Your eyes, ears, and teeth are connected to your body – Medicare/Medicaid at 56

Published in RINewsToday on August 2, 2021

Over 56 years ago, Congress became actively involved in the health insurance business with President Lyndon Johnson signing the Social Security Amendments establishing Medicare and Medicaid. The bipartisan legislation creating a national health insurance program. It was introduced in March 1965, and was passed by large majorities of Democratic and Republican lawmakers in the House and Senate chambers. 

At the signing ceremony that took place at the Truman Library in Independence, Missouri on July 30, 1965, Johnson handed the first Medicare cards, numbers one and two, to 81-year-old former President Harry S. Truman and his wife, Bess. Johnson proclaimed the former president to be “the real Daddy of Medicare.” Truman, the 33rd President, was considered to be the first president to vigorously call for national health insurance who ultimately saw his proposals stall on Capitol Hill, as the American Medical Association, the American Hospital Association and conservatives tagged it “socialized medicine.” 

Celebrating Medicare and Medicaid 

On July 30th of this year, top federal officials, Congressional Democrats, and aging advocates celebrated the 56th Anniversary of Medicare and Medicaid.

“For decades, Medicare and Medicaid have been a lifeline and a steady foundation for our seniors, children, women, families, people with disabilities, and at every stage in life,” says HHS Secretary Xavier Becerra, noting that about 140 million Americans have health insurance coverage through either Medicare (63 million) or Medicaid (74 million). An additional 4 million adults could benefit if the remaining 12 states expanded Medicaid through the Affordable Care Act.

“For 56 years, Medicare and Medicaid have made health coverage a reality for individuals and families when they have needed it,” adds Administrator Chiquita Brooks-LaSure, of the Centers for Medicare Services (CMS). “When President Lyndon Johnson called on Congress to spare the nation’s seniors of ‘the darkness of sickness without hope,’ nearly half of seniors were uninsured, most hospitals around the country were segregated, and health coverage was out of reach for many,” she noted. 

“Medicare and Medicaid were critical steps forward in the fight for civil rights that brought the peace of mind that health coverage provides to many, made health care access more equitable by requiring the integration of hospitals, and improved health outcomes across the country,” says LaSure.

With the health needs of those CMS programs recipients always evolving, LaSure calls for the expansion and strengthening of Medicare and Medicaid so they remain quality and reliable health programs. “Ensuring these programs also work to advance health equity nationwide is also a top priority for CMS. Access to health coverage is a right and no one should be left out, left behind or left on the sidelines,” she says.

House Speaker Nancy Pelosi also took time from her schedule to celebrate President Johnson’s landmark law creating Medicare and Medicaid. “Fifty-six years ago, our nation made a bedrock promise to our seniors and working families: that they deserve the dignity and security of quality, affordable health care. Today Medicare and Medicaid stand as pillars of health and justice, ensuring that millions of Americans receive the care they need, regardless of age or financial means,” says Pelosi.

“As we celebrate this anniversary, Democrats reaffirm this longstanding and unyielding belief: health care is a right, not a privilege. That is why we remain committed to defending Medicare and Medicaid against Republicans’ constant, callous attacks, as well as advancing legislation to bring down sky-high prescription drug prices, improve Medicare’s benefits for seniors and build on the success of the Affordable Care Act to lower health care costs for American’s families,” Pelosi adds.

As the nation celebrates Medicare and Medicaid’s 56th Anniversary, Max Richtman, president and CEO, of the Washington, DC-based National Committee to Preserve Social Security and Medicare, watches Congress’s continued debates about expanding Medicare benefits. “If you need to see a dentist, if you can’t see properly, if you can’t hear alarms, it’s not a luxury; it’s essential for the safety and health of older people,” he says.

Social Security Works Goes to Washington

On July 30, Social Security Works came to Capitol Hill to celebrate Medicare’s 56th anniversary by delivering more than 125,000 petitions to lawmakers urging them to lower the popular program’s eligibility age from age 65 to 60, allow Medicare to renegotiate lower prescription drug prices for everyone and to upgrade coverage to include vision, hearing and dental services.

“The 56th anniversary is as good as any other occasion to expand Medicare to cover more people, to do work that has not been done for generations,” says Dr.  Sanjeev Sriram, an adviser to the advocacy group Social Security Works, during the Capitol Hill rally. The Maryland primary care provider called these changes long overdue. 

“Now, as a doctor I can tell you: Your eyes, your ears, and your teeth are connected to your body,” said, Sriram during Friday’s rally on Capitol Hill to explain the importance Medicare covering vision, dental and hearing benefits. “I did not have to go to medical school to tell y’all this, but apparently I do have to tell Congress this.”

