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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.

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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.

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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.


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House GOP Votes to Gut Medicaid, Weaken Medicare & Put Seniors' healthcare at Risk

The National Committee strongly condemns the American Health Care Act (AHCA) just passed by the House, which needlessly puts the healthcare of millions of older Americans in jeopardy. “Despite the bill’s name, risking the health of our nation’s most vulnerable citizens to give the wealthy an $880 billion tax cut is tremendously uncaring --- and does not reflect real American values,” says Max Richtman, President and CEO of the National Committee to Preserve Social Security and Medicare. “In modifying the original AHCA bill to give reluctant Republicans political cover, the House leadership made a bad piece of legislation even worse.”

“Recent amendments to this cruel, ill-advised bill could put coverage for older Americans with pre-existing conditions like cancer and diabetes out of reach. The $8 billion (over 5 years) added to the legislation at the last minute to defray the cost of higher premiums is woefully inadequate.  It’s a thin veil that covers a head of snakes.”

Paul Waldman of the Washington Post wrote a scathing, but accurate article about the human costs of the GOP healthcare bill - especially to patients with pre-existing conditions: 

"Make no mistake, if you’re one of them and this bill passes, your life will become hugely  more complicated, potentially more costly and possibly in danger if you’re unlucky." - Paul Waldman, Washington Post 5/3/17

The bill contains several other poison pills for older Americans. It replaces Obamacare subsidies with meager tax credits which discriminate against older Americans.  A $4,000 annual tax credit doesn’t come to close to covering premiums for seniors ages 60-64, meaning millions of older Americans will lose coverage altogether.

The bill cuts nearly $1 trillion from Medicaid by converting it into a block grant program or imposing per capita caps, which will make it harder for impoverished seniors to access long term skilled nursing care and community or home care.  Overall, the Congressional Budget Office estimates that 14 million people will be kicked off the Medicaid rolls in the next 10 years if this bill becomes law.

The AHCA reduces Medicare’s solvency by repealing Obamacare’s 0.9% payroll tax on wages above $200,000. This could lead to cuts in Medicare, including privatizing the program --- harming current and future beneficiaries.  

Under the GOP bill, insurers can charge older enrollees five times more than younger ones.  The Congressional Budget Office predicts that by 2026 this provision will substantially raise premiums for older people by as much as 25%.

“We can only hope that the Senate majority will kill this reckless legislation before it punishes seniors - and millions of other Americans – for the crime of needing and wanting affordable health care,” Richtman says. 

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If you missed our "Behind the Headlines" analysis of the GOP healthcare bill on Facebook Live, you can watch it here

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New Bill in U.S. House Boosts Social Security Benefits, Keeps System Solvent for Decades

 

Legislation just introduced in the U.S. House would put extra money in Social Security beneficiaries’ pockets while keeping the system solvent through the rest of this century.  Rep. John Larson’s Social Security 2100 Act does all of that and something more:  It gives lie to the myth that Social Security is going bankrupt and the only way to fix it is by cutting benefits.

Larson’s solution is simple… and fair.  It asks the wealthy to pay their fair share of Social Security payroll taxes. In exchange, the legislation ensures Social Security stays solvent through the year 2100 – with no benefit cuts and no turning over the program to Wall Street, which budget hawks have long dreamed of doing. 

The Act provides much needed relief to seniors who are having a difficult time paying for basic expenses like healthcare, housing, and utilities.  The bill includes a modest 2% benefit increase for all beneficiaries, higher cost of living adjustments (COLAs), and a tax break for 11 million seniors.  Since 2014, the National Committee’s Boost Social Security Now campaign has lobbied Congress to pass expansion legislation on behalf of its millions of members and supporters.  

In a Facebook Live interview with the National Committee, Congressman Larson says he hopes his bill will ride the wave of grassroots energy that defeated the GOP healthcare plan last month.  “What we saw was people saying, ‘Wait a minute, keep your hands off my healthcare.’  It’s the same with Social Security.  We want to continue to build a groundswell in this country.” Larson says the bill has already attracted more than 150 cosponsors in the House. The Congressman calls on President Trump to support it, based on his campaign promises to “protect” Social Security.

In order to keep the system solvent through the year 2100, the Larson bill would apply the Social Security payroll tax to wages above $400,000, which only would affect the top 0.4% of wage earners.  (Currently, earnings above $127,200 are exempt from the payroll taxes.)  Eventually, the cap would be phased out completely.  In addition, the legislation would gradually raise the overall payroll tax rate by 1% over 25 years – an increase of only 50 cents per week for a worker making $50,000 per year (or, as Larson himself is fond of pointing out, the price of one Starbucks coffee drink every nine weeks).  These financing changes would not only keep Social Security flush, they would allow for a modest 2% benefit increase for all beneficiaries --- and a tax break for 11 million seniors earning under $50,000 a year (or $100,000 for older married couples).

The Larson bill not only provides an increase in benefits, it would help retirees better keep up with inflation by linking cost of living adjustments (COLAs) to an index called the CPI-E (Consumer Price Index for the Elderly).  The CPI-E takes into consideration what seniors really spend for crucial goods and services, including housing and medical costs. 

The National Committee has enthusiastically endorsed the Social Security 2100 Act.  As President and CEO Max Richtman explains, “This bill is a win-win for beneficiaries and the entire country, because it protects the commitment to hard working Americans who pay into the system and enhances benefits.”

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Watch Congressman Larson’s full Facebook Live interview here.

Watch the Social Security 2100 Act event on Capitol Hill Facebook Live here

 


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