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Ryan's Revised Healthcare Bill Even Worse Than the Original

 


Let us not speak of pigs and lipstick, but simply say that the freshly tweaked GOP health care bill introduced last night still socks it to older Americans. In an attempt to throw bones to both moderate Republicans and Tea Partiers, Speaker Paul Ryan has come up with a revised bill that’s even worse than the original for seniors and “near seniors” (under 64 years of age).  The Center for Budget and Policy Priorities has just released a detailed analysis forecasting higher net premiums, co-pays, and out-of-pocket costs for older Americans under the revised bill.  Here is our own take on why there's nothing to like in the tweaked legislation: 

 

MEDICAID

 

Millions of seniors depend on Medicaid to cover the cost of long-term care, while low income Americans 50-64 rely on the program for basic health care.  The original GOP bill cut nearly $1 trillion from Medicaid and imposed per capita caps on federal payments to the states.  The revised legislation adds another insidious idea to the equation by introducing block grants, where states can decide to curtail or outright cut certain services.  Per capita caps and block grants mean one thing:  less funding for older patients who need medical services and long-term care - and in some cases, complete loss of coverage.  For seniors, It’s two bad ideas in one bill.

 

AGE RATING

 

The revised GOP bill does nothing to address a major problem with the original.  Under the revised legislation, Insurance companies would still be able charge older Americans up to five times as much as people in their 20s (a practice referred to as “age rating”), one reason why the Congressional Budget Office estimated that 24 million people would lose coverage under the Republican plan.

 

 

PREMIUM SUPPORT         

 

Obamacare provided generous subsidies to people who couldn’t afford private insurance premiums.  The GOP bill replaced those subsidies with paltry tax credits that discriminate against older patients.  Paul Ryan’s tweaked version kicks the problem over to the Senate by authorizing the upper chamber to increase tax credits for older Americans… if it wants to. There’s no guarantee the Senate will actually do this, or that fatter tax credits will make it into the final bill.  Once again, the revised GOP plan leaves older folks worse off.

 

TAX CUTS

 

While giving nothing to seniors, the revised bill still repeals $600 billion in tax cuts for the wealthy (and $24 billion for pharmaceutical companies) that Obamacare utilized to expand health coverage and strengthen Medicare.  The tweaked bill actually sweetens the deal for the wealthy – repealing the taxes in 2017 instead of 2018.

 

 

MEDICARE

 

The GOP plan still weakens Medicare through the repeal of a 0.9% tax on income over $200,000.  By rescinding the tax, the GOP plan reduces the solvency of Medicare by 3 years – and the revised bill does nothing to lengthen it.  Reducing Medicare’s solvency gives budget hawks an excuse to privatize and cut the program, which hurts seniors.

 

We don’t know whether the dressed-up GOP plan will pass the House.  It’s possible that the concessions to Tea Partiers and token gestures to moderates – plus active lobbying on President Trump’s part – will allow it to squeak by.  Either way, Speaker Ryan squandered an opportunity to reverse some of the damage to healthcare and long-term care for our older and most vulnerable citizens.

 

 

 

 

 

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CBO Report on GOP Health Plan: More Bad News For Older Americans

National Committee President Max Richtman has rightly called the GOP Obamacare replacement “a triple whammy for seniors” because of its impacts on the private insurance market, Medicare, and Medicaid.  Yesterday’s report from the Congressional Budget Office confirms this grim assessment.  Of the 24 million Americans who will lose health coverage over the next decade, many will be seniors and “near-seniors” aged 50-64 who can least afford to go without much needed medical care.     

