Tag Archives for Medicaid

National Report Grapples with Impending Alzheimer’s Epidemic

Published in the Pawtucket Times, July 25, 2013

.This 56 page report must not sit on a bureaucrat’s dusty shelf.

With the graying of the nation’s population and a skyrocketing incident rate of persons afflicted with Alzheimer’s disease, the Chicago-based Alzheimer’s Association and the U.S. Centers for Disease Control (CDC) and Prevention release a report last week to address a major public health issue, an impending Alzheimer’s disease epidemic on the horizon.

Researchers say that in 2013, an estimated 5 million Americans age 65 and older have Alzheimer’s disease. Unless more effective ways are identified and implemented to prevent or treat this devastating cognitive disorder the prevalence may triple, skyrocketing to almost 14 million people.  Simply put, Alzheimer’s disease is now the 6th leading cause of death and 5th among those 65 to 85 years of age.

A Call to Arms

A July 15, 2013, CDC, the federal agency charged with protecting public health and safety through the control and prevention of disease, injury, and disability, and the Alzheimer’s Association, the world’s leading voluntary health organization in Alzheimer’s care, support and research, unveiled The Healthy Brain Initiative: The Public Health Road Map for State and National Partnerships, 2013-2018 at the 2013 Alzheimer’s Association International Conference in Boston.

The released report calls for public health officials to quickly act to stem the growing Alzheimer’s crisis and is a follow-up to the 2007 The Healthy Brain Initiative: a National Public Health Road Map to Maintaining Cognitive Health.

“The public health community is now paying greater attention to the Alzheimer’s epidemic that millions of families have been facing for decades and that is poised to drastically increase,” said Robert Egged, Vice President of Public Policy at the Alzheimer’s Association. “On the heels of the 2012 release of the country’s first-ever National Alzheimer’s Plan, the Alzheimer’s Association and CDC have partnered again to create a tool for public health officials to improve the quality of life for those families and advance cognitive health as a integral component of public health,” says Egged.

Released five years ago, the original Road Map addressed cognitive health and functioning from a public health perspective and provided a framework for the public health community to engage cognitive health, cognitive impairment, and Alzheimer’s disease and other dementias. More than 280 experts in the field contributed to this new Road Map report that outlines specific actions steps that state and local public health officials can take to promote cognitive functioning, address cognitive impairment for individuals living in the community and help meet the needs of caregivers.

While federal agencies play a critical role in leading and funding efforts to address Alzheimer’s disease, state and local health departments organize and provide public health services at the community level.

“The goal of the Healthy Brain Initiative is to enhance understanding of the public health burden of cognitive impairment, help build evidence-based communications and programs, and translate that foundation into effective public health practices in states and communities. This Road Map provides guidance to states, communities, and national partners to plan for and respond to this major public health issue,” said Lynda Anderson, PhD, Director of the Healthy Aging Program at CDC.

A former Assistant Secretary at the U.S. Administration on Aging, Bill Benson, now a managing partner of Silver Spring, Maryland-based, Health Benefits ABC, notes that the cost of providing care to people with Alzheimer’s disease will have a drastic impact on the nation’s economy due to the cost of lost productivity, and the care costs for those no longer able to care from themselves. “This does not include the profound personal impact and consequences to those who suffer from Alzheimer’s and to their loved ones,” he says.

“The scope, cost and the extraordinary burden both to individuals and to society make it a true health crisis,” says Benson, stressing that public health officials need to know more about the disease and those who have it, better ways to diagnosis it.  There must also be a better understanding of the economic impact and programs and services that are proven to ease the burden of those who suffer from it and their caregivers, he adds.

Action Steps for Local Communities to Follow

The Road Map report includes more than 30 action steps that the public health community can take at the federal, state and local levels over the next five years to address cognitive health and cognitive impairment from a public health perspective. The actions are intended as a guide for what state and local public health officials could do – on their own or with other national, state and local partners. Agencies are encouraged to select those actions that best fit state and local needs and customize them to match priorities, capabilities and resources.

