Trump’s Budget Proposal Comes ‘Dead on Arrival’ to Aging Groups

Published in Woonsocket Call on February 18, 2018

Last Monday, President Donald Trump released his 2019 budget proposal, “An American Budget,” providing guidance to Congress on how to spend hundreds of billions of dollars in new federal spending plan authorized by the Bipartisan Budget Act recently passed into law. Trump’s federal spending wish list clearly shows that many programs and services for older Americans will take a huge hit if any of these proposals are picked up by the Republican-controlled Congress.

The Washington, DC-based National Committee to Preserve Social Security and Medicare (NCPSSM) expresses concern that Trump’s budget proposal contains many of the same harmful proposals that the Administration and Republican-controlled Congress has pushed before, including $1.4 trillion in Medicaid cuts, $490 billion in Medicare cuts, and repeal of the Affordable Care Act.

Social Security on the Chopping Block

According to the NCPSSM’s analysis released this month, the President’s budget blue print calls for deep cuts to Social Security Disability Insurance, breaking his campaign promise not to touch Social Security.

Trump proposes to slash up to $64 billion from Social Security Disability Insurance (SSDI) benefits through eight demonstrations “ostensibly” geared toward helping disability beneficiaries to stay at work or return to work, says NCPSSM, noting that these Social Security Administration’s (SSA) demonstration projects, established in 1980, had only “a modest effect on beneficiaries’ workforce participation.”

NCPSSM’s analysis warns that the President’s proposed budget also calls for other benefit cuts for disabled seniors, including limiting the retroactivity of applications for disability benefits from 12 months to six months. It would also deny unemployment compensation payments to SSDI beneficiaries who work but get laid off. Social Security Income recipients that live together, even with families, would see their benefits reduced, too.

The Trump Administration also proposes $12.393 billion for SSA’s FY 2019 appropriation for administrative funding, says NCPSSM, warning that this $89 million funding cut will result in longer waits for decisions on initial disability claims and time to speak to a representative from SSA’s 800 number. “With 10,000 baby boomers reaching age 65 every day, SSA needs substantial yearly increases just to keep pace with increased workloads, says NCPSSM.

President Trump’s budget plan only funds production and mailing of only 15 million Social Security statements. “This proposal is part of SSA’s overall plan to limit sending statements only to individuals who are 60 or older rather than sending them to all workers every five years,” says the aging advocacy group, urging the Administration “to send these important financial planning documents to all workers, as is required in section 1143 of the Social Security Act.”

Medicare Takes a Blow

President Trump’s draconian budget calls for over $500 billion in cuts to Medicare, many of these savings coming from cuts to Medicare providers and suppliers. This is another campaign promise broken.

NCCPSSM warns that President Trump’s 2019 budget proposal also includes policy changes to the prescription drug benefit that would impact Medicare’s spending and beneficiary costs. It would create an out-of-pocket maximum for Part D. Medicare t beneficiaries with very high drug costs would no longer have cost sharing responsibility once they hit the catastrophic threshold. This would add $7.4 billion in costs over 10 years.

Trump’s budget proposal would also change the way the threshold for moving out of the coverage gap or “donut hole”” is calculated that would make it more costly to seniors to move through it. “Taken together with an out-of-pocket cap, it will mean savings for some seniors with very high drug costs, but costs will climb for a larger number of seniors. This saves $47.0 billion over 10 years,” reports NCPSSM.

Finally, Trump’s 2019 budget proposal saves $210 million over 10 years by eliminating the cost-sharing on generic drugs for low-income beneficiaries.

Hurting Medicaid Recipients

In FY 2015, federal and state governments spent about $158 billion or 30 percent of Medicaid spending on long-term services and supports (LTSS). The federal and state partnership pays for about half of all LTSS for older adults and people with disabilities.

The President’s 2019 budget proposal slashes the program’s funding by changing the structure of the program into either a per capita cap or Medicaid block grant, with a goal of giving states more flexibility of managing their programs. Through 2028, the president’s budget would cut $1.4 trillion from the Medicaid program through repealing the Affordable Care Act, restructuring the program.

NCPSSM expresses concern that if states lose money under per capita caps or block grants, state law makers would have to make up the funding themselves if federal funds do not keep up with their Medicaid population’s needs. This can happen by either by cutting benefits and/or limiting eligibility, requiring family members to pick up more nursing home costs, or scaling back nursing home regulations that ensure quality, service and safety protections.

And That’s Not All

NCPSSM’s analysis says that Trump’s budget proposal also calls for the elimination of the Older Americans Act Title V Senior Community Service Employment Program (SCSEP). The program, funded $ 400 million in FY 2017. provides job training to nearly 70,000 low-income older adults each year.

