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From the category archives: Aging Issues

Nursing Homes Say: Hold the Meatloaf...Pass the Lo Mein, Please

There’s a growing trend among the nation’s more than 15 thousand nursing homes to break away from rigid meal schedules and standard menus to individualized meals which acknowledge their residents’ dietary, ethnic and cultural diversity.  Rather than chicken and mashed potatoes Tuesdays imagine instead a Thai-style soup with fresh ginger, vegetables and thin-sliced beef as an option.

The Associated Press reports:

“...the federal government is proposing regulations that would require facilities to create menus that reflect religious, cultural and ethnic needs and preferences, as well. Further, the proposed rules would empower nursing home residents with the "right to make personal dietary choices."

The government acknowledges that the nation's 1.4 million nursing home residents are diverse and that ‘it may be challenging’ to meet every preference. But it wants facilities to offer residents ‘meaningful choices in diets that are nutritionally adequate and satisfying to the individual.’ “

Advocates have argued for these changes for decades but cost is a challenge. 

“Janet Burns, chief executive at Sunny Vista, said the cost of fresh food is lower than prepackaged meals, but labor costs are higher. Her dietary costs were $1.08 higher than the nation's average in 2014. However, she said, higher costs are offset by things like preventing weight loss, a problem experienced by many nursing home residents. For example, she said, medication to increase a resident's appetite is more expensive than preparing a special meal. Costs aside, Burns said, ‘It's the right thing to do.’"

The benefits of more appealing and healthier food options could improve not only the quality of life but the health of residents.

“Sandra Simmons, a professor at Vanderbilt University who studies quality of care and life in institutional settings, says studies have shown that the daily caloric intake of 50 percent to 70 percent of nursing home residents is below recommended levels, she said.”

Something as simple as providing more appealing menus could make the difference. 

New Medicaid Rules Designed to Put Care Over Profit

CMS has announced tightened Medicaid rules for private insurance plans that administer most Medicaid benefits for the poor. The Obama administration says the rules will limit profits, ease enrollment, require minimum levels of participating doctors and eventually provide quality ratings.  However, those ratings would still be years away as the industry continues to fight against such measures. 

Kaiser Health News provides details on the biggest changes for Medicaid managed care in a decade.  The new rules will:

  • Require states to set rules ensuring Medicaid plans have enough physicians in the right places. The standards will include “time and distance” maximums to ensure doctors aren’t too far away from members.
  • Limit insurer profits by requiring rate setting that assumes 85 percent of revenue will be spent on medical care. Unlike a similar rule for other plans, such as insurance sold through Obamacare marketplaces, the requirement would not compel Medicaid insurers to rebate the difference if they don’t hit 85 percent. Future rates would be adjusted instead.
  • Make plans regularly update directories of doctors and hospitals. A 2014 investigation by the Department of Health and Human Services’ inspector general found that half the doctors listed in official insurer directories weren’t taking new Medicaid patients.
  • Push plans to better detect and prevent fraud by providers, including mandatory reporting of suspected abuse to the states.
  • Tighten rules for Medicaid plans and states to collect patient data and submit it to HHS.
  • Make it easier for states to offer managed-care plans incentives to improve clinical outcomes, reduce costs and share patient information among hospitals and doctors.

Nearly two-thirds of Medicaid’s 72 million member are enrolled in private managed-care plans.  Consumer advocates have pushed HHS to set stricter rules for managed-care plans, which they said too often favored profits over patients. The industry and some state Medicaid directors resisted, saying plans needed flexibility to serve different members in different states.

The rules will be phased-in over the next three years, starting next summer. 


Unequal Pay’s Lasting Legacy: Lost Income from Your 1st day at Work until the Day You Die

Max Richtman, NCPSSM President/CEOMax Richtman, NCPSSM President/CEO

It’s certainly not news that American women continue to earn less than men for the same work, typically 79 cents on the dollar.  But what’s less understood is the devastating impact those lost wages have over time.  In fact, over a working woman’s career, that pay gap could accumulate to a half million dollars in lost income and even more for women of color.  A comprehensive analysis of gender pay inequality, released by the Joint Economic Committee’s Democratic staff, shows how the gender pay gap grows over time.  It’s not just an issue for working women because this inequality can also have a compounding and devastating impact on retired women.

