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Two Paths Forward on Obamacare: One Reasonable, the Other Perilous

Newly back from summer recess, Senators are taking two divergent paths on healthcare after the Republicans’ spectacular failure to repeal and replace the Affordable Care Act (ACA).  For Americans who rely on the ACA for health insurance, one path is encouraging; the other, fraught with peril. 

On the encouraging side, the Republican and Democratic leaders of the House Education, Labor, and Pensions (HELP) committee are working on a bi-partisan plan to stabilize the ACA insurance markets, recognizing that the healthcare of millions of Americans hangs in the balance.  In fact, Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) are up against a hard deadline.  Insurers need to know the level of federal support for the ACA marketplaces before they set premiums for 2018 at the end of September.

The legislation they devise will likely beef up cost-sharing payments to insurers who waive certain out-of-pocket costs for lower income patients, as well as re-insurance payments to help insurers cover high-risk populations.  While President Trump and hardline conservatives in Congress have indicated they would be content to let the Affordable Care Act languish, Senator Alexander wisely recognizes that the public will hold Republicans accountable if Americans lose healthcare.  In other words, the GOP will own the ACA, whether they like it or not. 

Unlike the Senate and House leadership during the repeal and replace debacle, the HELP committee has been holding hearings (imagine that!) to get input from outside of Congress on possible fixes to the ACA.  Last week, a group of Republican and Democratic governors of widely different ideologies sang from the same hymnal:  the ACA marketplaces must be stabilized.

Senators Alexander and Murray must finish their hearings, mark-up the bill, pass it out of committee, and hope that it reaches the Senate floor.  If Senate leadership feels the bill has bipartisan support, it may come to a vote.  Whether all of that can happen by the end of September is anyone’s guess.

On the discouraging side, Senators Bill Cassidy (R-LA) and Lindsey Graham (R-SC) just won’t let go of the repeal and replace agenda.  Undaunted by the GOP’s failure to get rid of the Affordable Care Act, Senators Cassidy and Graham are working on legislation to try, try again.  The Cassidy-Graham amendment is just as bad as - if not worse than - the failed Senate repeal bill last summer, and retains many of the most objectionable parts of the House-passed legislation.  Among other things, Cassidy-Graham:

*Ends the ACA’s Medicaid expansion  

*Cuts hundreds of billions of dollars in Medicaid spending

*Imposes per capita caps on Medicaid payments to the states

*Ends ACA subsidies and replaces them with inadequate block grants

*Leaves older and poorer Americans with no guarantee of affordable or adequate coverage

Were Senators Cassidy and Graham not paying attention when Americans at town halls across the nation expressed outrage at the GOP repeal and replace plans, including drastic cuts to Medicaid and more than 20 million people losing health coverage?  Did they not take seriously the Congressional Budget Office reporting on the negative impacts of repeal and replace on everyday Americans?  Apparently not. 

Fortunately for seniors – and all Americans who need healthcare – Senators Cassidy and Graham are running out of time.  Under Senate rules, their amendment cannot pass with a simple majority vote after the fiscal year ends on September 30th.  If they wanted to keep pushing for passage after that, they’d need 60 votes under regular order – a threshold they are not likely to meet.

Of course, it is premature for supporters of the ACA to declare victory.  We have seen seemingly dead repeal and replace bills suddenly spring back to life.  The legislative rollercoaster of last Spring and Summer are fresh in our memories.  Advocates and everyday Americans must keep the pressure on their elected representatives to work in a bipartisan fashion (like Sens. Alexander and Murray) to strengthen the Affordable Care Act– and reject repeal and replace once and for all.

Coming soon to a pharmacy or grocery store near you: Hi-Quality Over the Counter Hearing Aids

Seniors suffering from hearing loss have good reason to cheer. They should soon be able to purchase quality hearing aids over the counter. The Over the Counter (OTC) Hearing Aid Act of 2017 is poised to become law.  Passed by Congress this summer, the Act authorizes the FDA to create a new category of regulated, over the counter hearing aids.  With 30 million Americans (and 4 in 5 seniors) experiencing hearing loss, this is sweet relief for seniors’ pocketbooks and overall health.

Prescription hearing aids can cost as much as $2,500 each (or $5,000 a pair).  The hefty price tag can be a severe strain for seniors living on fixed incomes, especially since Medicare does not cover hearing aids. That’s why some 70% of Americans between age 65 and 84 with hearing loss are not using hearing aids.  They simply cannot afford to. 

