Dems Listening to Calls to Strengthen and Expand Social Security, Medicare

Published in the Woonsocket Call on September 23, 2018

The political clock is ticking…The midterm elections are less than 50 days away and just days ago, the Washington, D.C.-based AARP released a poll of age 50 and older Ohio voters who say they are especially concerned about their health care and personal financial issues.

The Politico-AARP poll, conducted by Morning Consult, surveyed 1,592 registered voters in Ohio from September 2 to 11, 2018 with a margin of error of +/- 2 percentage points. For voters 50 and older, the poll surveyed 841 registered voters and has a margin of error of +/- 3 percentage points.

“Don’t Touch Our Social Security, Medicare”

According to the newly released AARP-Politico poll findings, the older voters identified key issues that will influence how they will cast their vote in November at the polls. The respondents viewed health care (81 percent) the most important campaign issue followed by Social Security (80 percent) and Medicare (76 percent) and prescription drugs (65 percent). But, a strong majority (74 percent) support preserving the state’s Medicaid expansion, says the pollsters. .

“With less than 50 days to go before Election Day, candidates in Ohio would be wise to listen to the state’s most powerful voting group: 50-plus voters,” said Nancy LeaMond, AARP’s Executive Vice President and Chief Advocacy & Engagement Officer in a statement releasing the polls findings. “History shows older voters turn out in force in every election, and AARP is making sure they are energized and know where candidates stand on the issues.”

AARP is partnering with Politico to create a series titled “The Deciders,” (www.politico.com/magazine/thedeciders) that integrates original polling focused on 50-plus voters, reporting, data analysis and cutting-edge data visualization tools built by Politico’s specialized interactive team. The third edition in the series is focused on Ohio, a key election battleground state. Other recent polls surveyed voters in Arizona and Florida.

The AARP-Political Ohio poll findings say that 74 percent of age 50-plus voters “strongly support” (42 percent) or “somewhat support” (32 percent) preserving Ohio’s Medicaid expansion which extended Medicaid eligibility for low-income residents under the Affordable Care Act.

Ninety one percent of the older voter respondents say they are “very concerned” (55 percent) or “somewhat concerned” (36 percent) about their utility bills increasing. In addition, 69 percent of these respondents “strongly support” (27 percent) or “somewhat support” (42 percent) creating an Ohio retirement savings plan.

The AARP-Political poll also noted that 74 percent of 50-plus voters say opioid addiction is “a very serious problem” in the state right now, and 61 percent say the government is not doing enough to address it. And, 70 percent of the older voters “strongly agree” that jobs and the economy are major issues this election season. Only one in five (23 percent) feel “well-prepared” to get and keep a job, says the researchers.

Finally, nearly half (46 percent) of 50-plus voters think government is unprepared to prevent a cyber-attack on public infrastructure.

Democrats Zero in on Senior Issues

While poll after poll of older voters sends the message “Don’t touch my Social Security or Medicare” the GOP turns a deaf ear, but the Democrats listen. Following President Donald Trump’s claim that Democrats are trying to cut Social Security at a campaign rally in Montana, Sens. Bernie Sanders (I-Vt.) and Elizabeth Warren (D-Mass.) and Reps. John Larson (D-Conn.), Terri A. Sewell (D-Ala.) and Debbie Dingell (D-Mich.) on September 13, announced the bicameral Expand Social Security Caucus, over 150 members, including 18 Senators.

Senator Sheldon Whitehouse (D-R.I.) David Cicilline (D-RI) James Langevin (D-RI) are members of the newly formed Expand Social Security Caucus.

Alex Lawson, Executive Director of Social Security Works, an advocacy nonprofit group pushing for expanding Social Security, emceed the press conference and co-authored an opinion piece in The Hill celebrating the caucus launch.

Lawson noted, “We have members in the caucus from all corners of the country, from all parts of the Democratic Party. We’re waiting on some Republicans who might join, but they’ll be welcome when they realize that the American people are united in calling for an expansion of Social Security.”

The mission of this new congressional caucus is to push for the expansion of Social Security, one of the most popular and successful government programs. Last year alone, Social Security lifted 22 million Americans, including more than 15 million seniors, out of poverty. Before Social Security, nearly half of the nation’s seniors were living in poverty, says a caucus press release.

