Calls for Strengthening Medicare as it Hits 53

Published in the Woonsocket Call on August 5, 2018

Just before Summer recess House Democratic Leader Nancy Pelosi (D-CA) joined Seniors Task Force co-chairs Congresswomen Jan Schakowsky (D-IL) and Doris Matsui (D-CA), Democratic Policy and Communications Committee co-chair Congressman David Cicilline (D-RI) and seniors’ advocates gathered in the historic Rayburn Room of the U.S. Capitol, one of the largest rooms on Capitol Hill, to celebrate the 53rd anniversary of Medicare and Medicaid being signed into law by President Lyndon Johnson.

“We usually celebrate Medicare’s anniversary at the U.S. Capitol with balloons and cake. This year, the 53rd anniversary, was a more solemn occasion because of relentless attacks on the program by the Trump administration and Congressional Republicans, says Max Richtman, President and CEO of the Washington, D.C.-based National Committee to Preserve Social Security and Medicare, one of the advocacy groups in attendance.

When signing the landmark legislation into law on July 30, 1965, President Lyndon B Johnson said, “No longer will older Americans be denied the healing miracle of modern medicine. No longer will illness crush and destroy the savings that they have so carefully put away over a lifetime. No longer will young families see their own incomes and hopes eaten away simply because they are carrying out their deep moral obligations to their parents.”

At the July 25 birthday commemoration, Leader Pelosi called Medicare and Medicaid “the pillars of health and security for the nation,” noting that for years these two programs have been under unrelenting and constant attacks from Republicans.

“For years, Republicans have sought to deny seniors and working families the healing miracle of medicine. Republicans want Medicare, in their words, to ‘wither on the vine.’ They want to cut and cap Medicaid into oblivion. They want to give massive tax handouts to big pharma who are denying seniors lower prescription drug prices,” says Pelosi.

According to Pelosi, the Democrats plan, A Better Deal, provides a legislative strategy for lowering the price of prescription drugs. “Our plan calls for tough new enforcement of drug price gauging, allowing Medicare part D to negotiate drug prices,” she said, noting that President Donald Trump had promised that during his presidential campaign, “We’re going to negotiate like crazy.”

Echoing Pelosi, at the press conference Rhode Island Congressman Cicilline also called for the reining in of prescription drug costs to put the brakes on rising Medicare expenditures. “Democrats believe that seniors shouldn’t have to cut pills in half to afford prescription drugs. We need a president who will work with us to allow Medicare to negotiate drug prices, to compel drug makers to justify cost increases, and to crack down on price gougers,” said Cicilline.

Cicilline reminded those attending that the President once promised to take on the drug companies but now has decided to appoint a former drug company executive as his Secretary of the Department of Health and Human Service. “And right now, he’s pretty much letting the pharmaceutical lobby have the run of the place,” he charged.

At the press conference, the Democratic lawmakers were joined by ten yellow t-shirted senior volunteers from the National Committee to Preserve Social Security and Medicare’s Capitol Action Team (CAT), who demanded that the program be strengthened. One of the CAT members, Patricia Cotton, gave a powerful personal testimonial about the importance of Medicare in her life. Cotton, a Medicare beneficiary who suffers from a blood cancer known as Myelofibrosis, said she wouldn’t be alive today without the health care program.

“My cancer meds started at $10,000 every 30 days and have gone up twice in two years. Cancer meds are very expensive. My Medicare Part B and D premiums have gone up, and that is coming out of my Social Security check. That is why, without Medicare and Social Security, the rich will live and the poor will die,” said Cotton.
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Democratic Report Spotlights GOP’s Ongoing Attacks on Medicare

At this event, the House Democratic Seniors Task Force unveiled a new 24 page report, “The Republican Record on Medicare, Medicaid and Social Security: Attacks on Benefits Seniors Have Earned and Deserve,” detailing years of Republican’s attacks on seniors and demanded the GOP take action on lowering pharmaceutical prices.

