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Trump 2019 Budget Shortchanges Seniors, Poor, Disabled

President Trump released an FY 2019 budget today proposing deep spending reductions for Medicare, Medicaid, Social Security Disability Insurance (SSDI), and myriad other federal programs that help older Americans, the poor, and people with disabilities.

“This budget once again lays bare the Trump administration’s terribly misguided priorities.  In the wake of massive tax cuts for the wealthy and profitable corporations, President Trump proposes to slash programs that help retirees and working Americans attain proper medical care and make ends meet.  Not only is this budget callous toward society’s most vulnerable, it breaks explicit promises that candidate Trump made to the American people ‘not to touch’ Medicare and Medicaid.” -  Max Richtman, president and CEO of the National Committee to Preserve Social Security and Medicare. 

Here are some of the highlights (or lowlights) of the President’s proposed FY 2019 budget that impact society’s most vulnerable:

*Some $500 billion in Medicare spending reductions over ten years, most of which would affect providers and suppliers, but could potentially impact beneficiaries, too.

*$1.4 trillion in cuts to Medicaid (which covers long-term care for millions of seniors).   

*Some $700 billion in spending reductions from “repealing and replacing Obamacare.”

*$64 million in cuts to Social Security Disability Insurance (SSDI).

*Reduces the Social Security Administration’s request for administrative funding by $90 million from FY 2017 levels, which would further exacerbate SSA's customer service issues.

*Defunds the Low Income Home Energy Assistance Program (LIHEAP), which helps low income seniors pay their heating bills.

In stark contrast to the Trump budget, Congress last week struck a bipartisan deal to lift spending caps on non-defense discretionary spending, making billions of dollars available to many of the domestic programs that the White House proposes to cut. 

“We strongly favor the bipartisan budget agreement in Congress, which recognizes the real and growing needs of working class Americans. To the extent that the president’s budget is mostly a ‘messaging document,’ we roundly reject the administration’s message that federal taxation and spending policy should favor the wealthy and powerful --- at the expense of the elderly, poor, and the disabled.” - Max Richtman
Click here for a more detailed analysis of the President's 2019 budget.

Bipartisan Budget Bill a Pretty Good Deal for Seniors

The bipartisan budget bill passed by Congress early this morning is, on balance, good news for seniors and the federal programs that provide them with financial and health security. 

“Seniors will feel these changes in their pocketbooks and even in the way they feel physically. We have been fighting for these measures for quite some time and are happy to see Congress take action on a bipartisan basis.” - Max Richtman, National Committee president 

On the positive side, the budget bill:

*Closes Medicare Part D “donut hole” in 2019.  The prescription drug coverage gap embedded in the original law, which the Affordable Care Act has been gradually closing, will be altogether eliminated one year early. This will save seniors thousands of dollars in out-of-pocket prescription drug costs.

*Repeals Medicare therapy caps.  The bill scraps arbitrary caps on physical, speech, language and occupational therapies that have cost seniors money – or delayed care at crucial times.  Beneficiaries will now find it easier – and more affordable – to get the therapies they need without undue interruption. 

*Lifts non-defense domestic spending caps, allowing Congress to appropriate more adequate funding for the Social Security Administration’s operating budget. The SSA has suffered from draconian budget cuts since 2011 which have impinged on customer service, even as 10,000 Baby Boomers retire every day.  This badly-needed (but yet unspecified) higher level of funding should allow SSA to improve customer service for the program’s 67 million beneficiaries.

On the negative side, the bill increases Medicare premiums for some individuals by further expanding Medicare means-testing. 

“Congress continues to expand Medicare means-testing, and they will not stop until middle-class seniors are burdened with higher Medicare premiums.” - Max Richtman.

Here is a more detailed summary of the budget bill’s implications for seniors. 

For more on this story, view our Behind the Headlines broadcast live from Capitol Hill here


President Trump and the State of Prescription Drug Prices: More Talk, No Action?

Some of President Trump’s pronouncements in last night’s State of the Union address were outright falsehoods.  Others were simply misleading.  Some, like his pledge to lower prescription drug prices, were likely hollow promises.  Here is what he told assembled lawmakers and television viewers around the country: 

One of my greatest priorities is to reduce the price of prescription drugs. In many other countries, these drugs cost far less than what we pay in the United States. That is why I have directed my Administration to make fixing the injustice of high drug prices one of our top priorities. Prices will come down.” – President Trump, 1/30/18

Like many of the President’s promises – to rebuild the nation’s infrastructure, to bring back manufacturing jobs, and to protect Social Security and Medicare – this one seems dubious.  His administration has been in place for an entire year and so far… hasn’t taken any serious action to bring down the cost of prescription drugs.  The United States still pays more for prescription drugs than most other nations. 

