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GOP Health Care Reform Moves to Senate

Published in Woonsocket Call on May 7, 2017

House Speaker Paul Ryan’s words are now coming back to haunt him and GOP leadership that rammed American Health Care Act (AHCA), without procedural safeguards, through the House chamber days ago. “I don’t think we should pass bills that we haven’t read that we don’t know what they cost,” said Ryan in a 2009 interview on MSNBC when Congress was debating President Obama’s 1990-page Affordable Care Act (ACA), or Obamacare.

Last month, the Trump Administration efforts to repeal and replace Obamacare, with the American Health Care Act (AHCA) went down in flames when so many GOP moderates and conservative House lawmakers opposed the bill that the leadership didn’t dare bring it up for a vote. Successful negotiations of the GOP factions crafted a new version that passed last Thursday by a razor-thin vote of 217-213, a slim margin of four votes. All 193 Democrats opposed passage, along with 20 Republican lawmakers. With House passage, the bill moves to the Senate for deliberation.

Before the House vote on the GOP health bill there were no legislative hearings held to debate its merits and its full text was posted on the Web less than 24 hours before the vote. Ryan did not even wait for the nonpartisan Congressional Budget Office (CBO) to provide an updated financial analysis of AHCA. The CBO’s analysis of the original bill, pulled moments before a scheduled vote on March 24, 2017, found that the GOP health care proposal estimated that if passed 24 million or more Americans could be uninsured by 2026.

Opposition Mounting to GOP Health Care Proposal

With the passage of AHCA, Democratic Policy and Communication Committee Co-Chair David N. Cicilline (D-RI) issued the following statement, saying “This is the cruelest and most immoral thing I’ve seen the Republican Party do to the American people. They just passed a bill that they know will result in the deaths of thousands of working people each year. I don’t know how they sleep at night.”

“All you need to know about this bill is that Republicans tried to exempt themselves from coverage [of the GOP health care proposal]] before they got caught. That’s because they know it’s a raw deal,” says Senator Sheldon Whitehouse. This legislation sets us on a path to the bad old days when insurance companies could refuse coverage to those with preexisting conditions and deny people health benefits that should be in every plan – like ‎maternity and mental health care, he says.

Whitehouse warns that AHCA’s passage will leave millions of Americans without access to affordable health insurance. “Rhode Islanders rely on the Affordable Care Act and it’s working here. If they want to improve it, that’s one thing, but this House bill will hurt Rhode Islanders,

Within hours of the House vote on AHCA, a joint statement was issued by six prestigious national medical organizations (American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American Congress of Obstetricians and Gynecologists, American Psychiatric Association American and the American Osteopathic Association), representing over 560,000 physicians and medical students, denouncing the GOP health bill. Dozens of other state and national health care organizations, including the American Medical Association, American Nurses Association and American Hospital Association (and this number grows daily) also gave a thumb down on the Republican health bill that is considered “unworkable and flawed.”

Aging advocacy groups came out swinging, too.

AARP, representing 38 million members and considered to be one of the nation’s most powerful aging lobbying groups, plans to hold GOP House lawmakers accounting for their support of AHCA while gearing up to oppose the Republican health care proposal in the Senate.

In a statement, AARP Executive Vice President Nancy LeaMond reiterated AARP’s opposition to the GOP health bill passed in the U.S. House of Representatives, calling it “flawed” and warning that the legislative proposal “would harm American families who count on access to affordable health care.”

LeaMond says, “the bill will put an Age Tax on us as we age, harming millions of American families with health insurance, forcing many to lose coverage or pay thousands of dollars more for health care. In addition, the bill now puts at risk the 25 million older adults with pre-existing conditions, such as cancer and diabetes, who would likely find health care unaffordable or unavailable to them.”

According to LeaMond, AARP will continue its opposition of AHCA as it moves for Senate consideration because it “includes an Age Tax on older Americans, eliminates critical protections for those with pre-existing conditions, puts coverage at risk for millions, cuts the life of Medicare, erodes seniors’ ability to live independently, and gives sweetheart deals to big drug and insurance companies while doing nothing to lower the cost of prescriptions.

LeaMond warns, “We promised to hold members of Congress accountable for their vote on this bill. True to our promise, AARP is now letting its 38 million members know how their elected Representative voted on this health bill in The Bulletin, a print publication that goes to all of our members, as well as through emails, social media, and other communications.”

