Tag Archives for Home and Community-based Services

House passes Budget resolution – Seniors would benefit

Published in Rhode Island News Today on August 30, 2021

During a late-night negotiating session held Monday, Aug. 23, House Speaker Nancy Pelosi mended fences and brought centralist Democrats led by Rep. Josh Gottheimer (D-NJ), back to the fold. The next day, a united Democratic caucus adopted the Senate-passed $3.5 trillion budget resolution (S. Con. Res. 14) for fiscal year 2022, by a party vote of 220-212.

In order to push the budget resolution over the goal line, Pelosi had hammered out an agreement with 9 Democrat moderates, some representing swing states, to schedule a nonbinding vote on a separate, Senate bipartisan $1 trillion infrastructure package. Once the Senate bill is passed by the House chamber and signed by President Biden, the new law would authorize new federal spending to repair the nation’s highways, bridges, waterways, encourage transition of gas to electric cars, modernize airports, expand high speed internet and to protect the nations to electric grid. President Joe Biden considers the legislation to be “a once-in-a-generation investment in our infrastructure.”

“We are committed to passing the bipartisan infrastructure bill. We have long had an eye to having the infrastructure bill on the president’s desk by Oct. 1, the effective date of the legislation,” says House Speaker Pelosi.

The passage of the House budget resolution also clears the way for a vote on legislation what would restore portions of the 1965 Voting Rights Act that required localities with histories of voter suppression to get federal clearance before making changes to election laws. 

The Budget resolution, advancing President Biden’s Build Back Better agenda, also included reconciliation instructions to provide Senate Democratic leadership with the means to pass a comprehensive reconciliation package, without the threat of a Republican filibuster, with just 51 votes in the Senate, rather than the usual 60 votes. 

Now it is sausage making time as 13 House Committees and 12 Senate Committees begin to craft legislative text, allocating the $3.5 trillion to various investment priorities, to fulfill the reconciliation instructions with a tentative deadline to submit tax and spending legislation by Sept. 15. Committees begin marking up their contributions to the Budget reconciliation package during the week of Sept. 6.

House Adopts Sweeping Legislative Reforms

“The historic passage of this budget resolution puts Congress on track to pass some of the most sweeping legislative reforms in more than a half-century. As President Biden likes to say, ‘Don’t tell me what you value, show me your budget, and I’ll tell you what you value,” stated Rep. David N. Cicilline (D-RI) in a statement released after the budget resolution’s passage.

“This budget paves the path for the Build Back Better Plan to make historic investments in lowering costs for health care, prescription drugs, and childcare while cutting taxes for middle class families and creating millions of new jobs to tackle the existential threat of climate change,” said the Rhode Island lawmaker. Even better, it’s completely paid for by making sure the wealthiest Americans and largest corporations pay their fair share in taxes, he says.

“The transformative investments in women and families – including childcare, paid leave, home-based care and universal free pre-K – will unlock the full economic potential of parents in the workforce and boost our economy. This is the first step in the process, but I’m hopeful this investment in hardworking American families will be able to make our country stronger than ever before America’s seniors will see the strengthening of the nation’s social safety net by allocating billions for affordable housing, home, adds Cicilline. 

Rep. Tom Cole (R-OK) slammed the passage of the House budget resolution which included a provision to allow Democrats to bypass debate and a separate vote on the Senate-passed budget for fiscal year 2022, which includes reconciliation instructions to usher in $3.5 trillion in new federal spending on socialist-style programs.

“I am astounded by the irresponsible manner in which Speaker Pelosi operated the House this week, simply because she could not get members of her own party in line and on board with her will and wishes,” states Cole. “As a result, Speaker Pelosi had the House skip critical debate and an individual vote on a consequential budget resolution solely intended to trigger $3.5 trillion worth of radical tax-and-spend legislation. Instead of going through the normal process, the reckless budget was buried in another measure to ensure its adoption, whether a majority of support actually existed within the Democratic Caucus,” adds Cole.  

