Senate Republicans Pushing to Vote on Latest Health Care Proposal

Published in the Woonsocket Call on September 24, 2017

With the September 30 expiration of its special Senate budget reconciliations status that allows the chamber to repeal and replace Obamacare with just a simple majority, Senate Republicains are rushing to bring their latest health care fix up for vote by the end of next week. The GOP’s last attempt failed by a razor thin margin.

Critics charge that the Senate Republicans push to quickly vote on their latest health care bill, crafted by Republican Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, comes before the issuance of a complete analysis of the Congressional Budget Office (CB)) that would detail the legislative proposal would impact coverage nationwide.

AARP, the National Committee to Preserve Social Security and health care provider groups say that Graham-Cassidy’s fix to put the brakes to rising health care costs will increase premium and out-of-pocket costs for millions. They say that the nonpartisan CBO would give the details to its negative impact.

Even Gov. Chris Christie came out opposing the GOP health care over haul bill that Senate Republicans are pushing. “I can’t support a bill that takes $3.9 billion away from the people of the state of New Jersey,” said the New Jersey Governor, reported last Wednesday by the Trentonian News. Democratic Colorado Gov. John Hickenlooper and Gov. Republican Governor John Kasich, of Ohio, held a bipartisan news conference this week calling for a bipartisan approach to reforming health care.

Talk Show Host Jimmy Kimmel also came out swinging against the Graham-Cassidy proposal, calling Sen. Cassidy, a co-sponsor of the bill, a liar. Earlier this year the Republican Senator had appeared on his show and after hearing that Kimmel had an infant son with a heart condition, he assure Kimmel that any GOP proposal would protect those with pre-existing conditions. It does not, at least to Kimmel’s satisfaction.

For days, aging and provider groups and even Democrats on cable shows expressed concern that the Graham-Cassidy Bill would allow states to permit insurance companies to charge people with preexisting conditions (an estimated 25 million Americans age 50 to 64) just because they have cancer, diabetes, high blood pressure, asthma, etc.

Age Tax Hits Seniors Right in their Wallets

On September 20, 2017, AARP writer Dena Bunis, charges in a blog posting, “Latest Senate Health Care Bill Revives Age Tax for Older Americans,” the GOP’s latest effort to repeal President Obama’s landmark Affordable Care Act (ACA), imposes an “age tax” on older Americans by eliminating premium tax credits and cost sharing payments that helped low-income persons afford deductibles and copayments for medical services.

The Graham-Cassidy bill would also allow states to get federal waivers for insurers to charge older Americans more so as to lower the cost for younger policyholders. The ACA limits the expense for older policyholders at three times the amount younger ones pay, says Bunis.

To illustrate the “age tax” Bunis, citing an AARP analysis, notes, that for a 60-year-old earning $25,000 a year, premiums and out-of-pocket costs could increase by as much as $16,174 a year. If that 60-year-old lives in a state that allows insurers to charge older individuals dramatically higher premiums, he or she would face an additional $4,124 increase in premiums,” she says.

The Graham-Cassidy bill takes away the premium tax credits that help older adults pay for their health care coverage, notes Bunis. . “About 6 million 50- to 64-year-olds buy their health coverage in the individual market, and about half of those individuals receive tax credits to help pay their premiums, she says, citing an analysis by the AARP Public Policy Institute.

The Graham-Cassidy bill would also eliminate vital cost-sharing payments that help low-income persons — especially those over age 50 — afford deductibles and copayments for medical services, too, adds Bunis, noting that “about 58 percent of adults enrolled in ACA marketplace plans get cost-sharing assistance, and 35 percent of those individuals are between 50 and 64 years old.”

Bunis notes that the latest Senate health care proposal would shift federal funds to the state through block grants that would allow each state to develop their own specific health care coverage initiatives to reduce costs. But, she says that Medicaid per capita cap or block grants funding proposals, “fundamentally change the Medicaid program [covering 17.4 million older Americans and people with disabilities], which has been a safety net for millions of poor Americans and people with disabilities.

Receiving Medicaid eligibility for coverage and services would leave fewer doctors and other providers willing to take Medicaid patients or provide needed care because reimbursement is too low.

Block grants, mandated by the Graham-Cassidy bill, would only last through 2026, offering no replacement health care plan, says Bunis. “Over 20 years, Graham-Cassidy would slash Medicaid funding by $1.2 trillion to $3.2 trillion, turning control of the program to the states and shifting costs over time to states and Medicaid enrollees,” she says.