Medicaid Takes a Major Blow

“The bill threatens the very heart of the Medicaid program, taking away the guarantee that Medicaid will be there when seniors need it most. By slashing Medicaid funding by over $800 billion, the AHCA will place tremendous strain on state budget, says Kevin Prindiville, Executive Director of Justice in Aging, a nonprofit advocacy group for low-income seniors. “States will be forced to cut services, restrict eligibility, and reduce benefits for seniors, children, people with disabilities, and low-income older adults, he says.

“Congress is forcing families to pay more out-of-pocket when grandparents and other loved ones need nursing home care or home care. Two-thirds of all Medicaid spending for older adults pays for long-term services and supports. The AHCA puts this vital care for seniors in jeopardy,” says Prindiville. “By passing the ACHA, the House chose to cut taxes for the wealthy and pharmaceutical companies while harming Medicare beneficiaries by increasing Part B premiums and reducing the life of the Medicare Trust Fund, he says.

Max Richtman, President and CEO of the National Committee to Preserve Social Security and Medicare calls the AHCA vote “appalling” for retirees and views the “raid of Medicare, cuts to Medicaid among the most problematic parts of the AHCA.”

“Despite the bill’s name, risking the health of our nation’s most vulnerable citizens to give the wealthy an $ 600 billion tax cut is tremendously uncaring — and does not reflect real American values,” says Richtman. In modifying the original AHCA bill to give reluctant Republicans political cover, the House leadership made a bad piece of legislation even worse,” he says.

No Protection for Pre-existing Conditions

“Recent amendments to this cruel, ill-advised bill could put coverage for older Americans with pre-existing conditions like cancer and diabetes out of reach. The $8 billion (over 5 years) added to the legislation at the last minute to defray the cost of higher premiums is woefully inadequate. It’s a thin veil that covers a head of snakes,” notes Richtman

“Equally inadequate are the meager tax credits that the GOP bill offers older Americans to buy insurance. A $4,000 annual tax credit doesn’t come to close to covering premiums for seniors ages 60-64, meaning millions of older Americans will lose coverage altogether,” says Richtman.

According to Richtman, AHCA slashes nearly $1 trillion from the Medicaid by converting the social health care program into a block grant program or imposing per capita caps. “This would make it harder for impoverished seniors to access long term skilled nursing care and community or home care. Overall, the Congressional Budget Office estimates that 14 million people will be kicked off the Medicaid rolls in the next 10 years if this bill becomes law,” he says.

Richtman observes that the enactment of AHCA would reduce Medicare’s solvency by repealing Obamacare’s 0.9 percent payroll tax on wages above $200,000. This could lead to cuts in Medicare, including privatizing the program — harming current and future beneficiaries, he says.

“Under the GOP bill, insurers can charge older enrollees five times more than younger ones. The Congressional Budget Office predicts that by 2026 this provision will substantially raise premiums for older people by as much as 25 percent,” notes Richtman.

Senate Becomes New AHCA Battle Ground

After the politically decisive House vote to pass AHCA, President Donald Trump and House GOP lawmakers celebrated their major political victory at the White House Rose Garden claiming that they had fulfilled a promise made 7 years ago to repeal and replace Obamacare. But this celebration was short lived. Like House Democratic lawmakers, Democratic and Republican Senators began voicing their skepticism and strong opposition to the House’s passed health bill. Holding a slim 52-to-48 advantage in the upper chamber, GOP Senate Leadership must craft a bill that can win the support of at least 50 of their caucus members.

Washington insiders are now reporting that the House’s unpopular AHCA is “Dead on Arrival” in the Senate. Senate Republicans say they will not vote on the House passed bill and the upper chamber is expected to move slowly in crafting its health bill, starting from scratch. Many GOP Senators opposed AHCA, especially those who want to protect their constituents with pre-existing conditions and others who represent states that have expanded their Medicaid program under Obamacare.

A group of 13 Republican Senators (all men) have begun the process of hammering out their own health bill. Senate rules do not allow a review of the legislation or the determination of the rules of the debate until the CBO provides its official fiscal impact estimate. Because of this the health policy debate may not begin until summer.

Hopefully, Senate Majority Leader Mitch McConnell, a Republican from Kentucky, and his partisan working group will reach across the aisle to Democratic Senators to assist in crafting a bipartisan solution. Won’t that be refreshing.

