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House GOP Recklessly Pursues Privatization of Medicare in Budget Process

Congress is targeting the health and financial well-being of America’s seniors by making yet another attempt to privatize Medicare.   Yesterday the House Budget Committee passed the GOP’s FY 2018 budget resolution, which includes Speaker Paul Ryan’s “Medicare premium support” scheme – an innocuous name for turning time-tested senior health care coverage into “Coupon-Care.”  

The House budget blueprint slashes nearly $500 billion from Medicare over ten years and raises the eligibility age from 65 to 67 – along with gutting Medicaid and other social safety net programs for needy seniors.  

The Associated Press had a pithy summary of the painful cuts that the GOP proposes in its new budget:

“The plan, in theory at least, promises to balance the budget through unprecedented and unworkable cuts across the budget. It calls for turning this year's projected $700 billion or so deficit into a tiny $9 billion surplus by 2027. It would do so by slashing $5.4 trillion over the coming decade, including almost $500 billion from Medicare, $1.5 trillion from Medicaid and the Obama health law, along with enormous cuts to benefits such as federal employee pensions, food stamps, and tax credits for the working poor.” – Associated Press, 7/18/17

 National Committee President Max Richtman says that converting Medicare into a voucher program is an existential threat to the program itself. 

 “Over time, giving seniors vouchers to purchase health insurance would dramatically increase their out of pocket costs since the fixed amount of the voucher is unlikely to keep up with the rising costs of health care. And, as healthier seniors choose less costly private plans, the sicker and poorer seniors would remain in traditional Medicare, leading to untenable costs, diminished coverage, and an eventual demise of traditional Medicare, plain and simple.” – Max Richtman, NCPSSM President

Of course, raising the Medicare eligibility age from 65 to 67 as the House spending plan also proposes, is in itself a drastic benefit cut.

Undermining Medicare has been a long-held dream of fiscal conservatives. Their “premium support” proposal is a thinly veiled scheme to allow traditional Medicare to “wither on the vine,” as former House Speaker Newt Gingrich once put it.

Privatization is being sold as “improving customer choice,” but based on the way current Medicare Advantage plans work, private insurance will continue to offer fewer choices of doctors than traditional Medicare does.  If traditional Medicare is allowed to shrink and collapse, choice will disappear, too.

“Weakening Medicare is a politically perilous path for Republicans.  Recent polling indicates that large majorities of Americans across party lines prefer that Medicare be kept the way it is, not to mention that President Trump repeatedly promised to protect the program during the 2016 campaign.” – Max Richtman, NCPSSM President

Meanwhile, the National Committee strongly condemns other priorities of the House Republican budget resolution, as well.  The GOP budget resolution will mean: 

*Hundreds of billions in painful cuts to Medicaid, which seniors depend on for long-term care services and supports.

*Reaffirmation of a House rule that puts 11 million Social Security Disability Insurance (SSDI) beneficiaries at risk of a 7% benefit cut in 2028.

*Reductions to SSI (Supplemental Security Insurance), which provides cash assistance to low-income seniors and people with disabilities.

 *Caps on non-defense spending that will likely lead to devastating cuts to Older Americans Act programs and the Social Security Administration (SSA) operating budget.

 *Slashing of programs that benefit our nation’s veterans and deep cuts to spending on medical research (including cancer, diabetes, heart disease, and other conditions afflicting the elderly).

The savings from these devastating cuts will likely go to tax breaks for the wealthy.  Last year’s House Republican tax plan gave 99.6% of its benefits to the top one-percent of earners, with virtually nothing for middle and low income Americans.

 

 

Social Security and Medicare are Financially Sound, Not “Going Bankrupt,” says Trustees Report

The 2017 OASDI Trustees Report confirms that the Social Security Trust fund is stable and healthy for now, but faces challenges in the future if corrective action is not taken.  The most important figures remain consistent with last year’s report:  The combined OASDI (Old-age, Survivor, and Disability Insurance) trust funds will remain fully solvent until 2034, after which Social Security can pay 77% of benefits if there are no changes to the program. The Trustees report there is now $2.847 trillion in the Social Security Trust Fund, which is $35.2 billion more than last year --- and that it will continue to grow by payroll contributions and interest on the Trust Fund's assets.  

