Monthly Archives for April 2015

Making Genocide and Holocaust Education Mandatory

Published in Woonsocket Call on April 26, 2015

By Herb Weiss

With newspapers reporting an increase of religious and cultural intolerance and hate crimes, it is refreshing to see the Rhode Island General Assembly pass resolutions condemning the systematic and barbarous murder of Armenians and Jews.

On Friday, April 24, Armenians across the nation stopped to remember the Ottoman authorities eight-year brutal campaign taking place 100 years ago to eliminate their ethnic group from its homeland in what is now Turkey. Both chambers of the Rhode Island General Assembly passed resolutions calling this day, “Armenian Genocide Remembrance Day” and urging President Obama and Congress to officially recognize the genocide which resulted in the estimated death of 1.5 million Armenians and to make restitution for the loss of lives, confiscated properties, those who endured slavery, starvation, torture, and unlawful deportations.

Taking Responsibility for Your Actions

On April 6, it was a personal and professional triumph for Rep. Katherine S. Kazarian (D-Dist. 63, East Providence), a fourth-generation Armenian-American, to take the lead in sponsoring Rhode Island’s House resolution to commemorate the 100th Anniversary of the Armenian Genocide of 1915. In the afternoon before the vote, the East Providence lawmaker unveiled her resolution at a ceremony in the State House State Room attended by elected state officials and fellow lawmakers.

“The only thing worse than trying to eliminate an entire generation and culture is to deny that such a genocide ever took place,” said Kazarian. “For the past 100 years, the government of Turkey has continually refused to acknowledge their part in the ethnic cleansing of the Armenian people, “she said. Until the Armenian genocide that happened 100 years ago on her ethnic group is recognized by the government of Turkey, Kazarian promised to return to the State House every year to keep the issue alive.

Rhode Island Attorney General Peter Kilmartin says, “On this 100th anniversary, it is more important than ever to remember the horror and tragedy that the Armenian people went through, and it is long overdue that as a nation, we recognize the Armenian Genocide. Hopefully, through recognition, vigilance and education, this type of history will cease to repeat itself.”

“From my first days as a legislator to today as Attorney General, I have always advocated for recognition of the Armenian Genocide, and more recently filed an amicus brief in support of the Armenian fight to seek the return of stolen Armenian Genocide era assets through the United States Courts,” says Kilmartin.

“There are many parallels between the Armenian Genocide and the Holocaust carried out by Adolf Hitler, which ultimately killed six million Jews,” says the Attorney General, stressing that the Armenian Genocide served as an example for Hitler, who used the lack of consequences for the perpetrators of the Genocide as encouragement for the Nazis in planning the Holocaust.

“When giving a speech to Nazi leaders one week before the invasion of Poland, which effectively began World War II, Hitler reportedly noted, ‘who, after all, speaks today of the annihilation of the Armenians?,’ notes Kilmartin, saying that “some historians have even suggested that if more had been done to thwart the Ottomans’ massacre of Armenians, perhaps the Holocaust could have been prevented.”

Eradicating Religious and Cultural Bigotry

Marking the 70th anniversary of the liberation of Auschwitz, Buchenwald, Dachau and Bergen-Belsen concentration camps, Rep. Mia Ackerman (D-Dist. 45, Cumberland, Lincoln) submitted a resolution commemorating Holocaust Remembrance Day (Yom Ha’Shoah). The resolution was passed by the House of Representatives.

“The citizens of Rhode Island have a rich tradition of fighting those who would trample individual liberty and human dignity,” said Representative Ackerman. “We must never allow anyone to forget the time when a handful of evil people tried to turn the earth into a graveyard by systematically exterminating an entire race of people.”

The resolution, which was passed by both the House and Senate, also applauded the courageous efforts of those who took part in the Warsaw Ghetto Uprising of 1943, stating “the brave actions in April and May of 1943 stand as testimony to a rare and indomitable human spirit and extraordinary courage exhibited in the darkest hours of man’s inhumanity.”

According to the Conference on Jewish Material Claims Against Germany, by 2020 there will be only 67,000 Holocaust survivors left, 57 percent who will be at least 85 years old. How can the story of the horrific holocaust be told to the younger generation when the eye witnesses are dying off?

