Category Archives for Congress

Social Security funds could be up for grabs

Published in Pawtucket Times on September 10, 2001

Don’t expect quick government action to provide prescription drug benefits to seniors or immediate meaningful Social Security or Medicare reforms soon.  With the backdrop of a $1.35 trillion Bush White House tax cut, a shrinking budget surplus combined with an ailing economy and dwindling consumer confidence, Congress may be forced to take from “Peter to pay Paul.”

But let me give you the political translation…According to a recent released Congression Budget Office (CBO) August 2001 report, the federal government will need to use $9 billion of the tax receipts used to buy bonds invested in the Social Security trust fund in the fiscal year that ends September 30 to made ends meet, increasing the likelihood that heated bipartisan bickering and congressional gridlock will occur when lawmakers being their efforts to pass next year’s 13 spending bills.

Don’t look for things to get better soon, says the nonpartisan CBO, because by 2003 it’s estimated that $18 billion in Social Security reserves will be needed to keep the government in operation.  By 2005, CBO notes that if current tax and spending policies are followed, and the economy performs as the agency estimates, on budget surpluses will emerge.

Senior groups have expressed concern about the federal government having the dip into the cash generated from Social Security payroll taxes, calling it a tragedy that will block passage of any meaningful prescription drug benefit proposals or Medicare and Social Security reforms.  “The loss of tax revenue due to the present’s tax cuts and the slowing economy will lead to new federal debt and $600 billion in additional interest payments over the next ten years,”  predicted Max Richtman, executive director of the Washington D.C. based National Committee to preserve Social Security and Medicare.

“It’s enough to pat for a generous prescription drug benefit under Medicare,” Richtman says.

“Now it looks like the federal government will have to pay bondholders instead of providing seniors with the help they need on prescription drugs, Richtman added, noting that it’s a case of misplaced priorities.

“The $600 billion (in additional interest payments) could fund a prescription drug program with co-payments and deductible at a level that is more affordable for all seniors,”  Richtman says.  Meanwhile, any funds not used could help pay for repair of glasses, refitting dentures and new batteries for hearing aids, all costs not covered by Medicare. 

Adds Ed Zesk, president of Aging 2000, a nonprofit consumer organization focused on improving health care for seniors, “Its is unfortunate that the Bush administration got caught up in tax cut rhetoric to the point where they are focused into a corner and gave a tax cut without accessing its impact on the future of Medicare and Social Security.  While Americans certainly appreciate a few bucks back from Uncle Sam it is a shame that a nation we are potentially mortgaging our future health care and Social Security for a short term tax rebate.

“Clearly the tax cut has made it virtually impossible to develop any kind of meaningful prescription drug proposal for Medicare,”  Zesk told All About Seniors.  “This is just one example of the long-term benefit being sacrificed for the short-term gains,” he says.

Kathleen S. Connell, executive director of AARP Rhode Island, states that  AARP also opposes a federal government raid on the Social Security funds to finance other government programs.  However, the nation’s largest senior advocacy group was pleased that earlier this year both Congress and President Bush had agreed to protect Social Security by using surplus funds in the program for only debt reduction.  “To use the surplus funds other than for debt reduction would undermine that consensus and signal a trend that we believe would not be good economic policy,” Connell said.

According to AARP research, the overall balances for the program funds would not be affected and full benefits could be paid up until 2038, Connell said.  “The key thing that needs to be understood as long as the surplus is used for debt reduction, it would reduce the obligation of future generations and free up money to help the economy.”

With Congress going back into session, lawmakers must now begin the task of passing 13 appropriation bills for the fiscal year beginning October 1.  With the CBO report raising the issue of spending the Social Security receipts, it is now time for Congress to quit finger-pointing and charging each other of raiding the  Social Security and Medicare program.

With the graying of America, Congress must be aside its political differences and work toward long-range bipartisan solutions to ensure the solvency of the Social Security and Medicare programs.  No longer should seniors accept quick political fixes from either political party.

Congressional report spotlights nursing home abuse

Published in The Times dated August 6, 2001

Congressional investigators have recently released a scathing report charging that within the last two years more than 30 percent of the nation’s nursing homes – about 5,285 facilities – were cited by state inspectors for at least one abuse violation that had the potential to cause harm.

These facilities were cited for almost 9,000 violations during the two-year congressional study, the report said.

Citing information gleaned from a sampling of state inspection reports or formal complaints, the 15-page report released last week at a hearing called by Henry Waxman (D-Calif), Minority Chairman of the House Committee of Government Reform, found that in more than 1,600 nursing facilities, approximately one out of every 10, the abuse violations were serious enough to cause significant harm to residents or to place them in immediate jeopardy of death or serious injury.

