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Trump's Executive Order on Healthcare is Bad Medicine

With all the skill of a surgeon wielding a machete, President Trump signed an executive order today that could undermine the affordability and quality of health insurance in America.  Republicans in Congress couldn’t enact their ill-considered legislation to repeal Obamacare, so the President hastily reached for his pen, despite admitting earlier this year that he had no idea “healthcare could be so complicated.”

The executive order instructs Trump’s cabinet agencies to look at ways to allow insurers to sell health policies across state lines.  The aim is to open-up association health plans (currently covering employees of various businesses and organizations) to people in the individual market.  These insurance policies would not be subject to Obamacare rules mandating coverage for pre-existing conditions or essential benefits, in theory making them cheaper – but also skimpier.  

These lower-cost, bare bones plans could siphon off younger and healthier enrollees, leaving older and sicker patients in the Obamacare exchanges and driving up their premiums. Ultimately, this could result in a death spiral for Obamacare, as we discussed on today’s Behind the Headlines Facebook Live broadcast. The administration’s own Centers for Medicare and Medicaid Services (CMS) says on its website:

Older Americans between ages 55 and 64 are at particular risk: 48 to 86 percent of people in that age bracket have some type of pre-existing condition. 

To some, the idea of selling insurance across state lines sounds appealing. (Republicans have been proposing this scheme in one form or another since 2005.)  Senator Rand Paul (R-KY) has been pushing it hard this year. But evidence – and history – indicate that the idea doesn’t work.  This Kaiser Health News video briefly and crisply explains why.

Not only does the selling-across-state-lines concept undermine important patient protections and drive up premiums for the most vulnerable, it has never proven viable for insurers or the insured.  According to today’s Hill newspaper:

A few states have opened their borders to out-of-state health insurers, and the response has been a uniform, “Thanks, but no thanks.”

One of Obamacare’s architects, Dr. Zeke Emanuel, told CNN today that, in addition to other concerns, association health plans have a “checkered history” and are especially vulnerable to fraud and scam artists. “Hundreds of thousands of people could be affected by fraud, unreimbursed medical bills,” he warned.  Emanuel also cautioned that patients with employer-provided insurance could see their rates rise “significantly.”

The biggest problem of all, though, is that Trump’s executive order may well be illegal.  The New York Times reports:

Several experts in healthcare and employment law said Trump’s plan could violate the U.S. Employee Retirement Income Security Act (ERISA), a federal law that governs large group plans that must be provided or maintained by employers or employee organizations.

In fact, a coterie of Democratic states attorneys general are poised to sue the administration if it enacts these harmful changes.

For all the Republicans’ talk of federalism, the executive order would actually weaken states’ power to regulate insurance markets, which is one of their primary responsibilities in the health care arena.

But as with the President’s trickle-down tax plan and other haphazard policies, history, precedent and data don’t seem to matter to this White House.  That’s especially troubling when – once again – the most vulnerable members of society will pay the price.


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Mitch McConnell's "Secret" Healthcare Plan... and the SeniorHeroes who could stop him

When the House passed its American Health Care Act (AHCA) last month, conventional wisdom said it was doomed in the Senate.  Moderate Republican Senators would never go along with the more harmful provisions of the House bill – or so the narrative went.  It appears those predictions were off base.  If the latest reporting from Capitol Hill is accurate, Majority Leader Mitch McConnell has put the Republican healthcare plan on a fast-track for passage in late June or early July.  A 13-member working group has been meeting in secret to craft the Senate version of the AHCA – without committee hearings.  Zero open debate.  Zero public input.  Or as the Washington Post described the process:  “sabotage, speed and secrecy.”  In order to keep pushback to a minimum, McConnell may not release the details of the bill until about 48 hours before the Senate votes on it.  That is insufficient time for Senators – and the public at large – to evaluate legislation that could dramatically affect the lives of tens of millions of Americans.

 Another false prediction from a few weeks ago said that the Senate would scrap the House bill and start from scratch. But this week Senator John Cornyn (R-TX) revealed that the Senate bill retains about 80% of what the House passed.  Since the House bill was so unequivocally bad for older Americans, hearing that the Senate version is at least 80% as bad is cold comfort. The Senate leadership will try to appease GOP moderates with the same kind of token gestures that saved the AHCA from defeat in the House.  It is vitally important that those moderates not cave like their House colleagues did.  Too much is at stake for our nation’s seniors and Americans as a whole.