In fact, as Stat News points out, the President made an identical pledge a year ago:

“[Trump] met with pharmaceutical industry executives and said that ‘we have to get prices down for a lot of reasons.’ Just a few weeks before, he said that the industry is ‘getting away with murder.’” – STAT News, 1/29/18  

Trump’s previous Secretary of Health and Human Services, Tom Price, seemed more concerned with undermining Obamacare than lowering drug prices --- until he left office under a cloud of scandal.

Alex Azar, who was just sworn-in this week as Trump’s new Health and Human Services (HHS) Secretary, is a former executive at Eli Lilly, Inc.  As a Big Pharma exec, Azar presided over prescription drug cost increases --- and the company was scrutinized for allegedly fixing the price of insulin on his watch.  He seems hardly the ideal candidate to lead a crusade against overcharging.  Yet, Azar promised after his swearing-in to bring down prescription drug prices, echoing the President’s so-far empty pledges.

Seniors (especially those on fixed incomes) have a special stake in the Trump administration making good on its word. Soaring drug prices drive medical costs (and Medicare costs) ever upward.   However, Medicare is expressly forbidden from directly negotiating lower prescription drug prices with pharmaceutical manufacturers.  We have long argued that Medicare should have that prerogative.  It could save the government – and patients – billions.

Allowing the importation of prescription drugs from Canada would also ease the financial pain we all feel when we reach the pharmacy counter. If the President were serious about reducing drug prices, he could get behind Senator Bernie Sanders’ Affordable and Safe Prescription Drug Act.  The legislation would allow pharmacists and individuals to import drugs from Canada while empowering the FDA to ensure the safety of those imports.

There are several bi-partisan proposals in Congress to facilitate the approval and production of generic alternatives for pricey prescription drugs.  Where is the Trump administration in all this? On the sidelines, mostly.  Bottom line: There are many steps the administration could take to make prescription drugs cheaper.  The question is whether the President and HHS will truly take action --- or simply say the right thing, and then do nothing. 

SSA Funding Cuts Will Hurt the Disabled, Retirees, and Children

National Committee President Max Richtman joined advocates and elected representatives on Capitol Hill today to demand that Congress adequately fund the Social Security Administration (SSA).   Richtman, Senators Bernie Sanders (I-VT), Elizabeth Warren (D-MA), and Bob Casey (D-PA) railed against Republican plans to cut nearly $500 million from the Social Security Administration's operating budget in the upcoming government funding bill.

The agency has been woefully underfunded since 2011 and Social Security claimants have been paying the price in the form of reduced service and long wait times.  Social Security's core operating budget shrank by 11 percent from 2010 to 2017 in inflation-adjusted terms. This occurred even as 10,000 baby boomers a day reach retirement age.  Congress has the ability to solve this problem, but has not signaled a willingness to do so.  

The House-approved FY 2018 appropriations legislation would continue underfunding the agency, freezing SSA's operating funds for another year.  The Senate Appropriations Committee has proposed an even more painful reduction of $460 million, nearly 4 percent of the operating budget. 

At today’s event on Capitol Hill, Max Richtman highlighted the costs of SSA budget cuts to applicants and claimants:

“The result of this neglect is obvious.  When workloads increase, and funding is cut, service suffers – big time. The money to adequately fund the administration of Social Security is there. But the collective conscience of Congressional leaders is absent. Time and again, they have knowingly cut the number of lifelines available to workers, retirees, the disabled and their families.” – Max Richtman, president of the National Committee to Preserve Social Security and Medicare, 1/18/18

In fact, some 10,000 disabled Americans died last year waiting for a Social Security disability hearing. That shameful figure alone should be a compelling enough argument for restoring SSA’s funding to adequate levels. Budget cuts have forced SSA to close more than 60 field offices across the country, reducing in-person access to services. The average wait time on SSA’s toll-free number is 18 minutes.  The average national wait time for a disability hearing exceeded 600 days in 2017.  Ironically, these service cuts come at a time when 10,000 Baby Boomers become eligible for Social Security every day.

 “The enemies of Social Security in Congress are making a very bad situation even worse (by proposing cuts to SSA’s operating budget.)  They want to make it impossible to effectively administer the program, and ultimately want to destroy Social Security.” – Senator Bernie Sanders, 1/18/18

“America made a promise to Social Security beneficiaries.  America must honor its promise and that means no cuts to the Social Security Administration.  We must make sure that seniors, the disabled, and survivors of beneficiaries receive the benefits they are entitled to.” – Senator Elizabeth Warren (D-MA), 1/18/18

Senator Bob Casey (D-PA) decried the majority party’s “maniacal obsession” with cutting costs “in the most pernicious way,” making it harder for the Social Security Administration to carry out its mission.