“This report shows how the passage of the GOP tax bill was just one step in a long line of Republican attacks on seniors,” says Congressman Matsui (D-CA). “In budget after budget, year after year, Republicans have reaffirmed their commitment to gutting Medicaid, scaling back Medicare, and cutting seniors’ earned Social Security benefits. Democrats are focusing on efforts that help seniors and families, like lowering drugs prices, and fighting to ensure that these vital programs are here for current and future generations.”

“The House GOP budget proposal includes more than $500 billion in Medicare cuts, a higher eligibility age, and privatization of the program through a voucher system,” the National Committee’s Max Richtman explains. “The President’s 2019 budget would inflict similar harm on Medicare. The Trump administration is undermining the program through skillfully worded enrollment information that favors private Medicare Advantage plans over traditional Medicare. These actions are contrary to the mission of Medicare so eloquently stated by President Lyndon Johnson is when he signed it into law 53 years ago,” says Richtman.

AARP Calls Medicare an Economic Engine for Rhode Island

Last year, Medicare, which helps pay the health care costs of 56 million beneficiaries, is a critical part of the country’s economic infrastructure, investing about $ 710 billion in the national economy that year, says AARP.

On July 25th, the same day that House Democratic Leadership and aging groups celebrated the 53rd anniversary of the signing of Medicare, AARP released fact sheets illustrating Medicare’s contribution to the economies of each state and the District of Columbia.

Let’s take a close look at the Ocean State.

Medicare contributes $2.5 billion to Rhode Island’s economy, equivalent to 21% of state and local government spending in the state, according to the released AARP Rhode Island fact sheet, noting that the program also covers 192,186 beneficiaries in the state. In polls, older Americans have said Medicare is one of their top issues in the 2018 mid-term elections, and AARP Rhode Island is working to encourage older Rhode Island voters to participation this election season.

“Medicare is a major economic engine in our economy security, as well as a key part of, providing health security to Rhode Islanders,” said AARP State Director Kathleen Connell in a statement. “Older Americans have said Medicare is one of their top issues in this election, yet too many politicians fail to recognize the contributions Medicare makes to the economy and our residents. Any candidate who fails to talk about how they would strengthen Medicare for future generations does so at their peril,” says Connell.

Below the AARP fact sheet breaks down some of Medicare’s spending in Rhode Island:
• $1.1 billion for hospitals
• $551 million for doctors
• $338 million for prescriptions and medical supplies
• $198 million for skilled nursing facilities
• $159 million for home healthcare agencies
• $92 million health professionals
• $24 million for medical equipment

Also, businesses in Rhode Island receiving Medicare dollars use them to pay employees’ salaries, rent, state and local taxes, and buy equipment, and make capital improvements to their facilities, says the AARP fact sheet.

With the mid-term elections looming, it is now time to send a clear message to Congress and President Donald Trump, “Stop Attacking Medicare.” Lawmakers on both side of the aisle must work to craft a bipartisan solution to strengthen the program for the benefit of America’s retirees. Consider sending this message when you vote…

AARP’s “Be The Difference. Vote” campaign includes a one-stop online portal – aarp.org/vote – to provide people with information (about Social Security, Medicare, Medicaid and aging issues} they need to. know about before voting in the upcoming November elections.

To see the House Democratic Senior Task Force report, “The Republican Record on Medicare, Medicaid and Social Security: Attacks on Benefits Seniors Have Earned and Deserve,” go to
http://www.schakowsky.house.gov/uploads/Seniors%20Task%20Force%20Report%207.24.18.pdf

Report highlights major flaws, calls for improvements in Medicare Plan Finder

Published in Pawtucket TImes on July 23, 2018

July 23, 2018 | Times, The (Pawtucket, RI)

When shopping around for the best Medicare coverage options in fee-to-service and Medicare Parts C and D, beneficiaries are often told they can rely on the Medicare Plan Finder (MPF) to provide the needed information to compare and choose the plan that best meets their needs. But, a recently released report, co-authored by the Clear Choices Campaign, a health care cost transparency initiative of the Council for Affordable Health Coverage, and the nonprofit National Council on Aging (NCOA), charges that the federal government’s online tool may not be delivering on that promise. “MPF is in the need for significant reform,” advises the report.

