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Posts Tagged 'medicaid'

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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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Massachusetts Congressman is an Unassuming, Unrelenting Champion of Social Security

This morning National Committee President Max Richtman interviewed a real fighter for Social Security and Medicare on Facebook Live from Capitol Hill – Congressman Richard Neal (D-MA-1). 

The Congressman, who the Boston Globe called “an unassuming everyday guy from Western Massachusetts,” has a unique vantage point on seniors’ issues.  He is the ranking member of the powerful House Ways and Means Committee, which oversees (among other things) Social Security, Medicare, Medicaid, and taxes.  He assumed the post just before President Trump arrived in Washington, and has become a key point person against a Republican assault on these programs.

Neal is a true believer in Social Security, partly because he grew up with it.  He and his sisters were raised by an aunt in Springfield, MA after their parents died, and relied on Social Security survivors’ benefits to make ends meet and remain under one roof.  “Social Security allowed us to live as a family, and I’ve never forgotten that,” Neal told Max Richtman.

The Congressman is determined that Social Security be preserved for future generations – without benefit cuts – as a singular form of retirement insurance.  “You can outlive an annuity.  You cannot outlive Social Security,” he said on Facebook Live.  “That’s the guarantee.  That’s the genius of Mr. Roosevelt’s program.”  (Social Security was signed into law in 1935 by President Franklin D. Roosevelt, father of National Committee founder James Roosevelt, Sr.)

Social Security, Neal says, gives American families a modicum of financial predictability for their senior years.  He told the Globe that Social Security “is the reason Mom and Dad aren’t living in your attic.”

Neal is co-sponsoring Connecticut Rep. John Larson’s Social Security 2100 Act – one of the Democrats’ resounding replies to Republican schemes to shrink the program.  Larson’s bill keeps Social Security solvent for decades without cutting benefits.  In fact, The Social Security 2100 Act modestly increases benefits.  Rep. Neal admits that the bill probably won’t go very far while Republicans control Congress.  But he says the legislation “invites fresh thinking about how to encourage growth in Social Security.”

Meanwhile, the Congressman vehemently opposes a bill from House Social Security Subcommittee Chairman Sam Johnson (R-TX) that would do the opposite of Larson’s – reducing cost-of-living adjustments, raising the retirement age to 69 and cutting the benefit-computation formula. All of this, Neal says, would amount to a 30% cut in benefits for middle-class retirees.

Neal shoots down conservative arguments that Americans’ increasing longevity justifies raising the retirement age.  Without Social Security, nearly half of our nation’s seniors would live in poverty – all the more reason, Neal says, not to pull the rug from under retirees by delaying eligibility for benefits.  “We applaud each other regularly for increases in life expectancy in America,” says Neal.  “But all that means is that we have to reinforce the guarantees that Social Security provides.”

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Of Course People Will Die if Senate Health Bill Becomes Law

Two days in a row now we have seen CNN anchor Kate Bolduan react with incredulity when a Democratic member of Congress points out the obvious:  that people will die if the Senate healthcare bill becomes law.  “We’ll have to ask a Republican about that!” Bolduan breathlessly replied to one Democrat. What she – along with advocates of the bill – fails to understand or prefers to ignore is that you cannot snatch healthcare away from 22 million people without incurring casualties.  Of course people will die as a result. 

Speaking against the GOP healthcare bill last week, Senator Elizabeth Warren (D-MA) called its cuts to healthcare for older and lower-income Americans “blood money.”  She went on to say:

“Let’s be very clear.  Senate Republicans are paying for tax cuts for the wealthy with American lives.  People will die.” – Sen. Elizabeth Warren, 6/22/17

Republicans propose to pay for those tax cuts by gutting the Medicaid program – 40% of which pays for services to the elderly like nursing home care.  Some one million seniors nationwide could lose the ability to pay for the long term care they need to survive.  States facing $770 billion in federal Medicaid cuts will have no choice but to offer skimpier coverage or kick seniors off the Medicaid rolls altogether.

By law, state Medicaid programs have to cover nursing homes. If those states receive less funding from the federal government, it could increase the pressure on the operations of nursing homes, in turn possibly limiting who can qualify for care. – Yahoo Finance, 6/26/17 

We are talking about people with Alzheimer’s, cancer, diabetes, neurological disorders, and other chronic diseases.  Few seniors (or their families) can afford to pay the average cost of nursing home care (running some $80,000 a year) without government assistance. Many of these seniors were formerly in the middle class, but had to impoverish themselves to qualify for Medicaid.  If they are forced to go without skilled long term care (whether in a nursing home, in the community, or at home), the real question is not whether some of them will die, but how will they survive? 

