Posts Tagged ‘Medicare’

Changes to Medicare Signed into Law

Monday, May 4th, 2015

By Robby Stern

One of the most significant Medicare bills in decades just became law. Every Washington Representative voted in favor of H.R. 2, “The Medicare Access and CHIP Reauthorization Act of 2015” with the exception of Rep. Adam Smith who did not vote. Both of our U.S. Senators also voted for the bill and the President has signed it.

The Congressional Progressive Caucus voted for the bill. Families USA, The Center for American Progress, The Center for Budget & Policy Priorities, SEIU, American Nurses Association, and a whole raft of medical associations supported the legislation. I was told by my contact at the Center for Medicare Advocacy that AARP first opposed the legislation and in the end supported it. Meanwhile, the Tea Party organizations and the ultra-conservative magazine American Spectator hated the legislation for a variety of reasons I will not enumerate here.

Nancy Pelosi joined hands with Speaker Boehner talking about “bipartisan compromise”. Speaker Boehner spoke of H.R. 2 as one of the most significant “entitlement” reforms in decades. What was the compromise and what is it likely to mean in the long term?

When trying to understand what is going on with Medicare policy, I turn to the Center for Medicare Advocacy (CMA), the equivalent of Social Security Works (SSW) in terms of Medicare policy but not nearly as influential politically as SSW. While there are a number of nationally influential organizations that serve on the Board of Social Security Works, from what I can tell, the Board of CMA are individuals who support progressive Medicare policy but do not have nearly the political clout.

After researching this legislation for the last several weeks, I am fairly certain that it will have the long-term impact of continuing the process of undermining traditional Medicare, one of the best hopes for universal health care in our country. I believe some of its provisions will drive a larger proportion of future Medicare recipients into the privatized Medicare Advantage programs.

There were some significant sweeteners in the legislation. The driving force for H.R. 2 was the repeal of the flawed SGR formula for determining payments to physicians. Everyone agreed, including critics of H.R. 2, that the SGR formula was a bad method for determining provider reimbursements. The SGR formula was part of the Balanced Budget Act of 1997. It was a cap on aggregate spending on physician services which led to recurrent lastminute crises. H.R. 2 applies a new and controversial payment system known as “merit-based incentive payment system” (MIPS) which is, as yet, untested. It is based on the principle that levels of reimbursement should be based on quality of the care provided.

I am not ready to pass judgement on this effort to pay for quality. It might be a step forward and then again it might be an administrative nightmare providing lots of opportunities to game the system. I do know that the previous system of paying per procedure created incentives to order tests and procedures that were sometimes unnecessary. I am glad the SGR formula is no longer being used but worry about what they have decided to use to replace it.

The SGR fix is projected to cost $70 billion over 10 years and $35 billion of that will come from Medicare beneficiaries including changes that increase out-of-pocket costs by adding deductibles to Medigap plans purchased in the future, further means-testing premiums for higher-income beneficiaries, and overall increases to Part B premiums.

A big sweetener was that the legislation extends the Children’s Health Insurance Program for two years, which is obviously a good thing, although advocates hoped for a four-year rather than a two-year extension. It also extends funding for community clinics that was part of the Affordable Care Act for an additional two years.

There are two provisions of the legislation which most concern me because I believe they will create even more incentives for Medicare recipients to abandon traditional Medicare and enroll in Medicare Advantage plans, further privatizing the Medicare social insurance system.

Currently, Medigap Plans C and F cover the deductibles that are part of Medicare Part A and B. The Medigap provision in H.R. 2, which takes effect in 2020 for new Medicare enrollees, will eliminate the ability of Medigap plans C and F to cover Part A and Part B deductibles. You can be sure that Medicare Advantage Plans will utilize this provision to entice an even higher proportion of enrollees into private Medicare. It will weaken the traditional Medicare program and strengthen the private insurance market.

