How the Election Impacts Social Security

Published in Woonsocket Call on July 24, 2016

On the final night of the Republican National Convention (RNC) an average of 32 million Americans tuned in to watch Donald J. Trump, a New York Real Estate Developer, author, television personality and now politician, formally accepted the GOP nomination for President of the United States.

After he delivered his July 21 speech, reporters, political commentators, and even postings trending on twitter called Trump’s hour and 15 minute speech (4,400 words) “dark” because of its stark tone and content. This GOP presidential candidate’s speech was even referred to as being the longest acceptance speech in history since 1972.

Before more than 2,400 delegates Trump, 70, pledged to be the nation’s law and order president who would crack down on crime and violence. America first would be Trump’s mantra during the negotiation of international trade deals and the existing NAFTA trade accord would be renegotiated.

Trump also called for defending the nation’s borders against illegal immigrants and giving parents more choice in choosing schools for their children. And to the forgotten men and woman across the country who were laid-off because of President Obama’s mishandling of the economy Trump promised to be their voice. Syrian refugees would be vetted and only those individuals who “will support our values and love our people” will be admitted, he said.

Trump Ignores Social Security in Speech

Aging advocates say that Trump’s acceptance speech was short on details when it can to domestic policy, specifically Social Security and Medicare. But, you won’t need tea leaves to read how a future Trump Administration will change the way the nation supports its retirees. .

According to Max Richtman, President and CEO of the National Committee to Preserve Social Security and Medicare (NCPSSM), the choice of Governor Mike Pence as Trump’s running mate should send “a very clear message to America’s seniors that their priorities will hold little weight in a Trump administration.” While Trump has promised on the campaign trail that he won’t cut Social Security and Medicare.

During his 12 years serving as a U.S. Congressman, Pence consistently voted in favor of GOP legislative efforts to cut benefits in Social Security, Medicare and Medicaid, says Richtman, charging that Trump’s vice presidential running mate is one of a few Congressional lawmakers that has a strong “anti-seniors voting record.”

Richtman says that “Mike Pence was one of Congress’ biggest proponents of privatization. He supports cutting Social Security benefits by raising the retirement age, reducing the COLA, means-testing and turning Medicare into “CouponCare.” As he told CNN, ‘I’m an all of the above guy. I think we need to look at everything that’s on the menu,’ and the record shows he has done just that by supporting every form of Social Security, Medicare and Medicaid benefit cut proposed in the past decade.”

While Trump has promised not to cut Social Security benefits on his year-long campaign trail, he continues to surround himself with advisors who are “polar opposite” of his positions says Richtman. “They say actions speak louder than words — Donald Trump’s choice of Mike Pence as his Vice-Presidential running mate will speak volumes to American seniors,” he adds.

Political Experts Weigh in

Darrell M. West, Ph.D., Vice President and Director of Governance Studies at the Brookings Institution, says that “Trump is on record as saying he does not want to cut Social Security so that is considerably different from most Republican leaders, who support benefit reductions as a way to balance its books. This probably is the reason the [GOP] platform is vague on Social Security. The party could not reconcile Trump’s view on not cutting benefits with the party’s general view that cuts are needed. That left them with a reference to market solutions without explaining what that meant.”

“Party leaders have said they want to raise the retirement age for people under age 50. That issue certainly would be on the issue in a Trump presidency although it is not clear how he views that issue. But there would be significant support in a GOP-run Congress for doing that and cutting the benefits of future retirees,” adds West.

West believes that “Democrats have a very good chance of recapturing control of the Senate. If that happens, that will allow them to block benefit reductions or raising the retirement age, he says.

Wendy Schiller, professor and chair, Department of Political Science at Brown University, warns that talking about changing Social Security can be risky and this “involves a depth of knowledge about entitlement financing that eludes most political candidates especially those without any political experience.”