Andy Hollinger, Director of Communications for the Washington, D.C.-based U.S. Holocaust Memorial Museum, makes an obvious comment. “No one who did not live through the Holocaust can experience its horrors, he says, noting that “Holocaust survivors are our best teachers.”

Today, about 80 Holocaust survivors are still telling their stories and working to educate new generations about this history at the U.S. Holocaust Memorial Museum.

“When they are no longer here we will rely on the collections — artifacts, documents, photographs, films, and other materials to tell this story,” says Hollinger, noting that the Museum is “racing to collect the evidence of the Holocaust.”

“We’re working in 50 countries on six continents to ensure this proof [witness testimonies, artifacts, and documents] is secured, preserved and made available through exhibitions and, increasingly, digitally, adds Hollinger.

Marty Cooper, Community Relations Director, Jewish Alliance of Greater Rhode, believes it is “vitally important that the next generations learn about the holocaust and other genocides and atrocities that have taken place and continue to take place.” He calls for genocide education to be mandatory and part of the middle and high school curriculum.

One of the great lessons we can learn from the Holocaust and Armenian genocide is that hatred cannot go unchallenged. It must be immediately confronted wherever it emerges, by governments, religious leaders, nonprofit and business organizations, more important by each and every one of us. We must avow that these horrendous atrocities will never happen again to future generations.

Herb Weiss, LRI ’12 is a Pawtucket writer who covers aging, health care and medical issues. He can be reached at hweissri@aol.com.

Advertisement

“Doc Fix” Law Brings Permanent Changes to Medicare Physician Payments

Published in Woonsocket Call on April 19, 2015

Congress put aside its fierce partisan bickering and came together to pass H.R. 2 – the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). This week President Obama took the opportunity to sign the legislation package into law.

The Congressional fix repeals and replaces the flawed Medicare physician reimbursement system known as the sustainable growth rate or Sustainable Growth Rate (SGR). For the past 13 years, physicians have faced the possibility of an arbitrary cut in their Medicare payments unless Congressional lawmakers passed a so-called “Doc.fix” Medicare bill. Since 2003, Congress has passed 17 short-term bills to block these cuts in Medicare doctors’ fees that were called for under the existing law.

On April 14, the U.S. Senate passed the MACRA by a whopping 92 to 8 (the House passing its version of the bill in late March by a large margin, 392-37). Two days later, at an outdoor signing ceremony in the Rose Garden, President Obama signed the legislation into law, with the House bill brokers, Speaker John Boehner (R-Ohio) and House Minority Leader Nancy Pelosi (D-Calif.) in attendance. .

A Permanent Fix Prevents Payment Cuts

Just hours before a cut in reimbursement that would take place this week, a rare bipartisan Congressional effort prevented a 21 percent cut in Medicare payments to occur. It’s a permanent fix. And the new law extends the Children’s Health Insurance Program, which has provided coverage to millions of American children.

At the signing, Obama called the passage “a milestone for physicians, and for the seniors and people with disabilities who rely on Medicare for their health care needs,” noting that it would also strengthen the nation’s health care delivery system for the long run.

Obama stated this new law “creates incentives to encourage physicians to participate in new, innovative payment models that could further reduce the growth in Medicare spending while preserving access to care.”

According to the Center for Medicare Advocacy (CMA), a national nonprofit, nonpartisan law group that provides education, advocacy and legal assistance to older people and people with disabilities, the estimated cost of the new law is roughly $214 billion over 10 years. CMA says roughly half (approximately $35 of the total $70 billion over 10 years) will come from Medicare beneficiaries through changes that will increase their out-of-pocket costs for health care.(through means testing of higher-income Medicare beneficiaries, increased Part B premiums, and added deductibles to Medigap plans purchased in the future.”

CMA adds that the nation’s pharmaceutical and insurance industries were not required to pay for any of this law, although doing so would have paid for a major portion of the SGR replacement.

On the Back of Medicare Beneficiaries

Aging advocacy groups, including the Center for Medicare Advocacy and AARP, failed in their attempts to improve the Senate bill Medicare beneficiaries, including a repeal of the annual therapy caps, raising eligibility standards for low-income programs and permanently extending outreach and education funding for critical programs aimed at low-income beneficiaries. The Senate bill passed without amendments.