As a Medicare recipient, I am in the traditional Medicare program. I purchase a Medigap plan F policy and Medicare Part D prescription drug coverage. Beginning in 2020, the Medicare Advantage plans will be able to develop and promote no- or low-deductible products to new Medicare recipients and continue advertising one premium for all services including prescription drugs. With Medicare Advantage plans receiving higher reimbursement rates (which we heard nothing about in the discussion of H.R. 2) they will have a competitive advantage over traditional Medicare by offering simplicity and smaller or no deductibles.

Additionally, there is a further undermining of Medicare as a social insurance program. Seniors with incomes above $133, 501 or couples with incomes above $267,001 will pay higher premiums. I do not cry crocodile tears for these folks but that is not the point. Part of the principle of a social insurance program is that we all have the same skin in the game. This provision, which further stratifies what was already a stratified payment system, creates less support for the Medicare program across the board among our population. I predict that we will see a movement on the part of higher-income people to remove themselves from the Medicare system and allow themselves to purchase their health insurance separate from the rest of the population. Let’s be clear what that means. In general, this group is a healthier cohort, and if they successfully withdraw from the Medicare system, costs will be driven up. In addition, they will lose their incentive to defend Medicare.

We had genuinely good friends vote for H.R. 2. It is puzzling to me why we heard so little criticism. I hope I am wrong and H.R. 2 improves Medicare, but I have my serious doubts.

Long-Term Care: Why the Government Must Step Up

Monday, May 4th, 2015

By Mike Andrew

Adding a long-term care benefit to Medicare is one of the most important issues PSARA raised in the context of the White House Conference on Aging. There was no commitment from federal officials to do so, but there really is no alternative to the federal government stepping up and covering long-term home health care.

Let’s look at the numbers.

According to the US Department of Health and Human Services, 70% of Americans who are 65 today will need long-term care before they die.

But care is expensive. Insurance industry studies show that the average cost of home health care in the Puget Sound region works out to $28 per hour, or $980 for a 35-hour week, $50,960 for a year of care.

Seniors who need extra care can expect to pay more. Assisted living costs an average of $5,000 per month, and could cost as much as $8,750. Nursing home care averages $276 per day and could go as high as $349.

Puget Sound, by the way, is more expensive than the national average, but few local seniors have the option – or the desire – to move to Mississippi or Alabama to find less expensive home care.

As currently set up, Medicare will pay for skilled nursing care and physical therapy in the patient’s home as they recover from disease or injury, but Medicare will not pay for home health aides to assist seniors with day-to-day tasks – getting into and out of bed, cooking, cleaning, and getting regular exercise. Medicaid will kick in only when seniors have exhausted their own resources, and even then, it is designed mainly to assist people who are not capable of living in their own homes.

But many seniors lack the resources to pay for necessary home care themselves. A recent federal survey found that median household income for people ages 55-64 – in other words, workers who will be retiring in the very near future – was $55,000. For the households that had retirement savings, the median amount saved was $100,000, but half the households don’t have savings at all.

In other words, those people who even had retirement savings have saved enough to pay for only about two years of home health care – if they pay for nothing else!

Although women tend to live longer than men, they earn less and will have saved less when they retire, meaning they will be burdened even more than men by the costs of long-term care.

Similar wage disparities also burden working people of color, who accumulate far less wealth over their working lifetimes than their white co-workers do.

My mother gets survivor benefits from my father’s pension plan as well as Social Security, but pensions are no longer a resource available to most working people. According to the Bureau of Labor Statistics, only 13% of non-unionized private sector workers will get defined benefits pensions, the way my father did when he retired in 1985.

The situation is better for union members (67% will get pensions) and public sector workers (78%), but there are still many workers who will be unable to rely on the resources my mom counts on.

Gay and lesbian workers who are ready to retire will get no survivor benefits – regardless of whether they are members of a union or not – because until very recently we were prevented by law from marrying our partners.

Although many workers are now enrolled in 401(k) plans, these have proven to be a poor substitute for defined benefit pensions.