MPF Tool Needs a Complete Overhaul

While the 46-page report acknowledges MPF’s “wealth of unbiased information,” it warns that “the status quo is not acceptable, and that a re-tooling of MPF’s plan comparison features and enrollment functions is essential.” “The site is overwhelming, information is poorly presented, and the user design is potentially misleading – all of which confuses beneficiaries and can contribute to many making poor plan selections. Two of the biggest shortcomings are out-of-pocket cost information is difficult to understand and provider directories are difficult to navigate,” concludes the report.

The report’s scorecard gives the MPF “A” grades only for its anonymous browsing capabilities and non-English translation services., but MPF earned “D” or “F” grades in seven other criteria (specifically, Customized Plan Information, Highlights Supplemental Benefits, Integrated Provider Directory, Layout, Access to Human support).

“Modernizing Medicare Plan Finder: Evaluating and Improving Medicare’s Online Comparison Shopping Experience,” released on April 25, 2018, is the result of the first-ever independent stakeholder assessment of MPF. Along with the scorecard rating 12 criteria, the report highlights the evaluation findings and provides specific recommendations to improve MPF.

For its analysis, Clear Choices and NCOA staff undertook a detailed review of all online MPF functions, conducted 25 interviews with Medicare beneficiaries, and surveyed Medicare State Health Insurance Assistance Program (SHIP) directors, who routinely use the tool in assisting millions of Medicare beneficiaries. The findings highlight a number of MPF challenges for beneficiaries, ranging from the unavailability of human support, to language that is unfamiliar to the typical consumer, to confusing out-of-pocket cost estimates.

“In order for competition to work in the increasingly complex Medicare program, beneficiaries must be well-informed and have consumer-friendly tools available to make wise plan choices,” said Howard Bedlin, NCOA’s Vice President of Policy and Advocacy. “I sat with seniors and talked with them while they struggled to use the Plan Finder and I can assure you, this is clearly not the case today. This report includes 11 key and 25 detailed recommendations for making this goal a reality, and ensuring that every beneficiary has access to the information they need to make the best Medicare decision for their situation. NCOA, and the diverse groups and thought leaders who contributed to this report stand ready to help make it happen.”

Joel White, Clear Choice’s president, says “our members know that transparency is key to unlocking greater competition and to ultimately drive down healthcare costs.”

Markets respond when consumers are empowered to make informed decisions by using tools to compare their options, he says.

“Sadly, in this case, a tool designed to help beneficiaries better understand their choices is failing in its mission and adding to the confusion and opaqueness that typifies too many Americans’ healthcare experience. We must fundamentally re-imagine how MPF delivers information to consumers and, ultimately, have an honest conversation about whether beneficiaries would not be better served by the private sector,” adds White.

“Medicare beneficiaries need to be able to understand and compare their Medicare options so they can choose the plan that is best for them. We hope that CMS will implement the recommendations in the report in order to improve MPF’s consumer-facing features,” says Karin Bolte, senior director of health policy, National Consumers League,

Creating a Better Online Consumer Tool

The report includes 11 key and 25 detailed recommendations that NCOA and Clear Choices believe will improve the Medicare Plan Finder and ensure that every beneficiary has access to the information they need to make the best Medicare decision for their situation.

These include:

• Displaying costs with decision and prominence

• Basing estimated out-of-pocket costs on more detailed information

• Integrating a provider directory

• Utilizing saved information about consumers’ drugs

• Allowing consumers to compare Medicare Advantage plans with an equivalent combination of fee-for-service, Medigap, and standalone drug plans

• Redesigning the layout and display to enhance usability and promote intuitive navigation

• Replacing insurance jargon with graphics, charts, and plain language

• Integrating a web chat feature

• Enabling the website to suggest plan options

• Contracting to ensure more stringent oversight of MPF’s accuracy

• Testing the site with consumers on a regular basis

With 10,000 Baby Boomers enrolling in Medicare every day, its crucial for the U.S. Centers for Medicare and Medicaid Services to closely review the “Modernizing Medicare Plan Finder” report’s recommendations and make appropriate changes for this online tool to remain relevant. To access the report, go to http://www.ncoa.org/wp-content/uploads/CC-2018-MedicarePF- Report-Final-0418.pdf.