The anticipated new generation of OTC hearing aids – meant for people with “mild to moderate” hearing loss – will retail for a fraction of the prescription price:

“By opening the market to OTC aids, manufacturers of consumer electronics --- from giants such as Apple and Samsung to small startups --- could enter the hearing aid space and sell directly to consumers… [at a retail price] between $150 and 299.” - The Hill Newspaper

Imagine being able to buy high-quality hearing aids at your local pharmacy or grocery store for as little as $150, bypassing the time-consuming and expensive process of acquiring them from an audiologist.  Of course, those with more serious hearing impairment will and should continue to seek prescription hearing aids through a specialist.

As we discussed yesterday on Facebook Live, this is not just a matter of personal cost.  It’s a public health issue. Hearing loss is a gateway to other potential medical problems – including fatigue, stress, depression and memory loss.  Access to affordable, high-quality OTC hearing aids means that millions of seniors will likely be able to hear better and stay healthier.

National Committee President Max Richtman hailed the new law as a victory for seniors and all Americans with hearing impairment:

“As someone who suffers from hearing loss, I understand what this new law means for seniors’ health – and their pocketbooks.  While we hope that Medicare will eventually cover hearing aids, the OTC Hearing Aid Act is a common sense, compassionate measure that will improve seniors’ access to quality devices.” – Max Richtman, President of the National Committee to Preserve Social Security and Medicare

The new law is the product of the kind of bipartisanship that most Americans yearn for.  It was cosponsored by Senators Elizabeth Warren (D-MA) and Charles Grassley (R-IA). The House bill was cosponsored by Democratic representative Joe Kennedy III and Republican Congresswoman Marsha Blackburn. The Over the Counter Hearing Aid Act of 2017 proves that, under the right circumstances, sensible members of both parties can come together to improve the lives of ordinary Americans.

FDR's Grandson on Social Security... Which Turns 82 Today

President Franklin D. Roosevelt signed Social Security into law on this day in 1935 to provide seniors with basic income security after retirement, mitigating against the “vicissitudes and hazards of life.” Eighty-two years later, the program he created has kept several generations of seniors – and their families – out of poverty.  In turn, the nation is very fortunate to have had several generations of Roosevelts dedicated to preserving Social Security. 

Franklin Roosevelt’s son, Congressman James Roosevelt, Sr., founded the National Committee to Preserve Social Security and Medicare in 1982 to protect the financial security, health, and well-being of current and future generations of Americans.  FDR’s grandson, James (“Jim”) Roosevelt, Jr., carries on his family’s legacy as a leading healthcare advocate and vice-chair of the National Committee’s Advisory Board. 

Last March, Jim Roosevelt sat down with National Committee President Max Richtman for a wide-ranging Facebook Live interview.  We have included some highlights of that interview below as we look at the legacy of Social Security on its 82nd anniversary.

Jim’s grandfather, President Franklin Roosevelt, became inspired to create a national retirement insurance program after seeing older Americans relegated to the poor houses because they had no means of supporting themselves. “It tears my heart to see those old men and women there,” said then-Governor Roosevelt after visiting the poor houses of New York state.  As Jim Roosevelt explained, FDR felt that seniors deserved an assurance of fundamental financial security.

He believed (and we still believe) that Social Security is basic to the lives of the American people. And he was very clear that it was a family program.  It was created not only so that people, when they reach retirement age, have enough money for the basics of a decent life. It’s also so that their children don’t have to spend down their money to take care of them. – Jim Roosevelt

Working with Secretary of Labor Frances Perkins, FDR pushed the Social Security Act of 1935 through Congress at the height of the Great Depression.  To some, it was counterintuitive that  President Roosevelt put such a high priority on retirement insurance at a time when so many millions of Americans couldn’t find work.  But Jim Roosevelt told us that FDR viewed retirement security and employment as inextricably linked.