In other words, the federal government must step up and cover long-term care to provide secure and healthy lives for seniors.

Social Security, Medicare & Labor Day

Friday, August 2nd, 2013

By Robby Stern 

Labor Day will be a special time to send a message to our elected officials and the broader community that working people and retirees insist our earned benefit programs be preserved, strengthened and passed on to the generations to come.

The Martin Luther King, Jr. County Labor Council has invited PSARA and the broader Social Security Works WA coalition to participate in their annual Labor Day Celebration at Woodland Park and also to communicate our message as part of the activities of the day. The picnic draws a large crowd, including elected officials and the press. It is an opportunity to emphasize the critical nature of our earned benefits and the absolute necessity to strengthen these programs so they can become even more effective in the 21st century.

Our activity will begin at 10 a.m. We gather at Lower Woodland Park — Shelters 1, 2 & 3, (N. 50th Street & Woodland Park Avenue N, Seattle). We will walk with our signs to the busy intersection at Greenlake AV N. and N. 50th St, stretch out along the intersection(along the side, not blocking traffic) and wave our signs to passing motorists. If some of us feel inspired and want a little exercise, we can walk to Greenlake with our signs. At 11:30 we march from Greenlake AV N. & N 50th as one large contingent back to the site of the Labor Day Celebration. We will carry our signs to participate in the celebration of Labor Day. (The PSARA table is known for providing a delicious assortment of cookies. All PSARA members are welcome to bring their favorite cookies!)

We will offer everyone at the Celebration the opportunity to wear a newly designed sticker that says “Social Security & Medicare, Preserve Them, Strengthen Them and Pass Them On”.

People we meet at the picnic, on the street and at Greenlake will be asked to call our U.S. Senators and ask them to oppose any cuts to the earned benefits programs (like the chained CPI cut proposed by the President). Our Senators will be urged to fight to make these programs stronger by Scrapping the Cap on Social Security and allowing Medicare to be available to all people in the U.S.

Please join us at 10 a.m. on Labor Day. Meet us at the location where the Labor Day Celebration will be happening and where there is plenty of parking. Late arrivals or those who have a hard time walking can meet us at N 50th & Greenlake AV N where there is also abundant parking.

Help make Labor Day an advocacy day for Social Security and Medicare and also have some fun!!

Medicare’s Birthday

Monday, July 1st, 2013

By Mike Warren 

Celebrate Medicare’s 48th birthday on July 27th. Meet at 2:30 P.M. at the Seattle Center, east of Key Arena at the southwest end of the fountain near the metal sculpture of the dolphins. We will walk through Downtown Seattle to Victor Steinbruek Park starting at 3:00 and ending at 5:00.

People will be gathering in downtown Seattle for the Seafair Torchlight Parade. We will hand out information on the importance of Medicare and the threats it faces. This is a celebration so there will be balloons and noisemakers as well as signs, music and theater. The event is sponsored by Washington Alliance for Retired Americans and Physicians for a National Health Program of Western Washington. All are welcome to join in the festivities.

Mike Warren is President of WA Alliance for Retired Americans & a PSARA Exec. Board member 

Seattle Says: “No Cuts to Social Security, Medicare, Medicaid or Service Delivery”

Wednesday, January 16th, 2013

By Steve Kofahl

On December 5, at the entrance to the building that houses the Social Security Administration Regional Office (SSA RO), nearly 100 people gathered to send our message to Congress. AFGE Local 3937 organized the one-hour rally, one of about 80 held by the Union at SSA offices throughout the country.

Labor, community leaders and activists joined the assembled crowd. What was particularly impressive and inspiring was the involvement by the Asian/Pacific Islander Community. Gary Tang, Director of the Aging and Adult Services Program at the Asian Counseling and Referral Service (ACRS), brought 15 immigrant seniors from the Rainier Valley. Sharyne Shiu-Thornton, Deputy Director of the InterIm Community Development Association, escorted 23 elders who walked from the International District. It was very difficult for them to walk, but that does not compare to the hardship that service barriers have created for them.