Strengthening the Nation’s Social Safety Net

According to a blog posting, “The House-passed Budget Resolution Holds Historic Promise for Seniors,” on the Washington, DC-based National Committee to Preserve Social Security and Medicare’s (NCPSSM) website, the House budget resolution expands Medicare benefits by adding dental, vision and hearing coverage to traditional Medicare. “This expanded coverage is crucial to seniors overall health, since the absence of proper dental, vision and hearing care can increase the risk of grave medical consequences – from dementia to disabling injuries. Seniors have not seen their Medicare benefits expanded since 2003, with the passage of the significant but flawed D prescription drug program,” says NCPSSM.

NCPSSM says that the Democratic budget blueprint “will aim to correct the main shortcomings in Medicare Part D by allowing the program to negotiate drug prices directly with Big Pharma.  This will save beneficiaries an estimated $102 billion over 10 years.

NCPSSM adds that the budget resolution would allocate billions of new federal Medicaid dollars to support Home and Community-based Services (HCBS).  This historic new level of funding would allow seniors to age in place in their community rather than being institutionalized. “Research has shown that older people have better health outcomes when they can remain in their homes and communities. Meanwhile, the pandemic has only highlighted the risks of putting seniors into nursing homes, notes the blog article.

It’s Wait and See

Will Sens. Kysten Sinema (D-Ariz.) and Joe Manchin (D.V.), who are concerned over the cost of the emerging reconciliation bill, stay with their Democratic colleagues when a vote takes place? There is no wiggle room for passage if they choose not to cast their votes with the Democratic caucus.

With a slim Democratic majority in both the House and Senate chambers, the political necessity of keeping their caucuses unified in passing legislation may well result in paring down spending levels. We may well see a smaller expansion of Medicare and less funding for HCBS.

Stay tuned. 

Seniors would benefit in President Biden’s $6 trillion budget

Published in RINewsToday on June 14, 2021

On May 28, with the release of a $6 trillion budget for fiscal year (FY) 2022, President Joe Biden outlined his values and vision as to how he proposes to revive the nation’s sputtering economic engine as it emerges from the devastating impact of the COVID-19 pandemic. The 72-page budget document, “Budget of the United States,” (with more than a 1,400-page appendix) details his spending priorities that begin next Oct. 1. Biden’s generous budget depends on increasing taxes on America’s corporations (from 21 to 28 percent) and high earners, who received significant tax breaks from the President Trump/GOP tax cuts of 2017.

With the FY 2022 Budget pushing federal debt to the highest levels since World War 1I, Republican lawmakers quickly called the proposal “dead on arrival” in Congress.  However, Cecilia Rouse, chair of President Biden’s Council of Economic Advisors says the Biden Administration is willing to live with a budget deficit to invest in the economy now, especially with low interest rates to borrow; deficits can be reduced later. 

President Biden’s new spending under the just released proposed FY 2022 budget, recognizing his Administration’s priorities, reflects the major proposals already outlined under the administration’s $2.3 trillion American Jobs Plan and $1.8 trillion American Families Plan. Provisions in these two proposals would overhaul the nation’s aging infrastructure and invest in education, childcare, paid family and medical leave, fight climate change. 

President Biden’s spending plan also recognizes priorities outlined in the American Rescue Plan passed earlier this year as well as the Administration’s “skinny” discretionary budget request released in April. Most importantly, it reflects a commitment from the president to safeguard Medicare, Medicaid and Social Security.

Loving It or Hating It Depends on Where You Sit

In remarks delivered Thursday in Cleveland, President Biden made the case for his budget request and what he describes as an investment in the country’s future. “Now is the time to build [on] the foundation that we’ve laid to make bold investments in our families and our communities and our nation,” he said. “We know from history that these kinds of investments raise both the floor and the ceiling over the economy for everybody.”

In the FY 2020 Budget proposal’s “Message from the President”, Biden says, “The Budget invests directly in the American People and will strengthen the nation’s economy and improve our long run fiscal health. It reforms our broken tax code to reward work instead of wealth while fully paying for the American Jobs and American Family Plans over a 15- year period. It will help us build a recovery that is broad-based, inclusive, sustained, and strong,”

Of course, response to Biden’s Spending plan depends on which side of the aisle you are sitting.

House Speaker Nancy Pelosi (D-CA) released a statement strongly endorsing Biden’s fiscal blueprint. “Congressional Democrats look forward to working with the Biden-Harris Administration to enact this visionary budget, which will pave the path to opportunity and prosperity for our nation. The Biden Budget is a budget for the people,” she said.

