Tag Archives for Centers for Medicare and Medicaid Services

Medicare Drug Savings Eclipsed by Part B Premiums, COLA Challenges and ACA’s Rising Costs

Published in RINewsToday on January 5, 2026

The official arrival of the New Year was marked by millions of viewers channel surfing between ABC, CBS, NBC, and CNN, eager to watch the ball drop in Times Square and ring in 2026. The iconic New York City ball—12,000 pounds and adorned with 5,280 Waterford Crystal discs and LED lights—descended a 139-foot flagpole atop One Times Square. In just 60 seconds, it reached the bottom at midnight on New Year’s Eve, signaling the beginning of 2026.

Just two days before January 1—when Medicare-negotiated prices for 10 prescription drugs take effect—AARP Executive Vice President and Chief Advocacy & Engagement Officer, Nancy LeaMond, shared good news. As the clock struck midnight, she announced that older Americans would see lower prices for the first 10 Medicare-negotiated drugs, which would take effect on January 1, 2026. AARP quickly issued a statement, celebrating the first-ever Medicare-negotiated drug prices and estimating a whopping 50% reduction in out-of-pocket costs for beneficiaries.

“For millions of older Americans managing chronic conditions, prescription drugs are not optional—they are a lifeline. But medicine doesn’t work if people can’t afford it,” said LeaMond in a Dec. 29 statement. She emphasized that AARP has been at the forefront of advocating for drug pricing reforms since 2022. The nation’s largest aging advocacy group, representing nearly 38 million members, shared their stories, conducted national research on drug costs, and urged lawmakers on both sides of the aisle to support legislative efforts to lower drug costs.

According to LeaMond, this advocacy has delivered significant progress. On January 1, negotiated prices will take effect for the first time, marking a major milestone for both patients and taxpayers. “Older Americans will see real results and billions in savings as the first Medicare-negotiated prices take effect,” she stated, pledging that “AARP won’t stop fighting to lower drug prices until every American can get the medications they need at a price they can afford.”

“These drugs are used by nearly 9 million Medicare beneficiaries and treat conditions such as diabetes, heart disease, autoimmune disorders, and cancer,” she noted.

While Medicare beneficiaries are set to see substantial savings, the Centers for Medicare and Medicaid Services (CMS) anticipates that the Medicare drug price negotiation program will save billions. CMS, a federal agency providing health coverage to over 160 million people through Medicare, Medicaid, the Children’s Health Insurance Program, and the Marketplace, expects the program to save enrollees roughly $1.5 billion in out-of-pocket costs in 2026 while saving the Medicare program $6 billion per year.  The negotiated prices are a minimum of 38% off the 2023 list price.

On the Other Hand

Though Medicare beneficiaries will benefit from lower out-of-pocket costs on 10 Medicare-negotiated drugs in the new year, the 2026 Social Security COLAs will barely cover Medicare Part B premiums and rising inflation.  Meanwhile, older Americans who are not eligible for Medicare coverage will face soaring health insurance premiums due to the Senate’s failure to extend the Affordable Care Act (ACA) Tax Credits.

Max Richtman, President and CEO of the National Committee to Preserve Social Security & Medicare, stressed the importance of ACA marketplace coverage for older adults, who often struggle to find affordable health insurance. “It’s not only cruel to let their premiums skyrocket; it costs everyone in the long run,” observes Richtman. “Older patients without insurance will be forced to use emergency rooms for care, which drives up costs for all healthcare consumers,” he says in a statement released on Dec. 11, 2026.

“They’ll also arrive at Medicare sicker or more disabled, which not only costs taxpayers more but raises premiums for all older Americans on Medicare,” warns Richtman.

Richtman pointed out that 40% of ACA enrollees are between the ages of 45 and 64. Without the extended tax credits, many of these individuals—including farmers, ranchers, entrepreneurs, and small business owners—will face unaffordable premium increases and may be forced to drop or downgrade their health care coverage. “Extending these tax credits to prevent premium hikes would have made simple common sense,” Richtman argued. “Why would Senators vote to push people off health insurance instead of widening the safety net when the ACA is so clearly beneficial, especially for older, vulnerable enrollees?,” he asked.

Additionally, this year’s premium increase for the standard Medicare Part B program, while not as high as originally projected, will still affect beneficiaries, too. They will face an increase of nearly $18 per month, marking roughly a 10% hike in 2026. In a statement on Nov. 17, 2025, Richtman said that this rise basically cancels out one-third of the average beneficiary’s cost-of-living adjustment (COLA) for 2026.