The Brown professor of politics does not see Trump tackling this issue in any meaningful way in the campaign and she does not believe it will be a priority for him or the GOP if he wins. “Recall George W. Bush tried to reform Social Security immediately after he won reelection in 2004 – by late January 2005 it was dead on arrival in Congress,” she says.

“Overall I am not sure the GOP leadership in the Congress has fully processed what a Trump presidency would look like in terms of policy or what his priorities might be. It is unclear to me that they will align closely and getting anything through Congress these days is nearly impossible, no matter who sits in the Oval Office,” she adds.

Stark Differences in Platforms to Fix Social Security

On Friday, the released Democratic Platform released reveal a stark difference as how to the Democratic and Republican parties will fix the ailing Social Security program. The GOP platform. Although current retirees and those close to retirement will receive their benefits, changes are looming with a Trump administration and a Republican-controlled Congress. For younger generations all benefit cut options to be put on the table, opposing the lifting of the payroll tax cap and sees privatization of Social Security as a way for older American’s to create wealth for use in retirement. On the other hand, the Democratic Party platform calls for a strengthening and expansion of the existing Social Security program. The Democrats oppose any attempts to “cut, privatize or weaken” Social Security, and calls for lifting the payroll tax and exploring a new COLA formula.

NCPSSM’s Richtman notes “ It’s also very telling that while the GOP buried their cuts and privatization plans for Social Security under the Platform’s Government Reform heading, the Democrats addressed Social Security, as they should, as part of their plan to restore economic security for average Americans. That’s been Social Security’s fundamental role for more than 80 years — providing an economic lifeline impacting the lives of virtually every American family.”

As AARP’s John Hishta noted in his July 22 blog, even though the “political spotlight was not on Social Security” at the RNC in Cleveland, delegates, rank-and-file politicians and even political operatives that he talked with clearly understand the programs importance to retirees and younger generations.

“If political leaders fail to act, future retirees could lose up to $10,000 a year. All beneficiaries could face a nearly 25 percent cut in their benefit,” warns Hishta. .

Hishta tells his blog readers that “AARP’s Take a Stand campaign left the RNC with renewed determination to make updating Social Security a bigger part of the presidential debate.” He pledges to continue pushing for strengthening and expanding the nation’s Social Security program at next week’s Democratic National Convention in Philadelphia and until the November presidential elections.

To keep informed about Social Security discussion during this presidential campaign go to http://takeastand.aarp.org/,

Whitehouse Pushes for Medicare to Pay for Person-Centered Care

Published on July 11, 2016 in Pawtucket Times

At a June hearing of the U.S. Senate Special Committee on Aging, Senator Sheldon Whitehouse calls for improving care for over 90 million Americans with advanced illnesses like Alzheimer’s disease, cancer, and heart disease. On the day of this Aging panel hearing, the Rhode Island Senator unveiled his legislative proposal, “Removing Barriers to Person-Centered Care Act,” at this panel hearing that would promote better coordination between health care providers, and place greater emphasis on the care preferences of Medicare beneficiaries with advanced illnesses.

The hearing, titled “The Right Care at the Right Time: Ensuring Person-Centered Care for Individuals with Serious Illness,” explored ways to improve the quality and availability of care and examined care models that are helping people with serious illness and their families.

Having Important Life Conversations

The June 23 hearing pulled together witnesses who called for “about the need for families and health care providers to prioritize these important life conversations, so that individuals’ wishes are known and person-centered care is prioritized,” noted U.S. Senator Susan Collins, who chairs the Senate Special Committee on Aging. In her opening statement the Maine Senator called for federal policies to “support efforts to relieve suffering, respect personal choice, provide opportunities for people to find meaning and comfort during serious illness, and – most important – remain in control of their own care.”

Advance care planning conversations to a patients’ physical, emotional, social and spiritual well-being are important in the care of a patient, says Collins. However, studies reveal that less than one-third of physicians have reported that their practice or health care system has a formal program in place to assess patients’ goals or preferences, she notes.

