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From the category archives: Budget

House GOP Recklessly Pursues Privatization of Medicare in Budget Process

Congress is targeting the health and financial well-being of America’s seniors by making yet another attempt to privatize Medicare.   Yesterday the House Budget Committee passed the GOP’s FY 2018 budget resolution, which includes Speaker Paul Ryan’s “Medicare premium support” scheme – an innocuous name for turning time-tested senior health care coverage into “Coupon-Care.”  

The House budget blueprint slashes nearly $500 billion from Medicare over ten years and raises the eligibility age from 65 to 67 – along with gutting Medicaid and other social safety net programs for needy seniors.  

The Associated Press had a pithy summary of the painful cuts that the GOP proposes in its new budget:

“The plan, in theory at least, promises to balance the budget through unprecedented and unworkable cuts across the budget. It calls for turning this year's projected $700 billion or so deficit into a tiny $9 billion surplus by 2027. It would do so by slashing $5.4 trillion over the coming decade, including almost $500 billion from Medicare, $1.5 trillion from Medicaid and the Obama health law, along with enormous cuts to benefits such as federal employee pensions, food stamps, and tax credits for the working poor.” – Associated Press, 7/18/17

 National Committee President Max Richtman says that converting Medicare into a voucher program is an existential threat to the program itself. 

 “Over time, giving seniors vouchers to purchase health insurance would dramatically increase their out of pocket costs since the fixed amount of the voucher is unlikely to keep up with the rising costs of health care. And, as healthier seniors choose less costly private plans, the sicker and poorer seniors would remain in traditional Medicare, leading to untenable costs, diminished coverage, and an eventual demise of traditional Medicare, plain and simple.” – Max Richtman, NCPSSM President

Of course, raising the Medicare eligibility age from 65 to 67 as the House spending plan also proposes, is in itself a drastic benefit cut.

Undermining Medicare has been a long-held dream of fiscal conservatives. Their “premium support” proposal is a thinly veiled scheme to allow traditional Medicare to “wither on the vine,” as former House Speaker Newt Gingrich once put it.

Privatization is being sold as “improving customer choice,” but based on the way current Medicare Advantage plans work, private insurance will continue to offer fewer choices of doctors than traditional Medicare does.  If traditional Medicare is allowed to shrink and collapse, choice will disappear, too.

“Weakening Medicare is a politically perilous path for Republicans.  Recent polling indicates that large majorities of Americans across party lines prefer that Medicare be kept the way it is, not to mention that President Trump repeatedly promised to protect the program during the 2016 campaign.” – Max Richtman, NCPSSM President

Meanwhile, the National Committee strongly condemns other priorities of the House Republican budget resolution, as well.  The GOP budget resolution will mean: 

*Hundreds of billions in painful cuts to Medicaid, which seniors depend on for long-term care services and supports.

*Reaffirmation of a House rule that puts 11 million Social Security Disability Insurance (SSDI) beneficiaries at risk of a 7% benefit cut in 2028.

*Reductions to SSI (Supplemental Security Insurance), which provides cash assistance to low-income seniors and people with disabilities.

 *Caps on non-defense spending that will likely lead to devastating cuts to Older Americans Act programs and the Social Security Administration (SSA) operating budget.

 *Slashing of programs that benefit our nation’s veterans and deep cuts to spending on medical research (including cancer, diabetes, heart disease, and other conditions afflicting the elderly).

The savings from these devastating cuts will likely go to tax breaks for the wealthy.  Last year’s House Republican tax plan gave 99.6% of its benefits to the top one-percent of earners, with virtually nothing for middle and low income Americans.

 

 

Of Course People Will Die if Senate Health Bill Becomes Law

Two days in a row now we have seen CNN anchor Kate Bolduan react with incredulity when a Democratic member of Congress points out the obvious:  that people will die if the Senate healthcare bill becomes law.  “We’ll have to ask a Republican about that!” Bolduan breathlessly replied to one Democrat. What she – along with advocates of the bill – fails to understand or prefers to ignore is that you cannot snatch healthcare away from 22 million people without incurring casualties.  Of course people will die as a result. 