As to specifics, the Road Map report calls for improved monitoring and evaluation of persons with dementia including Alzheimer’s disease and younger onset as they relate to employment and employers, and defining the needs of these individuals and their caregivers.  Also, increased support should be given to state and local needs assessments to identify racial/ethnic; lesbian, gay, bisexual, and transgender; socioeconomic; and geographic disparities related to cognitive health and impairment.

Public health officials must educate and empower the nation in confronting the epidemic of Alzheimer’s disease by promoting advance care planning and financial planning to care partners, families, and individuals with dementia in the early stages before function declines.  They can and promote early diagnosis.

The Road Map report urges that sound public health policies be developed and partnerships created to collaborate in the development, implementation, and maintenance of state Alzheimer’s disease plans. It also recommends that state and local government integrate cognitive health and impairment into state and local government plans (e.g. aging, coordinated chronic disease, preparedness, falls, and transportation plans).

Finally, the Road Map report also recommends that strategies be developed to help ensure that state public health departments have expertise in cognitive health and impairment related to research and best practices.  Support must also be provided to continuing education efforts that improve healthcare providers’ ability to recognize early signs of dementia, including Alzheimer’s disease, and to offer counseling to individuals and their care partners.

A Local View

Maureen Maigret, policy consultant for the Senior Agenda Coalition of RI coordinator of the Rhode Island Older Women’s Policy Group, agrees with the assessment of theRoad Map report, especially with the Ocean State having the “highest percent of persons age 85 and over in the 2010 Census and this is the population that is growing fast and most likely to have dementia.”

Maigret notes the economic impact will have significant impact across our economy for the state budget and for individual families. “It is imperative for our public officials to promote programs to identify those with early cognitive problems and implement policies to strengthen community and caregiver supports that will help persons to safely remain in home and community settings as long as possible, she says.

The Rhode Island General Assembly passed legislation this year that requires caregiver assessments in the state Medicaid long term care system.  “It’s a good first step in helping caregivers. But we must do so much more to inform the public about available resources, to adequately fund assistance programs such as RIde, Meals on Wheels and respite services and to promote cognitive screening as part of annual wellness visits funded by Medicare,” she says.

“Having a clear active mind at any age is important but as we get older it can mean the difference between dependence and independent living,” says Executive Director, Donna McGowan, of the Alzheimer’s Association-Rhode Island Chapter. “We are excited that the CDC has partnered again with the Alzheimer’s Association to create a tool for public health officials to improve the quality of life for those families afflicted by the disease,” she says.

For more information on The Healthy Brain Initiative: The Public Health Road Map for State and National Partnerships, 2013-2018, visit alz.org/publichealth. For more information on Alzheimer’s disease and the Alzheimer’s Association, call 1-800-272-3900 or visit alz.org®.

 

Aging Groups Consider Obama’s Fiscal 2014 Budget Proposal a “Mixed Bag”

Published in Woonsocket Call, April 21, 2013

President Barack Obama, missing the federal mandated budget submission deadline by over two month, finally unveils his fiscal blueprint on April 10, giving Capitol Hill a peek as to how he would fund the nation’s federal agencies, programs and services.

The President proposed a $3.8 trillion budget plan for fiscal 2014, that seeks to slash the huge federal deficit by a net $600 billion over 10 years, raises taxes on the wealthy, and puts the breaks to rising costs of two very popular senior programs, Social Security and Medicare.

Senior groups call President Obama’s the first budget proposal of his second presidential term, a “mixed bag.” His fiscal blueprint would eliminate the draconian cuts of the sequester, that is the arbitrary, across the board cuts Congress imposed this year. However, Obama seeks to reduce the federal deficit by calling for another $200 billion in cuts to discretionary programs – half from defense programs and half from domestic programs.

Braking the Rising Costs of Social Security Despite the Social Security Trustee’s 2012 Annual Report that the entitlement program has the financial resources to pay all benefits through 2033 (see my June 1, 2012 Commentary in Pawtucket Times), Social Security benefits are targeted in the recently released budget plan for substantial cuts by adopting the “chained” consumer price index (CPI) for the purpose of calculating Social Security cost-of-living adjustments, or COLAs.