GOP Health Care Proposal Pulled at Last Moment

Published in Woonsocket Call on March 26, 2017

Days ago, unified Democratic lawmakers combined with a deep philosophical wedge between the conservative House Freedom Caucus and moderate Republicans over policy details of the American Health Care Act (AHCA), forced the Trump Administration and House Speaker Paul Ryan to pull the AHCA proposal minutes from a floor vote to steer it away from a humiliating legislative defeat last Friday. Interestingly, the seventh anniversary of President Barack Obama signing the Affordable Care Act (ACA), his signature health care law, took place one day before the House vote.

A day before Friday’s scheduled vote to dismantle and repeal Obama’s ACA, President Donald Trump taking a high-risk negotiation tactic straight out of his bestselling book, “The Art of the Deal,” gave a late-Thursday night ultimatum to the House GOP lawmakers. Trump told to them to vote up or down on AHCA or he would be prepared to move on to other legislative agenda items.

As to Trump’s ultimatum to GOP House lawmakers, CNN Presidency Historian Timothy Naftali noted on CNN Newsroom with Fredricka Whitfield, “He played chicken and he blinked.”

House GOP Making Legislative Sausage

In a report issued on March 13, the Congressional Budget Office (CBO), detailed the drastic impact of the initial AHCA legislative proposal. CBO, a federal agency that provides budget and economic information to Congress, found that AHCA would result in 24 million losing health insurance coverage by 2026, Medicaid would be cut by $880 billion over the next ten years, and premiums and out-of-pocket costs would skyrocket increase, particularly for older adults and individuals with lower incomes.

Earlier this week, on Monday, Ryan and his House GOP Leadership team made eight amendments to AHCA to pull in skeptical GOP moderate and conservative lawmakers, including the controversial speeding up tax cuts while whittling down the Medicaid program. Later, on March 23, CBO confirmed that these amendments would lead to essentially the same level of coverage losses, about 24 million people and cost increases for individuals and would yield $187 billion less in savings than the original GOP health care proposal.

Meanwhile, on Wednesday, Senator Wyden and Congressman Pallone revealed that the Center for Medicare & Medicaid Services’ independent Actuary “estimated that the repeal of the tax on prescription medications, known as the ‘pharma fee,’ beginning January 1, 2017 would increase Medicare Part B premiums by $8.7 billion through fiscal year 2027.” noted the Center for Medicare Advocacy.

On Thursday, three more amendments were offered to sway GOP House critics. One would strip the requirement that insurance companies cover essential health benefits (EHB). This amendment would effectively eliminate annual out-of-pocket caps, reinstate annual and lifetime coverage limits, and gut protections for pre-existing conditions. Another would delay – but not remove – the Medicare payroll tax cut that will undermine Medicare’s financing and its future stability.

After the defeat of AHCA, Trump blamed the Democrats for the House GOP’s failure to pass its health care proposal to scrap Obamacare. “The Democrats were not going to give us a single vote,” he said, warning that “Obamacare will explode” forcing the opposition party back to the negotiation table to craft a better health care law.

House Speaker Ryan also noted that “We are going to be living with Obamacare for the foreseeable future.”

“We just really did not get a consensus today,” say Ryan. “That’s why I thought the wise thing to do was not proceed with a vote but to pull the bill. When asked if he was going to try “to prop it up, Ryan responded by saying “it is so fundamentally flawed, I don’t know that that is possible.”

Sighs of Relief from Aging Groups, Democrats

“The American Health Care Act is not American in spirit or health care in substance. In fact, it’s a tax cut bill for the wealthy, not a health care bill for the people. It will make America sicker. Congress should reject this charade and this disaster of a bill today,” states Judith Stein, Executive Director of the Center for Medicare Advocacy.

“The House Congressional leadership was destined to lose on their disastrous American Health Care Act, which would have effectively repealed Obamacare and hurt seniors, including beneficiaries of Medicare and Medicaid. It doesn’t matter whether they pulled or failed to pass the bill,” says Richtman, President and CEO of the National Committee to Preserve Social Security and Medicare in a statement. “It needed to go down and we thank the millions of National Committee members and supporters – and those of other senior advocacy organizations – whose protests were loud, numerous, and furious.”

