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Posts Tagged 'medicaid'

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New Medicaid Rules Designed to Put Care Over Profit

CMS has announced tightened Medicaid rules for private insurance plans that administer most Medicaid benefits for the poor. The Obama administration says the rules will limit profits, ease enrollment, require minimum levels of participating doctors and eventually provide quality ratings.  However, those ratings would still be years away as the industry continues to fight against such measures. 

Kaiser Health News provides details on the biggest changes for Medicaid managed care in a decade.  The new rules will:

  • Require states to set rules ensuring Medicaid plans have enough physicians in the right places. The standards will include “time and distance” maximums to ensure doctors aren’t too far away from members.
  • Limit insurer profits by requiring rate setting that assumes 85 percent of revenue will be spent on medical care. Unlike a similar rule for other plans, such as insurance sold through Obamacare marketplaces, the requirement would not compel Medicaid insurers to rebate the difference if they don’t hit 85 percent. Future rates would be adjusted instead.
  • Make plans regularly update directories of doctors and hospitals. A 2014 investigation by the Department of Health and Human Services’ inspector general found that half the doctors listed in official insurer directories weren’t taking new Medicaid patients.
  • Push plans to better detect and prevent fraud by providers, including mandatory reporting of suspected abuse to the states.
  • Tighten rules for Medicaid plans and states to collect patient data and submit it to HHS.
  • Make it easier for states to offer managed-care plans incentives to improve clinical outcomes, reduce costs and share patient information among hospitals and doctors.

Nearly two-thirds of Medicaid’s 72 million member are enrolled in private managed-care plans.  Consumer advocates have pushed HHS to set stricter rules for managed-care plans, which they said too often favored profits over patients. The industry and some state Medicaid directors resisted, saying plans needed flexibility to serve different members in different states.

The rules will be phased-in over the next three years, starting next summer. 


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Social Security & Medicare Finally a Topic of Debate

Ok, not a debate so much as a battle to see who can cut seniors’ benefits faster.  While Trump remains the only GOP Presidential candidate who promises he won’t cut Social Security, even that promise became squishy last night.  More on that, later. 

Here’s just a sampling of some of last night’s comments on what the remaining GOP candidates plan for generations of American families counting on Social Security, Medicare and Medicaid, followed by our comments:


Senator Marco Rubio

Social Security will go bankrupt and it will bankrupt the country with it.”

This is conservatives’ favorite lie.  Social Security isn’t going bankrupt.  According to SSA actuaries, the nearly $3 Trillion Trust Fund will be depleted in 2034 (as planned) to cover the baby boomer generation.  After that, there will still be enough income coming into the program to pay 79 percent of all benefits owed. If Congress does nothing seniors will face a 21% benefit cut.  A 21% benefit cut is not bankruptcy and certainly could not cause America’s bankruptcy.

“Medicare could very well become the option of using my Medicare benefit to buy a private plan that I like better”

The Republican dream of giving seniors a coupon to go out and buy private health insurance is a favorite of Speaker Paul Ryan and those in Congress who hope to destroy Medicare once and for all.  The program is too popular to kill outright, so they’ve chosen a privatization route for Medicare that is a political kissing-cousin to President Bush’s failed effort to privatize Social Security.  If they can’t kill these programs, conservatives want to (at least) turn America’s most successful retirement and health security programs over to industry so Wall Street, insurance companies and drug makers can profit. 


Senator Ted Cruz

“Social Security right now is careening towards insolvency... We need to see political courage to take this on and save and strengthen Social Security.”

In the classic case of “save” meaning “slash” and “strengthen” meaning privatize, Senator Cruz offers the well-worn conservative trope that cutting benefits to millions of American families while at the same time cutting taxes for the wealthy shows political courage and leadership.  See our comments above on the “careening towards insolvency” nonsense.

“We need to change the rate of growth of benefits so it matches inflation instead of exceeding inflation...we need to have for younger workers, that a portion of your tax payments are in personal accounts.” 

If hard to imagine how anyone can seriously argue that a zero cost of living increase for 3 out of the past 7 years, somehow exceeds inflation.  Seniors, veterans and people with disabilities have seen their costs increase in the same years their COLA was flat.  Social Security beneficiaries need a new COLA formula, one that actually measures seniors’ cost of living.  However, Ted Cruz wants the Chained CPI to cut benefits not to accurately measure inflation.


John Kasich

“I also had a plan in 1999 to save Social Security and take the $5 trillion projected surplus and not only have Social Security for our young people, but also to give them private accounts.”