 The National Committee has identified 11 moderate GOP Senators who may be persuaded to vote against the Republican health care plan – if they are willing to put their constituents’ well-being above party and political expediency.  They are:

 Sens. Lisa Murkowski and Dan Sullivan (R-AK)

Sens. John McCain and Jeff Flake (R-AZ)

Sen. Cory Gardner (R-CO)

Sen. Charles Grassley (R-IA)

Sen. Susan Collins (R-ME) 

Sen. Dean Heller (R-NV)

Sen. Rob Portman (R-OH)

Sen. Lamar Alexander (R-TN)

Sen. Shelley Moore Capito (R-WV)

 In fact, we call on these Senators to become what we call “SeniorHeroes” – real-life superheroes standing up for older Americans while the rest of their party pursues a dubious scheme.  From what we know of the Senate bill, there isn’t much in the evolving Senate bill for moderates to applaud.  Sen. Lisa Murkowski expressed those doubts publicly on Thursday.  Here are some of the key areas where the Senate version will likely fail older Americans:

 MEDICAID EXPANSION.  Senate Republicans are considering “compromises” that would phase out funding more slowly – but do not appear to be considering any approach that would maintain Medicaid expansion over the long run.  (Many of the more moderate Senators represent states which chose to expand Medicaid – and have a lot to lose.)

 PER CAPITA CAPS.  The Senate reportedly will retain the House-passed bill’s Medicaid per capita caps, which would strain state budgets and possibly force rollbacks in benefits or outright termination of coverage for millions of seniors who depend on Medicaid to pay for long-term care.  Although it’s unclear whether the Senate will keep the House bill’s $834 billion in Medicaid cuts, Medicaid still likely will be slashed by hundreds of billions of dollars. 

PRE-EXISTING CONDITIONS AND ESSENTIAL HEALTH BENEFITS.  The Senate may reject provisions in the House bill that would have allowed insurers to charge higher premiums for individuals with pre-existing conditions, but will likely allow states to waive essential benefits coverage.  This would dearly cost older Americans seeking essential benefits, such as hospitalization, ambulance services, and rehabilitation services. 

TAX CREDITS.  The House bill would drive up seniors’ out-of-pocket costs by replacing Obamacare’s income-based subsidies with tax credits based solely on age.  Older Americans could pay up to 800 percent more in net premiums under this plan.  The Senate has toyed with making these tax credits more “robust,” but the more it increases these credits, the deeper it must cut Medicaid to match the savings in the House bill. 

We do not know whether the Senate will allow insurers to charge older enrollees five times more than younger ones, as the House legislation does.  Also uncertain is whether the Senate will repeal the Medicare payroll tax on high income wage earners (as the House did), which would reduce the solvency of Medicare by three years.

It’s a safe bet that, like the House version, the Senate GOP healthcare plan will cost older Americans more, make essential health benefits harder to obtain, and cause millions who desperately need healthcare to lose coverage.  GOP moderates will be under intense political pressure to toe the line and support the party’s plan, even though the Republican bill has scant public support in even the reddest of states.  In asking GOP moderates to don their capes and become SeniorHeroes, we hope they remember who they were elected to serve.  It certainly wasn’t Mitch McConnell. 

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For more about the GOP's secret Senate healthcare plan, watch this week's "Behind the Headlines" on Facebook Live from Capitol Hill. 

 

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Oh, yes: the Trump Budget Definitely Does Cut Meals on Wheels

 

Would the Trump administration and its acolytes please stop saying that the President's budget does not cut funding for Meals on Wheels?

Just today, Budget Director Mick Mulvaney made that very claim at a House hearing on the new budget: 

"Let's talk about Meals on Wheels, because we don't reduce it.” – Mick Mulvaney, Trump Budget Director, 5/24/17

Meals on Wheels is a program that delivers hot meals to more than 2.4 million needy seniors across the country every year. Volunteers not only deliver sustenance; they check in on isolated seniors and provided a much needed human connection.


Anyone looking at the actual numbers can plainly see that the Trump budget does, in fact, slash funding for Meals on Wheels. In addition to cutting Older Americans Act home-delivered meals by $1.5 million, the President’s budget eliminates the Community Services, Community Development and Social Services Block Grants, upon which some Meals on Wheels programs rely for funding.

Because of previous budget cuts, Older Americans Act nutrition programs are already serving 23 million fewer meals than in 2005.  The loss of Community Services Block Grants ($715 million), Community Development Block Grants ($3 billion) and Social Service Block Grants ($1.7 billion) funding for home delivered meals would increase the number of seniors threatened by hunger.

According to Feeding America, 5.7 million Americans over the age of 60 were food insecure as of 2014. That means 9% of all seniors in the wealthiest nation in the world are at risk of going hungry.  Worse yet, the number of food insecure seniors is projected to increase by 50% when the youngest of the Baby Boom Generation reaches age 60 in 2025. There are waiting lists in every state for seniors who need food assistance. Cutting Meals on Wheels funding at a time of growing need is outrageous and dangerous.