Abused residents were punched, choked or kicked by staff members or other residents, the report said, stating that the attacks frequently caused serious injuries such as fractured bones and lacerations.  In other instances, residents were being groped or sexually molested.

Although the report, “Abuse of Residents is a Major Problem in U.S. Nursing Homes,” prepared by Minority Staff of the Committee’s Special Investigation Division, found that the percentage of nursing facilities with abuse violations is increasing, it noted that the reasons for this increase are unclear.

In his opening remarks, Waxman stated that it had been unwise for Congress to repeal the Boren Amendment in 1997, a federal law which mandated that states provide nursing facilities with adequate funding to operate.  Because of this, he said, Medicaid funding for nursing facility care has not kept pace with the rising costs of providing care.

Waxman’s legislative prescription for attacking the growing abuse in the nation’s nursing facilities is to introduce a legislative proposal that would reestablish the abolished Boren Amendment, mandating minimum nurse staffing requirements, imposing tougher regulatory sanctions on poorly performing facilities, and instituting criminal background checks for nursing facility employees, or increasing internet disclosures on nursing facility care.

What’s playing out in Rhode Island?

According to Wayne Farrington, Chief of Facilities Regulation at the state’s Department of Health, the reporting of Rhode Island abuse complaints has risen by 10 percent.  The statewide increase in reports of abuse, neglect and mistreatment probably mirrors the tragic national problem, he tells All About Seniors, but is smaller because the Rhode Island 1987 statute has made it a misdemeanor for health care professionals or public safety officials not to report suspected abuse, neglect, mistreatment.  The size of the national increase is partially due to abuse reporting being a new requirement in some states.  Farrington added. 

Farrington states that the biggest factor that increases the number of reported calls of abuse, neglect and mistreatment is the severe statewide staffing shortage in Rhode Island’s nursing facilities.

“Overworked staff may become short tempered and this can result in abuse.  Not enough staff in the facility may also result in resident’s needs not being met,” he added.

Administrator Hugh Hall, of Cherry Hill Manor, also feels that the state’s critical staffing crisis contributes to the possibility of increased abuse and that crisis also affects the quality of care provided in the state’s 104 nursing facilities.

“Today’s nursing facility employees are underpaid, overworked creating an environment in which even the best employee may falter,” Hall said.

The administrator urges the General Assembly to increase Medicaid payments to more adequately cover the nursing facility’s actual cost of care, allowing for greater increases in direct care provider salaries.

“While last year’s average cost of care in a Rhode Island facility was $140 per day the state’s Medicaid program only reimbursed facilities $116 for the care provided, creating a serious shortage of funds in many facilities, Hall added.

“There are not enough certified nursing assistants in the system to deliver the care,” Hall said noting that opportunities must be created and a fair wage paid to attract people into this profession.

Meanwhile, Hall believes that the overwhelming majority of nursing facilities in Rhode Island provide quality care.  These facilities do criminal background checks and provide staff training.  They educate their staff about the facility’s expectation on quality patient care, he said.

Hall says facilities that have on going problems with abuse should be prosecuted to “the fullest extent of the law.”

Although Roberta Hawkins, the state’s Long-Term Care Ombudsman and Executive Director of the Alliance for Better Long-Term Care sides with Farrington and Hall about the critical need to directly confront the adverse impact of the staffing shortage in facilities, “it’s not to excuse to provide bad care,” she says.  “If facilities can’t care for residents then they should not admit them.”

A mandated continuing education program for both professional nurses and certified nursing assistants can be an effective strategy for reducing the incidence of abuse while enabling the better trained worker to care for more medically complex residents.

Additionally, Hawkins and long-term care providers are pushing for more state and federal Medicaid dollars to be allocated to provide a living wage for direct care workers.

Although lawmakers this year gave a small increase, “it’s not what was needed but it’s a start,” she acknowledges.

A divided Congress and a conservative Bush White House may well keep Waxman’s legislative proposal that addresses the problem of rising abuse in the nation’s more than 17,000 nursing facilities from every being enabled.

So, change must begin in the Ocean State.

When the Rhode Island General Assembly comes back into session next year, it becomes critical that the serious direct care staffing shortage in Rhode Island’s nursing facilities become a top legislative priority.

As the Republican and Democratic Gubernatorial candidates gear up their political campaigns and dream of becoming the state’s top elected policy official, they might well consider taking up the just cause of improving the care provided in the state’s nursing facilities.