The thought of running out of money in retirement keeps 57% of women awake at night. That’s not a surprise when you consider the many combined factors which make retirement especially challenging for American women. Women earn less than men even when doing the same jobs, they more often work part-time or in jobs that do not offer retirement savings plans, and they tend to spend more time out of the workforce as a consequence of their caregiving responsibilities. Women could lose $430,480 in earnings over the course of a 40-year career due to the wage gap alone.  For Latinas the career losses mount to $1,007,080, and for African American women the losses are $877,480. Lower career earnings also translate to fewer savings for many women in retirement. At the same time, their longer lifespan and higher chances of disability means that they will have higher retirement costs, both for everyday expenses and necessary medical care.

These financial obstacles facing older women explain why women are 80% more likely than men to be impoverished at age 65 and over. The median income of women age 65 and older is 44% lower than the median income of men of the same age and that poverty gap widens over time due to decreasing income for women at older ages. Women aged 75 to 79 are three times as likely and those over the age of 80 are twice as likely to live in poverty compared to men. While it’s self-evident that working women must be aware of the unique challenges they could face in retirement, simply understanding these issues won’t be enough to bridge the very real gap created by systemic and demographic forces far beyond their control.  That’s why the National Committee to Preserve Social Security and Medicare launched our Eleanor’s Hope initiative.  We’re not only educating but also advocating for legislation that addresses the inequities threatening millions of retired women while also working to elect lawmakers who share our vision of retirement equity for women. 

There are a number of proposals which, if adopted, could significantly level the playing field for women and reduce the threat of poverty in their old age: 

Gender Pay Equity. Eliminating the wage gap that limits women’s earnings is essential to helping our daughters and granddaughters save for their own retirement. Congress should strengthen and reform the “Equal Pay Act” by putting an end to pay secrecy, strengthening workers’ ability to challenge discrimination and bringing equal pay law into line with other civil rights laws.  

Caregiver Credit. Compute the Social Security benefit by giving an annual caregiver credit for each year of caregiving so that total earnings for the year would equal 50 percent of that year’s average annual wage. Caregiving service years would be those in which an individual provides care to children under the age of six or to elderly or disabled family members. Up to five family service years could be granted to any worker.

Improve Survivor Benefits. Increase the benefit paid to a surviving spouse to an amount that is equal to 75 percent of the total combined benefits that were paid to the couple prior to the spouse’s death, capped at the benefit level of a lifelong average earner.

Consumer Price Index for the Elderly. Adopt the Consumer Price Index for The Elderly (CPI-E) for the purpose of determining the amount of the cost-of living adjustment (COLA) adjustment for Social Security benefits. This is especially important for women who tend to receive benefits longer because they live longer.

It’s been more than 50 years since our nation acknowledged and attempted to address, with passage of the Equal Pay Act, the gender wage gap which unfairly targets half of our population with billions in lost wages.   Yet, at the current rate of change, it will take another 40 years to close that gap.   That’s simply not an option for generations of American women who will continue to face the consequences of income inequality from their very first day on the job until they die.  

The Economic Crisis Candidates Continue to Ignore

The Economic Policy Institute’s “The State of American Retirement” combined with the National Institute on Retirement Security’s new report on women and retirement paint a very clear picture of a nation on the brink of an economic crisis that will devastate millions of average American families, if Washington continues to turn a blind eye.

The median family between the ages of 32 and 61 has only $5,000 saved in a retirement account, while the top 1 percent of families has a million dollars or more. For many groups—lower-income, black, Hispanic, non-college-educated, and unmarried—the typical working-age family has no savings at all in these accounts....The State of American Retirement.