Collins also shared a personal story of a close friend who benefited from the person-centered care she received while she was a patient at the Gosnell Memorial Hospice House in Scarborough, Maine. “Despite her serious illness, because of hospice care her days were filled with visits from friends and families and many joyful moments, and she was surrounded by her family when she died peacefully,” she said.

“I’ve heard from Rhode Islanders about how difficult it can be for patients battling serious, advanced illnesses to get the care and respect they want,” said Whitehouse.

Whitehouse noted that “We can do better by these patients. Because so many of the rules and incentives in our health care system are tied to the payment structure, we should design payment systems that support models of coordinated care that focuses on the full person. Payment systems should reward providers for honoring patients’ own preferences for their care.

As Dr. Atul Gawande, surgeon and author of the New York Times best-selling book, “Being Mortal, mentioned in his testimony, “people with serious, potentially life-limiting illnesses face substantial and increasing suffering, particularly during the last year of life. Medical care today typically exacerbates this suffering, often without any benefit of lengthened life. We have an opportunity to change this.”

“The goal is not a good death. Instead, the goal is to have as good a life as possible all the way to the very end,” say Dr. Gawande.

In her testimony, Amy Berman, a nurse and senior program officer at the John A. Hartford Foundation, who is living with stage IV inflammatory breast cancer stand stressed the importance of palliative care, which is designed to improve the quality of life for patients with serious illness.

“Palliative care is the best friend of the seriously ill,” said Berman, “Studies have shown that when palliative care is added at the beginning of a serious illness that people feel better and live longer.”

Finally, Dr. Kate Lally, Chief of palliative care for the Providence-based Care New England Health System, Medical Director of the Integra Accountable Care Organization, and Assistant Professor of Medicine at Alpert Medical School of Brown University, urged Congress to consider legislation that would improve the quality, not just the quantity, of life of the seriously ill. “I feel blessed to do this work, and to be able to reflect with my patients on the life they have lived, their joys and regrets,” she said. “I feel I am able to share some of the most sacred moments of their life, and be at their side as they consider what is most important to them in their limited time.”

“The healthcare system as a whole, as well as Medicare and Medicaid, need to face growing expectations about how people with serious or terminal illnesses are treated,” said AARP Rhode Island State Director Kathleen Connell. “We are investing in prevention and early treatment and getting better results. Ultimately, however, people will still face serious illness and palliative care. Person-centered care is the proper prescription, and we must strive to make sure that it’s available. We need to be vigilant when it comes to supporting a healthcare environment in which patients with serious illness feel they are well informed and can remain properly in control of their options. And while families still tend to avoid these discussions in advance, when the time is right proper guidance makes a world of difference.

“People form especially strong opinions about decisions made that may prolong their existence, but add little to the quality of lives and, in fact, can prolong suffering,” Connell added. “Conversations on this phase of life are critical and we applaud Senators Collins and Whitehouse for their contribution to this dialogue.”

Legislation to Support New Models of Coordinated Care

The thrust of Whitehouse’s legislative proposal is to promote better coordination between health care providers, and place greater emphasis on the care preferences of Medicare beneficiaries with advanced illnesses.

“Too many Rhode Island Medicare patients battling difficult illnesses are struggling to get the right care at the right time,” said Whitehouse. “We need to break down the barriers between patients and the care they need. Because so many of the rules and incentives in our health care system are tied to the payment structure, we should design payment systems that support new models of coordinated care that are focused on human beings and not some rule or regulation.”

Whitehouse’s legislation would establish a pilot program administered by the Centers for Medicare and Medicaid Services (CMS) made up of twenty “advanced care collaboratives” of affiliated health care providers and community-based social service organizations. Collaboratives would receive a planning grant to assess the needs of the population of patients it would serve; to purchase or upgrade health information technology to facilitate better coordination of care between providers; and to support education and training on documenting and communicating beneficiary treatment preferences and goals.