Speaking against the GOP healthcare bill last week, Senator Elizabeth Warren (D-MA) called its cuts to healthcare for older and lower-income Americans “blood money.”  She went on to say:

“Let’s be very clear.  Senate Republicans are paying for tax cuts for the wealthy with American lives.  People will die.” – Sen. Elizabeth Warren, 6/22/17

Republicans propose to pay for those tax cuts by gutting the Medicaid program – 40% of which pays for services to the elderly like nursing home care.  Some one million seniors nationwide could lose the ability to pay for the long term care they need to survive.  States facing $770 billion in federal Medicaid cuts will have no choice but to offer skimpier coverage or kick seniors off the Medicaid rolls altogether.

By law, state Medicaid programs have to cover nursing homes. If those states receive less funding from the federal government, it could increase the pressure on the operations of nursing homes, in turn possibly limiting who can qualify for care. – Yahoo Finance, 6/26/17 

We are talking about people with Alzheimer’s, cancer, diabetes, neurological disorders, and other chronic diseases.  Few seniors (or their families) can afford to pay the average cost of nursing home care (running some $80,000 a year) without government assistance. Many of these seniors were formerly in the middle class, but had to impoverish themselves to qualify for Medicaid.  If they are forced to go without skilled long term care (whether in a nursing home, in the community, or at home), the real question is not whether some of them will die, but how will they survive? 

The bill’s age rating provisions could also prove deadly for older Americans.  The Senate legislation – like the House’s – allows insurers to charge near seniors (aged 50-64) up to five times as much as younger adults, which will price many out of the market.  The rate of uninsured Americans who earn up to 200% of the federal poverty line will double if this bill becomes law.  Chronic health conditions tend to develop and intensify during this period of life.   If millions of near seniors can’t afford health insurance, they will go without the care they need – which could lead to premature death.  You don’t have to be a brain surgeon to figure that one out.

Taking away the guarantee of essential benefits coverage – which the Senate bill also threatens to do – means Americans (especially the poor and elderly) will no longer benefit from timely treatment of festering health problems.  One of those is heart disease. According to Kaiser Health News, the leading killer of men and women in the U.S. has been decreasing since Obamacare went into effect. 

“The Journal of the American Heart Association found that the rate of sudden cardiac arrest outside of a hospital dropped by 17% among people aged 45-64 after the Affordable Care Act expanded insurance coverage.” – Kaiser Health News, 6/28/17

It stands to reason that repealing the Affordable Care Act could lead to an increase in heart attacks, which could also mean an increase in fatalities. 

This is why the pleas for bipartisanship from Republicans and some of the media ring especially hollow.  We have heard pundits describe the disagreements between Republicans and Democrats on healthcare as “semantics”:  is the Senate bill a true “repeal” of Obamacare or not?  Why, oh why, can’t both sides just get along? Of course, that misses the point.  Not only does the bill roll back important protections for all Americans, it is a Trojan Horse for gutting Medicaid and giving the wealthy a $700 billion tax cut.  Congressional Democrats refuse to enable the GOP to make these drastic changes.  Seniors and their advocates must keep that issue at the forefront – and work to defeat the Senate bill while there is still time. This is not semantics. It is literally life and death. 

Mitch McConnell's "Secret" Healthcare Plan... and the SeniorHeroes who could stop him

When the House passed its American Health Care Act (AHCA) last month, conventional wisdom said it was doomed in the Senate.  Moderate Republican Senators would never go along with the more harmful provisions of the House bill – or so the narrative went.  It appears those predictions were off base.  If the latest reporting from Capitol Hill is accurate, Majority Leader Mitch McConnell has put the Republican healthcare plan on a fast-track for passage in late June or early July.  A 13-member working group has been meeting in secret to craft the Senate version of the AHCA – without committee hearings.  Zero open debate.  Zero public input.  Or as the Washington Post described the process:  “sabotage, speed and secrecy.”  In order to keep pushback to a minimum, McConnell may not release the details of the bill until about 48 hours before the Senate votes on it.  That is insufficient time for Senators – and the public at large – to evaluate legislation that could dramatically affect the lives of tens of millions of Americans.