The standard Part B premium for 2026 will be $ 202.90 a month, which is $17.90 more than last year’s $ 186.  The average COLA will be $ 56 a month in 2026. After accounting for the $18 Part B premium increase, the average Social Security beneficiary will be left with an effective monthly increase of only $36 next year, notes Richtman.

Richtman pointed out that the 2.8% COLA for 2026, announced in October, was already modest before the Medicare premium hike. “In this economy, an extra $36 per month will provide only marginal relief for Social Security beneficiaries,” he said, stressing that seniors with below-average benefits will see even less of a benefit increase once Medicare Part B premiums are deducted.

“Some in lower-income brackets may experience an effective COLA of zero,” predicts Richtman.

A Final Note…

Yes, Medicare beneficiaries will see a decrease in Medicare-negotiated prices for 10 prescription drugs that took effect last week.  But, with inflation rising and older adults struggling to afford basic needs such as food, rent, utilities, and healthcare costs, aging advocates urge Congress to  take action to mitigate the negative impacts of HR 1, the 2025 budget reconciliation bill, on the Medicare drug price negotiation program.  It’s also crucial that Social Security COLAs accurately reflect the out-of-pocket expenses faced by beneficiaries, they say.

“Unfortunately, the 2025 budget reconciliation bill—HR 1—further limits the drugs that can be negotiated under the IRA’s negotiation program, reducing its effectiveness,” warns Julie Carter of the Medicare Rights Center in an October 9, 2025, blog post for Medicare Watch. “KFF, an independent health policy and research organization, estimates that this change will increase Medicare spending by at least $5 billion. As always, increases in Medicare spending lead to higher out-of-pocket costs for beneficiaries,” she says.

“At Medicare Rights, we strongly oppose efforts to scale back the IRA’s negotiation framework. We believe more drugs should be subject to negotiation, not fewer. We also advocate for expanding other cost-saving aspects of the law to reduce expenses for those covered by other forms of insurance,” Carter adds.

“Social Security COLAs are meant to offset the impact of inflation on beneficiaries. However, they are clearly insufficient for many seniors living on fixed incomes,” argues NCPSSM’s Richtman. He explains that this is why his organization has been pushing for an improved COLA formula—the CPI-E (Consumer Price Index for the Elderly). The CPI-E would more accurately reflect the inflationary effects on the goods and services seniors rely on, he says.

“We support legislation that would adopt the CPI-E for determining COLAs, but Congress has yet to take action. Adopting this formula would be a reasonable step toward expanding benefits and truly meeting the needs of 21st-century seniors,” Richtman concludes.

HHS Shake-Up Sends Shockwaves Through Aging Network

Published on April 31, 2025

Taking a page from President Donald J. Trump’s to “Make America Great Again,” last week the U.S. Department of Health and Human Services (HHS) announced a major restructuring of the federal agency to “Make America Healthy Again.” The dramatic restructuring in accordance with Trump’s Executive Order, “Implementing the President’s ‘Department of Government Efficiency’ Workforce Optimization Initiative.”

The U.S. Department of Health and Human Services (HHS), under management of HHS Secretary Robert F. Kennedy, Jr., last week announced a major restructuring and renaming of the federal agency under the initiative “Make America Healthy Again.” This dramatic reorganization follows Trump’s Executive Order, Implementing the President’s ‘Department of Government Efficiency’ Workforce Optimization Initiative.

“We aren’t just reducing bureaucratic sprawl. We are realigning the organization with its core mission and our new priorities in reversing the chronic disease epidemic,” said HHS Secretary Robert F. Kennedy, Jr. in a statement announcing the massive overhaul. “This Department will do more—much more—at a lower cost to taxpayers.”

“Over time, bureaucracies like HHS become wasteful and inefficient, even when most of their staff are dedicated and competent civil servants,” Kennedy added. “This overhaul will be a win-win for taxpayers and those HHS serves. That’s the entire American public, because our goal is to Make America Healthy Again.”

During the Biden administration, HHS’s budget increased by 38%, and its staffing grew by 17%, prompting the new HHS chief to place the federal agency on the budgetary chopping block.

According to HHS, this restructuring will not impact critical services while saving taxpayers $1.8 billion per year through a reduction of approximately 10,000 full-time employees. When combined with other cost-cutting initiatives, including early retirement, and the Fork in the Road program, the total downsizing will reduce HHS’s workforce from 82,000 to 62,000 employees.