PRIVATE HEALTH INSURANCE

On the private health insurance front, the CBO projects that premiums will rise by more than 20% for older Americans.  This is mainly because the bill allows insurers to charge older customers up to 5 times more than younger ones.  At the same time, the GOP legislation yanks the financial rug from underneath older enrollees by replacing generous Obamacare subsidies with meager tax credits. According to today’s New York Times:

“The CBO estimates that the [net] price an average 64-year-old earning $26,500 would need to pay… would increase to $14,600 under the Republican plan.” – New York Times, 3/14/17 

The Times reports that older American’s out-of-pocket insurance costs would also rise:

“The hypothetical older customer who could pony up $14,600 for insurance under the GOP plan would also pay substantially more out of pocket for any health care services. And changes to the requirements for health plans mean that, across the board, deductibles and cost-sharing will increase.” – New York Times, 3/14/17

The reason for the word “hypothetical” is that most older Americans would not be able to afford $14,000 in premiums, let alone rising deductibles and co-pays.  Unable to pay these exorbitant prices, millions of “near seniors” (aged 50-64) will simply have to drop their health insurance during those crucial years before they are eligible for Medicare and need it most.

MEDICAID

The GOP phase-out of Obamacare’s Medicaid expansion will also hit near seniors in the lower income brackets particularly hard.  As a result of these changes, the CBO finds that people between 50 and 64 years old earning less than 200% of the federal poverty level would make up a larger share of the uninsured, from just over 10% under Obamacare to nearly 30% under the Republican replacement.   To re-iterate:  30% of near seniors earning a modest income will lose healthcare coverage from Medicaid.  That’s nearly one third of the lower income seniors who benefited from the Obamacare Medicaid expansion.  

The GOP bill also radically restructures Medicaid by ending guaranteed federal matching funds to the states and effectively cutting $880 billion from the program over ten years. Cash-strapped states will be compelled to compensate for this shortfall by cutting benefits and eligibility for Medicaid.  The CBO estimates that 14 million people will be forced off of Medicaid rolls by 2026. This is particularly bad news for seniors who rely on Medicaid to pay for long term care services and supports when their personal savings are depleted.  Those seniors will either have to rely on their financially-squeezed families to pay for long term care, or be forced to forgo the care they need.

MEDICARE

According to the CBO report, the Republican health plan achieves most of its budget savings by rescinding taxes on higher-income Americans.  Unfortunately for current and future retirees, those tax revenues were helping to keep the Medicare program on a sound financial footing.  By repealing a $117 billion tax on income above $200,000 a year, the GOP bill reduces the solvency of Medicare by 3 years. 

In a perversely self-fulfilling prophecy, the very budget hawks who insist that Medicare needs to be “reformed” because of its solvency problems are now making the program even less financially sound.  This opens the door for the “reformers” to argue even more vehemently for privatizing Medicare and turning it into a voucher program, which will hurt seniors with low or modest incomes.

REVERSE ROBIN HOOD

In reviewing the CBO analysis, a theme quickly emerges.  The Republican plan rips benefits away from lower income and older Americans while rewarding upper income earners with billions of dollars in tax breaks. It achieves federal budget savings on the backs of the people who can least afford to sacrifice.  The young, healthy and wealthy do better under the GOP plan.  With the triple assault on Obamacare, Medicaid, and Medicare, seniors and near seniors are left in the cold. As National Committee president Max Richtman likes to say, the Republicans’ message to older Americans seems to be, “You are going to be on your own and good luck… and I'm not even sure about the ‘good luck’ part.”

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We discussed Trumpcare's impact on older Americans on Facebook Live "Behind the Headlines."  Watch here.  

Read the National Committee's response to the CBO report here.

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Trump Snubs Seniors in Speech to Congress

Millions of current and future retirees were no doubt hoping that President Trump would use last night’s speech to Congress to reaffirm his promises not to touch Social Security and Medicare.  Instead, the President ducked and covered.  He did not even utter the words “Social Security” or “Medicare” in his entire hour-long address.  As for Medicaid – which millions of American seniors rely upon for skilled nursing care – the President only touched on it once, with a veiled reference to converting guaranteed benefits into block grants, which would hurt beneficiaries.   

This begs the question – why the silence on Social Security and Medicare?  After all, during the campaign the President broke with Republican orthodoxy and repeatedly promised not to cut either earned benefit program. “I am going to protect and save your Social Security and your Medicare.  You made a deal a long time ago,” he told a crowd of supporters in November.  The most likely explanation for omitting America’s retirement security programs from last night’s speech is that the President knows his fellow Republicans on Capitol Hill vehemently disagree with him.  