Community Services Block Grants ($715 million), the Community Development Block Grant ($3 billion) and the Social Services Block Grant ($1.7 billion) programs are also targeted to be eliminated. Some Meals on Wheels programs rely on funding from these federal programs, in addition to OAA funding, to deliver nutritious meals to at-risk seniors.

Trump’s 2019 Budget proposal would also eliminate funding for the Low-Income Home Energy Assistance Program (LIHEAP) This program received $3.39 billion in FY 2017. “Of the 6.8 million households that receive assistance with heating and cooling costs through LIHEAP each year, 2.26 million or one-third are age 60 or older,” says NCPSSM.

Trump’s budget plan also eliminates funding for Senior Corps programs including the Retired and Senior Volunteer Program, Foster Grandparents and Senior Companions. Current Senior Corps funding at the FY 2017 level is $202.1 million. “These programs enable seniors to remain active and engaged in their communities, serving neighbors across the lifespan, and benefitting their own health in the process. In 2016, 245,000 Senior Corps volunteers provided 74.6 million hours of service,” says NCPSSM. .

Finally, research into cancer, Alzheimer’s Parkinson’s and other diseases affecting older persons will be negatively impacted with $ 46 million in funding cuts to National Institute on Aging at the National Institutes of Health.

Aging advocacy groups view Trump’s second budget “flawed,” jam-packed with “damaging policies” for Congress to enact with an aging population. It’s “Dead on Arrival.” If Trump and GOP lawmakers choose not to listen to their older constituents, the results of the upcoming mid-term elections might just get their attention.


Earth: The Gray(ing) Planet

Published in Woonsocket Call on April 17, 2016

Last month, a National Institute of Health funded U.S. Census Bureau report was released announcing that the world’s older population is growing dramatically at an unprecedented rate. According to the newly released federal report, “An Aging World: 2015,” 8.5 percent of people worldwide (617 million) are aged 65 and over. This percentage is projected to jump to nearly 17 percent of the world’s population by 2050 (1.6 billion).

The new 165 page report, released on March 28, 2016, was commissioned by the National Institute on Aging (NIA), part of the National Institutes of Health, and produced by the U.S. Census Bureau.

“Older people are a rapidly growing proportion of the world’s population,” said NIA Director Richard J. Hodes, M.D. “People are living longer, but that does not necessarily mean that they are living healthier. The increase in our aging population presents many opportunities and also several public health challenges that we need to prepare for. NIA has partnered with Census to provide the best possible data so that we can better understand the course and implications of population aging.”

“An Aging World: 2015” is chock full of information about life expectancy, gender balance, health, mortality, disability, health care systems, labor force participation and retirement, pensions and poverty among older people around the world.

“We are seeing population aging in every country in every part of the world,” said John Haaga, Ph.D., acting director of NIA’s Division of Behavioral and Social Research. “Many countries in Europe and Asia are further along in the process, or moving more rapidly, than we are in the United States. Since population aging affects so many aspects of public life—acute and long-term health care needs; pensions, work and retirement; transportation; housing—there is a lot of potential for learning from each other’s experience.”

A Look at Some of the Details

The report noted that America’s 65-and-over population is projected to nearly double over the next three decades, from 48 million to 88 million by 2050. By 2050, global life expectancy at birth is projected to increase by almost eight years, climbing from 68.6 years in 2015 to 76.2 years in 2050.

In addition, the global population of the “oldest old”—people aged 80 and older—is expected to more than triple between 2015 and 2050, growing from 126.5 million to 446.6 million. The oldest old population in some Asian and Latin American countries is predicted to quadruple by 2050.

The researchers say that the graying of the globe is not uniform, “a feature of global population aging is its uneven speed across world regions and development levels.” The older population in developed countries have been aging for decades, some for over a century. “In 2015, 1 in 6 people in the world live in a more developed country, but more than a third of the world population aged 65 and older and over half of the world population aged 85 and older live in these countries. The older population in more developed countries,” says the report.

Meanwhile, the researchers report that in the less developed world, “Asia stands out as the population giant, given both the size of its older population (617.1 million in 2015) and its current share of the world older population (more than half).” By 2050, almost two-thirds of the world’s older people will live in this continent, primarily located in the eastern and northern hemispheres. “Even countries experiencing slower aging will see a large increase in their older populations. Africa, for instance, is projected to still have a young population in 2050 (with those at older ages projected to be less than 7 percent of the total regional population), yet the projected 150.5 million older Africans would be almost quadruple the 40.6 million in 2015, notes the report. .

