In the waning hours of 2018, President Trump signed into law a bipartisan bill to boost federal efforts to address the Alzheimer’s epidemic that impacts some 5.7 million Americans and their families. The BOLD Infrastructure for Alzheimer’s Act provides $100 million in new funding and “restates priorities” in the fight against a disease that’s aptly been called “The Long Goodbye.”
The BOLD Act was cosponsored by Senators Tim Kaine (D-VA), Susan Collins (R-ME), Shelley Moore Capito (R-WV), and Catherine Cortez-Masto (D-NV):
“The… Act will improve early detection and diagnosis, provide assistance for caregivers and educate the public on Alzheimer’s disease and brain health. This bipartisan legislation is the first step in addressing [this] ongoing public health crisis…” – Sen. Catherine Cortez-Masto, BOLD Act co-sponsor
The National Committee, which fights for the financial and health security of America’s seniors, endorsed the bill to confront Alzheimer’s (whose victims are mostly over 65 years of age).
“The BOLD Act would create a public health infrastructure to implement effective interventions to combat Alzheimer’s disease and related dementias including prevention, early detection and diagnosis and treatment.” – National Committee letter endorsing BOLD Act, 5/2/18
While it’s commendable that a bipartisan group of Senators sponsored the bill and that President Trump signed the BOLD ACT into law, defeating the Alzheimer’s epidemic will require much, much more. One-hundred million dollars in new spending over 5 years is a small step forward, and advocates for Alzheimer’s victims are right to celebrate. But federal funding for Alzheimer’s research continues to fall short of what is needed to invest in an aggressive and intensive research strategy to develop effective treatment and, hopefully, a cure.
Estimated federal spending on Alzheimer’s research was some $1.8 billion in 2018, compared to President Trump’s demand for $5.6 billion for his border wall. His administration’s Fiscal Year 2019 budget called for a freeze in biomedical research. A significant shift towards disease research priorities is urgently needed.
Alzheimer’s is a fatal scourge deserving considerably higher funding. It is the 6th leading cause of death in the United States, felling more Americans than breast and prostate cancer combined. A startling one in three seniors dies with Alzheimer’s or other form of dementia. By 2050, the disease is expected to claim 14 million victims – almost three times the number of Alzheimer’s patients today.
The disease also poses a direct threat to Medicare and Medicaid. In 2018, the two programs spent an estimated $186 billion caring for beneficiaries with Alzheimer’s and other dementias – representing nearly 70 percent of total costs. “By 2050, combined Medicare and Medicaid spending on patients with Alzheimer’s is expected to quadruple to $750 billion (in today’s dollars),” according to the nonprofit Alzheimer’s Impact Movement. This is an enormous financial burden for Medicare and Medicaid, which seniors’ advocates are already fighting to strengthen in the face of conservatives’ demands for benefit cuts.
The nearly six million Americans suffering from Alzheimer’s, along with their families and caregivers, rightly expect an increased funding commitment from the federal government. The beginning of the 116th Congress – with its fresh faces and new leadership – presents an opportunity to build on the BOLD Act and put more brain power into the fight. It’s time for our national leadership to muster the political will to defeat Alzheimer’s before the grim estimates for the future become reality.
It’s unfortunate that in a desperate attempt to fill the White House chief of staff position vacated by General John Kelly, President Trump turned to an avowed ‘entitlement reformer.’ The new acting chief of staff, Mick Mulvaney, is an outspoken fiscal hawk committed to cutting Social Security and Medicare. This should be of concern to seniors and their advocates.
Vox called the former South Carolina Congressman, current director of the Office of Management and Budget, and temporary head of the Consumer Financial Protection Bureau “a very ideologically orthodox conservative who hates the idea of spending money on domestic social assistance programs.”
As budget director, Mulvaney pressured the president to cut Social Security and Medicare – despite Trump’s campaign promise “not to touch” either program. In fact, the budgets Mulvaney submitted to Congress on behalf of the Trump administration called for some $500 billion in cuts to Medicare and $64 billion to Social Security Disability Insurance (SSDI).