There are proposals in both the House and Senate to cut and privatize Social Security and Medicare.  In fact, voucherizing Medicare is one of Speaker Paul Ryan’s highest priorities.  Perhaps the President did not want to unnecessarily ruffle feathers on the Hill last night.  If so, his refusal to recommit to protecting Social Security and Medicare is not an encouraging sign. If he’s afraid to even mention his position in a speech to Congress, he may roll over on campaign promises under pressure from the Congressional GOP.

President Trump may also be leaving himself wiggle room in negotiations with Congress over Social Security and Medicare.  The problem is, any compromise on his promise will hurt seniors and people with disabilities who depend on these programs, whether it’s cutting benefits, raising the retirement age, or trimming COLAs.  He may also be setting up a dodge, where the Congress agrees not to cut Social Security or Medicare for current retirees while leaving open the possibility of downsizing or privatizing both programs for younger Americans.  This approach is based on the falsehood that cutting benefits for future retirees doesn’t hurt current seniors, and cynically pits one generation against the others for political expediency. Mark Miller of Reuters has an excellent piece today explaining this ploy:

"The [Republicans’] political goal will be to defang public opposition, since younger workers tend not to focus much on retirement when it is several decades away. But that approach is not going to work. Retirees and their advocacy groups will fiercely resist cutting benefits down the road, because they understand the critical importance of Social Security and Medicare benefits. They also care about the future retirement of their own children.  - Mark Miller, Reuters

Social Security and Medicare are commitments that the government made to working class Americans who paid into the system most of their lives.  The President could have confirmed that commitment last night and comforted seniors who are worried about losing their retirement security and healthcare.  His silence on Capitol Hill was not reassuring.

 

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Democrats Challenge Price over Medicare and Medicaid Funding

Democrats concerned about seniors, children, the disadvantaged and disabled took HHS Nominee Tom Price to task in his first day of Senate confirmation hearings Wednesday before the Committee on Health, Education, Labor and Pensions. Price faced withering questions from committee Democrats which he sometimes struggled to answer or simply evaded. Skeptical about Price’s statement at the beginning of the hearing that, “Nobody’s interested in pulling the rug out from under anybody,” Democrats held his feet to the fire where his record contradicts that promise.   

Senator Elizabeth Warren (D-MA) confronted Price (a Republican member of the U.S. House) about his past proposals to slash Medicare and Medicaid.  “You would have cut Medicare by $449 billion… and would have cut Medicaid funding by more than $1 trillion dollars, correct?” Warren asked Price.  “You have the numbers before you,” he said.  When Warren asked if Price would honor President-elect Trump’s pledge not to cut Medicare or Medicaid by even one dollar, the nominee would not commit – insisting that the amount of funding is the “wrong metric.”

“The millions of Americans who rely on Medicare and Medicaid are not going to be reassured,” warned Senator Warren, suggesting that Price print out Trump’s pledge and post it above his desk.  “Americans will be watching to see if you follow through on that promise.”

Senator Patty Murray (D-WA) also confronted Price about the future of Medicare and Medicaid in the new administration.  “You have said you plan to overhaul Medicare in the first 6-8 months of this administration in a way that would end the guarantee of full coverage.” 

Senator Al Franken (D-MN) expressed concerns about Price’s policies and priorities, especially his fierce opposition to the Affordable Care Act.   “I see you as someone who is there for the doctors,” Franken chided.  (Price is a physician as well as a Congressman.) Franken told Price that repealing the Affordable Care Act “is going to unravel something that has given a lot of Americans peace of mind.”

Democrats also grilled Price about personal stock transactions affected by his decisions as a legislator.  "Do you believe it is appropriate for a senior member of Congress, actively involved in policymaking in the health sector, to repeatedly personally invest in a drug company that could benefit from those actions?" Murray asked. "That's not what happened," said Price.

Republicans on the committee were largely cordial and complimentary to Rep. Price.

