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After Passing Senate Tax Bill, GOP to Target Seniors' Earned Benefits

Maybe it’s no coincidence that the Senate passed its tax bill, vampire-like, in the dead of night.  How very apropos for legislation that could lead to the lifeblood being leached out of programs that the elderly and working class depend on.  Kudos to Senator Bob Corker for being the lone Republican to stand on principle and vote against the bill.  At the same time, Senator Collins, Murkowski, McCain, and other sensible GOP members have disappointed by betraying principles they proclaimed were important during the healthcare battle, but seem to have forgotten during the tax debate.  (Among other things, the bill zeroes out the tax penalty in the Obamacare insurance mandate, which could lead to 13 millions Americans losing coverage and higher premiums for older Americans.)  

In the wake of the bill’s passage early Saturday morning, National Committee President Max Richtman made the following statement:

“Senate Republicans have just given the wealthy and multi-national corporations an early Christmas present by passing the Trump/GOP tax plan, while leaving a lump of coal for seniors and almost everyone else.  The president and his party in Congress are asking the poor, middle class, and elderly to pick up the tab for trillions of dollars in tax breaks that the super-rich and profitable corporations do not need.” - Max Richtman, NCPSSM President, 12/2/17

Senator Susan Collins’ last-minute amendment to retain the current medical expense deduction threshold (up to 10% of adjusted gross income) made the Senate bill a little more tolerable, but not by much.  The House version outright repeals the medical expense deduction – which millions of seniors rely upon to mitigate high out of pocket medical and long-term care costs.  But the biggest poison pill for the elderly in this legislation is the existential threat it poses to Social Security, Medicare, and Medicaid.  

“If enacted, the tax bill will trigger an automatic $25 billion cut to Medicare.  It blows a $1 trillion hole in the deficit, inviting deep cuts to Social Security, Medicare, and Medicaid. It adopts the paltry “Chained CPI” inflation index for calculating deductions and tax brackets, setting a dangerous precedent that could spill over into cost-of-living adjustments for Social Security.” – Max Richtman, NCPSSM President, 12/2/17

The Senate bill is only slightly less objectionable than the House version, which passed in November.  The two must either be reconciled in a House-Senate conference – or the House may vote on the Senate version as-is.  Republican leadership has promised to have the legislation on President Trump’s desk before the holidays, making this one of the rottenest Christmas presents the Congress has ever given the American people. 

As if to confirm the warnings of seniors’ advocates, Republicans have signaled that their next targets after the tax bill are Social Security, Medicare, and Medicaid

“High-ranking Republicans are hinting that, after their tax overhaul, the party intends to look at cutting spending on welfare, Social Security, Medicare and other parts of the social safety net. House Speaker Paul Ryan, R-Wis., said recently that he wants Republicans to focus in 2018 on reducing spending on government programs.” – Washington Post

Senator Marco Rubio (R-FL) admitted as much in an interview with Politico last week, declaring that spending cuts in earned benefits programs will be necessary to pay for tax cuts for the wealthy and multinational corporations.

“We need to generate economic growth which generates revenue, while reducing spending. That will mean instituting structural changes to Social Security and Medicare for the future.” – Sen. Marco Rubio, 11/29/17

Of course, by “structural changes,” Rubio really means cutting earned benefits and turning Medicare into a voucher program.  He and other GOP leaders have been pushing this agenda for years; the difference is that now they have the power to enact it, common sense, decency, or the well-being of seniors be damned.

Senator Rubio’s pronouncements further expose the phoniness of candidate Trump’s promises “not to touch” Social Security and Medicare. By championing the Trump/GOP tax plan, the President has embraced the inevitable efforts to slash both programs to close the deficit. What’s more, the President’s own 2018 budget blueprint called for more than $60 billion in cuts to Social Security Disability Insurance (SSDI).  Notice that we don’t see President Trump contradicting Senator Rubio’s comments to Politico.  We can now safely say that seniors should take Republicans’ word for it:  After giving the wealthy and profitable corporations a multi-trillion-dollar holiday gift, Congress will take an axe to programs Americans have paid into for the entire working lives.

Click here for a detailed analysis of how the Senate GOP tax bill hurts seniors.