“We put Democrats in power to make changes, not excuses. It’s time to expand Medicare,” Sriram told senior advocates holding signs with the message, “Medicare for All” and “Medicare Expansion Now.”

Although Senate Democratic leadership agreed to expand Medicare in a recently $3.5 trillion budget reconciliation package, the measure does not lower the program’s eligibility from age 65 to age 60, says Sriram, noting that lowering the Medicare’s age requirement gives more than 23 million people health care coverage.

While critics say that the nation can’t afford to add vision, dental, hearing and vision benefits, a recently released poll says the Americans support this expansion of benefits. In June 2021, survey findings released by Data for Progress and Social Security Works proves just how popular these proposals are. A survey of 1,175 likely voters shows a full 83% of voters support expanding Medicare to cover hearing, vision and dental care, including 86% of those over the age of 45. That popularity even crosses party lines: 89% of Democrats, 82 of Independents, and 76% of Republicans are in favor.

Congress now has an opportunity to listen to constituents. And many think it’s time to expand Medicare’s benefits and lower the program’s eligibility age, for the benefit of America’s seniors.

Bill Protects Nursing Home Residents, Providers

Published in the Pawtucket Times on June 1, 2020

This month, U.S. Senator Bob Casey (D-PA) and Senator Sheldon Whitehouse (D-RI) throw a bill in the legislative hopper to slow the spread of novel coronavirus (COVID-19) in nursing homes. It’s a common-sense legislative proposal and needed.

A recently released Kaiser Family Foundation study reported, “COVID-19 has had a disproportionate effect on people who reside or work in long-term care facilities, including the 1.3 million individuals in nursing homes; 800,000 in assisted living facilities; 75,000 in intermediate care facilities; and 3 million people who work in skilled nursing or residential care facilities.”

Combatting COVID-19 in Congregate Settings

With COVID-19 quickly spreading throughout the nation’s nursing homes and intermediate care facilities, Casey and Whitehouse’s legislative proposal, S. 3768, The Nursing Home COVID-19 Protection and Prevention Act, seeks to provide needed resources to facilities to protect frail residents and staff. Residents in these facilities are among the most vulnerable because of their age and underlying medical conditions. According to an analysis conducted by Gregg Girvan for the Foundation for Research on Equal Opportunity, as of May 22, in the 39 states that currently report such figures, 43 percent of all COVID-19 deaths have taken place in nursing homes and assisted living facilities

As more than 20,000 nursing homes residents and workers have died due to COVID-19, according to the latest reports, on May 19, 2020, Casey and Whitehouse introduced S.3768 to help states, nursing homes and intermediate care facilities put the brakes on the spreading of the deadly COVID-19. The legislative proposal, with 14 Democratic cosponsors (including Rhode Island Senator Jack Reed}, would help states implement strategies to reduce the spread of COVID-19 in congregate settings, including through the purchase of personal protective equipment (PPE) and testing and to support nursing home workers with premium pay, overtime and other essential benefits.

S. 3768 was referred to Senate Health, Education, Labor, and Pensions. As of March 30, 2020, a Congressional Budget Office cost estimate or this measure has not been received.

Days after the introduction of 25-page Senate legislative proposal, a House version (H.R. 6972) was introduced by Rep. Ana G. Eshoo (D-CA), cosponsored by Reps. Janice D. Schakowsky (D-IL), Donna E. Shalala (D-FL), Madeleine Dean (D-PA), Seth Moulton (D-MA) and David N. Cicilline (D-RI). The House bill was referred to House Energy and Commerce

“This virus spares no state, no county, no facility. The unprecedented crisis unfolding in our Nation’s nursing homes demands an immediate, extraordinary response. Reports indicate nursing home residents and workers account for roughly 1 in 4 deaths from COVID-19 in the United States,” said Casey, who serves as Ranking Member of the U.S Senate Special Committee on Aging, in a statement announcing the bill’s introduction. “The Nursing Home COVID-19 Protection and Prevention Act would provide $20 billion in emergency funding [for staffing, testing, Personal Protective Equipment, etc.] to devise a sorely needed national, coordinated response to stem the spread of this terrible virus in nursing homes and intermediate care facilities,” notes Casey.

According to Casey, the Senate bill would also require the U.S. Department of Health and Human Services (HHS) to develop guidance on cohorting best practices, including on how to safeguard resident rights. It would also instruct HHS to collect and publish data on COVID-19 cases and deaths in nursing homes and intermediate care facilities, and finally fund surge teams of nurses, aides, and other critical staff to fill in at facilities where multiple residents and staff members have been infected.