 Another false prediction from a few weeks ago said that the Senate would scrap the House bill and start from scratch. But this week Senator John Cornyn (R-TX) revealed that the Senate bill retains about 80% of what the House passed.  Since the House bill was so unequivocally bad for older Americans, hearing that the Senate version is at least 80% as bad is cold comfort. The Senate leadership will try to appease GOP moderates with the same kind of token gestures that saved the AHCA from defeat in the House.  It is vitally important that those moderates not cave like their House colleagues did.  Too much is at stake for our nation’s seniors and Americans as a whole.

 The National Committee has identified 11 moderate GOP Senators who may be persuaded to vote against the Republican health care plan – if they are willing to put their constituents’ well-being above party and political expediency.  They are:

 Sens. Lisa Murkowski and Dan Sullivan (R-AK)

Sens. John McCain and Jeff Flake (R-AZ)

Sen. Cory Gardner (R-CO)

Sen. Charles Grassley (R-IA)

Sen. Susan Collins (R-ME) 

Sen. Dean Heller (R-NV)

Sen. Rob Portman (R-OH)

Sen. Lamar Alexander (R-TN)

Sen. Shelley Moore Capito (R-WV)

 In fact, we call on these Senators to become what we call “SeniorHeroes” – real-life superheroes standing up for older Americans while the rest of their party pursues a dubious scheme.  From what we know of the Senate bill, there isn’t much in the evolving Senate bill for moderates to applaud.  Sen. Lisa Murkowski expressed those doubts publicly on Thursday.  Here are some of the key areas where the Senate version will likely fail older Americans:

 MEDICAID EXPANSION.  Senate Republicans are considering “compromises” that would phase out funding more slowly – but do not appear to be considering any approach that would maintain Medicaid expansion over the long run.  (Many of the more moderate Senators represent states which chose to expand Medicaid – and have a lot to lose.)

 PER CAPITA CAPS.  The Senate reportedly will retain the House-passed bill’s Medicaid per capita caps, which would strain state budgets and possibly force rollbacks in benefits or outright termination of coverage for millions of seniors who depend on Medicaid to pay for long-term care.  Although it’s unclear whether the Senate will keep the House bill’s $834 billion in Medicaid cuts, Medicaid still likely will be slashed by hundreds of billions of dollars. 

PRE-EXISTING CONDITIONS AND ESSENTIAL HEALTH BENEFITS.  The Senate may reject provisions in the House bill that would have allowed insurers to charge higher premiums for individuals with pre-existing conditions, but will likely allow states to waive essential benefits coverage.  This would dearly cost older Americans seeking essential benefits, such as hospitalization, ambulance services, and rehabilitation services. 

TAX CREDITS.  The House bill would drive up seniors’ out-of-pocket costs by replacing Obamacare’s income-based subsidies with tax credits based solely on age.  Older Americans could pay up to 800 percent more in net premiums under this plan.  The Senate has toyed with making these tax credits more “robust,” but the more it increases these credits, the deeper it must cut Medicaid to match the savings in the House bill. 

We do not know whether the Senate will allow insurers to charge older enrollees five times more than younger ones, as the House legislation does.  Also uncertain is whether the Senate will repeal the Medicare payroll tax on high income wage earners (as the House did), which would reduce the solvency of Medicare by three years.

It’s a safe bet that, like the House version, the Senate GOP healthcare plan will cost older Americans more, make essential health benefits harder to obtain, and cause millions who desperately need healthcare to lose coverage.  GOP moderates will be under intense political pressure to toe the line and support the party’s plan, even though the Republican bill has scant public support in even the reddest of states.  In asking GOP moderates to don their capes and become SeniorHeroes, we hope they remember who they were elected to serve.  It certainly wasn’t Mitch McConnell. 

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For more about the GOP's secret Senate healthcare plan, watch this week's "Behind the Headlines" on Facebook Live from Capitol Hill. 

 

Tom Price's "Alternate Reality"

In the Orwellian world that Trump’s Washington has become, we are used to hearing language abused and misused to forward a right-wing agenda.  This week was no different.  As Kaiser Health News reported, HHS Secretary Tom Price was on Capitol Hill Thursday reciting a blatantly false Tea Party mantra:  government programs for our society’s most vulnerable members deserve to be cut because they “don’t work.”  This falsehood flies in the face of evidence - of history, really.  But in an attempt to dismantle the New Deal and Great Society programs that boost up the neediest – which includes millions of older Americans – the administration will literally say anything even if the opposite is true.