SSA is funded through workers’ Social Security payroll contributions and not from general revenue.  The agency is one of the most efficient in the entire federal government, spending less than 1% of its revenue on administrative costs.  Congress is wrong to leave the agency so grossly underfunded, but some lawmakers may have a hidden agenda in letting SSA languish. 

 “Starving the Social Security Administration’s administrative funding is not only pennywise and pound foolish, it also amounts to a backdoor way to dismantle Social Security by eroding the public’s confidence in the program.”  - Max Richtman, 1/18/18

It is not outrageous to suggest that the budget-induced aggravation and delay confronting claimants would, indeed, undercut public support for Social Security, smoothing the way for actual benefit cuts later. 

The retired, disabled and survivor constituents of members of Congress deserve better. That’s why the National Committee urges Congress to reject the Senate Appropriations Committee's $460 million cut and instead increase Social Security’s operating budget so it can do its job for the American people:  a job they deserve, and as it happens, a job for which they have pre-paid.

Medicare Therapy Caps: It's Time for a Permanent Repeal

Many of us have loved ones who’ve heard those dreaded words “Medicare won’t approve any more physical therapy (or occupational therapy or speech therapy) for you this year” – or have been told the same thing ourselves.  Whether recovering from a stroke, heart attack, serious fall or myriad other conditions, few things are more frustrating for convalescing seniors than being informed they have hit a coverage limit in the midst of medically necessary therapy.

Congress imposed caps on outpatient therapies for Medicare Part B beneficiaries in 1997 as part of the Balanced Budget Act.  Since then, the National Committee and other Medicare advocates have been shouting from the rooftops that therapy caps are bad policy.

Realizing the hardship these caps would cause patients, subsequent Congresses enacted - and continually renewed – an exceptions process for exceeding the caps.  Under this process, beneficiaries could get coverage for therapy beyond the caps until they hit a higher threshold (currently $3700 per year), after which Medicare would manually review every claim before deciding whether to pay.  

However, the current Congress failed to extend the exceptions process, meaning that as of January 1st, all Medicare beneficiaries are subject to a hard, annual cap of $1,980 on physical therapy – and the same for occupational therapy.

In a letter to Congress, the Legislative Council of Aging Organizations (of which the National Committee is a member) says the therapy caps are random – and harmful.

“These arbitrary caps are aimed at federal cost-savings rather than providing clinically appropriate service and disproportionately impact the most vulnerable Medicare beneficiaries who require ongoing therapy services.” – LCAO letter to Congress

Christina Metzler, Chief Public Affairs Officer at the American Occupational Therapy Association (AOTA), says Congress has left the Medicare community in the lurch by failing to at least renew the exceptions process:

“Consumers and practitioners are in a very difficult spot right now.  While few people will hit the cap right away, if you have a severe injury or are just getting out of the hospital, your outpatient visits are going to start piling up.” – Christina Metzler, AOTA, 1/5/18

The Centers for Medicare and Medicaid Services (CMS) has issued zero guidance for providers or patients on how to handle the situation, opening the door for potential confusion and denial of proper care.

Ironically, there already is a bipartisan solution to this problem.  Last fall, Republicans and Democrats on key Senate and House committees agreed on a policy to make the exceptions process permanent – and less onerous for patients and providers.

As Metzler describes it, the bipartisan policy would result in:

*Elimination of therapy caps

*A nimbler process for obtaining coverage beyond cost thresholds

*Greater clarity for beneficiaries and providers

“The benefit of this approach is that there are no caps.  Instead, we’d have a new and different methodology for documenting and reviewing therapy claims. Patients would be assured of a permanent policy, and we wouldn’t be in a situation of confusion where beneficiaries and providers are in the dark.”  - Christina Metzler, AOTA, 1/5/18

The National Committee, AOTA, and other advocacy groups are calling on Congress to attach the bipartisan measure to pending legislation without delay.  Some Hill-watchers believe that reauthorization of the Children’s Health Insurance Program (CHIP) funding is the most likely vehicle.  (Congress would have to act on CHIP by January 19th before some states run out of money for children’s health insurance.)

“Anything less than a permanent fix that finally allows patients to receive medically necessary therapies without interruption or financial worry would be a disservice to everyone who relies on Medicare.” - National Committee president and CEO Max Richtman, 1/8/18



   

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