This reassuring report will not stop Social Security’s opponents from seeing the glass half-empty and claiming that the program is in dire financial trouble.  Expect to hear more false cries about Social Security (and Medicare) going “bankrupt” in the coming months. 

“Opponents of Social Security may once again try to use this report as an excuse to cut benefits, including raising the retirement age.  We must, instead, look to modest and manageable solutions that will keep Social Security solvent well into the future without punishing seniors and disabled Americans.” - Max Richtman, NCPSSM president and CEO

The National Committee endorses bills introduced by Senator Bernie Sanders (I-VT), Rep. John Larson (D-CT) and others, which keep the Social Security trust fund solvent while boosting benefits and cost-of-living adjustments (COLAs).  The bills achieve this mainly by phasing out the payroll tax income cap so that the wealthy pay their fair share into Social Security.

Forty percent of seniors (and 90% of unmarried seniors) rely on Social Security for all or most of their income.  The average monthly retirement benefit of $1,355 is barely enough to meet basic needs, and the Trustees’ latest projected cost-of-living increase of 2.2% will not keep pace with seniors’ true expenses. 

The news media touted the 2.2% bump for 2018 as “the largest in several years.” While it’s true that next year’s COLA is far superior to this year’s 0.3% increase, it is still woefully inadequate.  What the media don’t always explain is that a 2.2% increase translates into an extra $28 per month – hardly a fortune for seniors struggling to meet rising expenses on fixed incomes. A single co-pay for a prescription or a trip in a wheelchair van could easily gobble up $28, if not more.

Currently, Social Security cost of living increases are pegged to the Consumer Price Index for Wage Earners or CPI-W.  This index does not reflect seniors’ true expenses.  Older Americans pay a disproportionate share of their limited incomes for items like housing and medical care compared to younger wage earners.  The National Committee advocates the adoption of the Consumer Price Index for the Elderly (CPI-E), which tracks rising costs for the goods and services seniors actually spend their money on.  The leading categories are Housing, Transportation, Food and Medical Care.  As the National Committee’s Webster Phillips told CBS Radio News: 

“The consumer price index for the elderly (CPI-E), which is focused on the spending patterns of seniors, is a better measure of inflation as it affects older people’s consumption patterns.” – Webster Phillips, NCPSSM Senior Policy Analyst, 7/13/17

On Medicare, the Trustees report shows that the Part A Trust Fund will be able to pay full benefits until 2029, and 88% thereafter if nothing is done to bolster the system’s finances.  Depending on what the final version looks like, the Republican healthcare plan could reduce the solvency of Medicare by two years. The National Committee opposes the GOP health plan and rejects efforts to privatize Medicare – which Speaker Ryan and the House Republicans have promised to undertake during the budget resolution process for 2018.

Instead of privatization, the National Committee champions innovation and continuing efficiencies in the delivery of care, allowing Medicare to negotiate prescription drug prices, and restoring rebates the pharmaceutical companies used to pay the federal government for drugs prescribed to “dual eligibles” (those who qualify for both Medicare and Medicaid) – in order to keep Medicare in sound financial health.

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.”

Mr. President, Stop Saying Obamacare Is Imploding (Because It's Not)

updated 7/10/17

During a CNN focus group of Trump voters last week, one educated, white collar professional said that the Republican congress had to repeal and replace Obamacare because it is “imploding.”  That Trump supporter directly mimicked Trump’s own comments about Obamacare – comments which are patently misleading.  This proves once again the effectiveness of demagogic language (“Obamacare is a disaster!”) shamelessly applied to important policy questions that impact almost every American.

Obamacare is most definitely not imploding, but Trump and the GOP in Congress have convinced an awful lot of people that it is – simply by repeating the same falsehoods on a regular basis. Why does this matter?  It matters because the Senate may vote on its Obamacare repeal and replacement plan within the next couple of weeks.