According to the Washington, D.C.-based, National Committee to Preserve Social Security and Medicare (NCPSSM), the Obama Administration sees this switch as “a technical adjustment.” Aging group warn that using the “chained” CPI will substantially reduce the Social Security benefits of current and future beneficiaries. “If it is adopted, a typical 65 year-old would see an immediate decrease of about $130 per year in Social Security benefits. At age 95, the same senior would face a 9.2 percent reduction—almost $1,400 per year,” notes NCPSSM.

While all beneficiaries will feel the impact of this change, its effect will be greatest on those who draw benefits at earlier ages (e.g., military retirees, disabled veterans and workers) and those who live the longest, says NCPSSM, especially “women who have outlived their other sources of income, have depleted their assets, and rely on Social Security as their only lifeline to financial stability.”.

With Republican Congressional lawmakers generally supportive of Obama’s push to rein in Social Security costs, through the use of the “chained” CPI, liberal Democratic lawmakers, including Rep. David Cicilline, representing Rhode Island’s 2nd Congressional District, strongly oppose the President or any Congressional efforts to cut Social Security to lower the nation’s federal deficit.

Rep. Cicilline calls for reforming the nation’s tax code by ending subsidies for “Big Oil,” along with “making responsible target spending cuts,” to slash the nation’s huge federal deficit .

AARP Poll Says, Keep Your Hands Off Social Security
In a statement, AARP Executive Vice President Nancy A. LeaMond, quickly reacted to the Democratic President’s efforts to use the “chained” CPI to control rising Social Security program costs.

While AARP recognizes the need for the President and Congress to confront budget challenges facing the nation, the nation’s largest aging advocacy group calls for “responsible solutions, not harmful proposals” that would hurt older beneficiaries or threaten the retirement security of the generations that follow, says LeaMond.

LeaMond said, “AARP is deeply dismayed that President Obama would propose cutting the benefits of current and future Social Security recipients, including children, widows, veterans and people with disabilities, to reduce the deficit. Social Security is a self-financed program that doesn’t contribute to the deficit, so it shouldn’t be cut to reduce it.”

AARP’s polls indicated that older Americans, across the political spectrum, agree with nonprofit group’s opposition to the “chained” CPI. LeaMond, notes. The recently released national survey found that “fully 84% of voters age 50 and over oppose cutting Social Security benefits to reduce the deficit.”

“Instead of making harmful cuts to Medicare or shifting additional costs onto beneficiaries, we need to look for savings throughout the health care system, including Medicare,” suggests LeaMond. She says that also “lowering the costs of prescription drugs, innovations that promote better care, reward improved outcomes and make health care programs more efficient and less wasteful have the potential to hold down systemic high health care costs, including costs in Medicare.”

Finally, LeaMond adds, “We know that prescription drugs are one of the key drivers of escalating health care costs, so we appreciate the President’s inclusion of proposals to find savings in lower drug costs. And we applaud his plan to accelerate closure of the ‘donut hole’ in Medicare Part D by 2015, which would reduce seniors’ often burdensome out-of-pocket health care expenses.”

A Snap Shot of Other Aging Budget Issues
Howard Bedlin, Vice President for Public Policy and Advocacy at the National Council on Aging (NCOA), in a written statement calls Obama’s budget proposal a “mixed-bag” when it comes to seniors.”

Bedlin acknowledges that the recently released Obama budget eliminates the sequester cuts to critical programs like Meals on Wheels and other Older Americans Act services, elderly housing, and other vital senior services. “It is unfortunate that cuts are proposed for low-income energy assistance and senior job training and placement programs,” he says.
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According to Bedlin, the President’s budget also protects SNAP (Food Stamps) and Medicaid, in sharp contrast to the drastic cuts approved in the Republican-controlled House budget proposal. “Cuts in Medicaid would be devastating to the millions of vulnerable seniors who rely on the program for long-term care and Medicare low-income protections,” he says.
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Meanwhile, a major concern for NCOA with the President’s budget surrounds Medicare and Social Security. While the organization supports some of the Medicare reductions, the proposed $370 billion in additional cuts are “excessive and several will harm” beneficiaries (more than half having incomes below 200 percent of the poverty line), says Bedlin, these cuts in addition to the $716 billion in Medicare cuts under health reform and significant reductions in spending growth over the past three years.

