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Posts Tagged 'Medicare'

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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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Hollow Victory for Trump & GOP is a Loss for Seniors, Working Americans

National Committee President and CEO Max Richtman issued the following statement after passage of the Trump/GOP tax plan::::


“Congressional Republicans have just pulled off the biggest heist in American history – transferring trillions of dollars of wealth to the rich and profitable corporations at the expense of working and middle class Americans.  By ramming this ill-considered legislation through Congress in a reckless manner, GOP members of Congress put partisanship over people and donors over constituents.  Last-minute revisions designed to woo holdout Senators – including a change benefitting real estate moguls like President Trump – tilted the bill even further toward wealthy elites.  

It is wrong to ask the poor, the working class, and elderly to pay for tax breaks for the rich and powerful, which is exactly what the Trump/GOP tax bill will do.  The tax cuts will explode the federal debt by at least $1.5 trillion, laying the groundwork for an all-out effort to cut Social Security, Medicare, and Medicaid.  House Speaker Paul Ryan and Florida Senator Marco Rubio have already promised as much in recent public statements.  Blowing up the debt for tax cuts, then claiming that there’s no choice but to cut benefits for seniors is the height of hypocrisy. As proof of Republicans’ intent, the 2018 GOP budget resolution slashes nearly $500 billion from Medicare and more than $1 trillion from Medicaid. 

The bill’s repeal of the Obamacare individual mandate will result in 13 million Americans losing coverage, and an average $1,500 hike in health insurance premiums for older adults aged 50-64.  Adopting the miserly “Chained CPI” inflation index for calculating tax brackets and deductions could easily creep into the formula for determining Social Security cost-of-living adjustments (COLAs), which would cost retirees thousands of dollars in the long run.  Unfortunately, the pleas of advocates and everyday Americans demanding that Congress abandon this cynical legislation has fallen on deaf ears. But it’s a hollow victory for the GOP. While the perpetrators of the tax scam may be popping the champagne today, next November they surely will see that voters have declared the party’s over.” 

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National Committee President, House Dems Decry GOP Tax Plan’s "Dire" Impact on Seniors

As Republicans remain indifferent – or in denial – about the impact of the Trump/GOP tax scam on older Americans, seniors’ defenders are sounding the alarm.  National Committee president and CEO Max Richtman joined House Minority Leader Nancy Pelosi and other Democratic representatives in front of the U.S. Capitol today to warn of the dangers the tax plan poses to seniors’ retirement and health security. Richtman called the tax bill a “con game that should be called the ‘Washington two-step.’”

“Step one is cutting taxes for top-earning households and profitable corporations. Step two:  use the higher deficits the tax bill will create to cut critical programs, like Medicare, Medicaid and Social Security.” – Max Richtman, NCPSSM president and CEO, 12/6/17

Senator Marco Rubio (R-FL) let the cat out of the bag when he acknowledged that Republicans will come after seniors’ earned benefit programs as soon as the tax cut passes.  In fact, the tax bill will trigger an immediate $25 billion cut to Medicare unless Congress quickly waives the PAYGO provision of federal budget law. (Both Medicare and Medicaid – which helps seniors afford long-term care – are targeted for deep cuts in the GOP budget plan.) The tax scam also hurts older Americans by zeroing out the Obamacare coverage mandate penalty (which could result in higher premiums for 50-64 year-olds).  It also imposes the paltry “Chained CPI” as an inflation index for taxes, which could later bleed over into Social Security cost-of-living adjustments and shrink badly needed increases in retirees’ checks. 

Speaking on this chilly December afternoon in the nation’s capital, Leader Pelosi said, “It’s a cold day for seniors because of this GOP tax scam. It is an assault on the older Americans who built this country.  Seniors are among the biggest losers in this legislation.”

Congresswoman Jan Schakowsky (D-IL) called the tax bill “the first step in the Republican plan to undermine the financial and health security of older Americans.”

Rep. Doris Matsui (D-CA) observed that the threat to seniors from the GOP tax legislation “keeps getting worse and worse” and said the bill would have “cruel and dire” consequences.  She slammed the House bill’s repeal of the medical expense deduction, which millions of seniors use to mitigate high out-of-pocket medical and long-term care costs.