John Kasich’s plan to “save” Social Security is standard GOP “we-must-slash-it-to-save-it” boilerplate with a little seniors just need to "get over it" thrown in.   Kasich would cut benefits to pay down the debt and privatize Social Security so seniors can watch their contributions ride the Wall Street roller coaster.  Then he’d cut billions more with lower COLA’s through the Chained CPI (again, what’s lower than zero?) and turning Social Security into a welfare program by means testing.


Donald Trump

Since we just wrote about Trump’s Social Security promises (there’s not really a plan) in detail we’ll focus only on last night’s twists.  For the first time ever, Trump’s promises to not cut Social Security benefits were offered with important qualifiers.  For a candidate who has no problem making big promises, last night’s about Social Security have taken on a downright passive tone – as if Trump, as President with potentially with a GOP House and Senate, wouldn’t have the power to leave Social Security benefits alone:

“I will do everything within my power not to touch Social Security”

“...it's my absolute intention to leave Social Security the way it is.”

This speech Trump gave to conservatives at the 2013 Conservative Political Action Conference provides one suggestion as to why he remains the only GOP candidate to promise he won’t cut Social Security & Medicare benefits (hint, it’s not because he loves the programs):   

"As Republicans, if you think you are going to change very substantially for the worse Medicare, Medicaid and Social Security in any substantial way, and at the same time you think you are going to win elections, it just really is not going to happen," Mr. Trump said, adding that polls show that tea partyers are among those who don't want their entitlements changed."  Donald Trump, 2013 CPAC speech, Washington Times

If you missed last night’s debate, you can read excerpts on what the candidates had to say specifically about Social Security, Medicare and Medicaid on our SeniorVote2016 website. 

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New Election Website Designed for Seniors Launches Today

As Primary Season Gets Underway, SeniorVote2016

Provides Timely, Comprehensive and Important Resources for Voters

Whose Futures Depend on Social Security & Medicare

The 2016 election for the White House and Congress will be expensive, combative and extremely important for the future of generations of older Americans. Literally millions of American families are impacted by decisions made in Washington on Social Security, Medicare and Medicaid yet these issues remain on the back-burner for many political candidates. To help arm voters with the facts, the National Committee has launched SeniorVote2016.org as a one-stop, easy to use source of information on the 2016 campaign. 

SeniorVote2016’s Candidate Watch provides easy-to-use interactive graphics showing the candidates’ campaign positions and plans for Social Security, Medicare and Medicaid with links to additional interviews and statements about these vital programs.  The Reading Room offers details of current legislative proposals which would impact American’s retirement and health security including questions voters can ask candidates about where they stand on issues such as: turning Medicare into a voucher program, cutting Medicare to fund other programs, raising the Social Security retirement age, cutting benefits through adoption of the Chained CPI and creation of a cost of living adjustment for seniors (CPI-E).  Visitors to SeniorVote2016 can also Take Action directly from the website by pledging to vote and engaging on social media with other Social Security and Medicare activists. 

In addition to the roll out of SeniorVote2016, the National Committee has launched a daily email news digest, providing readers with the latest media coverage on the campaigns and the issues. “Your Morning Read” will have a summary of the important need-to-know stories voters will value as they determine which candidates are most committed to preserving and strengthening America’s most successful programs. 


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The GOP Poverty Solution...Do Less and the Poor Will Do Better?!?

In 2014, 46.7 million people (14.8%) were living in poverty, according to the Census Bureau. The poverty rate for people aged 65 and older was lower, at 10%, thanks to the success of earned benefit programs like Social Security and Medicare.  In spite of these programs’ undeniable success in providing improved income and health security for older Americas, GOP leaders in Congress and most running for President, continue to target Social Security and Medicare for cuts. They also have supported cuts to other vital safety net programs serving America’s poor.  

While this weekend’s GOP Poverty forum may have signaled a shift to softer rhetoric on poverty (an issue that has seldom been addressed by Republican candidates, so far) there’s no sign that their policy prescriptions have changed at all. 