According to news reports, Mulvaney convinced the President to accept the cuts to SSDI by telling him that the federal disability program was “welfare.” The president reportedly responded, “OK. We can fix welfare.”
In 2017, Mulvaney told the moderator of CBS Face the Nation that SSDI is not really Social Security:
“Let me ask you a question, do you really think that Social Security Disability Insurance is part of what people think of when they think of Social Security? I don’t think so… It’s a very wasteful program and we want to try and fix that.” – Budget Director, Mick Mulvaney, CBS Face the Nation, 3/19/17
That same month, Mulvaney boasted that he had begun preaching the gospel of “entitlement reform” to the White House:
“I’ve already started to socialize the discussion around here in the West Wing about how important the mandatory spending is to the drivers of our debt. I think people are starting to grab it.” – Mick Mulvaney on Hugh Hewitt radio program, March, 2017
Never mind that tax expenditures (including the Trump/GOP tax scam) are the biggest drivers of the debt, not Social Security and Medicare Part A, which are fully self-funded.
When challenged to explain how his position was consistent with President Trump’s campaign vows, Mulvaney fudged. He suggested that Trump’s promise to protect Social Security and Medicare can be interpreted to allow any measure that helps both programs meet their obligations — “even and especially if those obligations are reduced.” According to Mulvaney’s contorted logic, we must cut Social Security and Medicare in order to save them.
The new acting chief of staff’s enmity for programs that help seniors extends beyond Social Security and Medicare. The budgets Mulvaney authored would have reduced federal home heating assistance and grants that support Meals on Wheels for needy seniors.
“Meals on Wheels sounds great,” said Mulvaney during a 2017 press conference, “[But] we’re not going to spend [money] on programs that cannot show that they actually deliver the promises that we’ve made to people.” The millions of seniors who receive hot meals every day from Meals on Wheels might disagree that the program doesn’t deliver on its promises.
Mulvaney’s fox-in-the-henhouse tenure as head of Trump’s Consumer Financial Protection Bureau (CFPB) cemented the perception that he is no champion of retirees or working people. Vox reported that “Mulvaney’s CFPB pulled back on its investigation of the data breach at Equifax, which exposed the personal information of 145.5 million U.S. consumers to hackers.” Meanwhile, according to the New York Times:
“Mr. Mulvaney…has dropped several of the agency’s lawsuits against predatory payday lenders and has taken a softer stance toward the industry than his predecessor did.” – New York Times, 6/05/18
This is not the man that seniors want whispering in the President’s ear. Given that President Trump tends to act on the last thing he’s heard, Mulvaney’s repeated entreaties may be more effective than when he was budget director. The good news is that Mulvaney is reportedly the one who insisted his title be ‘Acting’ Chief of Staff – and that he doesn’t intend to fill the role for more than six months. For the sake of older Americans, let’s hope that’s accurate.
During the Medicare open enrollment period that ends today, the Trump administration once again asked beneficiaries to choose plans without the benefit of accurate, unbiased information. Throughout this period and the year preceding it, the Centers for Medicare and Medicaid Services (CMS) has unabashedly steered seniors toward private Medicare Advantage plans, while downplaying traditional Medicare.
Case-in-point: The New York Times reported that CMS has been sending emails to millions of beneficiaries encouraging enrollment in Medicare Advantage. The emails uncannily resemble advertising from big insurance companies. Effectively, that’s what they are.
“Get more benefits for your money,” says a message dated October 25. “See if you can save money with Medicare Advantage,” said another sent a week later. The messages – “paid for the by the U.S. Department of Health and Human Services” – urge beneficiaries to “check out Medicare Advantage” and point to an online tool to compare different options. – Robert Pear, New York Times, 12/1/18
CMS’ online plan-finder tool is similarly skewed toward private plans. The questions in the tool’s questionnaire seem to have been selected so that the inevitable answer to the beneficiaries’ needs is… drumroll, please… Medicare Advantage!
The enrollment information on Medicare.gov in general is also biased, largely by omission.
