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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Congressional Panel Looks Over Medicare

Published in Woonsocket Call on March 20, 2016

Last Wednesday’s hearing of House Ways and Means Health Subcommittee signals the panel’s interest to bring Medicare, a federal health insurance program for people age 65 and over, into the 21st century to meet the needs of its current 55.3 million beneficiaries.

At the March 16 hearing, Chairman Pat Tiberi (R-OH), stated that “Today’s seniors [are] inundated with an array of confusing deductibles, coinsurance and copayments with no protection from high health care costs unless they enroll in a private plan. Despite major improvements and innovations in the health care sector that have transformed how care is delivered, traditional Medicare has barreled through the last 50 years on the same trajectory of increased costs and little innovation.”

In addition to the structural challenges facing the program, critical parts of Medicare are expected to run out of money by 2026. In other words, the benefits Americans were promised stand to disappear if policymakers don’t act soon, says Tiberi.

Putting the Spotlight on Medicare

Tiberi’s March 16 Health Panel hearing, entitled “Preserving and Strengthening Medicare,” held in room 1100 of the Longworth House Office Building, brought together three witnesses to discuss ways to sustain the nation’s Medicare program and to keep it from going bankrupt. From both sides of the aisle and expert witnesses all agreed that the federal government’s current approach to delivering high-quality health care is not working. As a result of an outdated Medicare program and harmful Obamacare policies, today’s seniors “must navigate a disjointed program, face rising health care costs, and have fewer healthcare choices,” says the GOP panel chairman.

“Of federal entitlements, Medicare presents the most difficult challenges,” says Heritage Foundation Senior Fellow Robert Moffit, warning that the Trust Fund “faces insolvency in 2026.”

At the hearing, Moffit gave his fix for revamping Medicare that have bipartisan support and promise to shore up the ailing entitlement program. He called for the Medicare program to be simplified by combining Parts A and B – including catastrophic coverage, an out-of-pocket cap, a single deductible, and uniform coinsurance in a single plan along with bringing reforms to Medigap coverage. Also, retargeting Medicare benefits to low-income enrollees can provide assistance to lower-income enrollees. Increasing Medicare’s eligibility age to 67 (the same eligibility age for Social Security) along with encouraging innovation and cultivating competition through Premium Support can put the brakes to rising program costs.

When it comes to simplifying Medicare and incorporating catastrophic coverage, Tiberi had called the need for reform a “no-brainer.” Moffitt overwhelmingly agreed, stating, “It is a no-brainer. It is absolutely a no-brainer … [seniors] do not have protection from the most important thing that health insurance should deliver, which is that ultimate protection.”

As Moffit explained, the lack of catastrophic coverage in Medicare not only puts financial strain on the beneficiary, but it also causes a significant increase in unnecessary health care spending.

Coming Up with a Commonsense Approach

In her testimony, Katherine Baicker, Harvard University Professor of Health Economic and serves on the Medicare Payment Advisory Commission, also called for commonsense solutions, specifically focused on the need for increased competition. She heighten the role that Medicare Advantage program plays in promoting innovation, as well as providing more seniors flexibility, choice, and quality at an affordable cost.

Baicker emphasized, “A thriving and competitive Medicare Advantage program can be a vital contributor to high quality beneficiary care in a sustainable health care system.”

When Baicker was asked which Obamacare provisions Congress should work to immediately repeal in an effort to protect Medicare Advantage, she replied, “I would like to see the cap on quality bonuses removed … and removing the double bonus for quality so that you’re appropriately rewarding plans for delivering the high-quality care that beneficiaries are seeking out.”

Finally, Stuart Guterman, senior scholar in residence at
AcademyHealth, told the panel that he believes the nation’s largest purchaser of health care can do more to ratchet up quality, enhance quality and coordinate care and control costs. “Because of Medicare’s unique position, it can be an important testing ground for cost and quality innovations. Policies have been put in place that encourage such development, including the expanding the power of the Secretary of Health and Human Services to put pilot programs on a ‘fast track’ and to work with private payers and providers to establish multi-payer initiatives.”

At the conclusion of the two hour hearing, like Baicker, Tiberi stressed the importance of bolstering support for Medicare Advantage, which serves approximately one-third of seniors today. Obamacare cut billions of dollars from Medicare Advantage and redirected those resources toward a one-size-fits-all, Washington-run entitlement, he says.

Tiberi also noted, “If we continue to berate a system that has been widely successful…I don’t think that’s a really good way to try to figure out how we bester serve patients, seniors, in a more cost-effective value-added, comprehensive way.”

Watching from the Sidelines

But, one aging group expressed strong concerns about the Health Panel’s look at Medicare. In his released statement, Max Richtman, President/CEO of the Washington, D.C.-based National Committee to Preserve Social Security Medicare (NCPSSM), viewed the Health Panel hearing as “an Orwellian political exercise in which politicians say preserve when they actually mean privatize, and strengthen when they mean slash.”

“Republicans in the House envision a future in which millions of seniors will lose their guaranteed Medicare benefits in favor of a privatized CouponCare system in which they receive a government coupon to try and buy private insurance. Millions of seniors in Medicaid will lose their benefits due to block-granting to states without providing the resources to pay for it. The repeal of the Affordable Care Act will leave tens of millions without insurance and strip benefits from seniors in Medicare,” says Richtman in NCPSSM’s statement.

Furthermore, “The Republican leadership has offered no plans to improve benefits in Medicare or make reforms to reign in the skyrocketing price of drugs and healthcare costs system wide. Instead, the GOP vision for seniors in Medicare is they must just do more with less. Stagnant wages are grinding away at the middle class’s ability to save for retirement. Many employers have significantly scaled back or eliminated the traditional retirement benefits offered to their employees. As a result, current and future retirees simply cannot afford proposals to cut benefits, raise the eligibility age or privatize the program,” says in the NCPSSM statement.

Finally, the aging advocate warns that the GOP majority on the House Ways and Means Health Subcommittee majority is moving to replace the nation’s traditional Medicare program in favor of a fully privatized system, and the GOP controlled House is in the process of producing a budget that would do just that.

A Democratic or Republican President? Which political party controls the House and Senate? When the dust settles these answered questions may result in a restructuring of the Medicare program, that may either be strengthened and expanded or put on the budgetary chopping block by the new incoming President or Congress. It’s a no brainer…Sitting on the political sideline will ultimately be detrimental to your pocketbook and coverage you receive for your health care.