The Graying of the Ocean State, Too

AARP Rhode Island State Director Kathleen Connell says that statistics gleamed from a new interactive online tool, the AARP Data Explorer, detailed by blogger Wendy Fox-Grage, a senior strategic policy advisor for AARP Policy Institute, suggests that Rhode Island for some time, has had the highest per capita 85 plus population of any state. But “Data Explorer also shows that Rhode Island was surpassed in 85 plus per capita in 2015 – second now to Florida by 1/10,000th of a percentage point. Interesting, by 1260, we are projected to rank 14th.

“Nationally, from 2010 to 2060, the 85-plus population will more than triple (260 percent), the fastest growth of any age group over that time period,” she says.

Connell says, “AARP Data Explorer clearly shows that the age 65-plus population will grow much faster than younger age groups. All three older age groups (65-74, 75-84 and 85-plus) will more than double between 2010 and 2060, while the younger age groups (0-17, 18-49, 50-64) will increase only slightly.”

“The growth of the age 85-plus population will significantly outpace all other age groups, once Boomers begin turning 85 in the 2030s,” adds Connell, noting that “This phenomenon will have significant impact on every aspect of society, ranging from our health care system to the economy.”

“People age 85-plus are the group most likely to need long-term services and supports (LTSS) to help them with everyday tasks. They not only have higher rates of disability than younger people, but they are also more likely to be living alone, without a spouse or other family member to provide them with assistance,” observes Connell.

Over the years, the Rhode Island General Assembly has enacted legislative changes in the way it delivers and funds aging services and supports for older Rhode Islanders and their family caregivers, says Connell.

According to Connell, early last year, AARP Rhode Island released, “Raising Expectations 2014: A Report Card for Rhode Island Long Term Services and Supports System Performance.” The report assessed the LTSS Scorecard and recommended policy goals.

Connell says that the results revealed that Rhode Island showed strengths. With the subsequent passage of key legislative proposals that included caregiver paid family leave and the CARE Act, the state has moved in the right direction, she says, stressing that “the policy report pointed to areas for improvement that state leaders should not ignore.”

“With the reauthorization of the Older Americans Act through 2019, and continued backing from Governor Raimondo, Rhode Island seniors and caregivers are benefitting from a host of home- and community-based programs,” says Director Charles Fogarty, of Rhode Island’s Division of Elderly Affairs. “A top priority for the agency is strengthening of those services so everyone can make it in Rhode Island. We are proud to partner with hardworking older Rhode Islanders and advocates; we are constantly listening to their suggestions which are helpful in providing direction on development of effective programming and policies,” he says.

Fogarty noted that during Governor Gina Raimondo’s first two budget cycles (FY 2016 enacted and FY 2017 proposed budgets), more than $1 million in additional general revenue funding has been allocated for programs such as Meals on Wheels, senior centers and other home and community care services. Seniors can remain in their homes with a high quality of life for as long as possible through the provision of affordable and accessible home and community-based services and living options preventing or delaying institutionalization.

Connell says a the nation’s population ages, Rhode Island now has an opportunity of showing other states, with growing age 85 plus populations what it takes to care for an aging population.

Rhode Island, too, can also teach the world community a thing or two about providing programs and services to their older citizens.

Calling on Congress to Increase Alzheimer’s Funding

Published in Woonsocket Call on February 21, 2016

Three weeks before President Obama released his Fiscal Year 2017 Budget on February 9,  Senators Susan Collins (R-ME), who chairs the U.S. Select Committee on Aging, and Amy Klobuchar (D-MN) along with seven of their colleagues, called on the Democratic President to increase funding for Alzheimer’s research as part of his last proposed budget request. Senator Sheldon Whitehouse (D-RI), who sits on the Senate Aging Panel, was among the cosigners.

In the bipartisan January 28 correspondence,  the cosigners said, “If nothing is done to change the trajectory of Alzheimer’s, the number of Americans afflicted with the disease is expected to more than triple between 2015 and 2050,” the Senators wrote.  Already our nation’s costliest disease, Alzheimer’s is projected to cost our country more than $1 trillion by 2050… Surely, we can do more for Alzheimer’s given the tremendous human and economic price of this devastating disease.”

Furthermore, cosigners warned that “$2 billion per year in federal funding is needed to meet the goal of preventing or effectively treating Alzheimer’s by 2025.” 

 Aging Groups Express Disappointment

Max Richtman, President and CEO of the National Committee to Preserve Social Security and Medicare (NCPSSM), says that the Consolidated Appropriations Act, 2016, (P.L.114-113) provided $936 million in FY 2016 (a $350 million or 59.7% increase over FY 2015) for Alzheimer’s disease research at the National Institute on Aging (NIA), the nation’s leading funder of Alzheimer’s disease research.

Richtman expressed disappointment that Obama’s budget proposal did not recommend funding about the FY 2016 level for Alzheimer’s disease and dementia research, it was essentially flat funded.