The caucus will ensure that expanding Social Security is a key part of the Democratic agenda before the midterm elections and next year and beyond. Over a dozen bills have already been introduced in the Senate and House to expand Social Security. With the caucus now playing a key role in expanding and strengthening Social Security, look for more bills to be introduced next Congress.

At the official unveiling of the new Congressional caucus, Sanders said, “We are here today to say very loudly and very clearly that at a time when millions of seniors are trying to survive on $12,000 or $13,000 a year, our job is not to cut Social Security. Our job is to expand Social Security so that everyone in America can retire with dignity and respect.” T

“Social Security is a lifeline for seniors and Americans with disabilities. We won’t let it be cut by one cent – and instead we will fight to expand it,” Co-chair Warren said. “The rich and powerful have rigged our economy to make themselves richer, while working families face a massive retirement crisis. If this government really works for the people, it should protect and expand Social Security.”

“A number of bills have been introduced in the Senate and House to expand Social Security, including legislation written by Sanders last year to lift the cap on taxable income that goes into Social Security, requiring the wealthiest Americans – those who make over $250,000 a year – to pay their fair share of Social Security taxes. That bill would increase Social Security benefits and extend the program’s solvency for the next 60 years.

Joining the caucus leadership Thursday were Social Security Works, the Alliance for Retired Americans, the Paralyzed Veterans of America, Latinos for a Secure Retirement, the National Committee to Preserve Social Security and Medicare, the American Federation of Government Employees, the Arc of the United States, the Center for Responsible Lending and Global Policy Solutions.

With the midterm elections looming, the progressive and centralists of the Democratic party must put aside their differences to work together to support Democratic Congressional candidates who can win. One unifying political issue may well be supporting the expansion and strengthening of Social Security, Medicare and ensuring that Americans can be covered by affordable health insurance. Stay tuned.

AARP Takes a Look at the Prescribing of Dementia Drugs

Published in the Woonsocket Call on September 15, 2018

Last month, the AARP Public Policy Institute released a report, Insight on Issues, 137, that just might be a good read for physicians, medical societies, insurers, even the Center for Medicare and Medicaid (CMS), and Congressional lawmakers. According to the report’s findings, dementia drugs are often prescribed long-term despite lack of clinical evidence. Of interest to payers, reducing overuse of dementia drugs could result in substantial savings for patients and payers.

The AARP report findings indicate that a majority (70 percent) of elderly dementia patients prescribed dementia drugs are on them long-term despite the lack of evidence that they provide any benefit beyond one year. The study found that some patients took dementia drugs for as long as a decade, costing as much as $20,000 per patient.

“Our research shows some health care providers continue prescribing dementia drugs to patients for much longer than is supported by the clinical evidence,” said Elizabeth Carter, Senior Health Services Research Advisor, AARP Public Policy Institute, and co-author of the study. “Not only do these drugs carry potential side effects, they are costing both patients and the health care system a lot of money,” she says.

With experts predicting a looming Alzheimer’s epidemic, AARP Public Policy researchers saw the need to gather data on the prescription of dementia medications, and the costs associated with the disease currently total more than $270 billion annually and could reach $1.1 trillion by 2050, says Carter. “The efficacy of drug treatment for dementia, however, remains limited and there is little information about how or when to de-prescribe these products. Given the potential for unnecessary costs and potential side effects, we thought that current prescribing patterns warranted a closer look,” adds Carter.

“While there’s a lot of research from clinical trials on the efficacy of dementia drugs, I could find no other study showing the real-world prescribing patterns of these drugs among older adults, notes Carter.

Taking a Closer Look at Prescribing Dementia Drugs

The AARP report takes a look at two types of drugs are approved by the U.S. Food and Drug Administration for the treatment of dementia symptoms: cholinesterase inhibitors (ChEl) (Aricept®, Razadyne®, Exelon®) and memantine (Namenda®, Namenda XR®). Both types may help with symptoms like memory loss and confusion for approximately three to twelve months, but some patients see no improvement.