“Americans have a right to know how this bill would impact them. Regretfully, the Majority Leadership is rushing the Senate to blindly consider Graham-Cassidy without fully vetting this proposal in committee hearings and mark-up, where amendments could be considered, and without a full Congressional Budget Office (CBO) score. CBO previously estimated that repeal-without-replace would cause 32 million people to lose health coverage,” said Max Richtman, President and Chief Executive Officer of the National Committee to Preserve Social Security and Medicare (NCPSSM), in a statement to Senate Finance. The Senate panel is scheduled to hold a hearing on the Graham-Cassidy bill next week.

“Senate consideration of any bill that would change the accessibility and affordability of essential health care for millions of Americans without a complete CBO analysis and committee debate would be the height of legislative malpractice,” says Richtman.

NCPSSM calls the latest GOP Senate Health care proposal “deeply flawed” and suggests that it be referred to the Senate Committee on Health, Education, Labor and Pensions where Chairman Lamar Alexander and Ranking Member Patty Murray are attempting to hammer out a bipartisan solution to strengthen the ACA’s individual health insurance market reforms.

A Final Take

A press time, Republican Sens. Ron Paul (Kentucky) and John McCain (Arizona) give thumbs down to the Graham-Cassidy bill with the Portland Press Herald reporting that Sen. Susan Collins of Maine, saying “I’m leaning against the bill.” Fifty Republican Senators must give their thumbs up, with Vice President Mike Pence casting the tie-breaking vote, to get a simple majority for passage. Now, the votes are just not there for passage.

But, one long-time Republican Senator speaks honestly on the record why President Donald Trump his fellow Senate caucus members are pushing so hard for passage of the latest Senate health care proposal. “You know, I could maybe give you 10 reasons why this bill shouldn’t be considered,” Iowa Republican Senator Chuck Grassley. “But Republicans campaigned on this so often that you have a responsibility to carry out what you said in the campaign. That’s pretty much as much of a reason as the substance of the bill.”

Sadly, if true the Republican-controlled Congress has put millions of Americans at risk of losing their health care coverage and at risk for the sake of a political promise. Our lawmakers must become statesmen and vote on legislative proposals because it is the right thing to do, not politicians who vote by party-line.

It’s Time to Pass RAISE Family Caregivers Act

Published in the Pawtucket Times on September 18, 2017

Editor’s Note: Four months after S. 1028, titled the Recognize, Assist, Include, Support, and Engage (RAISE) Family Caregivers Act, was introduced in the Senate, an updated House companion bill (H.R. 3759) gets dropped into the chamber’s legislative hopper. On September 13, Reps. Gregg Harper (R-MS) and Kathy Castor (D-FL) along with original cosponsors Reps Michelle Lujan Grisham (D-NM) and Elise Stefanik (R-NY) introduced the legislation that calls for the development of a strategy to support family caregivers. It was referred to House Committee on Education and the Workforce. At press time, Rep. David Cicilline (D-RI) will shortly become a cosponsor of H.R. 3759.

On May 3, Sens. Susan Collins (R-ME), the Chairman of Senate Aging Committee, and Tammy Baldwin (D-WI) reintroduced the RAISE Family Caregivers Act, with Sens. Lisa Murkowski (R-AK) Michael Bennet (D-CO) signing on as cosponsors. At press time, there are now 12 cosponsors. Sen. Collins and Baldwin and Reps. Harper and Castor first introduced the family caregiver legislation in July 2015, and it passed the Senate unanimously in December 2015.

Eight days later the Senate Health, Education, Labor and Pensions Committee unanimously passed this legislation by a voice vote later that month and the bipartisan legislation will now be considered by the full Senate.

The Nuts and Bolts

The House bill introduced this week is updated from the Senate version introduced in early May. That Senate version is almost identical to the Senate-passed version from 2015.

The RAISE Family Caregivers Act directs the Secretary of Health and Human Services to develop and update a national strategy to support family caregivers. The legislation would also create a Family Caregiving Advisory Council comprised of relevant Federal agencies and non-federal members, also including family caregivers, older adults with long-term care needs, individuals with disabilities, employers, health and social service providers, advocacy organizations engaged in family caregiving, state and local officials, and others with expertise in family caregiving.

The newly established Advisory Council would be charged with making recommendations to the Secretary. The strategy would be updated to reflect new
developments. The Advisory Council’s initial report would include an initial inventory and assessment of federally funded caregiver efforts that would be incorporated into the initial strategy. The strategy would then identify recommended actions that government, providers, communities, and others could take to support family caregivers.

The activities under the bill would be funded from existing funding appropriated for the Department of Health and Human Services. No new funding is
authorized and it would sunset in five years.

This bipartisan caregiver legislation has been endorsed by over 60 aging and disability organizations, including the AARP, the Alzheimer’s Association, the w Michael J. Fox Foundation and the Arc.

