as possible all the way to the very end,” say Dr. Gawande.

In her testimony, Amy Berman, a nurse and senior program officer at the John A. Hartford Foundation, who is living with stage IV inflammatory breast cancer stand stressed the importance of palliative care, which is designed to improve the quality of life for patients with serious illness.

“Palliative care is the best friend of the seriously ill,” said Berman, “Studies have shown that when palliative care is added at the beginning of a serious illness that people feel better and live longer.”

Finally, Dr. Kate Lally, Chief of palliative care for the Providence-based Care New England Health System, Medical Director of the Integra Accountable Care Organization, and Assistant Professor of Medicine at Alpert Medical School of Brown University, urged Congress to consider legislation that would improve the quality, not just the quantity, of life of the seriously ill. “I feel blessed to do this work, and to be able to reflect with my patients on the life they have lived, their joys and regrets,” she said. “I feel I am able to share some of the most sacred moments of their life, and be at their side as they consider what is most important to them in their limited time.”

“The healthcare system as a whole, as well as Medicare and Medicaid, need to face growing expectations about how people with serious or terminal illnesses are treated,” said AARP Rhode Island State Director Kathleen Connell. “We are investing in prevention and early treatment and getting better results. Ultimately, however, people will still face serious illness and palliative care. Person-centered care is the proper prescription, and we must strive to make sure that it’s available. We need to be vigilant when it comes to supporting a healthcare environment in which patients with serious illness feel they are well informed and can remain properly in control of their options. And while families still tend to avoid these discussions in advance, when the time is right proper guidance makes a world of difference.

“People form especially strong opinions about decisions made that may prolong their existence, but add little to the quality of lives and, in fact, can prolong suffering,” Connell added. “Conversations on this phase of life are critical and we applaud Senators Collins and Whitehouse for their contribution to this dialogue.”

Legislation to Support New Models of Coordinated Care

The thrust of Whitehouse’s legislative proposal is to promote better coordination between health care providers, and place greater emphasis on the care preferences of Medicare beneficiaries with advanced illnesses.

“Too many Rhode Island Medicare patients battling difficult illnesses are struggling to get the right care at the right time,” said Whitehouse. “We need to break down the barriers between patients and the care they need. Because so many of the rules and incentives in our health care system are tied to the payment structure, we should design payment systems that support new models of coordinated care that are focused on human beings and not some rule or regulation.”

Whitehouse’s legislation would establish a pilot program administered by the Centers for Medicare and Medicaid Services (CMS) made up of twenty “advanced care collaboratives” of affiliated health care providers and community-based social service organizations. Collaboratives would receive a planning grant to assess the needs of the population of patients it would serve; to purchase or upgrade health information technology to facilitate better coordination of care between providers; and to support education and training on documenting and communicating beneficiary treatment preferences and goals.

Once planning is complete, collaboratives would enter a three-year payment agreement with Medicare to provide coordinated, high-quality care for their target patient population. Under the terms of the pilot program, CMS would waive regulations to promote innovative care for patients with advanced illness.

Waivers would be granted to allow Medicare patients to receive hospice care and curative treatment at the same time. Currently CMS’s regulations force patients to choose one or the other for their terminal illness. Patients would be able to also receive Medicare coverage in a skilled nursing home without a consecutive three-day inpatient hospital stay. Under current Medicare rules, patients are often charged for skilled nursing care after they leave an inpatient hospital stay because they were hospitalized for observation rather than admitted to the hospital.

Whitehouse’s legislative proposal would also allow Medicare patients to receive home health services without the requirement that they be homebound. Under current rules, a patient’s condition must have progressed such that there “exists a normal inability to leave home,” denying these services to those who are seriously ill but still mobile. Finally, it would also allow nurse practitioners to sign home health and hospice care plans and certify patients for the hospice benefit. Right now, only doctors can do so, even though nurse practitioners are often the ones administering home health and hospice care. This forms another barrier for patients seeking these services, especially in underserved and rural areas.

According to Tom Koutsoumpas, Co-Chair of the Coalition to Transform Advanced Care’s (C-TAC) Board of Directors, Whitehouse’s legislative proposal is “a critical step forward to achieving high-quality, coordinated care for those with advanced illness. This legislation allows for important innovations in care delivery and removes obstacles to support patients throughout the care continuum.”