From the category archives: Disability
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.
“Does the name Ponzi all of a sudden come to mind?” – Donald Trump, 2000
As voters in 12 Super Tuesday states head to the polls today we thought it would be a good time to look at arguably the biggest policy flip seen by any Presidential candidate, let alone a front-runner, on the issue of Social Security. Simply put, the differences between Presidential candidate Donald Trump in 2000 and candidate Donald Trump in 2016 are h-u-u-u-g-e.
Here are just a couple of the Social Security proposals the Donald supported last time he ran for President:
Raise the Retirement age to 70
“A firm limit at age seventy makes sense for people now under forty,” Trump writes. “We’re living longer. We’re working longer. New medicines are extending healthy human life. Besides, how many times will you really want to take that trailer to the Grand Canyon?” Donald Trump, The America We Deserve.
As we’ve discussed here many times, the problem with the “everyone is living longer” argument for raising the retirement is that it’s simply not true.
“Men at the top of the economic ladder saw an eight-year increase in life expectancy, while men at the bottom saw virtually no change.”... National Academy of Science
Privatize Social Security
“Privatization would be good for all of us. Directing Social Security funds into personal accounts invested in real assets would swell national savings, pumping hundreds of billions of dollars into jobs and the economy. These investments would boost national investment, productivity, wages, and future economic growth.” Donald Trump, The America We Deserve.
The American people, of all political parties and ages, don’t want their guaranteed Social Security benefits put on the Wall Street roller coaster. They know that what’s good for Wall Street has proven disastrous for Main Street.
So, here were are with a second Presidential campaign and the promises are quite different. First we have this MSNBC appearance in February:
SCARBOROUGH: What about raising the retirement age? People are living older than they ever have --
TRUMP: Let me just say. Waste, fraud and abuse is massive in Social Security and Medicaid.
SCARBOROUGH: Why wouldn't you raise the retirement age if Americans are getting older and living longer and longer.
TRUMP: I'm not doing it. I don't want to do it. I don't want to do it. Two reasons. Number one I don't want to do it and number two, the Democrats aren't going to do it. You know the Republicans also have to get elected, you do know that. And if you watch Bernie, and if you watch Hillary, they don't only want to not cut, they want to increase Social Security.
SCARBOROUGH: All right.
TRUMP: Now. I'm not doing it for that reason. I'm just saying this. We don't have to do it. We're going to make our economy strong, we're going to make our economy rich, and we're not going to have to --
While no one has been able to pin Trump down to his actual plan for Social Security, his message in the South Carolina debate shifted to the perennial GOP promise to cut waste, fraud and abuse and grow the economy:
TRUMP: First of all, the -- when you say I'm the only candidate, if you listen to the Democrats, they want to do many things to Social Security and I want to do them on its own merit. You listen to them, what they want to do to Social Security, none of these folks are getting elected, OK, whether they can do it or not. I'm going to save Social Security. I'm going to bring jobs back from China. I'm going to bring jobs back from Mexico and from Japan, where they're all -- every country throughout the world -- now Vietnam, that's the new one.
TRUMP: You have tremendous waste, fraud and abuse. That we're taking care of. That we're taking care of. It's tremendous.
However, even those who’ve built careers urging Social Security cuts or privatization know this “waste, fraud and abuse” claim doesn’t hold water:
“Now, it is true, according to Social Security’s inspector general, that there are as many as 6.5 million Social Security numbers linked to people over the age of 112. Virtually none of those people are receiving benefits. Their accounts simply were never officially closed following their deaths.” ...Michael Tanner, CATO Institute
Here are the real numbers for the Trump’s mythically huge “waste, fraud and abuse” claims:
- Since 1989, SSA’s annual administrative costs have been about 1%
- Fraud in SSI is less than 1% with underpayments more likely than overpayments.