The AARP report asserts that the benefits of currently-approved dementia drugs are modest and do not affect the underlying cause of the disease or slow the rate of cognitive decline. They also do not delay institutionalization, improve quality of life, or lessen the burden on caregivers. Potential side effects of dementia drugs include low blood pressure and loss of consciousness, abnormally slow heart rate, and hip fracture.

The AARP report noted that claims data from 36,000 Medicare Advantage enrollees who started dementia drug treatment between 2006 and 2015 showed that 58 percent of patients were prescribed a ChEl, 33 percent were prescribed both ChEl and memantine together, and 8 percent were prescribed memantine. The majority (70 percent) of all patients taking dementia drugs were on them for 13 months or longer.

“Older adults typically take multiple medications, often on a long-term basis, and see multiple health care providers without any meaningful oversight of their overall prescription drug regimens,” said Leigh Purvis, Director of Health Services Research, AARP Public Policy Institute, and co-author of the report. “These findings really highlight the importance of ensuring that health care providers have access to reliable information to help them reassess medications that may no longer be of benefit, or even cause harm.”

Nursing Home Industry Weighs In

The AARP Study did not differentiate among patients who live in a nursing facility and those who live elsewhere, says Virginia Burke, President of the Rhode Island Health Care Association, representing the state’s nursing and assisted living facilities. She noted that the AARP study used billing records from a single Medicare Advantage plan, to see how frequently and for how long the drugs were purchased for Medicare beneficiaries.

Burke estimates that the percentage of billing records of nursing facility residents to be analyzed by the AARP researchers to be small because about three percent of those age 65 and older are in a facility at any given time – most of these individuals are age 80 and older.

“Keep in mind that nursing facilities don’t prescribe our patient’s medicines, rather we are required by regulation to administer the drugs prescribed by the patient’s physician. Nurses do have the ability to influence prescribing physicians, however, as evidenced by the reductions in use of anti-psychotics and antibiotics over the past few years,” says Burke. .

Changes in prescribing patterns of dementia drugs patterns starts must start with physicians, says Burke. “I expect that physicians might want to see more data, and perhaps a peer-reviewed replicated study, before it has an effect on their prescribing patterns [of dementia drugs],” she adds.

While Carter recognizes the efforts nursing facilities have made to reduce the unnecessary use of antipsychotic drugs on residents with dementia, there is still more work to do. “I’ve also heard anecdotal reports that some nursing homes are finding ways to skirt the problem by either replacing antipsychotics with other mood-altering drugs or diagnosing residents with conditions, such as bipolar or schizophrenia, that would justify the use of antipsychotics,” she says.

Carter says that AARP is planning to get the word out about their dementia drug prescription study through a partnership with OptumLabs to disseminate the findings to larger audiences, including physicians. “This type of potential overutilization is hardly unique to dementia drugs so we may look at the use of other prescription drugs in a follow-up study,” she says.

Physicians have other options to treat residents with dementia in nursing facilities, adds Carter. “There’s evidence supporting the use of non-pharmacological treatments such as environmental modification and cognitive behavioral therapy,” she says.

CMS Must Take Notice

CMS, the federal agency that oversees the Medicare program and insurers might consider taking a closer look at studies that look at the appropriate use and cost of the long-term prescribing dementia drugs. France’s health system did, says Carter, noting that “They will no longer reimburse for dementia drugs we studied (donepezil, galantamine, rivastigmine and memantine) as of August 2018,” she adds.

But, taking a closer look at the appropriate use, effectiveness and cost of long-term prescribing of dementia, might be a good strategy for Congress to put the brakes on the skyrocketing cost of pharmaceutical drugs.

Carter and Purvis, coauthors of this AARP report, conclude their study by urging health care providers to “regularly assess patients and their drug regimens to ensure these regimens remain appropriate reflecting the changing health status and needs of the patient.” They suggest more research can provide “up-to-date information on a drug’s effectiveness and side-effects that essentially can help increase the practice of de-prescribing medications that may no longer be of benefit, or even cause harm.”

This is sound advice to consider.

For details about AARP’s dementia drug study, go to http://www.aarp.org/dementiadrugstudy/.