Also, the proposed new home health co-payment will fall primarily on lower-income older women with multiple chronic health conditions, and lead to premature nursing home placement, predicts Bedlin. “The proposed increase in the Medicare Part B deductible would be especially harmful and unaffordable to millions of seniors with incomes just above the federal poverty line ($958 per month),” he says.

Finally, Bedlin notes that the proposed Medigap surcharge would penalize seniors for decisions made by their doctors, cause major market disruption, and seriously confuse many current policy holders. The proposal to further increase Medicare premiums based on income could result in those with incomes of about $47,000 being forced to pay more.

NCOA joined AARP and NCPSSM and virtually every other national aging organization in opposing the President’s proposal to cut the Social Security Cost of Living Adjustment (COLA) through the use of a “chained” CPI.

A Final Note… With Obama’s proposed budget now thrown in the ring with the House and Senate budgets already drafted and voted on, will Congressional gridlock keep the Democratic President, the GOP-Controlled House and Democratic Senate from working together to hammer out a consensus, bipartisan compromise? Only time will tell if elected lawmakers clearly get the message from the American people, “put the people first and not your political party.”

Herb Weiss, LRI ’12, is a Pawtucket-based freelance writer covering aging, health care and medical issues. He can be reached at hweissri@aol.com.

Defining Brendan Doherty: Romney Republican or Moderate

 Published September 28, 2012, Pawtucket Times

            With the upcoming November election just six weeks away, Republican Candidate Brendan Doherty held a news conference last Tuesday at Memorial, attempting to distance himself from House GOP leadership and from Mitt Romney, the Republican Party’s anointed Presidential candidate.

Surrounded by a backdrop of the 294 bed CommunityHospital in Pawtucket’s East Riverview Neighborhood, Doherty, the GOP challenger to Democratic Rep. David Cicilline, came before seniors and supporters to do political damage control, with an agenda to set the public record straight about his positions on Social Security, Medicare, and Medicaid.

Keeping Social Security, Medicare off the Chopping Block

Charging that Cicilline was misleading to voters on his positions on the nation’s most popular domestic programs, the Republican Candidate pledged his opposition to “privatization” of the nation’s Social Security Program, calling for Congress to keep the Social Security and Medicare programs off the budgetary chopping block.  The former state police superintendent, looking to become Rhode Island’s newest Congressman for the First Congressional District, also supported increased benefits for seniors already enrolled in the Social Security Program.

At the morning news conference, Doherty warned that he has no “secret plan” to cut Social Security and Medicare, as Cicilline charges.  He chastised the Freshman Congressman and his Democratic political operatives for using scare tactics and misleading political rhetoric to fuel a misinformation campaign to link him to Republican Presidential Candidate, Mitt Romney and his running mate, Rep. Paul Ryan’s support for a Medicare voucher program.  Doherty stated that a voucher system would shift healthier Americans to private insurance plans and leave the sickest and frailest American’s in a weakened version of traditional Medicare.

Putting the Spot Light on Fraud and Waste

Doherty, calling himself an “independent thinker” a “centrist” who pledged to reach across the aisle to House Democrats, to pass legislation that would root out fraud and abuse in Medicare and Medicaid.  He noted that a new RAND Corporation study showed that fraud and waste in these two programs may be as high as $98 billion.

“While Congressman Cicilline often speaks of his commitment to protect Medicare from any possibility of budget cuts, he failed to take this common sense action to address the fraud, waste and abuse that accounts for at least $48 billion being diverted every year from the Medicare program and taken away from our seniors who depend on the Medicare program,” commented Doherty.

Doherty, however, looks to push for the Medicare and Medicaid Fighting Fraud and Abuse to Save Taxpayers’ Dollars Act or the Medicare Fast Act (H.R. 3399), as types of legislative proposals he could support if he were elected to Congress.