- There are Social Security numbers linked to people that should have been closed; however, it has not led to significant overpayments
A speech Trump gave to conservatives at the 2013 Conservative Political Action Conference provides one suggestion as to why the massive change of position:
"As Republicans, if you think you are going to change very substantially for the worse Medicare, Medicaid and Social Security in any substantial way, and at the same time you think you are going to win elections, it just really is not going to happen," Mr. Trump said, adding that polls show that tea partyers are among those who don't want their entitlements changed." Donald Trump, 2013 CPAC speech, Washington Times
As the polls close tonight on Super Tuesday, we’ll likely see the GOP field narrow. This certainly wouldn’t be the first time a candidate promised a politically popular proposal on the campaign trail and then acted very differently in office. However, America’s seniors and their families must expect more from these candidates than big promises, no details and being wrong on the facts.
In just over a week federal funding runs out for the nation’s highways, bridges and roads. The House has passed a temporary fix but the Senate, led by Mitch McConnell, wants to take an entirely different approach.
What does this have to do with Social Security or Medicare? The answer should be “nothing” but thanks to legislation now being debated in the Senate, the real answer is “everything.” Once again, GOP leaders want to use Social Security and/or Medicare benefits to pay for something entirely unrelated to the income and health security of millions of Americans.
NCPSSM President/CEO, Max Richtman, has written to the Senate urging Members to reject efforts to use Social Security benefits to pay for the Transportation bill:
“...there are at least two Social Security policy changes that are currently being considered as “offsets” for legislation that would extend highway transportation funding. One of these is a measure barring payment of Social Security benefits for seniors with outstanding warrants for their arrest. Almost none of the seniors who would be affected by this provision are actual fugitives from justice and most of the warrants in question are many years old and involve minor infractions. Moreover, the Social Security Administration attempted to administer a similar provision for a number of years, with catastrophic effect for many vulnerable elderly seniors, employing procedures that did not withstand judicial scrutiny. Reenacting this requirement should be something the Congress does only after careful analysis and with ample opportunity for public discussion.
The second provision relates to the concurrent receipt of both Social Security Disability Insurance (SSDI) benefits and unemployment compensation. Given the importance that all policy makers ascribe to encouraging disabled Americans to return to the workforce, I am perplexed by the desire on the part of some in the Congress to strip working SSDI beneficiaries of their eligibility to receive unemployment compensation when, through no fault of their own, they lose a job. Concurrent eligibility, which derives directly from a disabled person’s efforts to return to work, is a work incentive. That incentive should be altered only after the committees of jurisdiction have carefully considered all of the ramifications associated with such a change and, again, after ample opportunity for public comment.”
This is the third time in less than a year that Congress has attempted to use Social Security and/or Medicare as an ATM to pay for a completely unrelated priority. Last year Congress voted to extend the Medicare sequester cuts into 2024 to cover a reversal of cost-of-living cuts to veterans' pension benefits. This summer Medicare was cut again to help pay for the Trade bill. Now it appears, rather than consider tax reform for huge corporate tax dodgers sending billions of profits oversee to avoid paying taxes, GOP leaders in the Senate prefer cutting benefits to seniors, people with disabilities and their families who depend on Social Security.
The Senate is expected to vote on the highway funding bill and these proposed Social Security benefit cuts this week. While we all want good highways, Congress should not pay for them by cutting Social Security benefits for seniors, people with disabilities and their families. Social Security is our money – not the government’s. We’ve worked hard to earn our benefits.
Call our Legislative Hotline ASAP and we’ll connect you to your Senators. Tell them to oppose cutting Social Security to pay for the Transportation bill.
In keeping with every GOP budget passed over many years, benefit cuts for average Americans and tax cuts for the wealthy rule the day. The Senate this week will pass the Budget Conference Report (it only needs a majority, which the GOP now has) including massive benefit cuts for seniors in Medicare.
National Committee policy staff has laid out what this Budget bill means for seniors in our letter to the Senate:
The conference agreement would be devastating to today's seniors and future retirees, people with disabilities and children due to the proposed changes it makes to Medicare, Medicaid and the Affordable Care Act. While it proposes huge cuts to our social insurance safety net, the conference report would give massive tax cuts to the very wealthy.