The website features a list of Medicare options, with Medicare Advantage plans at the top. “Original Medicare” is absent from the list. A new beneficiary could be forgiven for not even knowing that original Medicare exists. This is confusing – and misleading.
Unlike Advantage plans, original Medicare does not limit patients to a fixed network of providers, giving patients access to the best doctors and hospitals. Original Medicare covers beneficiaries when they are traveling. And, in combination with a supplemental Medigap policy, original Medicare insulates patients against high out of pocket costs. This bedrock health insurance program has served hundreds of millions of seniors for more than 50 years – with low overhead and no profit motive.
Yet, in its public outreach, CMS almost exclusively touts the benefits of private Medicare Advantage plans. These plans can have certain advantages for some beneficiaries, especially younger and healthier ones. Medicare Advantage plans often include prescription drug coverage, whereas subscribers to original Medicare must enroll under a separate plan (Part D) for that. Medicare Advantage can include extra goodies – including gym memberships and transportation to doctor visits – not covered in the traditional plan.
But the administration rarely mentions the downsides of private plans, which are considerable. Medicare Advantage patients are restricted to a limited network of providers, and may not be covered when traveling. They may encounter coverage limits and denied claims – and experience long delays in appealing claims.
The Trump administration hides the fact that your out-of-pocket costs for in-network care alone in a Medicare Advantage plan can top $6,700 a year. Or that you could wind up paying the entire cost for everything but emergency care if you need treatment while you’re away from home. Or, that the quality of care their providers offer can be poor. – Richard Eskow & Diane Archer, Common Dreams, 12/6/18
These issues may not matter as much to healthier patients, but everyone gets sick at some point. Beneficiaries with acute or chronic conditions often find it difficult to get quality care under Medicare Advantage. But if they try to switch midstream to original Medicare, they may not be able to obtain Medigap insurance to supplement it.
Our organization has partnered with the nonprofit Center for Medicare Advocacy to provide retirees (and near-retirees) with accurate, unbiased information about the two main Medicare options so that they can make a fully informed choice. Appropriately enough, the name of the initiative is the Medicare Fully Informed Project. One of the most compelling features of this project is a “Corrected Medicare & You Handbook,” including ‘red pencil’ notes correcting some of CMS’ misleading or incomplete language in its main consumer publication for Medicare.
There is little mystery as to why CMS is tipping the playing field toward Medicare Advantage. The Trump administration and its CMS chief, Seema Verma, have demonstrated a decidedly pro-corporate tilt in matters where the public interest should be the paramount concern.
Don’t let the insurance industry or the Trump administration deceive you. Don’t let them corporatize Medicare. Instead, let’s de-corporatize everyone else’s health care—and become a healthier, more humane nation. – Richard Eskow & Diane Archer, Common Dreams, 12/6/18
The National Committee does not oppose Medicare Advantage. For some beneficiaries, it may be the most practical choice – at least while they are relatively young and healthy. But we do believe that the playing field between private plans and original Medicare should be level. The Trump administration owes that to the tens of millions of Americans who rely on Medicare for health security in old age.
Instead of taking big, bold steps to lower prescription drug prices, the Trump administration has rolled out yet another incremental measure that merely nibbles at the edges of the problem – while at the same time putting additional burdens on beneficiaries. The Centers for Medicare and Medicaid Services (CMS) unveiled a new proposal this week that would limit coverage for drugs which treat several serious and chronic conditions:
“The Trump administration propose[s]… to cut costs for Medicare by reducing the number of prescription drugs that must be made available to people with cancer, AIDS, depression, schizophrenia and certain other conditions.” – New York Times, 11/27/18
As the New York Times explains, insurance plans providing prescription coverage to Medicare beneficiaries would no longer have to cover all of the drugs in six “protected classes.”
*Antipsychotic medicines (to treat schizophrenia and related disorders)
*Immunosuppressant drugs (to prevent rejection of organ transplants)
*Antiretrovirals (for treating H.I.V./AIDS)
*Various Cancer drugs
Some 45 million Medicare beneficiaries currently receive coverage for at least one of these classes of medications.