On the other hand, Senate Minority Leader Mitch McConnell strongly opposing Biden’s Budget proposal. “Americans are already hurting from far-left economics that ignores reality,” said McConnell, in a statement. “The Administration’s counterproductive ‘COVID relief bill’ has slowed rehiring. Families are facing painful inflation, just as experts warned the Democrats’ plans might cause. And the Administration wants to triple down on the same mistakes?” said the six-term Republican Kentucky Senator.

With the Democrats holding the slim majorities in the House and Senate and controlling the White House, Biden’s FY 2022 Budget proposal will have more weight than if the Republicans were in the majority, says Dan Adcock, Government Relations and Policy Director at the Washington, DC-based National Committee to Preserve Social Security and Medicare (NCPSSM).

According to Adcock, Biden’s funding numbers will change as his FY 2022 budget proposal goes through the appropriation process in the upcoming months. With its release, Congress can now begin negotiating funding levels and spending bills. Competition for a finite amount of funding will ultimately result in funding level ultimately allotted to programs and agencies by each of the 12 appropriations under their jurisdiction. Funding for most programs important to older Americans is under the jurisdiction of the Subcommittee on Labor, Health and Human Services and Education.

“With 10,000 Baby Boomers turning 65 every day – and the number of seniors projected to double by 2050 – it’s clear that President Biden understands the need to safeguard the older Americans he calls ‘pillars of every community – now and into the future.” Says Max Richtman, NCPSSM’s President and CEO.

Slashing Drug Costs to Pay for Expanding Medicare Coverage

Richtman says that Biden’s fiscal blueprint calls on Congress to allow Medicare to negotiate prices for certain high-cost, life-saving drugs that many seniors currently cannot afford and to require manufacturers to pay rebates when drug prices rise faster than inflation. These reforms could yield over half a trillion in federal savings over 10 years, which could help pay for coverage expansions and improvements, including access to dental, hearing, and vision coverage in Medicare,” he notes. Today, traditional Medicare does not cover routine care like dental checkups or hearing aids.

According to Richtman, President Biden’s budget also includes more than $400 billion in new spending over ten years to expand Home and Community-based Services (HCBS) for low-income seniors and people with disabilities who prefer to receive skilled care in the comfort of their homes and communities, even moreso after the devastation COVID wrought on nursing homes.  

In states that have not taken advantage of Affordable Care Act (ACA) opportunities to expand Medicaid, the budget proposes providing premium-free, Medicaid-like coverage through a federal public option, along with incentives for states to maintain their existing expansions. 

Biden’s FY 2022 budget also urges Congress to improve customer service for Social Security beneficiaries to prescription drug pricing reform to expanded HCBS, adds Richtman.  It also proposes a $1.3 billion (or 9.7%) funding increase for the Social Security Administration.  The increase seeks to improve customer service, including services at SSA’s field offices, state disability determination services, and teleservice centers.

 The Older Americans Act (OAA) provides funding for a wide range of home and community-based services, such as meals-on-wheels and other nutrition programs, in-home services, transportation, legal services, elder abuse prevention and caregivers’ support. These programs help seniors stay as independent as possible in their homes and communities. 

For details about Biden’s FY 2022 Budget proposal and OAA funding levels, made available from the Washington, DC-based National Association of Area Agencies on Aging, go to: https://www.n4a.org//Files/FY22%20PresBudget%20and%20historical%20Labor-HHS%20Appropriations%20Chart.pdf

 Stay Tuned 

The House continues its work on hammering out appropriation bills through subcommittees in June and in the full House in July.  The Senate’s work is expected to begin in mid-Summer and to continue well into September. If the appropriate bills are not passed and signed into law by Oct. 1, Congress will need to pass a continuing resolution to fund the federal government into the first months of FY 2022.

Like most Budget proposals, especially in a partisan Congress, Biden’s spending plan will need to be rewritten to win support from lawmakers on both sides of the aisle. However, it will serve as a roadmap for a Democratic controlled Congress in crafting 12 appropriation spending bills. Partisan bickering during the appropriations process may well force passage of a continuing resolution before Oct. 1 to block a government shutdown. 