Once planning is complete, collaboratives would enter a three-year payment agreement with Medicare to provide coordinated, high-quality care for their target patient population. Under the terms of the pilot program, CMS would waive regulations to promote innovative care for patients with advanced illness.

Waivers would be granted to allow Medicare patients to receive hospice care and curative treatment at the same time. Currently CMS’s regulations force patients to choose one or the other for their terminal illness. Patients would be able to also receive Medicare coverage in a skilled nursing home without a consecutive three-day inpatient hospital stay. Under current Medicare rules, patients are often charged for skilled nursing care after they leave an inpatient hospital stay because they were hospitalized for observation rather than admitted to the hospital.

Whitehouse’s legislative proposal would also allow Medicare patients to receive home health services without the requirement that they be homebound. Under current rules, a patient’s condition must have progressed such that there “exists a normal inability to leave home,” denying these services to those who are seriously ill but still mobile. Finally, it would also allow nurse practitioners to sign home health and hospice care plans and certify patients for the hospice benefit. Right now, only doctors can do so, even though nurse practitioners are often the ones administering home health and hospice care. This forms another barrier for patients seeking these services, especially in underserved and rural areas.

According to Tom Koutsoumpas, Co-Chair of the Coalition to Transform Advanced Care’s (C-TAC) Board of Directors, Whitehouse’s legislative proposal is “a critical step forward to achieving high-quality, coordinated care for those with advanced illness. This legislation allows for important innovations in care delivery and removes obstacles to support patients throughout the care continuum.”

We Need Congress to Step Up and Fix Social Security, Medicare

Published in Woonsocket Call on July 3, 2016

Expect the nation’s Social Security program to be fully funded for nearly two decades, and Medicare’s solvency to continue courtesy of health care reforms. Social Security beneficiaries may even get a very small .2 percent cost of living (COLA) adjustment next year but will get wacked with a Medicare premium increase. These facts are reported in the recently leased 262 page report issued by the Trustees of the Social Security and Medicare funds, transmitted to Congress and President Obama. This is the 76th report issued by the Trustees that financially reviews these two of the nation’s largest entitlement programs.

This 2016 Trustee Report, released on Jun 22, should be of interest to Rhode Island’s retirees who receive checks from Social Security, According to AARP, 153,349 Rhode Islanders received Social Security checks as of the end of 2014. Also, 22 percent of Rhode Island retirees depend on their Social Security check for 90 percent or more of their income. Their average benefit is $1,341 per month.
The Devils in the Details

The recently released 2016 Trustees Report notes there is now $2.81 trillion in the Social Security Trust Fund, which is $23 billion more than last year and that it will continue to grow by payroll contributions and interest on the Trust Fund’s assets.

Meanwhile, Social Security remains well-funded. In 2016, as the economy continues to improve, Social Security’s total income is projected to exceed its expenses. In fact, the Trustees estimate that total annual income will exceed program obligations until 2020.

The Trustees say that Social Security will be able to pay full benefits until the year 2034, the same as projected in last year’s Report. After that, Social Security will still have sufficient revenue to pay about 79% of benefits if no changes are made to the program.

Although the Trustees project a .2% Cost of Living Adjustment increase, retirees will be hit with a premium increase next year. Medicare Part B premiums are projected to increase by only a very small amount for about 70 percent of beneficiaries in 2017 from $104.90 to $107.60. The standard monthly premium is projected to increase from $121.80 to $149.00 while the annual deductible is projected to increase from $166 to $204 for all beneficiaries.

The Trustees peg Medicare solvency to the passage of healthcare reform, with the program paying full benefits until 2028, 11 years later than was projected prior to passage of the Affordable Care Act. However, this is two years earlier than projected in 2015.