Republican members of a House-Senate conference committee are currently meeting behind closed doors to work out the differences between each chamber’s version of the tax bill.  Leadership hopes to pass a final bill and send it to President Trump for signature before Christmas – perhaps the worst holiday gift Congress could possibly give to the American people.  Seniors and their advocates are right to be concerned about this legislation, which is deeply unpopular with the public (only 29% of Americans support it in the most recent polling).  But after years of dreaming about slashing Social Security, Medicare, and Medicaid, Republicans are now in a position to carry out their craven plans - without apparent regard for public opinion, fairness, or decency. 

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After Passing Senate Tax Bill, GOP to Target Seniors' Earned Benefits

Maybe it’s no coincidence that the Senate passed its tax bill, vampire-like, in the dead of night.  How very apropos for legislation that could lead to the lifeblood being leached out of programs that the elderly and working class depend on.  Kudos to Senator Bob Corker for being the lone Republican to stand on principle and vote against the bill.  At the same time, Senator Collins, Murkowski, McCain, and other sensible GOP members have disappointed by betraying principles they proclaimed were important during the healthcare battle, but seem to have forgotten during the tax debate.  (Among other things, the bill zeroes out the tax penalty in the Obamacare insurance mandate, which could lead to 13 millions Americans losing coverage and higher premiums for older Americans.)  

In the wake of the bill’s passage early Saturday morning, National Committee President Max Richtman made the following statement:

“Senate Republicans have just given the wealthy and multi-national corporations an early Christmas present by passing the Trump/GOP tax plan, while leaving a lump of coal for seniors and almost everyone else.  The president and his party in Congress are asking the poor, middle class, and elderly to pick up the tab for trillions of dollars in tax breaks that the super-rich and profitable corporations do not need.” - Max Richtman, NCPSSM President, 12/2/17

Senator Susan Collins’ last-minute amendment to retain the current medical expense deduction threshold (up to 10% of adjusted gross income) made the Senate bill a little more tolerable, but not by much.  The House version outright repeals the medical expense deduction – which millions of seniors rely upon to mitigate high out of pocket medical and long-term care costs.  But the biggest poison pill for the elderly in this legislation is the existential threat it poses to Social Security, Medicare, and Medicaid.  

“If enacted, the tax bill will trigger an automatic $25 billion cut to Medicare.  It blows a $1 trillion hole in the deficit, inviting deep cuts to Social Security, Medicare, and Medicaid. It adopts the paltry “Chained CPI” inflation index for calculating deductions and tax brackets, setting a dangerous precedent that could spill over into cost-of-living adjustments for Social Security.” – Max Richtman, NCPSSM President, 12/2/17

The Senate bill is only slightly less objectionable than the House version, which passed in November.  The two must either be reconciled in a House-Senate conference – or the House may vote on the Senate version as-is.  Republican leadership has promised to have the legislation on President Trump’s desk before the holidays, making this one of the rottenest Christmas presents the Congress has ever given the American people. 

As if to confirm the warnings of seniors’ advocates, Republicans have signaled that their next targets after the tax bill are Social Security, Medicare, and Medicaid

“High-ranking Republicans are hinting that, after their tax overhaul, the party intends to look at cutting spending on welfare, Social Security, Medicare and other parts of the social safety net. House Speaker Paul Ryan, R-Wis., said recently that he wants Republicans to focus in 2018 on reducing spending on government programs.” – Washington Post

Senator Marco Rubio (R-FL) admitted as much in an interview with Politico last week, declaring that spending cuts in earned benefits programs will be necessary to pay for tax cuts for the wealthy and multinational corporations.

“We need to generate economic growth which generates revenue, while reducing spending. That will mean instituting structural changes to Social Security and Medicare for the future.” – Sen. Marco Rubio, 11/29/17

Of course, by “structural changes,” Rubio really means cutting earned benefits and turning Medicare into a voucher program.  He and other GOP leaders have been pushing this agenda for years; the difference is that now they have the power to enact it, common sense, decency, or the well-being of seniors be damned.

Senator Rubio’s pronouncements further expose the phoniness of candidate Trump’s promises “not to touch” Social Security and Medicare. By championing the Trump/GOP tax plan, the President has embraced the inevitable efforts to slash both programs to close the deficit. What’s more, the President’s own 2018 budget blueprint called for more than $60 billion in cuts to Social Security Disability Insurance (SSDI).  Notice that we don’t see President Trump contradicting Senator Rubio’s comments to Politico.  We can now safely say that seniors should take Republicans’ word for it:  After giving the wealthy and profitable corporations a multi-trillion-dollar holiday gift, Congress will take an axe to programs Americans have paid into for the entire working lives.