“Scientists have estimated that spending at least $2 billion a year on research is necessary to accomplish the national Alzheimer’s plan goal of preventing or effectively treating Alzheimer’s disease by 2025,” says Richtman.

According to NCPSSM’s 2016 Legislative Report, “the number of people suffering from Alzheimer’s disease or a related dementia is expected to skyrocket over the next few decades because many people are living longer and the incidence of Alzheimer’s disease increases with age.”

Richtman says “making a significant investment in funding towards finding a cure and appropriate treatments for persons with Alzheimer’s disease and dementias is key to reducing the massive financial drain this disease will impose on the future of the Medicare program, along with the devastating emotional and financial toll exacted on the millions of Alzheimer’s victims and their family members and caregivers.”

The Alzheimer’s Foundation of America (AFA) also expressed disappointment in the proposed $337 million cut in research funding at NIA, contained in Obama’s 2017 Fiscal year budget proposal. “The Administration has been a champion in the fight against Alzheimer’s disease; however, we are disappointed that, in his final budget, the President is retreating,” said CEO and President Charles J. Fuschillo, Jr., of the Alzheimer’s Foundation of America (AFA). “We were hoping President Obama would take the dramatic step necessary to confront the dementia crisis in this country head-on. We will continue to work with Congressional appropriators to ensure we are on the path to a cure,” says Fuschillo, Jr.

Like NCPSSM, Cicilline, Reed, Whitehouse, and many members of congress, the New York-based AFA urged the Administration to build on the historic 60 percent increase in Alzheimer’s research funding that was included in this year’s budget that provided an additional $1 billion in research funding in the upcoming federal budget.  If done, total federal spending would reach almost $ 2 billion, an amount that Alzheimer’s experts say is necessary to finding a cure or meaningful treatment by 2025 (detailed in the National Plan to Address Alzheimer’s Disease.

According to AFA, currently Alzheimer’s disease is the sixth leading cause of death in the United States, with studies indicating it could actually be as high as the third-leading caused.  But this devastating disorder is the only disease in the top 10 for which there is neither a cure nor impactful treatment.  Furthermore, “even with the Fiscal Year 2016 funding increase, funding for Alzheimer’s lags far behind HIV/AIDS, cancer and heart disease.

On the Home Front

Congressman David N. Cicilline, who successfully led the effort in the House to increase funding for Alzheimer’s research by more than 50% last year, sees a need for increased funding a necessity in the Fiscal Year 2017. “Alzheimer’s disease afflicts 22,000 Rhode Islanders and their families each year,” the Democratic congressman representing Congressional District 1.

With Congress poised to begin hammering out next year’s federal budget, Cicilline plans to continue his efforts in the House to fight for an increase federal funding for a treatment and a cure of the devastating disorder.  He urges for Alzheimer’s disease research remain a major funding priority for policymakers at every level of government.

Senator Jack Reed, serving as a member of the Labor-HHS Appropriations Subcommittee, says, “Last year, we successfully included a $350 million boost in new spending for Alzheimer’s research, a 60% increase over the previous year.  Looking ahead to the coming fiscal year, we still have our work cut out for us in this challenging budgetary climate, but I am pushing to secure additional resources to help prevent, treat, and cure Alzheimer’s, as well as for education and outreach.”

“More and more Americans are being impacted by Alzheimer’s disease and we need a serious national commitment to finding cures and treatments.  That means making strategic investments now that will help save lives and future dollars in the long-term,” notes the Senator.

A Call for Action

Experts tell us an impending Alzheimer’s disease epidemic is now upon us. Federal and state officials are scrambling to gear up for battle, developing national and state plans detailing goals to prevent or treat the devastating disease by 2025.

According to the Rhode Island Chapter of the Alzheimer’s Association, an estimated five million Americans over age 65 are afflicted with Alzheimer’s disease in 2013.  The prevalence may well triple, to over 16 million, if research does not identify ways to prevent or treat the cognitive disorder, says the Rhode Island nonprofit.  By 2050, it’s noted that the estimated total cost of care nation-wide for persons with Alzheimer’s disease is expected to reach more than $1 trillion dollars (in today’s dollars), up from $172 billion in 2010.

Congress must not act “penny wise and pound foolish” when it ultimately comes to determining the amount of federal dollars that will be poured into Alzheimer’s research in next year’s fiscal budget.  Less dollars or level funding will only increase state and federal government’s cost of care for Alzheimer’s care in every municipality in the nation.  A total of 469 seats in the Congress (34 Senate seats and all 435 House seats) are up for grabs in the upcoming presidential election in November.  Lawmakers must remember that every voter may be personally touched, either caring for a family member with the cognitive disorder or knowing someone who is a caregiver or patient.  That ultimately becomes a very powerful message to Capitol Hill that it is important to increase the funding to NIA to find the cure.