The GOP’s Better Care Reconciliation Act would deprive 22 million Americans of health coverage over the next ten years and gut Medicaid, hitting the old and the sick unusually hard. As long as Republicans continue to justify repeal with false claims that Obamacare is in a “death spiral,” advocates for the most vulnerable members of our society must continue to call them out.

Both the New York Times and the Washington Post this week found it necessary to debunk misleading Republican claims about Obamacare and the Senate bill to replace it.  The Times entitled its piece, “Five Misleading Republican Claims About Health Care,” while the Post went with “Decoding the White House spin on Obamacare ‘failures.’”  The papers’ fact-checkers had plenty of material to work with. 

These and other analyses are crucial to understanding what’s really happening with Obamacare and the GOP repeal and replace legislation:

1) Obamacare is not “imploding” or in a “death spiral.”  Despite recent instability mostly induced by the Trump administration and Congress itself, Obamacare is hardly imploding.  A new study by the Kaiser Family Foundation suggests that Obamacare markets are, in fact, "stabilizing" and "regaining profitability."  The CBO forecasts that the Obamacare system will remain stable for the foreseeable future - if it is not further undermined. 

2) Premiums for Obamacare policies are not generally rising 200-300%.  Though a few states have unfortunately seen triple digit premium hikes, the National Conference of State Legislatures found that average premium increases nationwide were 25% this year.  Because some 84% of enrollees’ premiums are covered by Obamacare subsidies, few feel the effects of the increases.  Their net costs may even decrease.  

As the Post’s fact-checkers point out, “Average insurance premiums in the Obamacare marketplace now are about at the level predicted by the Congressional Budget Office for 2017 when it first evaluated the law in 2009.”  In other words, some premium hikes were predictable as the new marketplaces found their footing – and not likely to be repeated every year.

3) Insurers are not abandoning state insurance exchanges in droves.  The Post reports that an average of five insurers participated in each state’s marketplace in 2014, ranging from one to 16 companies per state. According to the Kaiser Family Foundation, the average number of insurers in 2017 is 4.3, ranging from one to 15 companies per state.  Not a huge decline.  Still, “slightly more than 2 million people, mostly in rural areas, don’t have competitive plans to choose from and are seeing premium increases,” writes the Post’s Dana Milbank.  But again, many of those premium hikes are offset by Obamacare subsidies.

4) The Trump administration and Congress could have done a lot more to stabilize Obamacare; instead they undermined it.  Here’s how:  

*The administration balked at paying cost-sharing subsidies that would have relieved financial pressure on reluctant insurers.

*President Trump signed an executive order soon after taking office instructing federal agencies not to enforce the Obamacare mandate that all Americans have health insurance, discouraging participation in the exchanges.

*The administration ended public outreach efforts to encourage Americans to sign up for health care.

*In fact, President Obama and the Democrats in Congress asked Republicans to work with them to strengthen Obamacare during the    first six years after the law was passed, only to have the GOP Congress vote to repeal it some 60 times.   

5) The President and his allies in Congress have spooked the insurance markets.  They have sown tremendous uncertainty about Obamacare’s future with their attempts to repeal the law and harsh rhetoric, spooking insurance companies and potential customers.  The former chief marketing officer for HealthCare.gov estimated that Trump’s rhetoric alone has deterred nearly 500,000 people from signing up this year.

Furthermore, the Post reports that figures the White House uses to smear Obamacare are often based on comparisons of the insurance markets from before the law took effect and today.  Such apples-to-oranges comparisons are misleading and not useful.

Meanwhile, the Republicans have employed similar demagoguery to promote their own repeal and replace legislation.  The Times found several GOP claims about the Senate healthcare bill to be factually dubious, including assertions that the legislation does not “pull the rug from anyone currently covered by Obamacare” – and that the bill “reduces taxes on the middle class” when, in fact, the top 1% of earners reap most of the benefits.  The cruel truth is that some 22 million Americans would lose health coverage under the GOP bill over the next ten years, including 15 million Medicaid beneficiaries – many of whom are needy seniors who rely on the program to pay for long-term care.  We must not allow the clever manipulation of language by those who would destroy Obamacare to hurt so many millions. 

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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