Shouldering Caregiver Burdens

“Every day, more than 40 million ordinary Americans take on the challenge of caring for parents, spouses, children and adults with disabilities, and other loved ones so they can live independently at home and in their communities,” says AARP Chief Advocacy & Engagement Officer Nancy A. LeaMond. “The RAISE Family Caregivers Act is a commonsense, bipartisan step to recognize and support our nation’s family caregivers. AARP appreciates the leadership of Representatives Harper and Castor, and we urge Congress to pass this important piece of legislation,” she notes.

According to LeaMond, the nation’s family caregivers assist loved ones with eating, bathing, dressing, transportation, medical tasks, managing finances, and more. Many do this while working full time and raising families. The unpaid care family caregivers provide—37 billion hours valued at about $470 billion annually—helps delay or prevent more costly care and unnecessary hospitalizations, saving taxpayer dollars.

“Caregiving is, in one way or another, now an inevitable part of everyone’s future,” said AARP Rhode Island State Director Kathleen Connell. “It has been said that if you ask people about caregiving they fall into one of three or more categories: They know a caregiver, they are a caregiver or they will require a caregiver. AARP works hard at the state and federal level to direct resources and support to family caregivers. In Rhode Island, we have fought successfully for temporary caregiver insurance (TCI), the CARE Act, accessory dwelling unit legislation and a new fund to help offset the cost of ‘livable’ home improvements that benefit caregiving and make aging in place easier.”

“In the upcoming special session of the General Assembly, another key caregiving bill will be before lawmakers,” Connell added. “Earned Paid Sick Leave will be especially helpful to working family caregivers whose employers do not offer paid time off. Temporary caregiver insurance requires several days advanced notice. That can be helpful, for example, if a family member has a scheduled test or medical procedure. Earned paid sick leave would allow employees to used paid sick time when they are called away to attend to immediate emergencies.”

“The RAISE Family Caregivers Act is intended to provide a policy framework for improving caregiver support from national level down to states, cities and towns. In short, where the caregiver rubber meets the road,” Connell said.

Caregiver Legislative Proposal a Bipartisan Issue

According to AARP’s Public Policy Institute, there are 40 million family caregivers in the United States who provided an estimated $470 billion in uncompensated long-term care in 2013. In the Ocean State at any time during the year, an estimated 134,000 Rhode Island family caregivers step up to provide 124 million hours of care for an aging parent or loved one, most often helping them to live independently in their own homes.

With many caregivers putting their own health at risk, experiencing experience high-levels of stress and have a greater incidence of chronic conditions like heart disease, cancer, and depression, these individuals need the support and assistance that the enactment of the RAISE Family Caregivers Act could help bring about. Both sides of the aisle must put their political differences aside and push for passage. Both Republicans and Democrats shoulder caregiving duties.

Quickly passing the RAISE Family Caregivers Act in the Senate and House and sending it to the desk of President Donald Trump for his signature is the right thing to do.

LRI Graduates Give Sage Advice to President Trump

Published in Woonsocket Call on September 3, 2017

“I never considered a difference of opinion in politics, in religion, in philosophy, as cause for withdrawing from a friend.” — Thomas Jefferson

With the dust settling after the surprising victory of GOP Candidate Donald Trump last November, the news analysis on the election results clearly revealed that America is a divided nation of red states and blue states, either leaning Republican or Democrat. Throughout the 2016 presidential campaign and into President Trumps 226 days in office, personal attacks are a very common occurrence on Face Book if the person disagrees with your posting.

Jeffersonian Dinners: Finding a Common Purpose

We have lost our way in agreeing to disagree on political issues. We are no longer able to civilly discuss our differences on issues. How can a politically divided nation relearn how to have civil political dialogue to find a bridge between our differing political philosophies and positions on policies. Here’s Leadership Rhode Island’s answer.

Last January, LRI released its second book in three years. “Dear President Trump,” a compilation of 31 letters written by LRI alumni who attended 1 of 13 structured “Jeffersonian Dinners” held across the state in 2016. The attendees began each dinner conversation answering the question, “When faced with ideological or principle-based differences with another, how did you and the other party find common ground and/or progress?”

Each letter compiled in this 32-page book was written “to the office/position and not the person,” as submissions and selections were made prior to the Presidential election on Nov. 8, 2016. “Given the emotional nature of this year’s presidential election, which might be best described as identity politics at its most divisive, we thought advice from accomplished Rhode Island leaders from different sectors and industries to our incoming president would be gladly received by the next President and the citizens of Rhode Island,” said Mike Ritz, Executive Director of Leadership Rhode Island, in a statement.