HHS also plans to streamline departmental functions. Currently, the agency’s 28 divisions contain redundant units. Under the restructuring plan announced on March 27, 2025, these units will be consolidated into 15 new divisions, including a newly created Administration for a Healthy America (AHA). Additionally, core organizational functions—such as Human Resources, Information Technology, Procurement, External Affairs, and Policy—will be centralized. The number of regional offices will be cut from 10 to five.

As part of the restructuring, several agencies will see workforce reductions. The U.S. Food and Drug Administration (FDA) will cut approximately 3,500 full-time employees, focusing on streamlining operations and centralizing administrative functions, though HHS asserts these reductions will not affect drug, medical device, or food reviewers, nor inspectors.

Similarly, the U.S. Centers for Disease Control and Prevention (CDC) will downsize by approximately 2,400 employees, refocusing its efforts on epidemic and outbreak response. The National Institutes of Health (NIH) will eliminate 1,200 positions by centralizing procurement, human resources, and communications across its 27 institutes and centers. Meanwhile, the Centers for Medicare and Medicaid Services (CMS) will cut around 300 positions, targeting minor duplication within the agency. HHS insists these changes will not impact Medicare or Medicaid services, but improve them.

Restructuring HHS to Focus on Chronic Illness Prevention

HHS’s overhaul aligns with the agency’s new priority of ending America’s chronic illness epidemic by focusing resources on ensuring safe, wholesome food, clean water, and the elimination of environmental toxins.

The Administration for a Healthy America (AHA) will consolidate five agencies—the Office of the Assistant Secretary for Health, the Health Resources and Services Administration, the Substance Abuse and Mental Health Services Administration, the Agency for Toxic Substances and Disease Registry, and the National Institute for Occupational Safety and Health—into a single entity. This unification aims to enhance health resource coordination for low-income Americans, emphasizing primary care, maternal and child health, mental health, environmental health, HIV/AIDS, and workforce development.

Additionally, the Administration for Strategic Preparedness and Response, responsible for national disaster and public health emergency response, will be transferred to the CDC to strengthen its core mission of protecting Americans from health threats.

To combat waste, fraud, and abuse, HHS will create a new Assistant Secretary for Enforcement, overseeing the Departmental Appeals Board, the Office of Medicare Hearings and Appeals, and the Office for Civil Rights.

Furthermore, HHS will merge the Assistant Secretary for Planning and Evaluation with the Agency for Healthcare Research and Quality to form the Office of Strategy, enhancing research to inform policy decisions.
Critical programs under the Administration for Community Living (ACL), which supports older adults and people with disabilities, will be integrated into other HHS agencies, including the Administration for Children and Families, the Office of the Assistant Secretary for Planning and Evaluation, and the Centers for Medicare and Medicaid Services (CMS). HHS assures that these changes will not impact Medicare or Medicaid services.

Sounding the Alarm

Following the announcement of HHS’s restructuring plans, which would broad without a lot of detail, aging advocacy groups quickly released statements to voice strong concerns.

“For decades, the federal health programs that retirees and people with disabilities depend on have been ably administered under both Democratic and Republican administrations. However, the radical cutbacks proposed by the Trump administration place the delivery of these programs in jeopardy,” warned Dan Adcock, Director of Government Relations & Policy at the National Committee to Preserve Social Security and Medicare (NCPSSM).

Adcock also noted that HHS plans to eliminate the ALC and divide its responsibilities between two offices with no prior experience in this area. “This administration has already demonstrated a reckless disregard for public interests in favor of slashing operations and staff under the guise of ‘efficiency,’” he added. “So far, all they have done is create chaos and confusion, disrupting essential programs for seniors and the disabled. We view Secretary Kennedy’s plans with alarm.”

Nancy LeaMond, Executive Vice President and Chief Advocacy and Engagement Officer at AARP, also urged HHS to prioritize older Americans’ health needs. “HHS must ensure access to senior centers, community health centers, nutritious meals, Medicare assistance, and other vital services that countless older Americans rely on. Health is central to the lives, well-being, and financial security of AARP’s members and the more than 100 million Americans over age 50,” she emphasized.

Terry Fulmer, PhD, RN, FAAN, President of the John A. Hartford Foundation, echoed these concerns. “The announcement of workforce cuts at HHS comes at a time of unprecedented growth in America’s aging population. The proposed reorganization of ACL and its integration into other agencies requires careful consideration.”

Fulmer stressed that ACL administers programs essential to older adults’ daily lives, such as meal delivery, transportation to medical appointments, and chronic disease management. Absorbing these functions with far fewer staff demands careful planning. The government’s commitment to older adults requires a cautious approach, she said.