The bill’s age rating provisions could also prove deadly for older Americans.  The Senate legislation – like the House’s – allows insurers to charge near seniors (aged 50-64) up to five times as much as younger adults, which will price many out of the market.  The rate of uninsured Americans who earn up to 200% of the federal poverty line will double if this bill becomes law.  Chronic health conditions tend to develop and intensify during this period of life.   If millions of near seniors can’t afford health insurance, they will go without the care they need – which could lead to premature death.  You don’t have to be a brain surgeon to figure that one out.

Taking away the guarantee of essential benefits coverage – which the Senate bill also threatens to do – means Americans (especially the poor and elderly) will no longer benefit from timely treatment of festering health problems.  One of those is heart disease. According to Kaiser Health News, the leading killer of men and women in the U.S. has been decreasing since Obamacare went into effect. 

“The Journal of the American Heart Association found that the rate of sudden cardiac arrest outside of a hospital dropped by 17% among people aged 45-64 after the Affordable Care Act expanded insurance coverage.” – Kaiser Health News, 6/28/17

It stands to reason that repealing the Affordable Care Act could lead to an increase in heart attacks, which could also mean an increase in fatalities. 

This is why the pleas for bipartisanship from Republicans and some of the media ring especially hollow.  We have heard pundits describe the disagreements between Republicans and Democrats on healthcare as “semantics”:  is the Senate bill a true “repeal” of Obamacare or not?  Why, oh why, can’t both sides just get along? Of course, that misses the point.  Not only does the bill roll back important protections for all Americans, it is a Trojan Horse for gutting Medicaid and giving the wealthy a $700 billion tax cut.  Congressional Democrats refuse to enable the GOP to make these drastic changes.  Seniors and their advocates must keep that issue at the forefront – and work to defeat the Senate bill while there is still time. This is not semantics. It is literally life and death. 

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Senate GOP's "Mean" Healthcare Bill Must be Defeated

Getting a look at the Senate Republican healthcare bill after weeks of secrecy is like peeking under a rock.  There’s a lot under there that you don’t really want to see – and would like to believe doesn’t really exist.  Unfortunately, the Senate version of the American Health Care Act is very real – and dangerously close to becoming law.

Prognosticators who said the House-passed bill would be “dead on arrival” in the Senate, or who predicted that the Senate would be a moderating influence on the legislation, were dead wrong.  Instead, Senate Republicans have clearly chosen to put political expediency above the health of our most vulnerable citizens.

In some ways, the Senate bill is slightly less onerous than the House version; in other ways it’s worse – especially for the old, the sick, and the poor.  In a press statement today, National Committee President Max Richtman calls the bill “unconscionably cruel.”

This is a lose-lose for seniors and the American people.  The biggest loss is that the AHCA ends the Medicaid program as we know it.  Astoundingly, the Senate bill makes even deeper cuts to Medicaid than the House did.  This is devastating news for today’s and tomorrow’s seniors suffering from Alzheimer’s, cancer, the after-effects of stroke and other serious conditions who depend on Medicaid to pay for long-term care.  Millions will lose Medicaid coverage over the next ten years.” - Max Richtman, President and CEO of NCPSSM

 

The Washington Post clearly explains why the Senate bill hurts Medicaid beneficiaries even more than the House version:

Medicaid would be funded by giving states a per capita amount or block grant, beginning in 2021. The amount would grow more slowly than in the House bill, meaning bigger spending cuts overall. - Washington Post, 6/22/17  

This is why the Senate healthcare bill is so hazardous for older Americans in several other ways:

*It still permits insurance companies to charge older Americans five times more than young adults. 

*The tax credits that replace Obamacare subsidies are still too meager to make up for net increases in older Americans’ premiums. 

*Though it forbids insurers from denying coverage for pre-existing conditions, the waivers of essential benefits mean older patients with chronic diseases like diabetes, cancer, or heart disease could see their premiums skyrocket. 

 *Like the House bill, the Senate legislation weakens Medicare by reducing the solvency of the Part A Trust Fund.