The conference agreement assumes the privatization of Medicare and achieves savings by shifting costs to Medicare beneficiaries. Beginning in 2024, when people become eligible for Medicare they would not enroll in the current traditional Medicare program which provides guaranteed benefits. Rather they would receive a voucher, also referred to as a premium support payment, to be used to purchase private health insurance or traditional Medicare through a Medicare Exchange. The amount of the voucher would be determined each year when private health insurance plans and traditional Medicare participate in a competitive bidding process. Seniors choosing a plan costing more than the average amount determined through competitive bidding would be required to pay the difference between the voucher and the plan's premium. In some geographic areas, traditional Medicare could be more expensive. This would make it harder for seniors, particularly lower-income beneficiaries, to choose their own doctors if their only affordable options are private plans that have limited provider networks. Wealthier Medicare beneficiaries would be required to pay a greater share of their premiums than lower-income seniors.
The plan to end traditional Medicare requires private plans participating in the Medicare Exchange to offer insurance to all Medicare beneficiaries. However, it is likely that plans could tailor their benefits to attract the youngest and healthiest seniors and still be at least actuarially equivalent to the benefit package provided by fee-for-service Medicare. This would leave traditional Medicare with older and sicker beneficiaries. Their higher health costs would lead to higher premiums that people would be unable or unwilling to pay, resulting in a death spiral for traditional Medicare. This would adversely impact people age 55 and older, including people currently enrolled in traditional Medicare, despite the conference agreement’s assertion that nothing will change for them.
The conference report threatens to shift costs to Medicare beneficiaries. S. Con. Res. 11 contains $431 billion over ten years in unnamed Medicare cuts. Over half of Medicare beneficiaries had incomes below $23,500 per year in 2013, and they are already paying 23 percent of their average Social Security check for Parts B and D cost-sharing in addition to paying for health services not covered by Medicare. When coupled with requirements to shift costs to beneficiaries in the Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114-10), the unspecified Medicare benefit cuts included in the conference agreement would be burdensome to millions of seniors and people with disabilities.
In addition, the conference agreement calls for repealing provisions in the Affordable Care Act (ACA), which would make health insurance inaccessible for seniors age 64 and younger. Without the guarantees in the ACA, such as requiring insurance companies to cover people with pre-existing medical conditions and to limit age rating, younger seniors may not be able to purchase or afford private health insurance.
Repealing the ACA would also take away improvements already in place for Medicare beneficiaries – closing the Medicare Part D coverage gap, known as the "donut hole"; providing preventive screenings and services without out-of-pocket costs; and providing annual wellness exams. The Centers for Medicare and Medicaid Services recently reported that since the passage of the ACA, over 9.4 million Medicare beneficiaries in the Medicare Part D donut hole have saved $15 billion on their prescription drugs, an average of $1,595 per person. An estimated 39 million people with Medicare took advantage of at least one preventive service with no cost sharing in 2014.
The agreement includes reductions to Medicaid funding that would affect low-income seniors. Medicaid provides funding for health care to help the most vulnerable Americans, including low-income seniors, people with disabilities, children and some families. The conference report would end the current joint federal/state financing partnership and replace it with fixed dollar amount block grants, giving states less money than they would receive under current law. In exchange, states would have additional flexibility to design and manage their Medicaid programs. The proposed block grants would cut federal Medicaid spending by $500 billion over the next 10 years. Giving states greater flexibility in managing and designing their programs in no way compensates for the significant reductions that beneficiaries, including nursing home residents and their families, could face by turning Medicaid into block grants.
The conference report also would repeal the Medicaid expansion in the ACA. Beginning in 2014, states have had the option to receive federal funding to expand Medicaid coverage to uninsured adults with incomes up to 138 percent of the federal poverty level ($16,242 for an individual in 2015). Over half of the states have expanded their Medicaid programs, and some others will likely participate in the future. The conference agreement would hurt states and low-income individuals by repealing Medicaid expansion, taking away $900 billion from the program over 10 years. Altogether, S. Con. Res. 11 cuts the Medicaid program by more than $1.4 trillion over 10 years, compared to current law.