In a letter to the editor of the Washington Post on March 20th, National Committee President Max Richtman recounted his days as staff director for the Senate Select Committee on Aging.  He tells the story of a Republican Senator who changed his mind about the program after riding along with a Meals on Wheels van:

“He (the GOP Senator) was impressed by not only the sustenance of the food, but also the seniors’ human connection to the volunteers, and became an enthusiastic advocate for the program.” – Max Richtman, Letter to the Editor of the Washington Post

At the end of the letter to the editor, Max suggested that a certain occupant of the White House follow the Senator’s lead. 

Perhaps Mr. Trump should ride with a Meals on Wheels van and witness the profound benefits to our nation’s most vulnerable seniors.

That suggestion seems even more appropriate today, given that the President obviously has no problem defunding Meals on Wheels in his new budget.  Perhaps Mick Mulvaney should ride along with him.

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Will Seniors Reject Republicans in 2018?

Older voters have been gravitating to the Republican party for the better part of the past two decades. Forty-eight percent of seniors identify or lean Republican compared to 45% for Democrats --- and Donald Trump won 53% of the senior vote last Fall.  But are we about to witness a “grey” re-alignment?  According to an article in today’s The Hill newspaper, Democrats say maybe so.  Democratic strategists are hoping that Republicans are starting to repel seniors by striving to repeal Obamacare, gut Medicaid, privatize Medicare and cut Social Security.  It doesn’t help that President Trump’s proposed budget slashes federal block grants that help pay for Meals on Wheels and other programs that stabilize and support seniors.

In a Facebook Live broadcast with National Committee President Max Richtman today, Congresswoman Jan Schakowsky (D-IL) agreed that seniors may swing back to the Democratic party in the next election cycle.  “Republicans like to imply that seniors are greedy geezers,” Schakowsky said, “But their Obamacare replacement would have allowed seniors to be charged up to 500% more than younger Americans for private health insurance.”

There are myriad reasons for older voters’ preference for the GOP in recent years.  The majority of white voters identify as Republicans --- and some 85% of today’s seniors are white.  Many of today’s older voters came of age during the prosperous post-war America of the 1950s – and may feel alienated by cultural changes associated with the Democrats.  In fact, candidate Trump skillfully played on seniors’ nostalgia for a bygone (and in many ways, imaginary) America.

Another factor may be that seniors have felt supremely confident – some would say overly confident – about the sanctity of the two federal programs that benefit them the most, Social Security and Medicare.  The Democrats may have done such a good job protecting these programs that seniors simply take them for granted.   In fact, the last time that the majority of seniors voted Democratic was in the 2006 congressional elections, after President George W. Bush tried to privatize Social Security.  Democrats and seniors’ advocates like the National Committee stopped him.  On the other hand, President Trump won the senior vote not only by thrumming the strings of nostalgia, but by promising not to touch Social Security, Medicare, and Medicaid (promises he is already breaking). 

To win back seniors in 2018 and beyond, Democrats must remind them that Republicans are an existential threat to our cherished retirement and health security programs.  In other words, thanks to the GOP, the time for overconfidence in the inevitability of Social Security, Medicare and Medicaid is over.  President Trump is already shattering his sacred promises to older voters.  He fought for the GOP’s American Health Care Act which would have cut nearly $1 trillion from Medicaid (on which poorer seniors depend for long-term care) and reduced the solvency of Medicare by three years.  House Speaker Paul Ryan still dreams of turning Medicare into a voucher program.  Congressman Sam Johnson (R-TX) is pushing a bill to cut cost of living adjustments (COLAs) for Social Security and raise the retirement age to 69. And despite his campaign vows, the president has surrounded himself with budget hawks who are sharpening their knives for seniors’ earned benefits programs.  (Earlier this month, Budget Director Mick Mulvaney questioned whether disability benefits should even be a part of Social Security.)

Democrats must also bust the oft-repeated myths that Republicans use to justify benefit cuts --- that Social Security and Medicare are going “bankrupt” and need to be “modernized” (translation: privatized and cut).  If Congress does nothing, Medicare still will be able to pay 87% of benefits beyond its 2028 “insolvency” date and Social Security 79% of benefits beyond 2034.  To win the senior vote, Democrats must push the kind of modest and manageable solutions proposed by Senator Bernie Sanders, Congressman John Larson (D-CT), and others to keep these programs solvent for the long haul – with no benefit cuts.