“Our retirement system used to reduce inequality, but since the shift to 401(k)s it has only served to magnify it. These accounts are accidents of history that were never designed to replace pensions, and it should come as no surprise that they have not worked for the majority of people.” ...Monique Morrissey, EPI Economist

The numbers are stark:

  • Nearly half of all working-age families have zero retirement savings.
  • Almost nine in 10 families in the top income fifth have savings in retirement accounts, compared to fewer than one in 10 families in the bottom income fifth.
  • Only 41 percent of black families and 26 percent of Hispanic families have retirement account savings, compared with 65 percent of white non-Hispanic families.
  • Only married couples are more likely than not to have retirement account savings.

News that the income inequality hindering American workers now is also carrying over to their retirement is alarming for future generations who are taking an economic hit at every stage of life.  For women, the retirement picture is even worse. 

“A new analysis finds that women are 80% likely than men to be impoverished in retirement. The National Institute on Retirement Security (NIRS) finds that across all age groups, women have substantially less income in retirement than men. For women age 65 and older, the data indicate that their typical income is 25 percent lower than men. As men and women age, men’s income advantage widens to 44 percent by age 80 and older. Consequently, women were 80 percent more likely than men to be impoverished at age 65 and older, while women age 75 to 79 were three times more likely to fall below the poverty level as compared to their male counterparts.”... National Institute on Retirement Security

Just as we’ve seen from climate change deniers, many Republican politicians won’t even acknowledge the retirement crisis exists because improving the nation’s most successful federal retirement programs is anathema to their misguided belief that Wall Street should be handling your savings and for-profit insurance companies managing your health. Instead of supporting proposals to improve the backbone of America’s retirement system, Social Security and Medicare, conservatives continue their campaign to privatize and cut. 

There are legislative proposals which would improve Americans’ retirement picture but they are languishing in the GOP controlled Congress.  You can see many of these proposals on our Legislative tracker.  We also continue to advocate for meaning changes impacting retirement security for women.  Please take a moment and see those details on our Eleanor’s Hope initiative website. 

A Tale of Two Medicares

CMS has announced it will raise rates for insurance companies offering privatized Medicare Advantage, rather than trimming back the billions of federal overpayments as required in the Affordable Care Act.  Wall Street and the insurance industry loved the news that taxpayers will continue to overpay Medicare Advantage plans:

“WellCare Health Plans Inc. jumped as much as 12 percent on Monday after the government proposed raising payments next year for private insurers that provide Medicare coverage.Shares in Humana rose 2.6 percent. Centene Corp. and Molina Healthcare Inc. also rose Monday following the CMS’s proposals, adding 4.2 percent and 6.2 percent respectively.”

The health insurance industry’s massive advertising and lobbying campaign to keep their government subsidies has become an annual ritual here in Washington – one that’s more predictable than the timing of the cherry blossoms. To head off any chance that CMS might reduce the massive federal overpayments, as required by the Affordable Care Act, the multi-billion dollar insurance industry floods the airways and hallways of Congress with threats to cut seniors’ MA benefits unless their overpayments are protected.  Clearly, that lobbying works. 

For the second year in a row, CMS has proposed a rate increase. This year’s 1.35%  rate hike, when combined with other industry requested changes, will lead to a 3.55% increase in revenue for America’s health insurance industry.  Last year, CMS initially proposed a .95% rate cut which was reversed after AHIP’s lobbying blitz turned it into a 1.25% increase.  In 2015, Medicare paid $8 billion more to provide coverage for seniors in Medicare Advantage than for traditional Medicare. That will now continue.

The Washington Post’s analysis last year, still fits today:

“Alas, since its origins in the early ’80s, MA has proven no more immune to perverse incentives and system-gaming than any of the government’s other health programs.

First, insurers cherry-picked healthier customers, who are less costly, and hence more profitable, to treat. Congress responded with new payment formulas to reward companies for accepting relatively sick customers. But this led to rampant “upcoding,” whereby MA plans find and report as many illnesses per enrollee as they can plausibly document.