Moreover, the conference agreement puts 11 million severely disabled Social Security Disability Insurance (SSDI) beneficiaries at risk of a 20 percent benefit cut next year by reaffirming a House rule requiring legislation to address the financing of the SSDI program be accompanied by revenue increases or much more likely benefit cuts. That’s why the National Committee urges the Senate to reject the House’s SSDI recommendations in the conference report and instead make a modest reallocation of Social Security payroll taxes from the retirement trust fund to the Disability Insurance Trust Fund as has been done 11 times in the past on a bipartisan basis.
The National Committee urges you to oppose the Conference Report on the FY 2016 Budget Resolution, which would be harmful to seniors, people with disabilities and children."
One of Congress’ strongest champions for strengthening and boosting Social Security, Medicare and Medicaid is Rep. Gwen Moore from Wisconsin. Congresswoman Moore has also been an effective voice in Congress for measures that focus on improving the economic and employment conditions in low-income communities. We’re so glad she’s agreed to share her views with us on the current Congress, Black History month and recent attempts to target Americans with disabilities by the GOP leadership in the House.
Rep. Gwen Moore (D-WI)
Each February, we are reminded of our country’s greatest African American leaders with the celebration of Black History Month. Black History Month provides us an opportunity not only to reflect on those who advocate on behalf of the African American community, but also to examine the critical concerns and issues facing African Americans today. Even with all of the progress made over the past half-century, African Americans still represent a disproportionate share of our nation’s poor. As we work to change the underlying causes for this reality, we must also make sure we’re providing an adequate safety net to prevent further harm of those who are already struggling to get by.
There is no program more vital to protecting those who are battling poverty than Social Security. Not only is Social Security responsible for allowing millions of Americans to enjoy a comfortable retirement after a life of hard work, but also provides insurance for more than 90% of American workers in the event of a debilitating accident or illness through the Disability Insurance program.
On the first day of the 114th Congress, House Republicans pushed through a rule change regarding the Social Security trust funds that would prevent the routine transfer of funds between the retirement and disability accounts. Without the ability to transfer funds, the Disability Trust Fund will be forced to cut all benefits by 20% in 2016. That’s 20% from a paycheck that already is not enough to keep 1.6 million people out of poverty.
A harsh truth we must come to terms with is that one out of every three young workers new to the labor force will either die or need Disability Insurance before they turn 67. Those odds get even worse for African American workers, who make up a disproportionate percentage of Disability Insurance beneficiaries. An unexpected disability or illness can be devastating to an individual or family, but the Disability Insurance program supplies protection to soften the blow of an immediate loss of income. While the benefits are modest, averaging around $1100 a month, they still represent the main or only source of income for over 80% of beneficiaries. Nearly one in five beneficiaries live in poverty, which translates to roughly 1.6 million people, or approximately the population of greater metropolitan Milwaukee, my home city.
Obviously, this critical program needs more funding, but my congressional colleagues across the aisle continue to stand in the way. The rule change proposed by House Republicans was slipped under the wire as a procedural fix. But let’s call it what it is: a brazen attack on our nation’s most vulnerable. These are people who paid their dues to Social Security while they were in the labor force who are now in need of the services they paid into.
Now is not the time to weaken the Disability Insurance program, but rather we should be strengthening it. One of the major lingering effects of the recession is the sharp increase in long-term unemployment. While this number is now on the decline for the overall population, disabled workers continue to struggle to find gainful employment. Cutting what meager benefits they have now would be a death sentence.
This Black History Month, instead of only reflecting on the African Americans of the past, we should also make sure we are taking care of the African Americans of today and tomorrow. Cutting benefits to the Disability Insurance program would disproportionately affect African Americans. I believe in a vision of government where we take care of those who have fallen on hard times due to disability. Black History Month serves as a good means to highlight these issues, but I will keep fighting for this vision all year-round, day-in and day-out, until every American receives the assistance they need to live a prosperous life.
Have a Social Security or Medicare question?