Lawmakers can gubernatorial candidates can ill afford to ignore this key policy issue, one that puts the state’s 10,000 frail nursing facility residents in continued jeopardy of abuse, neglect or mistreatment.

On a political note, hundred of thousands of families and friends of these residents, who are voters, are watching.

Scully Selected to Head Federal Health care Agency

Published in the Pawtucket times on May 14, 2001

Thomas A. Scully, a Washington, D.C.-based health care association executive who holds a law degree from Catholic University and has previous experience on Capitol Hill as a senate staffer and as a high-level White House official, has been tapped by the new Bush administration to run the Health Care financing Administration (HCFA), the federal agency providing health care to 74 million Medicare, Medicaid and the State Children’s Health Insurance Program.

The nomination of Scully, president and CEO of the Federation of American Hospitals, a trade group that represents 1,700 for-profit hospitals, went to Capitol Hill in early May.  When confirmed as HCFA administrator by the U.S. Senate, Scully will replace Nancy Min DeParle, who left last October for a teaching stint at Harvard University. With her departure, a string of acting directors temporarily took the reins of the federal agency.

At press time, Jill Kozney, a spokesperson for Chairman Chuck Grassley of the Senate Finance Committee, stated that a confirmation hearing has not been scheduled yet. “Not every piece of paper work is in, but the chairman would like to act on the nomination as soon as possible,” the Senate staffer says.

A Washington Insider

As Washington insider, Scully brings a potpourri of health policy experiences to HCFA. The health care association executive comes with legal expertise gleaned from his legal practice, which focused on regulatory and legislative work in health care. Scully also brings an understanding of the intricacies of Capitol Hill, gained by serving as a staff assistant to U.S. Senator Slade Gorton (R-Wash.), and as associate director of the White House Office of Management and Budget (OMB) and later as deputy assistant to the president and counselor to the director of OMB under the senior Bush administration.

Ties to the former Bush administration were forged when Scully served on the communications staff of the Bush-Quayle campaign in 1988 and as deputy director of the congressional affairs for the president-elect’s transition team.

“Scully is smart, quotable, and politically savvy,” says Edward Howard, executive vice president of the Alliance for Health Care Reform. “He’s described as a problem solver rather than an ideologue,” Howard adds.

Howard expects Scully to turn his attention to internal problems at HCFA, because the agency has “substantial management problems.” He notes that HCFA has lost a number of good people and Congress will most certainly give the agency new tasks to handle.

“At least Scully will not have to spend one and a half years to learn about the programs he supervises, because he knows them well with his past OMB experience and at the Federation of American Hospitals,” Howard adds.

Bill Benson, former deputy assistant secretary for aging and president of the Maryland-based Benson Consulting Group, warns “Don’t look for Scully to, be much of a consumer advocate,” because he will be sympathetic to providers because of his ties to the hospital provider community.

“That does not mean Scully’s going to be in any position to get hospitals any more money but he will be more attuned to less regulation and more flexibility in rules, and regulations or health care providers,” Benson states.

According to Benson, one of Scully’s first tasks will be to carry out Health ad Human Service Secretary Tommy Thomson’s wish to reorganize HCFA because “this agency is one that everyone loves to hate, especially Republicans.”

Providers Rally Around Scully

Meanwhile, provider groups give thumbs up to Scully’s nomination as HCFA administration.

“Tom Scully has a unique combination of both real-world perspective and public service experience,” states Rick Pollack, executive vice president of the American Hospital Association. “That makes him a great choice for HCFA administrator.”

“From crafting Medicare regulation and budgets to building strong relationships with lawmakers on both sides of the aisle, Tom has the right mix of knowledge or the job,” Pollack adds.

In a letter being distributed to U.S. senators, who must vote to confirm Scully, Dr. Charles H. Roadman, II and AHCA Legislative Counsel Bruce Yarwood states: “As HCFA administrator, Tom Scully will have the responsibility for leading dramatic change.”

The opportunity for HCFA reform is the brightest it’s been in years,” Roadman predicted, expressing confidence that the controversial survey and enforcement apparatus will be closely scrutinized by Scully and the Bush White House.

In a public statement, the American Association of Homes and Services for the Aging’s senior vice president Suzanne M. Weiss states that her nonprofit provider group looks forward to working with the new HCFA administrator.

“As we look for ways to improve the current nursing home and inspection and enforcement system and reimbursement system.  We hope Mr. Scully will be o pen to our efforts in his new position,” Weiss says.