Diane Narasaki, ACRS Executive Director and Chair of the Asian Pacific Islander Coalition-King County; Doug Chin of the Organization of Chinese Americans-Seattle; and PSARA Board Member Frank Irigon were among the other community leaders who joined us. Cantonese and Mandarin interpretation of speakers’ remarks ensured that all could fully participate.

Speakers including PSARA President and Social Security Works Washington Chair Robby Stern, Sharyne Shiu-Thornton, and Steve Kofahl insisted that earned benefits be protected during the fiscal negotiations, and that SSA service be restored in our communities.

It was fitting that we were in front of the Regional Office of the Social Security Administration. The Regional Commissioner, Stanley Friendship, recently made the decision to close two of our accessible community offices – one in Belltown and the other in the International District – and to relocate the staff to the fortress that is the Jackson Federal Building. There, visitors must show current government picture identification and are subjected to magnetometers, and x-rays of their belongings. For those who speak little or no English, or who can’t afford to pay for expensive parking (since there is none on site for visitors, even the handicapped), the face-to-face service that is often preferred and needed is difficult or inaccessible.

Comments by Seattle Community Law Center Executive Director Alex Doolittle, PSARA Board Member Chuck Richards, and Asian Counseling and Referral Service Executive Director, Diane Narasaki, reinforced the message of the day – No Cuts to Social Security, Medicare, Medicaid or Service Delivery- just before the event ended at noon.

The fight will continue! PSARA members are urged to call their elected representatives as the 2013 Congressional session commences at 1-888-659-9401. Tell them – No cuts to earned Social Security or Medicare benefits, or Medicaid! No more service cuts!

‘Lame duck’ with a dangerous bite

Friday, November 2nd, 2012

By Will Parry

Immediately after Election Day, a mighty alliance of labor and community organizations will launch a campaign to block any congressional deficit-reduction deal that damages Social Security, Medicare or Medicaid.

The allied groups are deeply concerned over the willingness of leading Democrats, including President Obama, to enter budget talks prepared to yield ground on the three vital programs to get a bipartisan deal.

The lame duck session, between Election Day and the installation of the new Congress, looms as the arena for the battle between the deficit hawks and the defenders of critical social programs.

Puget Sound Advocates for Retirement Action will be vigorously supportive of the campaign.

“People, groups, organizations and networks are working very hard to get Obama and the Democrats elected, and yet we are worried that it is possible that we could be betrayed almost immediately,” said Roger Hickey, co-director of the Campaign for America’s Future.

During talks with House Speaker John Boehner in 2011, White House negotiators agreed to cut at least $250 billion from Medicare over the next ten years, and an additional $800 billion over the following decade, and to water down the formula for determining Social Security cost-of-living adjustments.

“We don’t want Obama putting on the table what he proposed to Boehner,” Hickey said.

The talks within the so-called bipartisan “Super Committee” also raised red flags.
Before the talks collapsed, Democratic senators on the committee proposed hundreds of billions of dollars in cuts to Social Security and Medicare benefits, as well as Medicaid, while Republicans on the committee proposed even bigger cuts.

On the initiative of Senator Bernie Sanders (Independent, Vermont), 29 senators, including Washington State’s Patty Murray and Maria Cantwell, have signed a “Dear Colleague” letter to other senators, urging them to hold the line on Social Security, Medicare and Medicaid.

Sanders, who chairs the Senate Social Security Caucus, has been the foremost member of that chamber in vigorous defense of the three basic programs.

The AFL-CIO, the Service Employees International Union, the Strengthen Social Securities coalition and dozens of other groups are expected to be active in the campaign to prevent the deficit from becoming the pretext for program cuts.

AFL-CIO President Rich Trumka declared that labor will “oppose any cuts to Social Security or Medicare benefits, or to the federal contribution to Medicaid.

“We call on politicians of both parties to stand firm and demand that Wall Street and the wealthy finally pay their fair share – given the extraordinary increases in corporate profits and income inequality in recent years,” Trumka said.