Courtesy of AARP: Long-Term Care Data at Your Finger Tips

Published in the Woonsocket Call on September 2, 2018

Across the States 2018: Profiles of Long-Term Services and Supports, by Ari Houser, Wendy Fox-Grage, Kathleen Ujvari, of AARP’s Public Policy Institute, was released days ago. The jampacked 84-page AARP reference report gives state and federal policy makers comparable state-level and national data culled from a large number of research studies and data sources, some of the data gleaned from original sources.

AARP considers the 10th edition of Across the States, published for the past 24 years, “the flagship publication” to assist policy makers make informed decisions as they create programs, and policies for long-term services and supports (LTSS). State-specific data “is easily found, “at your fingertips,” claims AARP.

Across the States, released August 27, 2018, includes a myriad of aging topics include: age demographics and projections; living arrangements, income, and poverty; disability rates; costs of care; private long-term care insurance; Medicaid long-term services and supports; family caregivers; home- and community-based services (HCBS); and nursing facilities. Each state profile is a four-page, user-friendly, print-ready document that provides each state’s data and rankings.

Looking at Trends

AARP Public Policy Institute researchers have identified four trends in reviewing state data. Of most importance to Congress and state legislatures, Across the States gives a warning that America’s population is aging. The nation’s age 85 and over population, those most in need of aging programs and services, is projected to triple between 2015 and 2050, a whopping 208 percent increase.

But, by comparison, the population younger than age 65 is expected to increase by only 12 percent. The under age 65 population, currently, 85 percent of the total population, is projected to be 78 percent in 2050. Bad news for propping up the Social Security system with the worker-to – beneficiary ratio declining.

Across the States researchers say that the demographic shift of an increasing older population will have an impact on family caregiving. “The caregiver support ratio compares the number of people ages 45–64 (peak caregiver age) to the number ages 80+ (peak care need),” notes the report. Today, there are about 7 people ages 45–64 for every person age 80. By 2050, that ratio will drop to 3 to 1.

America’s older population is also becoming more diverse, reflecting overall trends in the general population. Across the States researchers note that the Hispanic population age 65 and over is projected to quadruple between 2015 and 2050.

Finally, Across the States report notes that State Medicaid LTSS systems are becoming more balanced due to the increase of state dollars going to fund home and community-based services (specifically to care for older people and adults with disabilities). But, this trend varies in level of balance, say the researchers, noting that: “The percentage of LTSS spending for older people and adults with disabilities going to HCBS ranged from 13 percent to 73 percent in 2016. While 40 states became more balanced, 11 states became less balanced for older adults and people with physical disabilities in 2016 compared with 2011.”

Taking a Closer Look

Across the States notes that the age 85 and over population is projected to significantly outpace all other age groups when the aging baby boomers begin turning age 85 in 2031. In 2015, people ages 85 and older made up 2 percent of the US population. By 2050, they are projected to represent 5 percent. By contrast, in the Ocean State the age 85 and over population was 2.7 percent of the state’s population. By 2050, look for the oldest-old population to inch up to 5.4 percent.

Throughout the nation the cost for private pay nursing facility care is well out of reach of most middle-income families. Across the States notes that in 2017 the annual median cost for nursing facilities is $97,455 for a private room and $87,600 for a shared room. But, in Rhode Island the annual cost is higher, with a private room costing $ 104,025 and $ 101,835 for a shared room. The researchers say that for the cost of residing in a nursing facility for one year, a person could pay for three years of home care or five years of adult day services.

Because of the high costs, most people go through their life savings paying for costly care and ultimately have to rely on the state’s Medicaid program. Nationally, the percent of Medicaid as primary payer in 2016 was 62 percent (61 percent in Rhode Island).

According to Across the States, family caregivers provided $470 billion worth of unpaid care in 2013, more than six times the Medicaid spending on home and community-based services. In Rhode Island, 134,000 provided 124 million hours of care annually with an economic value $ 1.78 billion. But, AARP’s report warns federal and state policy makers about the stark demographics in America’s future that will for the nation’s “Oldest Old” to scramble to find a caregiver, due to a shortage. Will state’s have the financial resources to fund programs and services to make up for this demographic reality.

For a copy of Across the States report and Rhode Island specifics, go to: http://www.aarp.org/content/dam/aarp/ppi/2018/08/across-the-states-profiles-of-long-term-services-and-supports-full-report.pdf.