“There’s much wisdom and perspective inside.” In all, about 30% of the 111 dinner attendees – corporate executives, small business owners, directors of state agencies, elected officials, executive directors of non-profits, retirees, and veterans – submitted a 300-word letter which began with “Dear President.” Inserted between letters are quotes by each of the 44 U.S. Presidents, which were curated by Dr. Jane Nugent, a 1995 graduate of Leadership Rhode Island and LRI’s volunteer project advisor.

Sage Words of Advice

Here are a few snippets of advice in letters from LRI graduates…

Tricia O’ Neil, LRI ‘09, Family Wealth Director and Financial Advisor at Morgan Stanley, asks the incoming president to remember: “You are no longer a Democrat or Republican; you are now the leader of the greatest country in the world. Regardless of party, we are a rightfully proud country that continues to hold the truths of our Declaration of Independence, all the freedoms it stands for, as self-evident. Sometimes we will agree with your stances and sometimes we will not, but if you talk to us with honesty, patience and understanding, and stay consistent and steadfast, we will all successfully grow together.”

Jerauld Adams, LRI ’14, President of North American Industries, Inc., urges the new president to: “Find the strength to negotiate a middle ground on issues and policies so that your team will lead responsibly and will gain respect. Americans need you to be strong; they crave someone they can look up to. As the earth grows smaller, we need a more united America.”

Mayor Scott Avedisian, LRI ’97, of Warwick, gives his thoughts to the incoming president, too: “When dealing with the opposition, please find ways to agree and to disagree without vilifying them. Lead this nation by being an example of calm, allowing all to have their say and make decisions that exemplify the best in all people and all things.”

The “Jeffersonian Dinner” series, which provoked the idea for the book, will continue by Leadership Rhode Island in 2017. Leadership Rhode Island is currently in talks with other organizations outside of the state to collaborate on a national initiative for helping citizens talk through their differences productively and with civility, an action which Ritz says is desperately needed to heal a divided country after very contentious and negative election campaigns.

Adds, Matt Coupe, LRI’s Alumni & Community Engagement Liaison, the idea for Jeffersonian Dinners came out of a series of alumni focus groups held in early 2016 regarding membership benefits. “Alumni told us they wanted to connect with each other in more intimate settings than the large parties and networking events we often host, and they wanted to discuss topics of substance, says Coupe.

According to Coupe, Maryellen Butke, of Providence-based Namaste Consulting who graduated from LRI in 2008, introduced the concept of Jeffersonian Dinners, which had been developed by Jeffrey Walker at the Monticello Foundation, to LRI. Walker wrote a book, called The Generosity Network, in which he describes the Dinners as being modeled after dinner parties that Thomas Jefferson had once hosted at Monticello. Jefferson’s idea was to bring people of different backgrounds together to discuss topics of importance, so he could hear multiple perspectives on various issues he was facing.

LRI launched its Jeffersonian Dinner series in March 2016, after a few months of initial planning. Each dinner took about a month to plan, said Coupe, noting that the nonprofit organization did not even any expenses in planning these dinners, other than some minor advertising costs and staff time. “Thanks to the generosity of Paul O’Reilly, President and CEO of the Newport Restaurant Group (graduating LRI in 1995), we were able to host six dinners at his restaurants [22 Bowen’s Avvio, Castle Hill Inn, Trio, and the Waterman Grille] at no cost to us. The rest of the Dinners were hosted and paid for by individual alumni, held a t the Hope Club, University Club and in their homes” he said.

LRI has recently conducted an online survey of participants, which showed an overwhelming consensus of agreement that the conversations held at the Dinners were valuable in and of themselves, even if they didn’t always change someone else’s way of thinking, says Coupe. “We view this as a validation of the Jeffersonian Dinner model, since their purpose is to expose participants to different viewpoints, not necessarily to build consensus,” he says.

LRI continues to hold its Jeffersonian Dinners in 2017 and plans to continue for at least another year, says Coupe, with the goal of eventually host inviting LRI graduates and the general public to participate. We want to eventually spread the word about the value of Jeffersonian Dinners outside Rhode Island with assistance from the Monticello Foundation and the national Association of Leadership Programs (ALP),” he says.

Now, is the time to work together to build a better American and world by learning how to discuss our differences and finding the root of compromise. Jeffersonian Dinners organized throughout the nation my just be the answer to bringing a politically divided country together.

Let’s hope that a copy of “Dear President Trump,” finds it’s way to Trump’s desk. It’s a great read.

Books may be purchased for $20 (domestic shipping included) online at http://bit.ly/dearpresidentbook or by credit card over the phone at 401-273-1574. About Leadership Rhode Island Leadership Rhode Island is a nationally awarded community leadership development nonprofit organization, founded in 1981, with over 2000 graduates across the state of Rhode Island. For more information about Leadership Rhode Island, visit http://www.LeadershipRI.org