Price appeared before two congressional committees yesterday to defend President Trump’s 2018 budget, which calls for drastic cuts to programs benefitting seniors - including Medicaid, Meals on Wheels, and medical research by the National Institutes of Health (NIH).  His testimony included the following whopper:

“The problem with many of our federal programs is not that they are too expensive or too underfunded. The real problem is that they do not work—they fail the very people they are meant to help.”  HHS Secretary Tom Price before the Senate Finance Committee, 6/8/17

In spreading these myths, Price is singing from the same hymnal as other administration officials, most notably Budget Director Mick Mulvaney who defended funding cuts for Meals on Wheels thusly:

“Meals on Wheels sounds great… [but] we're not going to spend [money] on programs that cannot show that they actually deliver the promises that we’ve made to people.” – OMB Director Mick Mulvaney, 3/15/17

With an extra-Orwellian touch, Mulvaney added that draconian cuts in safety net programs are “one of the most compassionate things we can do.”

All of this begs the question:  by what imaginary standard do these programs “not work” or “fail the people they are meant to help?”   How does Medicaid – which allows millions of needy seniors to afford long-term care at home or in skilled nursing care facilities – not work?  Or Meals on Wheels, which provides hot, nutritious meals for 2 million hungry and isolated seniors – not work?  These are programs that undeniably do work.

National Committee President Max Richtman takes Secretary Price to task for telling untruths about these vital federal programs:  

“As a former member of Congress and a physician, Secretary Price should know better.  By maligning programs that have been a lifeline for millions of Americans for decades, Secretary Price is denying history and facts.  He is attempting to create an alternative reality that is patently false and misleading.”  - Max Richtman, NCPSSM President & CEO

Price also resorted to the spurious claim that rising costs in programs like Medicaid demand cuts.  He insisted that cutting $610 billion from Medicaid would lead to “innovations and efficiencies.”  No, cutting billions from Medicaid will result in a shortfall for states facing rising costs, forcing them to cut benefits or kick people off the rolls altogether. 

The truth is that these federal safety net programs are incredibly efficient already. Medicaid’s per capita costs are significantly lower than private insurers’.  Meals on Wheels can feed a senior for an entire year at the same cost as a single day in the hospital.  And those are only two of the safety net programs which fall under the Trump budget axe.

Democrats on the Hill pushed back against Price’s pronouncements and Trump’s budget cuts, too:

It’s mean-spirited. It’s not good for America. We can do much better." - Rep. John Lewis (D-GA)

If Republican budget hawks like Price truly cared about seniors, children, the disabled, and other vulnerable segments of society, they would not be slashing safety net programs.  But they cannot pay for trillions in tax cuts for the wealthy and big corporations without cutting domestic spending, so programs that benefit our neediest citizens go on the chopping block.  The rationale that the Trump budget cutters are simply seeking “efficiencies” is a thin veil for denying needy seniors long term care or hot meals. 

President Franklin D. Roosevelt, father of the New Deal and grandfather of the Great Society (which today’s GOP is fighting to undo) put it best when he said:

"The test of our progress is not whether we add more to the abundance of those who have much, it is whether we provide enough for those who have little."  - President Franklin D. Roosevelt

Unlike Trump’s budget hawks, FDR understood the importance of authentic language that shines a light on fundamental truths.  He would never confuse “compassion” for cruelty, “helping people” for hurting them, or success for failure.  Neither should we.

Myths about Mental Illness and Social Security Disability Insurance Debunked

In order to justify its $64 billion in cuts to Social Security Disability Insurance (SSDI), the Trump administration and its allies have had to propagate several myths.  The most insidious one is that many SSDI recipients are not truly worthy of benefits.  They have suggested that mental illness is among the more dubious qualifications for SSDI.  Senator Rand Paul famously remarked that “over half the people on disability are either anxious or their back hurts.” Former Director of the National Economic Council Gene Sperling sums it up quite succinctly in The Atlantic:

 

The Administration is already deploying selective—and often deceptive—facts to stigmatize and caricature both the Social Security Disability Insurance program and its recipients. This sort of framing justifies using Social Security as a piggy bank to raid in order to help offset tax cuts for top-earning Americans. – Gene Sperling, 5/23/17

 

