Tag Archives for Centers for Medicare & Medicaid Services

Bush Flip Flops on Politically Charged Medicare Statement

Published in Woonsocket Call on August 16, 2015

On July 30, aging advocates celebrated the fiftieth birthday of Medicare, the nation’s second largest social insurance program in the United States. This program provides health care to more than 53.8 million beneficiaries, with total expenditures of $613 billion in 2014.  Three weeks earlier one GOP Presidential candidate was not calling for the celebration of this golden anniversary, but for the dismantling of it.

On Wednesday, July 22, at a New Hampshire town hall meeting, GOP Presidential candidate Jeb Bush suggested that its time to “phase out” Medicare.  This event was sponsored by Americans for prosperity, a conservative group financially backed by the extremely right-wing Koch Brothers, who oppose President Obama’s Affordable Care Act, the expansion of Medicare, minimum wage and anything else endorsed by Democrats and Progressives. . .

Bush Gets Cozy with Koch Brothers

At the town hall meeting, the former Florida Republican Governor called on the left to “join the conversation” of reforming Medicare.  “But they haven’t,” he charges.

GOP Presidential candidate Bush reminded the attending conservatives that over a year ago Rep. Paul Ryan (R-WI) offered his proposal in the 2015 Budget plan to replace the health program with vouchers and to increase the age eligibility from 65 to 67.  After this, television ads began to appear with a Ryan look-alike pushing a senior off a cliff in a wheelchair, he said, quipping “That’s their [liberals] response.”

Bush went on to say, “And I think we need to be vigilant about this and persuade people that our, when your volunteers go door to door, and they talk to people, people understand this. They know, and I think a lot of people recognize that we need to make sure we fulfill the commitment to people that have already received the benefits, that are receiving the benefits. But that we need to figure out a way to phase out this program for others and move to a new system that allows them to have something – because they’re not going to have anything.”

The Democratic National Committee (DNC) quickly seized Bush’s politically charged talking points, posting his comments at Americans for Prosperity event on YouTube.  The DNC jumped on the opportunity to send a message out to older Americans and liberal groups that the Florida Republican opposes a very popular domestic program.

One day later, on August 23, Bush worked hard to dodge intense political flack generated by his call for seriously “phasing out Medicare.” He explained that the Democrats and media took his previous comments out of context, he was only trying to reform Medicare to save it.

Medicare is an “actuarially unsound health system,” says Bush, who called for something to be done before skyrocketing costs burden future generations with $50 billion dollars of debt.

Keep the Status Quo

Bush’s campaigning in New Hampshire has revealed what many seasoned Republicans lawmakers know, there can be a swift political backlash to tinkering with the widely popular Medicare program.  A newly released national poll bluntly supports what AARP and other national aging advocacy groups and Democrats clearly know, the American public is quite happy with their Medicare program.

According to “Medicare and Medicaid at 50,” a new Kaiser Family Foundation poll released on last month, a majority of Americans and the vast majority of program beneficiaries view both Medicare positively.   Simply put, respondents had a strong preference for the status quo over major structural changes that would reshape how the programs serve beneficiaries, say researchers in their 27 page report.

The survey finds that a strong majority (70%) say that Medicare should continue to ensure all seniors get the same defined set of benefits. Far fewer (26%) say that the program should be changed to instead guarantee each senior a fixed contribution to the cost of their health insurance – a system known as premium support that has been proposed to address Medicare’s long-term financing challenges.

By a whopping two-to-one margin, majorities of Democrats, Republicans and independents favor keeping Medicare as is rather than changing to a premium support program. Adults under 65 years old are somewhat more likely than seniors to favor premium support (28% compared to 18%), though large majorities in all age groups prefer Medicare’s current structure.

But, despite the public’s lack of support for this change, the survey says that majority (54%) worry that Medicare will not be able to provide the same level of benefits to future enrollees, and two thirds (68%) say that changes are needed to keep Medicare sustainable for the future.

Improved Outlook for Medicare

While Bush, his fellow Republican Presidential Candidates and Republican Congressional Leadership say that Medicare costs are bankrupting the nation, a recently released Medicare Trustee’s 2015 Annual Report states the opposite.  This program will remain solvent until 2030, unchanged from last years analysis, but with an improved long-term outlook from the 2014 report, says the report released in July.   Under this year’s projection, the trust fund will remain solvent 13 years longer than the Trustees projections in 2009, before the passage of the Affordable Care Act.

“Growth in per-Medicare enrollee costs continues to be historically low even as the economy continues to rebound. While this is good news, we cannot be complacent as the number of Medicare beneficiaries continues to grow,” said Andy Slavitt, Acting Administrator of the Centers for Medicare & Medicaid Services (CMS). “That’s why we must continue to transform our health care system into one that delivers better care and spends our dollars in a smarter way for beneficiaries so Medicare can continue to meet the needs of our beneficiaries for the next 50 years and beyond,” he adds.

The Medicare Trustee’s 2015 Annual Report also noted that per-enrollee Medicare spending growth has been low, averaging 1.3 percent over the last five years. In 2014, Medicare expenditures were slightly lower for Part A and Part D, and higher for Part B than previously estimated. Over the next decade, and partially due to the cost-containment provisions in the Affordable Care Act, per-enrollee Medicare spending growth (4.2 percent) is expected to continue to be lower than the overall growth in overall health expenditures (5.1 percent).

Over the years, Republican Congressional Lawmaker efforts have been largely unsuccessful in changing a very popular Medicare program.  As Bush found out during his politicking in the granite state, touching Medicare can have instant negative political consequences.