The AFL-CIO will stage a series of coordinated events around the country on November 8, to pressure lawmakers not to sign onto any deficit-reduction deal that raises the Medicare eligibility age or changes the Social Security cost-of-living formula.

In a related development, the Institute for America’s Future, after Election Day, will release a letter signed by 350 economists warning that austerity measures could derail the economic recovery.

Advice to the media

Tuesday, October 2nd, 2012

By Rachael Levine

I am very disappointed in those in the media who continue to talk about “seniors” being relatively well off compared with those who are without any adequate income. No doubt having income from any source is more desirable, but these repeated assertions feed the notion that somehow all seniors are living the life pictured in the AARP magazines.

Herewith, my advice to the media:

When you talk about “seniors,” talk about the difference between those with private income from investments, pensions and savings – and those whose food and roof depend upon Social Security.

Talk about those who retire in relatively good health – then talk about the many for whom multiple health problems begin to demand costly medical attention.

Talk about those would could – and those who could not – afford the AARP’s Medicare Advantage plan that’s been a great boon to insurance companies, but that ran into big problems in overpaying providers.

Talk about the need for health care for all to lower medical costs for all – including seniors.

Talk about those who may have retired with their mortgages paid off, but who cannot afford the repairs and upkeep, insurances and taxes that make it possible to remain in their homes.

Talk about the differences between those who worked all their lives in caregiving, construction, food preparation, teaching, farming, fire fighting, fishing – and those who picked up a briefcase or opened a computer to begin their workday. Then consider whether raising the age of retirement for all workers is an acceptable way to “save Social Security.”

Talk about those who lived in poverty in childhood, and who may never have escaped an environment of substandard housing, environmental hazards, limited or no medical care, poor nutritional choices, and an ongoing, endemic indifference to the well-being of their children and grandchildren.

Talk about those who share their Social Security income with children who can’t quite meet their mortgage payments, or with grandchildren who need help to stay in school; or who provide a roof over the heads of these children and grandchildren.

In the light of these realities, Mr. and Ms. Media, reject the complacent view that all “seniors are relatively well off.” Then join the campaign to “scrap the cap” on Social Security withholding taxes as a way to improve the lives of all who depend on a monthly Social Security check.

Social Security and Medicare: Are they really protected in sequestration?

Thursday, August 2nd, 2012

By Steve Kofahl

In August, 2011, Congress and the White House negotiated a deal that slashes $ 1.2 trillion in Federal spending over 10 years, as the price for raising the debt ceiling for about 15 months. Across the board cuts will begin in January 2013 through sequestration, equally divided between military and domestic spending, unless another agreement replaces the one made last year.

The deal spared Social Security and Medicare benefits themselves, but there would be deep cuts in funding and staffing needed by the Social Security Administration to run these programs. It is not enough just to continue paying benefits, if there are delays and errors in new benefit applications.

By the end of this year, the Agency will have already lost 9,000 employees through attrition over three years, due to flat budgets. The same rate of attrition will continue. However, in his June 27 testimony before the House Ways & Means Social Security Subcommittee, SSA Commissioner Michael Astrue stated that the Agency might have to lay off another 1,000 employees next year, due to sequestration. The Agency would go from a flat budget to a likely 8% cut, crippling service delivery at a time when 10,000 people are filing for retirement benefits every day, and record numbers are applying for disability benefits.

The public has already felt the pain of cuts to SSA’s administrative budget. The Agency has closed dozens of field offices, and chopped office hours everywhere by 30 minutes a day. It takes longer to get a decision on a disability benefit application. It’s often hard to get through on the phones.

The employees of Social Security know that service has suffered in ways that are not apparent to the general public. Internet self-service, marketed aggressively by the Agency, is costing applicants money. Traditional benefit applications have been “streamlined” for the Internet, and important information is no longer collected, resulting in underpayments that will never be detected. Too many applicants have no discussion with a trained SSA employee who can explain their rights and responsibilities, what kinds of benefits are available, and when it may be best to start payments.