Congress Must Step to the Plate

Responding to the Social Security Trustees report, recently released report, AARP CEO Jo Ann Jenkins, said, “While the Trustees once again report that the combined Old Age, Survivor and Disability Insurance Trust can pay full retirement, survivor and disability benefits for some time, we know that if no action is taken, benefits could be cut by nearly 25 percent in 2034, and families could lose up to $10,000 per year in benefits.”

“Social Security remains a critical part of the fabric of our lives to protect us from both expected and unexpected challenge,” says Jenkins.

Jenkins calls on Presidential candidates and those running for Congress and the Senate to make a commitment to strengthening Social Security and outline their plans for the fix. “Throughout the 2016 election, we’ll continue to push candidates to take action if elected,” she says.

As to Medicare, Jenkins adds, “This year’s Medicare Trustees report reinforces the recent progress that has been made through greater Medicare savings and lower costs per enrollee. The report also highlights the financial challenges that continue to face the Medicare program, which is projected to provide critical health coverage to 64 million Americans by 2020.”

“A typical senior today has an annual income of just under $25,000 and pays roughly one out of every six dollars of this in out-of-pocket health care costs. The more than 55 million older Americans who today depend on Medicare for guaranteed, affordable health coverage simply cannot afford more than they already pay,” says Jenkins.

The Solution Could Be Simple

Jenkins urges Congress to make simple solutions to bring stability to the nation’s Medicare program. She suggests Congress find ways to reduce high prescription drug costs, improve the nation’s health care outcomes, eliminate unnecessary diagnostic testing, curb excess paperwork, and identify waste and fraud in the program.

Adds, Max Richtman, President/CEO of the National Committee to Preserve Social Security and Medicare, “What’s likely to be missing in headlines about today’s Social Security Trustees Report is that the program remains well-funded with total income, again, projected to exceed expenses. However, in order to head off a benefit cut in 2034 Washington should embrace the growing movement to lift the payroll tax cap and expand benefits for the millions of seniors struggling to get by on an average $1,300 retirement benefit.

The Trustees also project a tiny .2% cost of living adjustment next year yet Medicare premiums will increase in 2017, says Richtman. “Seniors continue to see their modest Social Security benefits eaten away by growing healthcare costs which illustrates, once again, that the current Social Security COLA formula isn’t accurately measuring seniors’ expenses. Congress needs to adopt a fully developed CPI for the elderly (CPI-E) and begin work on the many Social Security expansion bills now languishing in the House and Senate,” he adds.

This [Trustee’s] report reinforces the importance of ensuring that Social Security and Medicare are preserved and guaranteed, especially for working and middle class Rhode Islanders,” said Rep. David Cicilline (D-Rhode Island) who is a co-sponsor of the Protecting and Preserving Social Security Act. “Reasonable measures, such as raising the cap on high-income contributions, should be considered by Congress to extend the solvency of these programs. I will continue to advocate for commonsense legislation that strengthens benefits for working families and ensures the long-term stability of Social Security and Medicare,” he says.

RI. Reps Protect Social Security

Like Cicilline, Rep. Jim Langevin and Democratic Senators Jack Reed (D and Sheldon Whitehouse both view Social Security as an earned benefit and the primary source of income to millions of retirees that must be protected. The Rhode Island Congressional Delegation has fought off Republican efforts to privatize Social Security and have supported legislation to strengthen this program and Medicare.

It is very clear to aging advocates and to the Trustees of the Social Security and Medicare trust funds that the next President and Congress put political differences aside to make legislative fixes to strengthen and ensure the long-term stability of Social Security and Medicare.

The Trustees say this very clearly in their report, “Lawmakers have many policy options that would reduce or eliminate the long-term financing shortfalls in Social Security and Medicare. Lawmakers should address these financial challenges as soon as possible. Taking action sooner rather than later will permit consideration of a broader range of solutions and provide more time to phase in changes so that the public has adequate time to prepare.”

Political compromise will be the way to hammer out Social Security and Medicare reforms. When the dust is settled after the upcoming November president elections hopefully this message was delivered at the ballet box.