Click here for a detailed analysis of how the Senate GOP tax bill hurts seniors.

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Trump/GOP Tax Bill Would Trigger Devastating Cut to Medicare

In the latest in a series of “oops” moments for the GOP, Congressional leaders apparently didn’t realize that their deficit-swelling tax scheme would trigger $136 billion in automatic cuts to mandatory spending programs.  This includes a $25 billion reduction in Medicare spending, which would take effect almost immediately after passage of the tax bill.  Needless to say, that large a cut could be devastating to the 57 million seniors and disabled who rely on Medicare.  As a consequence of cutting taxes for the wealthy and big corporations, it would also be grossly unfair.

The automatic cuts would kick-in thanks to the little-known PAYGO law, which, according to the Congressional Budget Office, “requires that new legislation enacted during a term of Congress does not collectively increase estimated deficits.”  If such legislation produces a net increase in the deficit, the federal government is required to sequester enough funds to eliminate the overage; hence, the massive and instant cut to Medicare.

As we discussed on today's Behind the Headlines on Facebook Live, seniors’ advocates are understandably alarmed.  National Committee President Max Richtman issued the following wake-up call this morning:

“In their rush to enact a reckless tax bill, Congressional Republicans have overlooked a provision in federal budgetary law that would have immediate and devastating consequences for Medicare.  Left uncorrected, this would not only be a bald-faced admission that tax breaks for the wealthy and big corporations are more important than medical care for seniors, but also a betrayal of President Trump’s promise not to touch Medicare.” – Max Richtman, National Committee president, 11/15/17

Richtman sent a letter to the House of Representatives today urging members to oppose the GOP’s “Robin Hood in Reverse” tax plan in its entirety – or at least stop the imminent cut to Medicare while they have the chance.  The Congress can stop the sequestration – including the $25 billion hit to Medicare – when it enacts the tax plan.  House Democratic Whip Steny Hoyer (D-MD) says that GOP leadership should at least have the common sense to do that.

“While it is possible to avoid the PAYGO enforcement cuts triggered by their added deficits, Republicans would need Democratic votes to do it, requiring them to abandon their go-it-alone partisan strategy, which is only leading them on a path to failure and to putting our country in danger.” – House Minority Whip Steny Hoyer, 11/14/17

Of course, the entire tax scheme – which is being rushed through Congress without regular order – is harmful to seniors’ health and retirement security either way.  It eliminates the deduction for medical expenses like chronic and long-term care and balloons the deficit so that future Congresses will feel justified in raiding Social Security, Medicare and Medicaid to make up the difference. In fact, the tax plan presumes passage of the Scrooge-like Republican budget, which calls for $500 billion in Medicare cuts and slashes Medicaid by a whopping $1 trillion.  In effect, Republicans are asking seniors, the disabled, and the poor to pay for the lion’s share of a cut for the super-rich. Not to mention that some 36 million middle class Americans will actually see their taxes go up under the GOP plan.

None of these groups – the poor, the middle class, the disabled, or seniors – should be asked to shoulder this burden for a tax cut the wealthy and big corporations don’t need.  As Max Richtman writes in his letter to Congress:

Medicare beneficiaries cannot afford to pay more for less coverage – particularly when half of them have incomes of less than $26,200 a year and spend 25 percent of their Social Security check to pay for Medicare Parts B and D out-of-pocket costs for premiums and cost-sharing amounts.  

Regarding Medicaid, middle-class Americans often rely on the program for long-term services and supports when they exhaust their savings. Nearly two-thirds of all nursing home residents’ care is financed in whole or in part by Medicaid. In addition, Medicaid provides home and community-based services that allow seniors to stay in their homes. The fiscal crisis created by the tax bill is likely to result in a [trillion-dollar] cut to Medicaid that will limit seniors’ access to long-term care services. – Max Richtman’s Letter to Congress, 11/15/17

The public seems to grasp the gross unfairness of the Republican tax scheme.  A just-released Quinnipiac poll indicates that only 25% favor the GOP plan while 52% oppose it. Meanwhile, GOP leadership has made it clear that they are not beholden to ordinary Americans, but their wealthy and powerful donors:  a glaring case of backward priorities on Capitol Hill.

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Our Digital Media department created this clever graphic for our Facebook and Twitter feeds about the true nature of the GOP Tax Scam and the PAYGO cuts:


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