The American Federation of Government Employees has raised these issues with SSA and with Congress for the last five years, but our expressions of concern have largely fallen on deaf ears. That may be about to change. Entities responsible for oversight are beginning to notice. The independent Social Security Advisory Board reported that front-line Agency employees in Georgia complained to them on May 9 that Internet disability applications are often incomplete, and that applicants have problems selecting the most advantageous month for retirement benefits to begin when they file online.

A May 2012 report by SSA’s Office of Quality Performance assessed the impact of Internet application streamlining. It projected that streamlining of marriage history questions alone will result in $2.8 million in underpayments to applicants (mostly women) who filed in the year ending September 2011. The report concludes that a reassessment of the streamlining policy is warranted.

The SSA Office of Inspector General sent a report on Internet disability claims to the Commissioner early this year, but it has not been made public. This is the first time OIG embargoed a report in this way, to my knowledge, so it probably has more disturbing data about lost benefits and diminished service.

Congressmen Dicks, McDermott, and Reichert; as well as Senators Murray and Cantwell; serve on committees that affect SSA administrative funding and oversight. Let them hear from you.

Ryan’s Medicare: Poison for seniors

Wednesday, June 6th, 2012

By Will Parry

In the May issue of The Retiree Advocate, PSARA President Robby Stern summarized the many ugly specifics of Paul Ryan’s proposed budget for 2013 – a budget endorsed by Mitt Romney.

In this article, we single out an aspect of that budget of critical importance to today’s seniors – and tomorrow’s.  Our focus is on Medicare.  We’ll spell out exactly how the Ryan budget would undermine Medicare’s protections, callously shifting health care costs to the older men and women who rely on it.

The beneficiaries of Ryan’s scheme?  The big health insurance companies, the pharmaceutical giants, the medical device makers – in short, the powerful medical-industrial complex.

Ryan has now shelved his proposal of last year for the outright privatization of Medicare.   He would still offer seniors a voucher, capped at a harshly inadequate rate, for use with a private insurer.  But he would leave Medicare in place as an option that seniors could choose.

This would enable health insurance companies to cherry-pick younger and healthier seniors off Medicare into their appealingly-structured private plans (subsidized by the taxpayers).  The sicker seniors would then be marooned in an ever more costly Medicare program.

As George Zornick wrote in The Nation, “This is ironically perhaps a better deal for the health insurance industry than total privatization.  They don’t have to deal with the expensive, unhealthy elderly folks.”

The Congressional Budget Office (CBO) estimates that, under the Ryan scheme, seniors’ annual health care costs would be $1,200 greater by 2030, and $5,900 greater by 2050.

But that’s not all.  The Ryan plan would raise the age of eligibility for Medicare coverage by two months per year, beginning in 2023 and continuing until reaching age 67 in 2034.

This two-year delay in eligibility isn’t mentioned anywhere in Ryan[s 99-page budget document.  You have to go to the CBO report on the budget to find it.

During the two years from age 65 to age 67, seniors, being not yet eligible for Medicare, would confront the higher out-of-pocket health care premiums, deductibles, co-pays and coverage limitations typical of the private insurance market, chiseling away at their Social Security checks.

“The Republican Party intends to raise the Medicare age for people as they approach the costliest years for receiving health insurance, and they’re keeping it a secret from the public,” Zornick wrote.

Moreover, under the Ryan plan the private insurance industry, and not the federal government, would determine the level of expenditures for senior health care. Here’s how it would work.

All private insurance plans would participate in an annual competitive bidding process.  The second lowest bid would establish what the  government would pay for health insurance.

But private insurance rates have been climbing at three and four times the rate of today’s Medicare.

The insurance industry has shown no ability to restrain cuts – and has no motive to do so. With budgetary control over this major government program in the hands of the very insurance companies that profit from it,   Medicare as we have known it would be history.