Once the GOP whittles down its 16 presidential candidates to a chosen standard-bearer to push its conservative agenda in the upcoming 2016 Presidential elections, the party must reexamine its position of scrapping the existing Medicare program.  Recognizing future challenges in the nation’s health care system, AARP throws commonsense ideas into the national debate as to what is the best way of strengthening Medicare.  The Washington, D.C. aging advocacy group calls for lowering prescription costs, improving health care coordination, and cracking down on over-testing, waste and fraud.

As AARP suggests, simple fixes can lower costs, but it also continues health coverage to the program’s current and future beneficiaries.  That’s the way to reform a widely popular domestic program.  By small incremental steps.

 

Fed’s Proposal to Confronting Nursing Shortage is Not Enough

Published in Pawtucket Times on April 1, 2002

Responding to the nation’s serious nurse staffing shortage, a new Federal proposal gives states flexibility to allow nursing facilities to use paid feeding assistants to supplement the services of certified nurse aides (CNAs). The specialty trained staff would help residents eat and drink.

With a growing number of frail elderly resident in the nation’s nursing facilities, today’s nursing staff must take care of residents who require a higher level of medical care. This leaves less time to ensure that residents eat their meals and drink enough fluids on a daily basis.

Oftentimes, both physical and psychological changes will interfere with a resident’s ability to eat and consumer a meal. Some residents may only need encouragement or minimal assistance with eating.

On the other hand, frail residents may require staff assistance with feeding .  Assistance would be needed for residents with cognitive impairment, impaired swallowing due to muscular weakness or paralysis, a tendency to aspirate or choke, poor teeth, ill-fitting dentures or partial plates, poor muscular or neurological control of their arms or hands, as with Parkinson’s disease.

Under the Centers for Medicare & Medicaid Services (CMS) proposal, trained feeding assistants are allowed to help residents eat and drink, especially at meal times.

The workers would be required to complete a state-approved course to quality to be hired for the new position.  Currently nursing facilities rely primarily on CNAs, registered or licensed practical nurses to assist residents with eating and drinking.  However, volunteers and family members also may assist with these tasks.

At this time, there is no provision in federal regulations for the employment of nursing facility workers to perform only a single task without competing 75 hours of nurse aide training.

The proposed rule change published in the March 29 issue of the Federal Register would allow facilities to hire workers to perform a single task with training on feeding techniques and some basic information that is currently part of CNA training requirements.

“Meal times can often be the busiest time in nursing facilities,” says CMS Administrator Tom Scully.

“Feeding residents is often a slow process and competes with m ore complex tasks, such as bathing, toileting and dressing changes, as well as urgent medical care,” he added.

“Trained feeding assistants will free nurses and nurse aides to focus on residents’ other health care needs. The result will be that residents will receive better nutrition and care,” Scully noted.

The American Health Care Association (AHCA), a Washington, D.C.-based trade group, that represents both profit and non-profit nursing facilities, gives the new federal rules a thumbs up.

‘Simple common-sense dictates that when our nation’s health care system is being undermined by a chronic nursing staffing shortage, and the greater needs of increasing sicker patients, we should do everything conceivable to better the lives of our patients,” stated Dr. Charles H. Roadman II, president and CEO of AHCA. “The rule will also help the overextended nurses and nursing aides already on the job cope with competing important tasks.”

Hugh Hall, executive director of the Johnston-based Cherry Hall Manor Nursing and Rehabilitation Center, supports the federal government’s approval of the single task workers who feeds nursing facility residents.

“The prior regulation was not logical or practical when prohibiting other nursing home workers other than registered nurses, licensed practical nurses and CNAs from feeding, but allowing volunteers and families to participate in the feeding process with little training,” he said.

Hall, the former president of the Rhode Island chapter of AHCA, said the health care community would prefer that the federal government develop long-term care programs to recruit fully trained certified nursing assistants and to financially support those initiatives.

Roberta Hawkins, who serves as the state’s nursing facility ombudsman and executive director of the Alliance for Better Long-Term Care agrees.

“The federal proposal is only a Band-Aid fix.” Hawkins says, calling on the federal government to put more funds into the nursing facility reimbursement system to enable facilities to pay better wages to hire permanent full-time staff and to create career ladders.

“Even though you may teach an aide to just feed residents, they are not trained to spot medical changes in the resident, Hawkins told Everything About Seniors.  More important, she said, “they will not be familiar with the specific needs of the residents.”

Hawkins believes that the Bush administration’s proposal can become an obstacle in providing continuity of care in nursing facilities.

A state commission, chaired by Human Services Director Jane Haywood, is currently looking at Rhode Island’s staffing shortage and how the existing Medicaid reimbursement system can be improved.

Recommendations for a new and improved system coming from Haywood’s group might just fix a long-time systemic problem, enabling nursing facilities to better recruit and retain CNAs.

Hopefully, Haywood’s long-awaited proposals will be seriously considered by the administration and General Assembly and won’t end up on a dusty shelf or a circular file.

While allowing the use of single-tax workers, proposed by the Bush administration, it is a step in the right direction. Gov. Lincoln Almond, state lawmakers and state policymakers must not lose sight of the real issue – inadequate Medicaid payments- which fuels an ongoing CNA shortage in many of the state’s nursing facilities.

Almond and the General Assembly are currently at odds over subsidized gambling in the Ocean State.

During this year’s budget debates, overshadowed by a projected $70 million plus budget deficit, let us not forget about Rhode Island’s 10,000 nursing facility residents or the growing elderly population who may ultimately require that level of care or community-based long-term care services.

If the General Assembly can easily find $ 15 million next year to keep the greyhound racing industry afloat, lawmakers might dedicate some time and a little energy and effort in finding state dollars to increase funding to Rhode Island’s long-term care delivery system.

For older constituents and the state’s aging baby boomers it is the right thing to do.