“COVID-19 poses an immediate threat to the more than 1.3 million Americans, including more than 7,000 Rhode Islanders, who live in nursing homes,” says Whitehouse, noting that frontline staff across the nation are “doing heroic work under very challenging circumstances.”

“We need to get vastly more personal protective equipment and tests to nursing homes, which care for the patients who are most vulnerable to the coronavirus. Our legislation would also help states fund surge teams, sending additional staff reinforcements to facilities where they are needed to care for patients and prevent infection,” adds Whitehouse.

Before S. 3768 was officially introduced, in early March, Washington, DC-based AARP announced its support for the Senate proposal. “AARP supports the draft of the Nursing Home COVID-19 Protection and Prevention Act that would help protect the health and save the lives of people in nursing homes and other facilities by supporting testing, personal protective equipment, staffing and more,” said Megan O’Reilly, Vice President of Government Affairs for AARP. “The proposal would also improve public transparency and help protect the rights of residents and their families, adds O’Reilly, calling on Congress “to act immediately to stem the loss of life and slow the spread of the virus.”

In the House Chamber, Rhode Island’s Cicilline, a member of the House Democratic Leadership as Chair of the Democratic Policy and Communications Committee, has also pushed for Congressional funding to stop the spread of COVID-19 in nursing homes. The fifth term Congressman has called for additional funding for the Public Health and Social Services Emergency Fund in the next package for congregate care facilities, including nursing homes. He also signed a letter to HHS Secretary Azar and Administrator Verma, of the Centers for Medicare and Medicaid Services (CMS), urging that HHS and the CMS to ensure that a significant portion of the newly allocated $25 billion for testing in the recently passed CARES Act be utilized for testing in nursing homes and other congregate living facilities.

State-wide Efforts to Combat COVID-19 in Nursing Homes

With Governor Gina Raimondo declaring a state of emergency on March 9, 2020, with the COVID-19 arriving in Rhode Island, the deadly pandemic virus spread quickly throughout the state’s nursing homes. At press time, it has been reported that 75 percent of all related COVID-19 deaths are in nursing homes.

According to Joseph Wendelken, Public Information’s Officer for the Rhode Island Department of Health (RIDOH), the state moved quickly to stop the spread of the COVID-19 virus in the community and in nursing homes. He stated: “We curtailed and then prohibited visiting early on, and we have been doing extensive testing in every assisted living facility in the state. We are doing cyclical testing, meaning that we are continually testing all residents in all homes on a rotating basis. We are giving tailored infection control guidance to specific homes, and we are helping them procure additional PPE.”

Adds Wendelken, RIDOH has established two COVID-19 Specialty Nursing Homes [at Oak Hill Center in Pawtucket and Oakland Grove Health Care Center in Woonsocket] to be a COVID-19 Specialty Nursing Home. “These are centralized facilities to accept patients who are being discharged from the hospital and who are COVID-19 positive but no longer require acute-level care. This strategy allows COVID-19 positive patients leaving the hospital to receive specialized rehabilitation and step-down, post-acute care while reserving hospital beds for patients who need acute-level care,” he said.

On Smith Hill, the Rhode Island House Republican Caucus has recently called for members of the House Committee on Oversight to meet to address the increasing COVID-19 death rate in the state’s nursing and assisted living facilities.

Putting Politics Aside…

With less than 156 days until the upcoming 2020 Presidential election, will S. 3768 reach the Senate floor for a vote. Since the beginning of 2019, more than 350 House-passed bills—including hundreds that have bipartisan support—have been buried by Senate Majority Leader Mitch McConnell (R-Kentucky) in his legislative graveyard. With no Republican Senators supporting Casey and Whitehouse’s COVID-19 bill, will it even reach the Senate floor for a vote?

It’s time for McConnell, who has called himself the “grim reaper” of Democratic legislation, to lay down his deadly scythe, making the safety of millions of residents who reside in the nation’s 15,583 skilled nursing facilities a legislative priority. The GOP Senator from Kentucky, who is in a close Senate race with Democratic opponent Amy McGrath, might consider putting politics aside during a raging COVID-19 pandemic sweeping across the nation to work with Senate Democrats to protect frail residents and nursing home staff. Kentucky voters might view protecting residents against COVID a bipartisan issue.

Senators Seek to Identify Subpar Nursing Homes

Published in the Woonsocket Call on July 14, 2019

Last month, U.S. Senators Bob Casey (D-PA) and Pat Toomey (R-PA) succeeded in prodding the Centers for Medicare and Medicaid Services (CMS) to publicly release the April listing of underperforming nursing homes across the nation that require closer regulatory scrutiny but are not receiving any. Before CMS released the listing of candidates to the Special Focus Facility (SFF) program, the federal agency, charged with overseeing the care and quality in nursing homes, had not publicly identified these troubled facilities.