“Rather than talk about these incremental measures, it’s time for U.S. to do what every other industrialized country does and allow Medicare to negotiate the cost of drugs,” says Lisa Swirsky, Senior Policy Analyst at the National Committee.
In a 2018 Kaiser Family Foundation poll, 92% of respondents said they favored empowering the federal government to negotiate lower drug prices for people on Medicare. President Trump himself promised on the campaign trail to enact such a policy, but so far has not.
Democrats introduced legislation during the current Congress to allow Medicare to negotiate prescription prices, but GOP leadership refused to consider these measures. The 116th Congress taking office in January will have an opportunity to breathe new life into this effort, which would go much further in knocking down drug prices than anything the administration has proposed.
Meanwhile, proposals like the one just announced by CMS put the onus on Medicare beneficiaries – despite administrator Seema Verma’s claims to the contrary. Verma says that if seniors don’t like the restrictions in a drug plan, they can choose a different one. But Swirsky says it is unrealistic to expect seniors to pore through hundreds of pages of policy documents to divine a plan’s rules regarding protected class drugs. Far from putting seniors in the driver’s seat, as Verma insists, this proposal leaves them in the passenger’s seat – with Big Pharma at the wheel.
National Committee president Max Richtman stumped for Senate candidate Mike Espy in Tupelo, Mississippi yesterday. Democrat Espy faces GOP incumbent Cindy Hyde-Smith in a runoff election next Tuesday after neither captured a majority of the vote on November 6th. Speaking to a crowd of Espy supporters in front of Tupelo’s city hall, Richtman called this a “significant election” and proclaimed that a victory for the Democratic challenger would be “an earthquake.”
Richtman told the crowd that Espy is the candidate who will fight for Social Security, Medicare, and affordable health care. As a Congressman representing Mississippi’s 2nd district from 1987-1993, Espy consistently voted on behalf of senior citizens. His commitment to Mississippians’ earned benefits remains unflagging.
“We owe it to Mississippi seniors to honor and protect the commitment we made to care for them through Social Security and Medicare. It is vital that we safeguard the benefits Mississippians have worked their entire lives to earn.” – MS Senate candidate Mike Espy
Seniors make up 15.5% of Mississippi’s population. The state has some 660,000 Social Security beneficiaries and roughly 560,000 on Medicare.
Richtman joined several prominent national figures who have endorsed Espy for Senate, including former Vice President Joe Biden, Senators Cory Booker and Kamala Harris, and Congressman John Lewis, among others.
Biden declared that Mike Espy “promises to protect Social Security, Medicare and the federal requirement that health insurance companies cover people with pre-existing medical conditions.” Congressman Lewis affirmed that Espy will stand up for seniors’ earned benefits while “taking on the corporations to keep prescription drug prices affordable.”
Espy’s opponent, Cindy Hyde-Smith, is on the wrong side of issues affecting older Americans. Appointed last Spring to fill the seat of Republican Senator Thad Cochran, Sen. Hyde-Smith has voiced support for the Trump/GOP tax scam, voted for the bill designed to give Republican candidates a fig leaf on the issue of pre-existing conditions, and boasted that “no one will work harder” to pass a Balanced Budget Amendment, which would force cuts to Social Security and Medicare.
Her campaign became embroiled in controversy after she joked about attending a “public hanging” – prompting accusations of racism. For his part, the Democratic candidate continues to focus on kitchen table issues that affect working families and retirees.
“Mike believes that Mississippians need access to affordable health care and that fixing health care for the American people will require a bipartisan solution. He wants to lower the cost of prescription drugs and rein in out-of-control insurance premiums, high deductibles, and caps on individual health costs.” – Espy for Senate website
While Republicans will control the Senate regardless of the outcome of Mississippi’s special election, an Espy victory would give the GOP a thinner margin – and increase the chances for improving Social Security and Medicare in the next Congress.
“We feel like Mike Espy is the person we need to have in the Senate,” said Richtman.