Robert Greenstein is the founder and President of the Center on Budget and Policy Priorities and provides this Huffington Post analysis of the GOP’s primary poverty proposal:

Our analysis suggests Paul Ryan's "Opportunity Grant" proposal carries substantial risk of increasing poverty, rather than reducing it, for the following reasons:
  • Although Speaker Ryan has described the proposal as maintaining the same overall funding for anti-poverty programs, that would be a practical impossibility. 
  • Funds would likely be shifted away from direct assistance to needy families.
  • The proposal would jeopardize basic nutrition assistance for poor children, which research has shown reduces child malnutrition and improves children's long-term prospects.
  • Not only would food assistance funding likely decline, but total funding to assist low-income families would likely decline as well.
  • History shows that when federal policymakers merge programs into a broad block grant, federal funding typically declines over time, often dramatically.”
Economist Jared Bernstein says: 
“This is merely a gussied up version of “if your only tool is a hammer, then everything looks like a nail.” The idea, and Ryan’s budgets very much underscore this point, is that we can help the poor more by doing less for them.
The evidence points strongly in the opposite direction. As CBPP’s Arloc Sherman noted yesterday (and Ben Spielberg and I have explained in detail), a large and growing body of high-quality research...shows that the impact of income support and safety net programs like SNAP and Medicaid do not just occur upon receipt and immediately fade away. They have important, positive long-term benefits for children.  Next, the idea that liberal policies have failed is belied by…you know…data.”

Paul Ryan’s long-held and often-expressed Ayn Randian view of every man for himself and claims that federal safety-net programs (including earned benefits in Social Security, Medicare) only provide a “hammock” for the “dependency culture” of “makers and takers” remain as the core value that fuels the GOP approach to poverty.  Although, Speaker Ryan now acknowledges his “maker-taker” rhetoric was a mistake, that clearly hasn’t moderated his policy approach.  

“Under his “Opportunity Grant” proposal, Ryan has proposed converting a number of programs to state block grants, a decision that nonpartisan analysis suggests would reduce families’ ability to access key programs such as nutrition and housing assistance. In crafting this idea, Ryan and other conservatives often point to the Temporary Assistance for Needy Families program as a model—even though it does very little to mitigate poverty and hardship and is unresponsive to recessions.
Furthermore, in their most recent congressional budgets, Republicans obtained two-thirds of their cuts from programs helping low- and moderate-income families, while channeling additional resources towards tax cuts for the wealthy.” The Nation

The GOP/Ryan budgets have all been characterized by tax cuts for the wealthy, program cuts for the poor and turning Medicare into “Coupon Care.”

“Once again, the House GOP’s budget would privatize Medicare with a voucher plan, leaving seniors and the disabled – some of our most vulnerable Americans – hostage to the whims of private insurance companies.  Over time, this will end traditional Medicare and make it harder for seniors to choose their own doctor.  Vouchers will not keep up with the increasing cost of health insurance… that is why seniors will pay more.”...Max Richtman, NCPSSM President/CEO
The GOP/Ryan Budget: 
  • Ends the Medicaid joint federal/state financing partnership and replacing it with fixed dollar amount block grants, giving states less money than they would receive under current law. 

  • Repeals Medicaid expansion. Since 2014, states have had the option to receive federal funding to expand Medicaid coverage. Over half of the states have expanded their Medicaid programs, and others will likely do so in the future.  Repealing this option would result in at least 14 million people losing their Medicaid coverage and state Medicaid programs would lose a total of $900 billion over 10 years. 

  • Cuts Medicare by $431 billion over ten years.  Over half of Medicare beneficiaries had incomes below $23,500 per year in 2013, and they are already paying 23 percent of their average Social Security check for Medicare cost-sharing in addition to out-of-pocket costs.

Talking about poverty in America is a welcome first step from the Republican candidates; however, talk is cheap if action is just more of the same benefit cuts to pay for tax cuts.  

 

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Why 2016 Will Be a Defining Moment for the Future of America’s Retirement Safety Net

By Max Richtman, NCPSSM President/CEO 

Originally on Huffington Post

Saving for retirement continues to be a significant challenge for millions of workers still searching for economic stability in this post-recession era. What’s worse is it will likely become much more difficult if Congress adopts the privatization, benefit cutting and cost-shifting plans the GOP Presidential candidates’ propose for Social Security and Medicare. Before we look at what some of these plans would mean for generations of retirees and their families, it’s important to understand what the current retirement crisis actually looks like for the average American.