While many gave thumbs up to the new law, Max Richtman, President and CEO of the Washington, DC –based National Committee to Preserve Medicare and Medicaid, sees big problems with MACRA. “The Senate ‘Doc Fix’ vote has traded one bad policy for another, shifting the costs of Congress’ failed Medicare payment formula for physicians to seniors who can least afford to foot that bill. Contrary to claims by supporters, on both sides of the aisle, this ‘doc fix’ will hit millions of seniors who aren’t ‘wealthy’ by any stretch of the imagination. Seniors at all income levels who are already paying steep premiums for Medigap plans to help control their health care costs will now be hit with even higher costs. Forty-six percent of all Medigap policy holders have incomes of $30,000 or less.”

Richtman added, “Medicare beneficiaries will also be forced to contribute nearly $60 billion in premiums over the next decade thanks to passage of this so-called ‘fix.’

It’s no surprise that conservatives applaud this legislation as ‘the first real entitlement reform in two decades’ because it fulfills their political goal of shifting costs to seniors, cutting benefits and expanding means-testing to push Medicare further and further away from being the earned benefit seniors have long valued and depended on.”.

“Trading a bad deal for doctors for a bad deal for seniors is not a legislative victory and it is a surprising move from so many in Congress who have previously vowed to protect Medicare from harmful benefit cuts and seniors from cost-shifting,” says Richtman. .

AARP CEO Jo Ann Jenkins also expressed strong disappointment in the Senate not passing an amendment that would have removed Medicare’s arbitrary cap on physical therapy, speech language pathology, and occupational services. “Many Medicare patients, particularly stroke victims and people with Parkinson’s and Multiple Sclerosis would have benefited,” says Jenkins. With a majority of the Senate agreeing with this amendment, Jenkins says that AARP will continue to lobby to remove the arbitrary coverage cap.

But, Jenkins sees the positives. “Passage of MACRA moves Medicare in the right direction toward better quality health care and greater transparency for patients. These changes will benefit Medicare beneficiaries, as well as physicians and other providers, hospitals, and the overall health care system,” she says.
.
Through the enactment of MACRA Congress put aside its political differences that made a permanent fix to a flawed law. If you can do it once, let’s see our lawmaker do this again, to provide improved programs and services to our nation’s older population.

Herb Weiss, LRI ’12 is a Pawtucket-based writer covering aging, health care and medical issues. He can be reached at hweissri@aol.com.

Rethinking Rhode Island’s LTC Delivery System

Published in the Woonsocket Call on April 12, 2015

AARP Rhode Island releases a state-specific analysis, of the 2014 edition of “Raising Expectations: A State Scorecard on Long-Term Services and Supports (LTSS) for Older Adults, People with Physical Disabilities, and Family Caregivers” that just might give state officials cause for concern, a low rating on its long-term care delivery system, when compared to other states.

The 2011 Scorecard was the first multidimensional assessment of state performance of LTSS. Like this earlier version, the release of the 109 page 2014 report, referred to as the LTSS Scorecard, and its state-specific analysis (prepared by policy consultant Maureen Maigret), measuring how well the nation and each of the states is doing in providing long-term care services, does not bode well for the nation’s littlest state. It finds the Ocean State ranks 38th nationally on 26 performance indicators, with it achieving the lowest rank of all New England States.

“Our analysis provides a closer look at where Rhode Island is keeping pace and where we fall short,” said AARP State Director Kathleen Connell. “The report indicates that, as the state with the highest percentage of persons 85 and older, we face exceptional challenges. It is our hope that the General Assembly and state policymakers find the analysis to be a valuable tool,” she says.

Failing Grades

The 2014 LTTS Scorecard indicates that Rhode Island:

• Ranks 4th highest among states in nursing home residents per 1,000 persons age 65 and over

• Has a high percent of low-care nursing home residents and spends a far higher percent of its LTSS dollars than the national average on nursing home care as opposed to home and community-based services.

• Has some of the highest long-term care cost burdens in the country making private pay long-term services unaffordable for the vast majority of older households.
But, on a positive note, the state-specific analysis noted that Rhode Island’s best progress was made in the Legal and System Supports dimension largely due to the 2013 passage of the Temporary Caregiver Insurance program and Caregiver Assessment requirements for Medicaid Home and Community Based Services (HCBS).