Questions Raised About the State’s New Independent Provider Program

Published in the Woonsocket Call on July 15, 2018

In the waning days of the 2018 legislative session, the Rhode Island General Assembly passed legislation (S 2734 Sub A, H 7803 Sub A) that establishes in the Ocean State the “Independent Provider” (IP) model of at-home care, which allows consumers to hire and manage caregivers of their own choice while the state takes on certain responsibilities, such as setting caregivers’ wages, qualification standards and hours. With Gov. Gina M. Raimondo’s signature, the legislation became law on June 29th.

The enacted legislation is backed by the Rhode Island Campaign for Home Care Independence and Choice, a coalition that includes the Senior Agenda Coalition, RI Working Families Party, RI Organizing Project, District 1199 SEIU New England, RI AFL-CIO, Economic Progress Institute and the RI Chapter of the National Organization of Women (NOW). But, although on the losing side of the legislative debate the Rhode Island Partnership for Home Care continues to express its concern about the impact on the delivery by IPs to seniors and persons with disability.

Overwhelming Support on Smith Hill

The health care legislation, sponsored by Senate Majority Whip Maryellen Goodwin (D-Providence) and Rep. Christopher R. Blazejewski (D-Providence), easily passed both the House and Senate Chambers. The Senate Committee on Labor unanimously passed the measure by a 9-0 vote. By a count of 33-0, the legislation easily passed on the Senate floor. Meanwhile, in the other chamber, the House Committee of Finance put its stamp of approval on the measure by a vote of 13-0, with the legislation ultimately passing of the House floor by a vote of 60-11. But, because the House amended the bill (in committee and on the floor), it had to come back to the Senate for consideration again. The Senate vote on the revised legislation was 28-3.

In a statement announcing the new law, Goodwin and Blazejewski, say “By increasing both availability and quality of at-home care options, the new law’s ultimate goal is to move Rhode Island toward greater use of care in the community rather than in nursing facilities, since at-home care is both more comfortable and satisfying for consumers and less expensive than nursing facilities.”

“Presently, Rhode Island ranks 42nd in the nation in terms of investment in home care. Ninety percent of older Americans prefer home care. Not only is it more comfortable for seniors, it’s more cost-effective, as we’ve seen in states like Massachusetts. High-quality home care is what people want, and it saves money. I’m proud to support this effort to help make excellent home care available to more Rhode Islanders,” said Goodwin.

Adds, Blazejewski, “There is little question that people prefer to stay in their homes as long as possible. Particularly now, as the over-65 population in our state is rapidly expanding, Rhode Island must shift more of our long-term care resources toward supporting home care. Our legislation will help provide more options for home-based services, enhance access to them and establish standards that assure high-quality care.”

Hiring, Finding and Managing a Caregiver

Currently around 77 percent of Medicaid funding for long-term services and supports goes to nursing facility care rather than community-based care. Those who use community-based care generally go through agencies or find, hire and manage a caregiver on their own. This bill would create a third option.

Under the Independent Provider model, which has been in place in Massachusetts since 2008, consumers would still be the direct employer who determines when to hire or fire an employee, but the state would take on responsibilities for maintaining a registry of qualified caregivers, and would set parameters such as rates, qualifications and hours.

While the new law stipulates that they are not employees of the state, it would give home care workers the right to collectively bargain with the state over those parameters. Allowing them to organize would ensure that this otherwise dispersed workforce has a unified voice and a seat at the table to tackle the issues facing Rhode Island’s long term services and supports system, said the sponsors.

Consumers in states with independent provider models report higher levels of client satisfaction and autonomy, received more stable worker matches, improved medical outcomes, and reduced unmet need with agencies delivering fewer hours of care relative to the needs of the consumer.

In testimony supporting the health care legislation, Director Charles J. Fogarty, of Rhode Island’s Division of Elderly Affairs (DEA), told lawmakers that the health care legislation supports two goals of DEA, first it would enable elderly and disabled Rhode Islanders who are medically able to stay at home and second, it would address Rhode Island’s direct service provider workforce shortage.