Last fall, {2014} the Department of Health and Human Services released a comprehensive analysis showing that MA costs grew faster than they would have under fee-for-service between 2004 and 2013 — and that only upcoding, not patient demographics or other neutral factors, could explain this.”

Family physician and Senior Health Policy Fellow for Physicians for a National Health Program, Dr. Don McCanne says:

“Ensuring success of the MA plans is part of the plot to eventually privatize Medicare - converting it into a premium support system (vouchers) for a market of private plans that will displace the traditional Medicare program. The value of the voucher equivalents will erode with time, shifting ever more of the costs to the Medicare beneficiaries. It will be disastrous.

They (private MA plans) have been profitable only because they have continued to be successful in enrolling healthier, less costly patients while at the same time receiving overpayments from the government.”

So how did we get here?

Medicare Advantage was created by the Bush Administration to privatize Medicare. Prior to the ACA, the federal government paid MA plans up to 14 percent more than traditional Medicare for identical services, costing taxpayers about $1,000 extra per beneficiary.  MA plans attract younger and healthier customers by offering benefits not included under traditional Medicare, such as gym memberships.  That competitive and financial advantage has paid off, as MA enrollment continues to grow.  Seniors in private Medicare say they like their plans, as do people enrolled in traditional Medicare. 

The real irony in this debate is that while traditional Medicare has been repeatedly targeted in Congress for cuts, $8 billion in overpayments to the insurance industry remain protected. Congressional conservatives claim America can’t afford Medicare yet many of these same politicians defend sending billions of Medicare dollars straight to the insurance industry, in spite of growing concerns that insurers are gaming the system:

  • Independent analysis by the National Bureau of Economic Research shows private plans are “upcoding” or manipulating patient diagnoses in order to game payment systems and generating billions of dollars annually.  
  • Risk scores have risen 9 percent faster in Medicare Advantage, on average, than in traditional Medicare for comparable beneficiaries, MedPAC estimates.  This leads to excessive payments to Medicare Advantage plans. 
  • Last year, CMS took 35 enforcement actions against MA and Part D sponsors for a range of issues, including limited provider access and charges for higher than allowed out-of-pocket costs. Among the enforcement actions last year were 25 fines in the six figures. This year, CMS has fined $1 million to Aetna for Part D directories that erroneously listed 7,000 pharmacies as being in-network. 
  • GAO investigators found Medicare officials rarely enforce rules for private insurance plans intended to make sure beneficiaries will be able to see a doctor when they need care. In Connecticut, UnitedHealthcare, the nation’s largest health insurance company, dropped more than a thousand of health care providers and doctors leaving patients desperately scrambling for care. 
  • Brown University study shows that once medical care becomes costly for seniors in Medicare Advantage and the coverage no longer meets their needs for acute care, beneficiaries are leaving private MA plans to return to traditional Medicare. 

As we wrote here last year,

“Private Medicare Advantage plans continue to see growth as they promise gym-memberships, limited optometric coverage or zero premium plans.  However, as predicted by many healthcare experts and indicated in the Brown study, seniors find that once they actually need help with more costly care, MA plans aren’t providing the coverage they need. 

Ultimately, this means that younger and healthier seniors are being lured into private insurers’ plans only to have to switch to traditional Medicare once they need coverage for more serious health issues (and isn’t that why we have health insurance in the first place – to cover when we get sick, not when we’re healthy?).  Meanwhile, private insurance companies continue to reap the benefits of annual federal subsidies to provide this limited coverage for healthier seniors – which are tax dollars that could have been used in traditional Medicare to serve all beneficiaries.”

Modern Healthcare reports Medicare Advantage has been a boon for health insurers, which views taxpayer-funded insurance as a ripe business opportunity.  Meanwhile, the GOP Congress is preparing another round of cuts to traditional Medicare in their upcoming 2017 Budget plan

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