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Outrage Crucial as Trump-GOP Tax Scam Gets Dangerously Close to Passing the Senate

When President Trump and Congressional Republicans tried to repeal Obamacare earlier this year, the gross unfairness of taking healthcare away from 20-30 million Americans sparked outrage across the country.  Members of Congress got an angry earful from constituents every time they went back home.  Speaker Paul Ryan’s office got so many calls they had to shut the phone lines down.  Despite multiple attempts to kill the Affordable Care Act, Republicans repeatedly failed under a crush of public pressure.  Senators of conscience, including Sens. McCain, Murkowski, and Collins put principle over party and stood in opposition when it counted.  That is precisely the kind of outrage we need right now as the Trump/GOP tax scam rolls toward passage.

In the face of overwhelming evidence that the Republican plan is a shamelessly giveaway to the wealthy and big corporations, the public must continue to apply as much pressure as possible on elected representatives. (The Senate GOP bill even includes a provision repealing Obamacare’s mandate, and the opposition must rise with equal fervor.)  National Committee president Max Richtman sent a letter to the Senate yesterday urging that the bill be defeated.

Now is the time to seize on the opportunity to stop the Trump/GOP tax juggernaut before it wreaks permanent havoc on the lives of the poor, the sick, the working class, and the elderly. Yesterday the Senate Finance Committee advanced the bill to the floor on a 12-11 party-line vote. A handful of GOP Senators still oppose the plan, but the number is dwindling by the day and no doubt most of them will cave in the end. Meanwhile, in an effort to woo holdouts, Senate tax writers are making the bill even more generous to the wealthy.  

“[A] change demanded by… two unhappy senators — Ron Johnson of Wisconsin and Steve Daines of Montana — would further lower the tax bills of people like President Trump who earn most of their income through limited liability companies, partnerships and other ‘pass through’ businesses that do not withhold taxes on the money passed along to their owners.” – New York Times, 11/28/17

One could rightly ask, where is the outrage on the part of deficit hawks and so-called GOP moderates? What does it even mean to be a moderate who could vote for such a regressive piece of legislation?  Even Maine Senator Susan Collins is negotiating with tax writers instead of remaining firm in opposition.  Hopes that the requisite three GOP Senators will retain the courage to buck this bill are fading fast.

We need to look past the obvious distractions of Trump’s latest tweets and petty feuds and keep our eye on the ball.  The Trump/GOP tax scam is being served up for the benefit of billionaires and corporate titans in the party’s donor base.  Republicans have admitted as much:  big donations will dry up if they don’t get this done.

Months of careful and credible analysis has laid bare the truth about who will pay the price for this irresponsible legislation.  While the 1% get trillions in tax relief, many working class Americans will see their taxes go up in the next ten years:

Almost every independent evaluation of the House and Senate plans has found a $1 trillion tax cut for corporations and changes to the individual tax code that would benefit wealthier Americans while leading to millions of middle-class and lower-income people paying higher taxes than they do now. – Dylan Scott, Vox
Those earning under $10,000 would see their taxes rise by a cumulative $100 million; those earning between $10,000 and $20,000 would see taxes rise by $638 million; those earning between $20,000 and $30,000 would see taxes rise by almost $1.2 billion; and those earning between $30,000 and $40,000 would see taxes rise by $653 billion. – Politifact.

According to Politifact, some 40 million Americans would pay higher taxes in 2027 than they would today. Older Americans would be hit particularly hard.  Not only might their taxes go up if they are not fortunate enough to inhabit the upper income echelons, but the tax legislation would automatically trigger $25 billion in immediate cuts to Medicare.  The projected $1.5 trillion the tax cuts would add to the national debt would no doubt spur Republicans to pursue even deeper cuts to seniors’ earned benefits, leading to benefit cuts and higher eligibility ages for Medicare and Social Security.  Melissa Favreault of the nonpartisan Tax Policy Center warns:

Unless the tax cuts spur immense economic growth, which many prominent economists doubt based on decades of evidence, these cuts will harm future workers and Social Security and Medicare beneficiaries. – Melissa Favreault, Tax Policy Center

Not to mention that the Trump/GOP budget plan calls for over a trillion dollars in cuts to Medicaid, which millions of seniors rely on for long-term care.  Is it fair to punish current and future generations of seniors so the rich and multinational corporations can pocket trillions they don’t even need? 

Republican members of Congress continue to shill for the plan, perpetuating the lie that it provides significant tax relief for the middle class (it clearly doesn’t) or that it will grow the economy and create jobs (a myth disproven by history time and again).  The mainstream media focuses largely on the “horse race” aspect of the tax debate – who’s up, who’s down, how badly President Trump and the GOP need a “win.” Meanwhile, we know who loses, including large swaths of President Trump’s own base in the working class, which is perhaps the most egregious betrayal of all.  As Dylan Scott points out in Vox, candidate Trump promised to bring a new kind of populism to Washington.  “The forgotten men and women of our country will be forgotten no longer,” said the President at his inaugural.  