Fogarty said it’s critical for older adults and people with disabilities to have access to the quality of care that is right for them. “In some cases, care from an independent provider they know and trust will best meet their needs to remain independent. In other cases, a home care agency will be the right fit. And for some, particularly those with complex medical needs, our quality nursing homes are the right option,” he said.

When quizzed asked about The Rhode Island Health Care Association’s position, Virginia Burke, President and CEO, recognized the value of home care in the state’s long-term care continuum but stressed that residents in the state’s nursing facilities “are too sick or impaired to mange at home.” She said, “Our only concern with this proposal is the suggestion that it could drain Medicaid funding from the frailest and most vulnerable among our elders in order to pay for a new Medicaid service. Surely our elders deserve good quality and compassionate care in all settings.”

Calling for More Education, State Oversight of IPs

While most who testified before the Senate and House panel hearings came to tout the benefits of bringing IP caregivers into the homes of older Rhode Islanders and persons with disabilities, Nicholas A. Oliver, Executive Director of the Rhode Island Partnership for Home Care, sees problems down the road and calls the new policy “duplicative and costly.”

In written testimony, if the legislation is passed Oliver warns that Rhode Island will be authorizing untrained and unsupervised paraprofessionals to deliver healthcare to the state’s most frail seniors without Department of Health oversight, without adherence to national accreditation standards for personal care attendant service delivery and without protections against fraud, waste and abuse.

Furthermore, his testimony expressed concern over the lack of oversight as to the quality of care provided by IPs to their older or disabled clients. Although the legislation called for supervision from the Director of Human Services (DHS), this state agency does not have the mandated legislative authority to investigate IPs to ensure that patient safety is met and the recipients of care are protected against harm in their homes. Nor does it require daily supervision for adherence to the patient’s authorized plan of care, he says, noting that is a requirement for licensed home health and hospice agencies.

Oliver observes that the legislation does not require IPs to receive the same level of intensive training that Certified Nursing Assistances (CNAs) receive from their home health care and hospice agencies. While the state requires all CNAs to complete 120 hours of initial training, pass a written and practical examination, become licensed by the Department of Health and maintain a license by completing a minimum of 12 hours of in-service training annually, the legislation only requires IPs to take three hours of generalized training and no continuing in-service training is required.

CNAs deliver the same personal care attendant services as the IPs but have a specific scope of practices that they must follow as regulated by the Department of Health and their licensure board while IPs do not have these requirements, says Oliver.

Finally, Oliver says that “to ensure quality of care [provided by home care and hospice agencies], CNAs are supervised by a registered nurse (RN) that is actively involved in the field and who is available to respond to both the patient’s and the CNA’s needs on-demand to reduce risk of patient injury, harm or declining health status and to reduce risk of CNA injury, harm or improper delivery of personal care.” IPs do not have this supervision., he says.

Safe guards are put in place by home health and hospice agencies to ensure the safety of patient and direct care staff, says Oliver, noting that these agencies are nationally accredited by The Joint Commission, the Community Health Accreditation Program (CHAP) or the Accreditation Commission for Health Care (ACHC) in partnership with the Department of Health for compliance of state and federal rules and regulations, as well as national clinical standards for personal care attendant service delivery.

With the Rhode Island General Assembly bringing IPs into the state’s health care delivery system, the state’s Executive Office of Health and Human Services, granted authority by the legislation to develop the program, might just consider establishing a Task Force of experts to closely monitor the progress of the new IP program’s implementation to ensure that quality of care is being provided and to make suggestions for legislative fixes next year if operational problems are identified. Unanticipated consequences of implementing new rules and regulations do happen and every effort should be state policy makers that this does will not happen in Rhode Island with the creation of the new IP program.

To watch Oliver talk about the Rhode Island Partnership for Home Care’s opposition to the enactment of IP legislation that would increase state involvement in the home care sector, go to http://m.golocalprov.com/live/nicholas-oliver.