The Center for Medicare Advocacy also expressed deep concerns, particularly regarding plans to restructure ACL and consolidate oversight of Medicare appeals. “Given what we have seen with Social Security Administration cuts and restructuring, HHS’s claim that these changes won’t impact critical services rings hollow,” said Co-Director David Lipschutz.

LeadingAge, a national association representing nonprofit aging services providers, called for HHS to ensure older adults and their caregivers are not overlooked. “Cutting staff responsible for critical agency functions raises serious concerns. How will the work our members rely on get done? How will this impact quality care for older adults?” asked President and CEO Katie Smith Sloan.

Sloan also cautioned that reducing HHS’s field offices from 10 to five could impact CMS’s ability to oversee nursing home surveys and provider compliance. “A 25% workforce reduction must be undertaken with extreme care—especially given the millions of older adults who depend on these services,” she emphasized.

For a fact sheet on the HHS restructuring, visit https://www.hhs.gov/about/news/hhs-restructuring-doge-fact-sheet.html

Chair Casey leaves mark on national aging policy. Leadership changes in DC and RI 

Published in RINewsToday on December 16, 2024

Last week, U.S. Sen. Bob Casey (D-PA), Chairman of the U.S. Senate Special Committee on Aging, held his last hearing, entitled “Empowering People with Disabilities to Live, Work, Learn, and Thrive, in SD 106.  This hearing was his swan song as Chairman of the Senate Aging Committee. 

The 3-term Democratic Senator, first elected in 2006, lost his reelection bid for a fourth term to Republican Dave McCormick, a West Point graduate, combat veteran and Bronze star recipient, and a national security expert, and former hedge fund manager.  A recount of votes confirmed that Casey lost by 16,000 votes (3,398,628 to 3,382,423) and he conceded the race on Nov. 21st.

With the dust settling after the Nov. 5th presidential election, Republicans will take control of the legislative agenda of the upper chamber, with a 53-47 majority, and control the house.

According to a Senate Aging Committee, during the upcoming 119th Congress Sen. Tim Scott (R-SC), a former Ranking Member, is expected to replace Casey as chairman on Jan. 3rd, 2025. Former Ranking Member Mike Braun (R-Ind) will leave the Senate after becoming Governor-elect of Indiana. 

An advocate for America’s seniors

During the 118th, the Senate Aging Committee under the helm of Casey held 18 full hearings, five field hearings, and one joint full hearing.  His final hearing, lasting one hour and 46 minutes, highlighted his long record as a champion for people with disabilities, and laid out his vision for how Congress must continue to work to empower them. 

“From the beginning of my time in the Senate, I heard a constant refrain from disability advocates that their needs were not being met—they faced barriers to save for their future, they were being paid well below a living wage, and they could not afford or access the care they needed,” says Casey in his opening statement. “Those refrains, including from some of the people we heard from at today’s hearing, are what inspired me to make people with disabilities a focus of my Senate career and time as Aging Committee Chairman,” he said.

During his 18 years in the Senate, Casey has been one of the foremost champions in Washington for people with disabilities. He created the Stephen Beck Jr. Achieving a Better Life Experience Act (ABLE) program, which has helped hundreds of thousands of families save for long-term care for their disabled loved ones with a tax-advantage savings account. The Associated Press hailed this legislation as “the most important new law for [those with disabilities] in 25 years.  He also made federal websites more accessible for people with disabilities, and propelled the fight for access to home care to the forefront of the national conversation. 

In addition, the Pennsylvania Senator led efforts to improve care in nursing homes by expanding and strengthening oversight over poor-performing facilities while ensuring that nursing homes and long-term care facilities have the resources they need to provide high-quality care to residents. His work has led the Centers for Medicare and Medicaid Services (CMS) to publicly release information about nursing facilities with a documented pattern of poor care, ensuring older adults and their families have the information they 

At the Dec. 12th hearing, Chairman Casey also released a series of issue briefs documenting his record chairing the Aging Committee on making government technology accessible, expanding access to home care, improving nursing homes, lowering prescription drug costs, and ensuring economic security for older adults:

“We have made a lot of progress, from creating the ABLE program to making government technology more accessible,” Casey continued. “But as we heard today, there is still a lot more to do—from expanding access to home care to finally phasing out the subminimum wage,” he added.

Kudos to Casey’s advocacy for America’s disabled Seniors

At the hearing, witnesses from Pennsylvania and national organizations testified about the impact of Casey’s work impacting the disability community in the Commonwealth and around the country.