Only the young, healthy and wealthy will truly benefit from this bill, whose true purpose is not to facilitate health coverage, but to give a multi-billion dollar tax break to the rich and the pharmaceutical companies. Our family members and friends who cannot afford exorbitant premiums and out-of-pocket costs will suffer.  Some will doubtless go without healthcare altogether.  Their health will deteriorate, and when they arrive at the doorstep of Medicare, they may be in worse condition – which can increase the financial burden on Medicare, too. 

Make no mistake, if the bill passes the Senate and the House, President Trump will sign it into law. The National Committee has identified 11 GOP Senators who could be persuaded to stop the AHCA with sufficient public pressure.  As few as three Republican dissenters could kill this bill. Americans of conscience must demand that their Senators put people before party and defeat this heartless legislation before it’s too late.

 

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For the latest on Trumpcare and its devastating implications for seniors, watch “Behind the Headlines” on Facebook Live from Capitol Hill.

 

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Trump & GOP Should Do More than Pay Lip Service to Older Americans Month

May is Older Americans Month.  It began in 1963 as “Senior Citizens Month” by proclamation of President John F. Kennedy.  His proclamation half a century ago was not only an acknowledgment of seniors’ contributions to society, but an inspiring call to action:


“I urge all persons and public and private organizations to cooperate in its observance by increasing community awareness of the problems faced by older men and women, strengthening services and opportunities to meet their special needs… and making this special month the beginning of continuing interest and activity on their behalf.” – John F. Kennedy, April 18, 1963

 

At the time, approximately 33 percent of seniors in America lived in poverty. Today that figure is down closer to 10 percent, thanks in no small part to federal programs designed to buttress the financial and health security of older Americans, including Medicare and Medicaid – signed into law by President Lyndon B. Johnson in 1965.  LBJ also renamed Senior Citizens Month “Older Americans Month” that same year upon passage of the Older Americans Act.  This legislation created new forms of federal assistance for seniors – including Meals on Wheels and home heating assistance.  Every President since has issued proclamations honoring seniors during the month of May.  President Trump is no exception.  Today, the White House released a statement saying:


We… recommit ourselves to ensuring that older Americans are not neglected or abused, receive the best healthcare available, live in suitable homes, have adequate income and economic opportunities, and enjoy freedom and independence in their golden years.” – White House proclamation, 5/8/17


These sentiments sound quite noble.  But the Trump proclamation is an empty missive in light of the administration’s policies. National Committee President Max Richtman called out the President and his party in The Hill newspaper last week:


“May is Older Americans Month, but the Trump administration and Congressional Republicans are putting a serious damper on the celebration.” – Max Richtman, The Hill newspaper.


The Trump administration and its allies on Capitol Hill are engaged in a historic reversal of the promises of 54 years ago. In fact, not since President George W. Bush tried to privatize Social Security in 2005 have seniors’ programs been so much under siege.  In a little more than 3 months in office, here is what the President and/or Republicans in Congress have done to undermine the economic and health security of older Americans:

*Passed the American Health Care Act (AHCA), which weakens Medicare, cuts $1 trillion from Medicaid, and makes private health insurance unaffordable for most older Americans.

*Created a budget plan which eliminates federal funding for Older Americans Act programs including Meals on Wheels, community service jobs, and home heating assistance, among others.

*Pledged to turn Medicare into a voucher program during the mark-up of the FY 2018 budget later this month.

*Introduced a House bill to raise the Social Security retirement age to 70 and slow the growth of Cost-of-Living adjustments (COLAs), effectively cutting benefits 30%.

*Repeatedly pushed the concept of “entitlement reform” and questioned the validity of Social Security Disability insurance

Several of these break President Trump’s campaign promises “not to touch” Social Security, Medicare and Medicaid.  Some in the administration and Congress have attempted to fudge the issue by saying that none of their policies will affect current retirees.  But during this Older Americans Month, it’s wise to remember that all of us will be seniors some day.  Attempts to cleave today’s and tomorrow’s seniors is a cynical ploy that cannot be allowed to undermine time-honored programs that have helped older Americans for decades.  None of the actions of President Trump, his team, and his allies in Congress honor the spirit of Older Americans Month.  Much more fitting are the words of President Obama last night as he accepted an honor named after the President who created Older Americans Month, the John F. Kennedy Profiles in Courage award.

“… It actually doesn’t take a lot of courage to aid those who are already powerful, already comfortable, already influential — but it does require some courage to champion the vulnerable and the sick and the infirm.” - President Obama, 5/7/17

Seniors citizens are among society’s most vulnerable and infirm members. We must demand that our current elected leaders do much more than pay lip service to the ideals of Older Americans Month.


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