Less than 6 percent (88 facilities) out of more than 15,700 nursing homes nationwide are participants of the SFF program. CMS publicly identifies these facilities to the public. But an additional 2.5 percent (or approximately 400 facilities) qualify as candidates for the program because of having a “persistent record of poor care” but are not selected because of limited resources at CMS, according to a 26-page report, “Families’ and Resident’s Right to Know: Uncovering poor care in America’s Nursing Homes,” released in June 2019 by Pennsylvania’s two U. S. senators.

Nursing homes that are part of the SFF program have 12 to 18 months to correct any deficiencies and have two clean CMS surveys. If a facility fails to meet that target, it is are subject to increased regulatory enforcement, including being dropped from the Medicare and Medicaid programs.

Calls for Transparency

On March 4, 2019, Casey and Toomey wrote to CMS requesting information on its oversight of nursing homes in the SFF program. In that letter, the Senators requested the federal agency to provide the names of the 400 SFF candidates, calling for details about programs operations, scope and overall effectiveness. On May 3, 2019, CMS provided a written response and two weeks later, on May 14, the Senators received the listing of SFF candidates for April 2019. The names of these SFF candidates were not made public until Cassy and Toomey forced the issue by releasing this information in their report on June 5.

In CMS administrator Seema Verna’s May 14 letter to the two senators, Rhode Island-based participants and candidates in the SFF program were identified. They are: Charlesgate Nursing Center (SFF Candidate); Hebert Nursing Home (SFF Candidate); Oak Hill & Rehabilitation Center (SFF); St. Elizabeth Manor East Bay (SFF Candidate); and Tockwotton on the Waterfront (SFF Candidate).

In responding to the senators, Verma said that regardless of whether a nursing home is part of the SFF program, “any facility that performs poorly on surveys and continues to jeopardize residents’ health and safety will be subject to CMS enforcement,” which includes civil money penalties, denial of payment for new admissions or termination from the Medicare and Medicaid programs. Verma also stressed that in addition to her agency’s regulatory oversight, its Nursing Home Compare website has been improved to include “new, more reliable sources for obtaining staffing and resident census data, as well as including more claims-based quality measures.”

“Regardless of participation in the SFF program, any facility that performs poorly on surveys and continues to jeopardize residents’ health and safety will be subject to CMS enforcement remedies, such as civil money penalties, denial of payment f-or new admissions, or termination,” adds Verma.

Casey and Toomey believe that the list of SFF candidates is information that must be publicly available to individuals and families seeking nursing care for their loved ones. For that reason, the Senators have released the April 2019 list of SFF candidates and are continuing to work with CMS to make future lists public.

Through the release of the SFF candidate list and the Senate report, which details preliminary findings from surveys and public information about these candidate facilities, the Senators aim to provide Americans and their families with the transparency and information needed to choose a nursing home that would provide quality care to a loved one.

CMS Inquiry Identifies Issues

Casey and Toomey’s CMS inquiry into the SFF program put the spotlight on several issues. It became apparent to the two senators that a nursing home’s participation in the SFF program was not easily understandable to the public or would-be residents and their families. It became clear that CMS’s Nursing Home Compare, the agency’s online website, was not consistently updated to reflect any changes in the SFF program. “For example, in March 2019, the small icon used to indicate that a facility is an SFF participant was not on the webpage of five of the 17 newly-added SFF participants,” noted the Senate report. Most important, CMS’ website did not identify SFF candidates.

According to the released Senate report, only CMS and the state regulatory agency in which the nursing home is located and the facility itself, had knowledge of who is an SFF candidate. While CMS requires every nursing home to notify residents and its community of its regulatory SFF participant designation, these requirements do not apply to SFF candidates.

Aside from CMS recently updating its Nursing Home Compare webpage to more clearly indicate which nursing homes are SFF participants, it lacks details about the SFF program. There is no information explaining the reason for a facility’s participation in the program, the length of time it has been in the program or whether it has fixed the care issue. Most important, CMS does not include information on facilities that routinely cycle in and out of the SFF program, says the Senate report.

“There are few decisions more serious or life-altering than that of choosing a nursing home. I am pleased that CMS has taken the work that I have done with Senator Toomey seriously and is heeding our call to release the list of nursing facilities that are nominated to the Special Focus Facility program,” said Casey. “Our bipartisan work will ensure that families have all the information at their fingertips when choosing a nursing home. Now we must work in a bipartisan fashion to ensure the SFF program is working properly and that CMS has the funding it needs to improve underperforming nursing homes nationwide,” he says.

Adds, Toomey, “Ensuring that families have all the information they need about a nursing home will improve the quality of care at facilities across the country.”