I want to thank Senator Casey for your leadership. None of the successes I outlined would have been possible without your steadfast championship, advocacy and partnership. It is daunting to think about facing the challenges ahead, particularly the threats to Medicaid, without you at the helm, but we have been emboldened to reimagine what is possible because of your leadership,” says Witness Ai-Jen Poo, President of the National Domestic Workers Alliance and Executive Director of Caring Across Generations.

Witness Neil McDevitt, Mayor of North Wales, Pennsylvania, noted: “Senator Casey, you have been a steadfast ally of North Wales Borough, the Commonwealth of Pennsylvania, and millions of disabled and Deaf Americans. We owe you a debt that can never be repaid.”

“Things are actually changing. We are not yet where we need to be when it comes to disability access and acceptance, but we are getting there. It brings me great joy when I hear of disabled people in my community getting good paying jobs and not being relegated to sheltered workshops for less than minimum wage,” adds Erin Willman, CEO of White Cane Coffee in Warren, Pennsylvania. 

Witness Lydia Brown, Director of Policy, National Disability Institute, told the attending Senators:“Ten years ago, Sen. Casey’s leadership in introducing and passing The ABLE Act changed the game. People whose disabilities began before age 26 can now access a savings vehicle that can conserve up to $100,000 total without their savings counting against them in determining eligibility for SSI and Medicaid. Money in an ABLE account can be used for a wide range of qualified disability expenses, including otherwise unaffordable assistive technology and health care, as well as educational and employment related costs. For many disabled people on Medicaid, an ABLE account is also their only available means to save for retirement.”

A fond farewell 

“Bob Casey served honorably as the chair of the Senate Special Committee on Aging.  He held a wide range of hearings intended to develop a record that could be used to help shape future legislation,” says Max Richtman, President & CEO, National Committee to Preserve Social Security and Medicare who also is a  former staff director of the Senate Special Committee on Aging. Casey had held numerous hearings on issues facing older adults that helped build support for components of the Older Americans Act reauthorization – which just passed the Senate and may be included in the end-of-year package, noted Richtman. 

“Senator Casey also held hearings on disabled older adults, including one with former Social Security Commissioner Martin O’Malley to discuss what the Social Security Administration (SSA) is doing to make the application process easier,” added Richtman, noting that other hearings were held on scammers preying on the elderly – designed to help older adults and their families know what to look for — and protect against.  

“We can only hope that when Republicans assume control of the Senate in January, this committee will continue the serious work of looking after the interests of seniors, who have contributed so much to our society and yet are among our most vulnerable citizens,” says Richtman.

“Leadership Council of Aging Organizations (LCAO) thanks Senator Bob Casey for his leadership and dedication to improving the lives of older Americans through his work on the Senate Aging Committee,” said Debra Whitman, LCAO Chair. “We look forward to collaborating with incoming Chairman Rick Scott to continue addressing the needs and enhancing the well-being of our nation’s growing aging population,” she says.

“As Chairman of the Senate Special Committee on Aging, Senator Bob Casey was a critical champion for seniors. He fought to strengthen Social Security and Medicare, stop elder abuse, and improve conditions in nursing homes. Casey will be greatly missed in the Senate by everyone who cares about senior issues. We urge the next chairman of this invaluable committee to continue his legacy.” Says Nancy Altman, President of Social Security Works.

“It is wonderful to have a Senate Aging Committee and Senator Casey’s terrific advocacy but inexcusable for the House not to restore its counterpart, which Chairman Claude Pepper proved is indispensable,” said Robert Weiner, former Chief of Staff of the House Select Committee on Aging and later a senior White House spokesman.

Announcing job transitions and retirement – in Rhode Island

Two well-known aging advocates have announced their departures.

The Alliance for Better Long-Term Care announces the retirement of Kathleen “Kathy” Heren. She dedicated 26 years to serving Rhode Island’s seniors.  For the past 15 years, Heren has served as the Rhode Island State Long Term Care Ombudsman, tirelessly advocating for the rights and well-being of residents in long-term care facilities across the state. She is known for her “fierce dedication, wisdom, and compassion have made her an unwavering champion for those in need.”

After serving as Executive Director of LeadingAgeRI for over 16 years, James P. Nyberg is leaving the nonprofit to become Senior Advisor at the Boston-based Public Consulting Group.   He will provide his expertise to the company on home and community-based services.

During his tenure, he significantly advanced aging services by advocating for quality, affordable care and fostering partnerships with state and national stakeholders. His leadership has driven innovative initiatives addressing the needs of older Rhode Islanders while supporting workforce development and professional growth among member organizations.

Nyberg ably served as Chair of the state’s Advisory Commission on Aging for over six years.