Retirement USA reports the gap between what Americans need to retire and what they actually have is $7.7 trillion. In fact, about half of households age 55 and older have no retirement savings and a third of current workers aged 55 to 64 are likely to be poor or near-poor in retirement. Unfortunately, the median retirement account balance is a puny $3,000 for all working-age households and $12,000 for near-retirement households. Contrary to the political rhetoric that all Americans are living longer, the truth is high income men have gained 8 years of life expectancy while low income men have seen virtually no change. White men also live about 12% longer at age 65 than black men. At the same time, a survey of older people in 11 countries finds that U.S. adults are sicker than their counterparts abroad, and are more likely to have problems paying their medical bills and getting needed healthcare. Unfortunately, America’s retirement crisis has earned almost as many “deniers” as the climate change issue.  We can’t continue turning a blind eye to the millions of American families struggling with how to ensure grandparents, parents and ultimately their children can age with dignity without impoverishing themselves.

Rather than acknowledge our national retirement crisis and propose policy prescriptions to improve the ability of average Americans’ to save for retirement and boost benefits for Social Security and Medicare, policy proposals of most of the Republican Presidential candidates do just the opposite – cut benefits and shift more costs to middle-class families. The gap between what Americans need to remain economically secure as they age and what these candidates propose is huge. This is why 2016 will be critical to the economic security of generations of American workers who can’t, nor should they have to, work until the day they die.

Just as we’ve seen from climate change deniers, many Republican politicians won’t even acknowledge the retirement crisis exists because improving the nation’s most successful federal retirement programs is anathema to their misguided belief that Wall Street should be handling your savings and for-profit insurance companies managing your health. When you look at proposals for Social Security and Medicare offered this campaign season, there is virtually no disagreement among Republican Presidential candidates. On one end of a very narrow political spectrum, Governor Christie aggressively attacked Social Security early in the race to prove his conservative bona-fides as a “truth-teller” and to show that he’s willing to tell average Americans that he plans to cut their earned benefits. On the opposite end of the GOP field strategically is Mike Huckabee. He’s taken a more populist tone in defense of Social Security and Medicare while also maligning both programs as federal “confiscation” and “pick-pocketing.” His actual proposals come from the same GOP political playbook: repeal Obamacare which would terminate the billions in Medicare benefits and years of solvency that comes with it, privatize programs, and replace Social Security’s funding with a regressive tax changing the program from an earned benefit into a welfare program.

The rest of the GOP candidates have staked out their own version of “saving” Social Security by slashing benefits and “improving” Medicare by shifting even more costs to seniors. As you can see in the interactive chart below -- based on the candidates’ public comments, written proposals and legislative record -- they have plenty to say about their plans to privatize, cut benefits and shift costs in Social Security and Medicare. The only slight exception is Carly Fiorina, who says she won’t detail her Social Security and Medicare plans until after she’s elected President. In other words, vote first and ask questions later.

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On the Democratic side, all three candidates have plans for Social Security and Medicare which illustrate stark differences between the parties when it comes to addressing America’s retirement crisis.  Hillary Clinton, Bernie Sanders and Martin O’Malley would boost Social Security benefits in differing ways and none support privatization. As one the Senate’s most vocal defenders of Social Security and Medicare, Sanders has introduced legislation to boost basic Social Security benefits and lift the payroll tax cap so that the wealthy pay the same percentage of their wages as the middle class. O’Malley supports the same proposals. O’Malley and Clinton support creating caregiver credits in Social Security for those who take time away from work to raise a family or care for a family member. While Clinton has opposed lifting the payroll tax cap in the past, she now suggests she’s open to the idea. Clinton supports increasing Social Security benefits for the poorest recipients.

While it’s clear that the future of Social Security and Medicare would be radically different if GOP Presidential candidates have their way, the story doesn’t end at the White House. In Congress, Democrats have had their share of political successes and miscues in negotiations with GOP Congressional leaders. This year alone, there have been multiple attempts by Congress to use Social Security and/or Medicare as an ATM to pay for completely unrelated priorities.  Medicare sequester cuts have been extended into 2025. Then Medicare was cut again to help pay for the Trade bill. There was also a failed attempt this summer to fund the highway bill with Social Security cuts and let’s not forget that many Democrats have expressed support for the ill-fated Bowles-Simpson “Grand Bargain” deficit plan which would have been devastating for programs like Social Security and Medicare.

Sounding the alarm about these damaging proposals isn’t just about protecting the current generation of seniors. Cutting America’s most successful retirement income and health security programs at the same time younger workers are coping with stagnant wage growth, higher inflation, college loan debt, and an inability to save enough for retirement threatens their future financial security too. The 2016 elections will be a defining moment for whether America’s retirement safety net stays or goes. It’s critical that American voters of all ages demand that candidates for President and Congress – Republicans and Democrats – are held accountable for policies which will impact generations of American families. 

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