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From the category archives: Budget

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. 

Oh, yes: the Trump Budget Definitely Does Cut Meals on Wheels

 

Would the Trump administration and its acolytes please stop saying that the President's budget does not cut funding for Meals on Wheels?

Just today, Budget Director Mick Mulvaney made that very claim at a House hearing on the new budget: 

"Let's talk about Meals on Wheels, because we don't reduce it.” – Mick Mulvaney, Trump Budget Director, 5/24/17

Meals on Wheels is a program that delivers hot meals to more than 2.4 million needy seniors across the country every year. Volunteers not only deliver sustenance; they check in on isolated seniors and provided a much needed human connection.


Anyone looking at the actual numbers can plainly see that the Trump budget does, in fact, slash funding for Meals on Wheels. In addition to cutting Older Americans Act home-delivered meals by $1.5 million, the President’s budget eliminates the Community Services, Community Development and Social Services Block Grants, upon which some Meals on Wheels programs rely for funding.

Because of previous budget cuts, Older Americans Act nutrition programs are already serving 23 million fewer meals than in 2005.  The loss of Community Services Block Grants ($715 million), Community Development Block Grants ($3 billion) and Social Service Block Grants ($1.7 billion) funding for home delivered meals would increase the number of seniors threatened by hunger.

According to Feeding America, 5.7 million Americans over the age of 60 were food insecure as of 2014. That means 9% of all seniors in the wealthiest nation in the world are at risk of going hungry.  Worse yet, the number of food insecure seniors is projected to increase by 50% when the youngest of the Baby Boom Generation reaches age 60 in 2025. There are waiting lists in every state for seniors who need food assistance. Cutting Meals on Wheels funding at a time of growing need is outrageous and dangerous.

In a letter to the editor of the Washington Post on March 20th, National Committee President Max Richtman recounted his days as staff director for the Senate Select Committee on Aging.  He tells the story of a Republican Senator who changed his mind about the program after riding along with a Meals on Wheels van:

“He (the GOP Senator) was impressed by not only the sustenance of the food, but also the seniors’ human connection to the volunteers, and became an enthusiastic advocate for the program.” – Max Richtman, Letter to the Editor of the Washington Post

At the end of the letter to the editor, Max suggested that a certain occupant of the White House follow the Senator’s lead. 

Perhaps Mr. Trump should ride with a Meals on Wheels van and witness the profound benefits to our nation’s most vulnerable seniors.

That suggestion seems even more appropriate today, given that the President obviously has no problem defunding Meals on Wheels in his new budget.  Perhaps Mick Mulvaney should ride along with him.

Trump Budget Shatters President's Promise on Social Security, Medicaid

The President’s promise not to touch Social Security was officially revealed to be a sham today.  Trump’s proposed 2018 budget slashes $64 billion from Social Security Disability Insurance (SSDI).  Some media outlets have let the President off the hook by saying the budget does not cut Social Security benefits.  This headline from Fox Business News is typical, even in the mainstream media:

Trump’s Budget Slashes Spending, Leaves Social Security & Medicare Untouched – Fox Business News, 5/22/17


A CNN Money correspondent just perpetuated the administration’s misleading spin, telling Wolf Blitzer this afternoon that Trump’s budget “doesn’t touch Social Security.”   

Other media outlets are hedging by saying the Trump budget doesn’t cut “core” Social Security benefits – whatever that means.  Social Security Disability Insurance is a crucial and inseparable part of Social Security. Period.  No amount of parsing can cleave the two.  When you cut a program, you hurt people – whether the cuts affect “core” benefits or not.

In this case, the millions of Americans with disabilities who rely on SSDI for basic income security are the ones who stand to be hurt.  Though SSDI helps younger Americans, too, most of its beneficiaries are 55 or over – meaning any cuts to the program will hit older Americans particularly hard.   The human consequences do not seem to disturb the President’s Budget Director Mick Mulvaney, as is obvious from this exchange with a reporter in the White House press room:


Reporter:  Will any of those individuals who receive SSDI receive less from this budget?

Mulvaney:  I hope so.

Mulvaney clarified that he thought the program has been enrolling too many people and called for cuts in the number of enrollees, even though that number has been shrinking.  Earlier this year, the Budget Director wondered aloud on television why SSDI is considered part of Social Security, despite the fact that it unequivocally is – and has been – since 1956.  SSDI is funded by workers’ Social Security payroll tax contributions – just like retirement benefits.   Qualifying disability beneficiaries must meet certain work history requirements, same as they do for retirement benefits.  When SSDI recipients reach retirement age, they transition seamlessly into the Social Security retirement program.  In no way is SSDI separable from Social Security.

The Center for Budget and Policy Priorities (CBPP) reports that the Trump budget contains $72 billion in cuts to federal disability programs — primarily Social Security Disability Insurance and Supplemental Security Income, which provides income assistance to poor seniors and people with disabilities.  The budget does not contain hard details of exactly how SSDI will be cut, but CBPP offers this insight:

$48 billion would come from a vague proposal to “test new approaches to increase labor force participation.”  But the Social Security Administration has undertaken many demonstration projects over the years to test new ways to encourage beneficiaries to return to work, and they have consistently shown limited results or proved not cost-effective. The budget also contains other proposals that would cut Social Security benefits for disabled workers and SSI benefits for households with more than one disabled family member.  – Center for Budget and Policy Priorities

Cutting benefits for Americans with disabilities fits right in with the cruel theme running through the President’s entire budget, which decimates programs for society’s most vulnerable citizens in order to give the rich and big corporations a massive tax cut.  In addition to SSDI, the Trump budget guts Medicaid, and cuts funding for other programs benefitting seniors including Meals on Wheels, home heating assistance, and community service employment.  

Candidate Donald Trump repeatedly vowed not to touch Social Security, Medicare, and Medicaid.  The drastic cuts to SSDI and Medicaid – along with the weakening of Medicare’s solvency in the Republicans’ healthcare legislation – makes the President zero for three on these promises.   Knowing that he cannot be trusted to protect seniors, advocates and everyday Americans must work to defeat the Trump budget in Congress – and make sure it never reaches his desk.

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