People said to my grandfather, “Why are you worrying about people’s retirement when people need jobs?”  And he said these are tied together. If people have jobs, they can pay into Social Security knowing that they’ll have benefits later on.  Life is then worth living, work is worth doing.  And I think that’s what has remained the vision for me, for my father, and for the National Committee over these past 30 years. – Jim Roosevelt

It was very important to President Roosevelt that Social Security be funded directly through workers’ payroll contributions.  FDR said that payroll contributions would give retirees “the legal, moral, and political right” to collect their Social Security benefits. He knew that a perpetually self-funded program would guarantee Social Security’s endurance for generations to come, and protect the program from the whims of politicians who might seek to undermine it

The reason that Social Security is structured the way it is is so that nobody, just for political reasons, can cut Social Security out of the budget or out of the law.  Because Social Security has its own dedicated income stream from the payroll tax, we don’t just trade if off against education or defense or other important things.  My grandfather famously said, “With those taxes in there, no damn politician can ever scrap my Social Security program.”  That’s as true today as it was in 1935. – Jim Roosevelt

President Roosevelt’s vision has most certainly endured. Today, Social Security provides some 61 million Americans and their families with basic financial security upon retirement or disability.  For older Americans, Social Security can mean the difference between financial well-being and poverty.  Two out of three seniors rely on Social Security for most of their income, and one-third of seniors depend on it for at least 90% of their income. Public polling consistently shows that Social Security enjoys overwhelming support from majorities of Americans across party lines.

Over the years, Social Security has been modified (with bipartisan support) to expand benefits and keep the system financially sound. This year, Social Security has come under new threat from budget hawks in the Trump administration and on Capitol Hill.  But as generations of Roosevelts have shown us, Social Security is worth fighting for.  On this, Social Security’s 82nd anniversary, we at the National Committee recommit ourselves to preserving this landmark program for current and future generations of Americans.

Watch our full interview with Jim Roosevelt on Facebook Live

Summertime No Time to Stop Protecting Seniors' Healthcare

Washington, D.C. is noticeably mellower with Congress beginning its August recess.  Our “worst-in-the-U.S.” traffic is noticeably lighter.  The sidewalks are emptier.  The news from Capitol Hill has slowed to a trickle.  But the summer doldrums are no time for advocates here in D.C. or the 50 states to let our guard down.  (We just discussed this on "Behind the Headlines" from Capitol Hill on Facebook Live.) 

Last week, we narrowly escaped the passage of healthcare legislation that would have been devastating for poorer, older, and sicker Americans. The heroism of three GOP Senators and a united Democratic party pulled us back from the brink by voting against the latest Obamacare repeal bill.  

Make no mistake, intense grassroots activism in Congressional districts across the country played no small part in the defeat of repeal legislation in both houses of Congress.  From New Hampshire to Nevada, everyday Americans challenged their elected representatives to protect their healthcare – and won in a heart-pounding showdown.  

In the end, only Senators Collins, Murkowski, and McCain had the courage to defy party leadership and do the right thing.  That’s a thin reed on which to hang future hopes.  If a single one of those votes had gone the other way, at least 22 million Americans would have been well on their way to losing healthcare coverage – and the Medicaid program would have been decimated.  In fact, it’s disappointing that some of the Republican moderates who seemed to oppose the various repeal bills voted yes in the end.  Perhaps it’s because Senator McCain’s no vote gave them cover.  But where is the courage in that?

While Senate Majority Leader Mitch McConnell says it’s time to “move on,” Speaker Paul Ryan signaled that the House isn’t done trying to repeal the Affordable Care Act.   Meanwhile, President Trump continues to threaten to cut off crucial cost-sharing payments, spooking insurers and threatening to drive up premiums.  As Phil Moeller pointed out in his column for PBS NewsHour, there’s a real danger that the majority party will re-attack Obamacare after August recess ends.  

With Capitol Hill’s largely silent and long-postponed summer vacations underway, there is little appetite for re-engaging in nasty policy fights. But when the leaders and their troops are rested, there is little doubt that [they] will be back at it again. – Phil Moeller, PBS NewsHour

This means that we in the advocacy community cannot simply relax this month – tempting as that may be.  Advocates and everyday activists must continue to deliver the message to our elected representatives that it’s time to stop trying to destroy the Affordable Care Act and work across the aisle to improve it, as National Committee President Max Richtman argued in The Hill newspaper this week.  We must maintain the drumbeat whenever and wherever we encounter members of Congress this summer:  at their district offices, by phone, by email, or around town.

Make no mistake:  the activism we saw last winter and spring made a difference.  Members of Congress heard their constituents loud and clear at contentious town halls.  Phone lines, fax lines, and email accounts were jammed. Congress heard us when we said “Hands Off Our Healthcare!”