Rhode Islanders Will Benefit for Long-Term Care Improvements

Published in Pawtucket times on April 5, 2004

An AARP membership application just arrived last week, inviting me to join the nation’s largest senior advocacy group.

AARP’s invitation to join clearly announces my major milestone in my life, when my June birthday officially pushes me into my 50s.

Celebrating my 50th birthday is no problem for me on a personal level, especially with my philosophy that, as with wine, one gets better with age.

But, as a writer on health care and aging issues, I see problems as to how I might access needed home and community-based services or nursing hoe care in my later years, especially if the state does not fix its problematic long-term care deliverly system.

The graying of Rhode Island’s population is taxing the state’s existing long-term care delivery system and will continue to do so for years to come. In response, state policymakers have taken a Band-Aid approach in trying to fix the fragmented system.

Already the Ocean State’s senior population, ages 60 and over, comprises more than 18 percent of the state’s total population. Gov. Don Carcieri and state lawmakers should be very concerned that Rhode Island’s population continues to age at the same time its long-term care delivery system needs an immediate overhaul.

Everyone knows it is extremely difficult for caregivers and seniors to negative the Ocean State’s long-term care system. Just ask any aging baby boomer (persons born between 1946 and 1964), and many will say that it is extremely difficult to find the needed programs and services to k eep mom and dad at home.

Today, many adult children who are juggling careers and raising children are also shouldering additional caregiving responsibilities to their olde parents. Even if their parents have been able to put a little money aside for their retirement, their children see their inheritance quickly being whittled down by thousands of dollars a month, all spent on costly pharmaceuticals and long-term care services.

Money can buy you anything in life, including home and community-based care and nursing home services.  Staying independent at home is still difficult for may moderate-income Ocean State seniors who cannot pay or find providers , especially with the Department of Elderly Affair’s (DEA) co-pay program not being fully-funded.

DEA’s co-pay program aids more that 1,500 frail seniors who do not qualify for the state’s Medicaid program, but who require ongoing services to remain in their homes. This funding helps pay for certified nursing assistants, who assist seniors with bathing, meals, shopping, laundry and light house keeping. DEA’s co-pay program slso provides subsidies for adult day care.

Last October, DEA’s freeze on new admissions to its co-pay program left more than 200 frail seniors on a waiting list for home and community based services.

While Gov. Carcieri recently gave an additional $ 200,000 in funding to DEA’s co-pay program in his 2005 budget, senior advocates have warned this amount is not enough. It is estimated this additional funding will serve 60 to 80 seniors out of the 200 persons currently on the waiting list.

Meanwhile, DEA has even put a freeze on new admissions to its respite program, which enables caregivers to take a break from the grueling physical and psychological demands of taking care of a frail elderly family resident.  This freeze will continue for the rest of this fiscal year, and nobody is sure how long the freeze for this initiative will last.

Hugh Hall, chair of the R.I. Health Care Association, tells All About Seniors that nursing homes will also be especially hit hard as state funding continues to diminish at the same time as  the cost of services and regulatory requirements increases.

“The state’s budget crisis is causing the governor to not meet a commitment in restructuring an antiquated Medicaid reimbursement system that pays for the care provided to 75 percent of the 10,000 frail residents in nursing homes,” said Hall.

This year, Carcieri, citing budgetary constraints, did not keep his promise to move forward with Part Two of the Medicaid reimbursement restricting, said Hall.

“This will have serious effects on the financial viability and quality of care provided in more than 70 small nursing homes throughout the state,” he said.

The huge budget deficient will continue to force Carcieri’s and state lawmakers hacking of many worthy programs and services previously funded in the state budget.  However, the state’s 2005 budget must adequately fund DEA’s co-pay and respite initiatives that keep frail seniors at home in their communities through the use of less costly home and community-based services.

The state must also keep its promise to adequately fund the state’s nursing homes for providing the needed medical care to those who are too sick to stay at home.

Hopefully, in 15 years, when I reach my next milestone – turning 65 – the state policy makers will have hammered out a much improved long-term care delivery system.

A commitment by Carcieri and state lawmakers to fix today’s fragmented long-term care delivery system will have long-range consequences, ultimately beneiting aging baby boomers, their children, and their children’s children.

Indeed, all future generations in this state will ultimately benefit from sound long-term care policy.