Recent polling suggests that the party who sides with seniors on these crucial issues will reap political gains.  The National Committee’s own poll of likely voters showed overwhelming support for traditional Social Security and Medicare.  Even more encouraging, strong majorities opposed benefit cuts and higher eligibility ages --- and favored boosting benefits by scrapping the payroll tax cap so that the wealthy pay their fair share. As long as Democrats back up their rhetoric with action and vigorously oppose harmful changes to Social Security, Medicare, Medicaid, and Obamacare, they have a decent shot at winning back those coveted seniors at the ballot box.

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Will Seniors Reject Republicans in 2018?

Older voters have been gravitating to the Republican party for the better part of the past two decades. Forty-eight percent of seniors identify or lean Republican compared to 45% for Democrats --- and Donald Trump won 53% of the senior vote last Fall.  But are we about to witness a “grey” re-alignment?  According to an article in today’s The Hill newspaper, Democrats say maybe so.  Democratic strategists are hoping that Republicans are starting to repel seniors by striving to repeal Obamacare, gut Medicaid, privatize Medicare and cut Social Security.  It doesn’t help that President Trump’s proposed budget slashes federal block grants that help pay for Meals on Wheels and other programs that stabilize and support seniors.

In a Facebook Live broadcast with National Committee President Max Richtman today, Congresswoman Jan Schakowsky (D-IL) agreed that seniors may swing back to the Democratic party in the next election cycle.  “Republicans like to imply that seniors are greedy geezers,” Schakowsky said, “But their Obamacare replacement would have allowed seniors to be charged up to 500% more than younger Americans for private health insurance.”

There are myriad reasons for older voters’ preference for the GOP in recent years.  The majority of white voters identify as Republicans --- and some 85% of today’s seniors are white.  Many of today’s older voters came of age during the prosperous post-war America of the 1950s – and may feel alienated by cultural changes associated with the Democrats.  In fact, candidate Trump skillfully played on seniors’ nostalgia for a bygone (and in many ways, imaginary) America.

Another factor may be that seniors have felt supremely confident – some would say overly confident – about the sanctity of the two federal programs that benefit them the most, Social Security and Medicare.  The Democrats may have done such a good job protecting these programs that seniors simply take them for granted.   In fact, the last time that the majority of seniors voted Democratic was in the 2006 congressional elections, after President George W. Bush tried to privatize Social Security.  Democrats and seniors’ advocates like the National Committee stopped him.  On the other hand, President Trump won the senior vote not only by thrumming the strings of nostalgia, but by promising not to touch Social Security, Medicare, and Medicaid (promises he is already breaking). 

To win back seniors in 2018 and beyond, Democrats must remind them that Republicans are an existential threat to our cherished retirement and health security programs.  In other words, thanks to the GOP, the time for overconfidence in the inevitability of Social Security, Medicare and Medicaid is over.  President Trump is already shattering his sacred promises to older voters.  He fought for the GOP’s American Health Care Act which would have cut nearly $1 trillion from Medicaid (on which poorer seniors depend for long-term care) and reduced the solvency of Medicare by three years.  House Speaker Paul Ryan still dreams of turning Medicare into a voucher program.  Congressman Sam Johnson (R-TX) is pushing a bill to cut cost of living adjustments (COLAs) for Social Security and raise the retirement age to 69. And despite his campaign vows, the president has surrounded himself with budget hawks who are sharpening their knives for seniors’ earned benefits programs.  (Earlier this month, Budget Director Mick Mulvaney questioned whether disability benefits should even be a part of Social Security.)

Democrats must also bust the oft-repeated myths that Republicans use to justify benefit cuts --- that Social Security and Medicare are going “bankrupt” and need to be “modernized” (translation: privatized and cut).  If Congress does nothing, Medicare still will be able to pay 87% of benefits beyond its 2028 “insolvency” date and Social Security 79% of benefits beyond 2034.  To win the senior vote, Democrats must push the kind of modest and manageable solutions proposed by Senator Bernie Sanders, Congressman John Larson (D-CT), and others to keep these programs solvent for the long haul – with no benefit cuts.

Recent polling suggests that the party who sides with seniors on these crucial issues will reap political gains.  The National Committee’s own poll of likely voters showed overwhelming support for traditional Social Security and Medicare.  Even more encouraging, strong majorities opposed benefit cuts and higher eligibility ages --- and favored boosting benefits by scrapping the payroll tax cap so that the wealthy pay their fair share. As long as Democrats back up their rhetoric with action and vigorously oppose harmful changes to Social Security, Medicare, Medicaid, and Obamacare, they have a decent shot at winning back those coveted seniors at the ballot box.

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