Cicilline did not mince his words after Doherty’s news conference by continuing to tie his Republican challenger to the Radical Republicans who control the House.  He charged that “My Republican opponent supports raising the retirement age for Social Security and if he got to Congress, would vote to keep the Republicans in control of the House where they would continue to push an extreme agenda that would end the guarantee of Medicare and turn it into a voucher system.”

According to the Democratic Congressman, the Preserving Our Promise to Seniors Act, whish he is a cosponsor, is the best way to extend the life of Social Security Program along with improving the Cost of Living Adjustment formula to give beneficiaries an adjustment based on the cost of goods and services that they regularly purchased.  The Democratic Congressman also opposed the raising the Social Security eligibility age or any effort to privatize the system, these changes supported by many GOP lawmakers.

Responding to the news conference, the Rhode Island Democratic Party issued a release calling Doherty’s pledge to preserve Social Security and Medicare “an empty one,” given the Republican House Leaderships efforts to slash funding for these programs for years.

Countering Doherty’s attempt to label himself a moderate, Bill Fischer, spokesperson for the RI Democratic Party called Cicilline’s Republican opponent a “Romney Republican who has clearly stated he would repeal the Affordable Care Act; raise the eligibility age on Social Security; and will vote for Republican control in Congress.”

“If Doherty were serious about protecting seniors, he wouldn’t be calling for the repeal of our historic healthcare reform,” Fischer said. “Maybe he doesn’t understand the enormous benefits Rhode Island seniors have already received since its passage. Thanks to President Obama’s Affordable Care Act, 128,390 people on Medicare in Rhode Island have access to preventative health care services, such as colonoscopies and mammograms.

In Rhode Island’s First Congressional District alone, 7,300 seniors have saved over $4 million on prescription drugs because the Affordable Care Act closed the donut hole.”

TV Spot Ties Doherty to Radical Republicans

             With Doherty’s effort to distance himself from the Washington Republican agenda, Cicilline’s campaign released a new television spot, entitled “Fantastic,” to more firmly politically tie his Republican challenger to the Romney-Ryan agenda in Washington.

“At the end of the day, Brendan Doherty wants Republicans in control of Congress and Mitt Romney setting the agenda in the White House. In fact, he thinks Romney would “be fantastic for Rhode Island,’” said Cicilline campaign manager Eric Hyers, detailing the spot..

“Rhode Islanders will have a clear choice this November between re-electing President Obama and Congressman Cicilline so we can get our state back on the right track, or voting for Mitt Romney, Brendan Doherty, and the Washington Republicans who got us into this mess to begin with.”

In the 30 second spot, Doherty emphasizes his support for Romney at a March 3, 2012 candidate forum, saying, “I think he’d be fantastic for Rhode Island.”

In January 2012, Doherty formally endorsed Romney for President, describing him as a “proven leader.”  In the same month, Doherty traveled to New Hampshire to campaign for Romney and was later introduced to the Republican presidential nominee by former Rhode Island Governor Don Carcieri.

The political spot also outlines areas where Romney and Doherty agree on policy – including their support for repealing President Obama’s historic health care reform law, as well as their mutual opposition to reproductive freedoms for women and the Buffett Rule that would require millionaires to pay at least the same tax rate as the middle class.

As the Dust Settles…

Here are questions that voters in Congressional District 1 must ask themselves before they enter the polls in the November election:

Can Doherty successfully repackage himself as a moderate Republican?  If so, with a Republican-controlled House, captured by a radical Tea Party who philosophically opposes political compromise, as a moderate Republican will he vote for  Democratic initiatives that the majority of his Democratic constituents support.  Or can he stand the “heat in the kitchen” and vote against his House Republican leadership.

Can the voters forgive the former Providence Mayor, now their Congressman, for his statements made about the fiscal health of his City as he left office?  If so, they must determine if it is more important to keep this seat Democratic, in hopes of bringing the political party back to power in that Chamber.

With the November election looming, the Cicilline-Doherty political battle, truly becomes the classic “He said, She said,” debate, with the voters ultimately finding out the truth in the New Congress.

Herb Weiss is a Pawtucket-based freelance writer who covers aging, health care and medical issues.