In addition, to revisiting the 19 recommendations made following the release of AARP’s 2011 Scorecard, the more recent 2014 analysis recommends five new major policy initiates to improve the littlest state’s LTSS. Among the recommendations: funding of an Aging and Disability Resource Center; the developing an online benefits screening tool to allow access to income-assistance benefits and conducting outreach programs to increase participation; reviewing the Rhode Island’s Nurse Practice Act to allow nurse delegation of certain health maintenance and nursing tasks to direct care workers; requiring hospitals to provide education and instruction to family caregivers regarding nursing care needs when a patient is being discharged; and exploring emerging medical technologies to better serve home and community based clients.

The current analysis finds that only four recommendations out of the 2011 recommendations have been implemented, most notably those to promote coordination of primary, acute and long-term care and to strengthen family caregiver supports.

Meanwhile, only six recommendations were partially implemented, including the expansion of the home and community co-pay program and authority (but not implementation) under the 1115 Medicaid waiver renewal to provide expedited eligibility for Medicaid HCBS and for a limited increase in the monthly maintenance allowance for persons on Medicaid HCBS who transition out of nursing homes. Finally, nine recommendations, although still relevant, have not been implemented.

Response and Comments

Responding to the release of AARP’s 2014 Scorecard and state-wide analysis, Governor Gina Raimondo says, “we need to ensure that we have a strong system of nursing home care for those who truly need those services, but we must invest our Medicaid dollars more wisely to support better outcomes. We cannot continue to have the fourth highest costs for nursing home care (as a percent of median income of older households) and also rank near the bottom of all states in investments in home and community-based care.”

According to Raimondo, the state’s Working Group to Reinvent Medicaid is looking closely at AARP’s Scorecard and state-specific analysis and Rhode Island’s spending on nursing home and long-term care. Health & Human Services Secretary Elizabeth Roberts has directed her staff to look directly at the proposals recommended by AARP Rhode Island.

“I expect the Working Group will include specific proposals stemming from these findings in their April budget recommendations and their long-term strategic report they will complete in July,” says the Governor.

AARP Rhode Island Executive Director Connell, representing over 130,000 Rhode Island members, was not at all surprised by the findings of the recently released 2014 Scorecard. “Based on benchmarks set in the 2011 Scorecard, it was apparent that there was much work to do,” she says, recognizing that there are “limited quick fixes.”

“Some steps in the right direction will not lead to an immediate shift in the data. This is a big ship we’re trying to steer on a better course. We were encouraged, however, by ‘improving’ grades for lower home-care costs and the percentage of adults with disabilities ‘usually or always’ getting needed support rising from 64 percent to 73 percent,” adds Connell.

Connell says that the Rhode Island General Assembly is considering legislation to improve the delivery of care, which might just improve the state’s future AARP ‘report’ cards.” “In this session, there is an opportunity to improve long-term supports and services with passage of several bills, including one that would provide population-based funding for senior centers,” she says, stressing that it’s a “responsible investment that will help cities and towns provide better services.”

Connell adds, “The proposed CARE Act gives caregivers better instruction and guidance when patients are discharged and returned to their homes. This can be a cost saver because it can reduce the number of patients returned for treatment or care.”

The larger mission for state leaders is the so-called ‘re-balancing’ of costs from nursing care to home to community-based care. That’s where real savings can occur and home is where most people would prefer to be anyway.”

Finally, Virginia Burke, Executive Director of the Rhode Island Health Care Association, a nursing facility advocacy groups, supports the implementation of the policy initiatives recommended by AARP’s state-specific analysis. But, “The primary driver of our state’s nursing facility use is the extremely advanced age of our elders,” Burke says, noting that the need for nursing facility care is more than triple for those aged 85 and older than for seniors just a decade younger. Due to the state’s demographics you probably won’t see a change of use even if you put more funding into community based home services, she adds.

Governor Gina Raimondo and the General Assembly leadership will most certainly find it challenging to show more improvement by the time the next Scorecard ranks the states. Older Rhode Islanders deserve to have access to a seamless system, taking care of your specific needs. Creative thinking, cutting waste and beefing up programs to keeping people in their homes as long as can happen might just be the first steps to be taken. But, the state must not turn its back on nursing facility care, especially for those who need that level of service.

Herb Weiss, LRI ’12 is a Pawtucket writer who covers aging, health care and medical issues. He can be reached at hweissri@aol.com.