Committee Chairman Lamar Alexander (R-TN) allowed each member only one round of questions with a 7-minute time limit, prompting complaints from Democrats that important hearings were being rushed and the American people denied sufficient time to learn about the nominees.  Price will have another hearing before the Senate Finance Committee on January 24th

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A Dangerous New Year for Social Security, Medicare, and Medicaid

At a family gathering over the holidays in Florida, the conversation inevitably turned to politics.  Some of the seniors at the table who voted for Trump expressed their certainty that no one in Washington will really touch their earned benefits.  “Trump’s not going to let the Congress cut Social Security,” said a Great Aunt in her 70s.  “Paul Ryan’s not really going to mess with Medicare,” insisted her husband. Of course, these beloved family members could not be more wrong.

Their complacency (or, in this case, complicity) sets up a dangerous opportunity for the GOP-controlled 115th Congress, which was just sworn in yesterday.  Claiming a mandate that most certainly does not exist, Congressional Republicans are rolling out proposals that will destroy Social Security and Medicare as we know them, not to mention deep cuts to Medicaid and the repeal of the Affordable Care Act.  These actions will hurt not only the seniors at the holiday table, but their children and grandchildren, too.  As we have been warning for years, all Americans have a lot to lose if these programs are compromised by capricious politicians.

President-Elect Trump shows no signs of honoring his campaign pledge not to touch Social and Medicare.  He has been strangely silent about Congressional proposals that will wreck these two programs, and his appointments to crucial administration positions speak volumes – most notably Rep. Tom Price (a notorious privatization proponent) as Health and Human Services Secretary and Rep. Rick Mulvaney (a fiscal hardliner) as director of the Office of Management and Budget --- a likely ally for Congressional Republicans looking to cut entitlements.

A quick survey of GOP proposals shows just how much current and future beneficiaries of these crucial income security programs have to lose.  House Social Security Subcommittee Chair Sam Johnson (R-TX) has introduced a so-called Social Security “reform” bill that will result in benefit cuts, raise the retirement age to 69, and reduce Cost of Living Adjustments (COLAs) that seniors on fixed incomes rely on.  House Speaker Paul Ryan, who Tuesday gaveled the 115th Congress into session, has long promised to privatize Medicare, turning it into a voucher (or “Coupon Care”) program that would leave future beneficiaries to fend for themselves in the private insurance market while traditional Medicare slowly dies.  This will mean skyrocketing premiums and reduced coverage for seniors thrust into the private insurance market.

The 115th Congress just took the first procedural steps to repeal the Affordable Care Act, which not only jeopardizes health care coverage for 30 million Americans, but puts real improvements to Medicare at great risk.  If the Affordable Care Act is recklessly repealed, seniors will lose free preventative screenings under Medicare.  The Part D prescription drug “donut hole” will open up again, costing more than 11 million Medicare beneficiaries $2,100 per person on prescriptions.  Worse yet, Medicare beneficiaries will face higher premiums and deductibles to make up for the roughly $800 billion in cost savings that the ACA provided over 10 years.  Insurers will once again be able to overcharge or deny coverage to people with pre-existing conditions.

Combine this with GOP plans to block-grant Medicaid, which millions of seniors depend on for nursing home care and long term care services, and Americans are confronting a full-fledged assault on their earned benefits and income security.  As the 115th Congress convened yesterday, Democrats promised vigilance.  Incoming Senate Democratic leader Chuck Schumer declared from the Senate floor, “We demand that (Trump) keep his promise not to cut Social Security and Medicare… We will hold the President-elect accountable.”  On GOP efforts to dismantle the Affordable Care Act, Schumer warned, “It is not acceptable to repeal the law, throw our health care system into chaos” and leave the solution for another day.  Senator Bernie Sanders has called for a national Day of Action on January 15th “to oppose any cuts to health-care plans or subsidies,” including rallies in Congressional districts across the country.

We stand with our allies on Capitol Hill, our fellow advocacy groups, and our millions of members to protect Social Security, Medicare, Medicaid, and the Affordable Care Act.  We see the danger quite clearly… and hope that the seniors and their families who sat around holiday tables the past two weeks will, too.

 

 

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