But even after all that full-throated activism, several GOP moderates in the House and Senate still caved when it was time to cast crucial votes. We came dangerously close to losing the Affordable Care Act. If anything, we must step up our activism.  We must make the case for protecting the healthcare of seniors – and all Americans – even more vociferously, letting our leaders know in personal terms the true impact of changes to our healthcare coverage. But we must also demand that our elected representatives talk to us. Hold town halls, don’t cancel them.  Keep phone lines open instead of shutting them down.  Hear us instead of hiding. And if there are future votes to undermine our healthcare, we must insist that more GOP moderates stick to their stated principles instead of running with the herd.


Medicare Turns 52: A Time for Cake, Candles, and Continued Vigilance

Medicare turns 52 years old this weekend.  It’s an occasion for both celebration and vigilance.  Surely the anniversary of a federal program that has provided quality healthcare for millions of seniors since 1965 is a happy moment.  But the fact that this highly successful, highly efficient program is under threat from the right after more than half a century of proven results tempers the celebration – and reminds us all that programs we all rely upon can be snatched away if we don’t protect them.

President Harry Truman first proposed a national healthcare system, but it took a Democratic supermajority in Congress and the relentless advocacy of President Lyndon Johnson to make Medicare a reality in 1965. (Fittingly, Harry Truman received the first-ever Medicare card.)  

If it were up to some Republicans, there would be no Medicare in the first place. In 1964. then-Senate candidate George H.W. Bush described Medicare as “socialized medicine.”  Republican Presidential Candidate Barry Goldwater likened Medicare to giving seniors “vacation resorts” for free.  Former Senator Bob Dole bragged that he was there in 1965 “fighting the fight, voting against Medicare.”  And then there was this whopper from future President Ronald Reagan in 1961: 

“If you don’t [stop Medicare], one of these days you and I are going to spend our sunset years telling our children and our children’s children what it once was like in America when men were free.” – Ronald Reagan (1961)  

Fast forward to the 1990’s, when House Speaker Newt Gingrich endorsed privatization, with the intended result that traditional Medicare would “wither on the vine.” Destroying traditional Medicare has been a long-held dream of the right for five decades now.  Unfortunately, with Republicans controlling all three branches of government, this is their best opportunity to make that nightmare a reality. 

As we commemorate Medicare’s anniversary, budget hawks in Congress are actively scheming to privatize the program through the budget process.  The House Budget Committee’s spending plan turns Medicare into a voucher system and cuts some $500 billion from the program. The budget resolution also raises the Medicare eligibility age from 65 to 67, a huge benefit cut itself. It’s another step toward a long-held goal of the right to destroy Medicare as an earned benefit. And it truly is an earned benefit. Americans pay into Medicare during their working lives, knowing they can depend on it for healthcare in their senior years. 

Medicare covers some 58 million American seniors and people with disabilities.  Almost every American will need Medicare in their older years. Many literally could not live without it, which is why efforts to turn it into a voucher system and raise the eligibility age are particularly cruel. Listening to the stories of members of our online community, we are reminded that Medicare has a very human face. 

Pam Ruigh (Newport, VT):  I love Medicare. It has made it possible for me to see again. I had cataracts on both eyes removed, Without these surgeries, I was slowly going blind. - Pam Ruigh, Newport, VT
In 2014, I had aortic valve replacement surgery. That's a $170,000 operation. All I had was Medicare. I could never have had the procedure without it. - Ron Moore, Utica, NY
Without Medicare and my supplemental insurance, I'd be dead or dying right now. I have multiple but manageable health issues. If this is taken away, I'm a dead woman walking. - Kate Reed
My late wife passed away from complications of Parkinson's Disease. After her last hospital stay, I received a copy of her bill, showing what we would have been responsible for had we not been under Medicare. It amounted to over $200,000.00. I only had to pay $700.00 out of pocket. - George Betram Lane (Jacksonville, FL) 

There are millions of stories just like these, and we know that Medicare beneficiaries around the country share our enthusiasm that Medicare has reached another anniversary. 

Yesterday, our president, Max Richtman, and a group of senior volunteers from our Capital Action Team participated in an anniversary celebration on Capitol Hill yesterday with several sister organizations and members of Congress.  

There was “Medicare birthday” cake for all, and impassioned remarks from the podium.  The main message was:  we need to protect and expand – not slash and burn – Medicare. 

Representative Lois Frankl (D-FL) reminded the crowd of seniors and advocates that we will fight to keep traditional Medicare intact and thriving. “This is Medicare’s 52nd anniversary,” she began. “And next year, there will be another.  And another.  And another.  I promise you that.”




   

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