“Trump promised that the big, beautiful tax cut Republicans would pass would be a tax cut for the middle class. He went so far as to claim that he himself, allegedly worth $10 billion, would not benefit. He pledged that he wouldn’t be swayed by the Washington lobbying class.” – Dylan Scott, Vox

Those millions of working class Americans seem to have been all but forgotten now.  The President and the Republicans in Congress are clearly hoping that most voters are, in fact, distracted or looking the other way as they pull off one of the biggest transfers of wealth in U.S. history.  But we must not look the other way, or soon it will be too late.


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The Week Brings Good & Bad News for Medicaid

Let’s start with the good news. Yesterday, voters in Maine overwhelmingly approved the expansion of Medicaid in their state (59% to 41%), bucking the will of Republican Governor Paul LePage. The Governor had vetoed Medicaid expansion five times, but the people had the final say in yesterday’s referendum.  Now, some 70,000 Mainers should be newly eligible for Medicaid.  That includes thousands of older residents not yet eligible for Medicare who can’t afford private health coverage.  Forbes calls the outcome a “victory for Obamacare.” 

A spokesman for the group that sponsored the ballot initiative starkly defined the stakes.

“Too many Mainers have already waited too long for health care. They shouldn’t have to wait any longer. The governor cannot ignore the law or the Constitution of Maine. Simply put, the governor does not have veto power of citizen’s initiatives and he cannot ignore the law.” – David Farmer, Maine Medicaid expansion advocate

The federal government will cover 90% of the cost of expansion, injecting nearly $500 million into Maine’s economy in the next two fiscal years. A recent study says those federal funds will generate 6,000 new jobs (mostly in the health sector). 

Maine becomes the 33rd state (including D.C.) to expand Medicare.  But as Sarah Kliff writes in Vox, the way Maine did it provides a potential template for expanding the program in other states:

Maine is the first state to expand Medicaid during the Trump administration, and also the first to do so via a ballot initiative than legislation. This offers a possible playbook for health care advocates in other states looking to extend coverage but stymied by political opposition. – Sarah Kliff, Vox 11/7/17

Of the 17 holdout states, Utah, Idaho, and Kansas may see Medicaid expansion on the ballot in 2018.  Increased coverage, better access to care, and a huge economic boon should make this an obvious ‘yes’ vote – though outcomes are not guaranteed, especially without robust advocacy.

Advocates can expect the same kind of pushback from conservatives in these other states.  Governor LaPage peddled the falsehood that the expansion would put an unsustainable financial burden on the Maine government.  The Portland-Press Herald reports that the governor also perpetuated the myth that expanding Medicaid would give “free” healthcare to “able-bodied adults who can work and contribute to their own health insurance costs.”

And that leads us to some bad news, which is that the Trump administration is using that same canard to chip away at Medicaid in red states across the country.  Seema Verma, administrator of the Centers for Medicare and Medicaid Services (CMS), announced a rule change this week that will allow states to impose work requirements on Medicaid beneficiaries.  This supposes, of course, that there are legions of lazy Medicaid enrollees who could work, but just don’t want to – a total myth.

As Talking Points Memo reported, most adults on Medicaid suffer from some of disability and cannot work.  According to a 2017 study by the Kaiser Family Foundation, only 27% of Medicaid beneficiaries are adults without disabilities.  Of those, 60% are, in fact, working.  Most of the recipients not working have one of the following extenuating circumstances: 

  1. Caring for a family member full-time
  2. Lack of jobs in their area
  3. Criminal record prevents employment

The bottom line:  most of the Medicaid recipients who can work do work

These new conditions will especially onerous for some six million older Americans (age 45-64) currently on Medicaid.  This age group experiences more disability and chronic illness than younger recipients do.  If forced to go without care because of new restrictions, they will arrive at the doorstep of Medicare in worse health, which can drive up program costs. 

The Obama administration had it right, by allowing rule changes at the state level which “increase and strengthen overall coverage of low-income individuals” and “improve health outcomes for Medicaid and other low-income populations.” The Trump administration, under Verma’s leadership, is showing its contempt for the elderly and poor – and knee-jerk suspicion of federal programs that actually help society’s most vulnerable. What’s more, CMS’ new rules defy candidate Trump’s promises to “not touch your Medicaid.” But as we’ve seen with his pledges to protect Social Security and Medicare, the President’s promises are not worth the megabits they’re tweeted on. 


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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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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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