These convenient myths can be effective in undermining public support for SSDI, but they are dangerous for the millions of Americans with mental disorders who depend on federal disability benefits to prevent them from sinking into abject poverty.  Here are the facts: 

 

Nearly 25% of the nation’s 8 million SSDI recipients have a mental impairment as their primary diagnosis – or qualification – for benefits. They may suffer from a variety of disorders, including severe depression, anxiety, PTSD and intellectual impairment, which make it impossible for them to work or hold a job.  Many of those deemed eligible for SSDI benefits because of mental disorders also suffer from related physical disabilities.  The majority of these beneficiaries are over 50 years of age.  These are some of the vulnerable people the Trump administration is targeting with budget cuts – beneficiaries who struggle to make ends meet on an average $1172 per month from SSDI, just above the federal poverty line.  As Think Progress reports, for eight in ten beneficiaries, SSDI is their main or sole source of income. 

 

Why don’t these SSDI recipients simply work for a living, as OMB Director Mick Mulvaney and other administration apologists insinuate that they should?  Stacy Cloyd, Deputy Director of Government Affairs for the National Organization of Social Security Claimants Representatives (NOSSCR), explains why it’s so difficult for people with severe mental impairments to hold a job:  

 

“The symptoms of mental illness can make it difficult to concentrate on tasks, to routinely interact with customers and put on a friendly face, or handle changes in the workplace.  Like people with physical disabilities, those struggling with mental disorders may need to miss an excessive amount of work for doctor’s appointments, hospitalizations, or because of side effects from medications.”  - Stacy Cloyd, Deputy Dir. of Gov’t Affairs, NOSSCR

 

Stacy recalls two clients from a previous job assisting SSDI claimants whose stories starkly illustrate why it’s so difficult for the mentally impaired to sustain paying work.  One was a woman who suffered from PTSD due to domestic abuse.  After her husband tried to burn down their house, she experienced debilitating flashbacks and panic attacks that resembled seizures, and could barely leave home.  No longer to able to work, she had to discontinue her job in the fast food industry and applied for SSDI.  “She was awarded benefits at the time she needed them, which enabled her to keep a roof over head and food on the table while seeking treatment,” Cloyd explains.

 

The second client was a man in his 60s who had an intellectual impairment (formerly known as “mental retardation”) who for several years worked as a custodian through a special employment program and paid into Social Security.  He was later forced to give up the custodial work due to a variety of ailments.  Unable to find alternate employment because of his intellectual impairment, he applied for – and received – SSDI benefits.  It’s hard to imagine this older man being able to meet his basic living expenses without a job and without SSDI. 

 

While some fiscal conservatives and others perpetuate the myth that people on SSDI are simply lazy and scamming the system in order to avoid working, Cloyd insists that the opposite is true.

 

“If given a choice between dealing with the pain they suffer – mentally or physically – and collecting SSDI benefits… or being free of this pain and working for a living, I can tell you that they all would choose to work.” - Stacy Cloyd, Deputy Dir. of Gov’t Affairs, NOSSCR

 

Of course, having a severe mental or physical impairment is no guarantee of receiving SSDI benefits. The United States has one of the strictest federal disability standards in the world (only South Korea is more stringent).  Only one in four SSDI applicants is actually approved for benefits.  Wait times for approvals and appeals can be anywhere from months to years. In case anyone doubts the severity of beneficiaries’ conditions, one in six men on SSDI die within 5 years of approval for benefits; for women, the figure is one in seven.

 

Unfortunately, the cold facts do not deter the administration’s propagandists from insisting that many SSDI beneficiaries are somehow undeserving of help – even though they must have worked and paid into Social Security for five of the past ten years before applying.  The ARC advocacy organization estimates that 946,000 beneficiaries could be booted off SSDI if the Trump budget cuts are enacted:  that’s nearly one million mentally and physically impaired Americans deprived of minimal benefits to “keep a roof above their heads and food on the table” in order to give the wealthy and big corporations a massive tax cut. Capitol Hill watchers say the President’s budget is simply a “messaging document” with little chance of passage, in which case we say it is a cruel and frightening message to send some of our nation’s most vulnerable citizens.  

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For more on mental impairments and Social Security Disability Insurance, watch this week's "Behind The Headlines" on Facebook Live. 

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