“No one knew’ that health care could be so complicated. Hopefully, he has learned a lesson… that health legislation is built on a complex foundation that considers the real human needs – and costs – of changes to the system. A common refrain from Donald Trump during the campaign was, ‘What do you have to lose by electing me?’ Now we know what’s at stake: affordable health care for older Americans, Medicare, and Medicaid,” says Richtman.

“The leadership’s decision to withdraw the bill from consideration proves that the voices of Americans are very powerful. This harmful legislation would have added an Age Tax on older Americans and put vulnerable populations at risk,” says AARP Executive Vice President Nancy LeaMond, in a statement.

LeaMond calls on Congress to focus on the issues important to older Americans and their families, including: protecting and improving Medicare’s benefits and financing; providing access to affordable quality coverage; preventing insurers from engaging in discriminatory practices; lowering prescription drug costs; providing new incentives to expand home and community based services; and strengthening efforts to fight fraud, waste, and abuse.

Adds, Justice in Aging Executive Director, Kevin Prindiville, “Congress tried to rush this disastrous bill through Congress without regard for the health and safety of older Americans and their families, and such a bill cannot and should not be revived. Older adults and their families rely on Medicaid and Medicare and these programs must be protected.”

Compromise might well be the way to make sound changes to the nation’s health care law, says Rep. David N. Cicilline (D-RI), who serves as House Democratic Policy and Communications Committee. “The Affordable Care Act is a good law, and Republicans and Democrats should be working together to make it even better. If Republicans ever decide to come to the table, we should work together to increase competition, expand coverage, and bring down premiums. That’s a decision that Republicans have to make – whether to work with Democrats or continue down the path they’re on,” he says.

Rep. James Langevin (D-RI) also stresses the importance of reaching over the aisle to create a better health care law and getting away from partisan bickering. “It’s time for Republicans to move on from their misguided crusade to dismantle the ACA. The health care law has brought insurance coverage to millions of Americans. Its consumer protections, premium assistance, essential health benefits, and countless other provisions that were at risk of elimination have improved our nation’s health and saved lives. We must work together in a bipartisan manner to strengthen and improve the ACA, not risk the health and wellbeing of everyday Americans for an empty, partisan victory,” he says.

Trump Budget Proposal Makes Draconian Cuts to Aging Programs

Published in Woonsocket Call on March 19, 2017

Since his inauguration, GOP President Trump/s controversial and surprising Cabinet picks, some who have even called for the elimination of federal agencies that they were appointed to oversee, has sent a chilling message to the nation. That is business as usual is over inside the Washington Beltway, especially as to how federal dollars will be spent. The release of Trump’s first budget proposal, for fiscal year 2018, reveals draconian cuts throughout the federal government, this causing alarm among aging advocacy groups.

Trump Slashes Funding for Aging Programs and Services

James Firman, President and CEO, of the Washington, D.C.-based National Council on Aging (NCOA), notes Trump’s 62 page $.15 trillion budget proposal to remake the nation’s federal agencies and the programs they provide eliminates the Senior Community Service Employment Program (SCSEP), which provides job training and placement for adults 55 and over who have limited incomes and are trying to make ends meet. “Last year under SCSEP, 70,000 older adults received on-the-job training while providing nearly 36 million hours of staff support to 30,000 organizations, he says, noting that the value of this work exceeded $800 million, or nearly twice the program’s appropriations.

Trump’s budget proposal also zeros out the Low-Income Home Energy Assistance Program (LIHEAP), which provides assistance to low-income households to meet the costs of electricity, heating, and cooling, says Firman, noting that about a third of the nearly 7 million households receiving LIHEAP benefits include an older adult aged 60 or older.

Finally, Trump’s budget proposal eliminates the Corporation for National and Community Service (CNCS), which funds volunteer programs that serve distressed communities and vulnerable population, says Firman, noting that three Senior Corps programs (the Foster Grandparent Program, Senior Companion Program, and Retired Senior Volunteer Program (RSVP), will lose funding. “Together, these programs provide the nation with approximately 96 million hours of service, with a value of $2.1 billion,” he says.

“While the President’s budget blueprint does not cut Social Security Administration (SSA) funding (unlike the drastic reductions in non-defense discretionary spending), the 0.2% increase for SSA does little to solve serious customer service deficiencies for Social Security beneficiaries,” says Max Richtman, President and CEO of the Washington, D.C.-based National Committee to Preserve Social Security and Medicare (NCPSSM). “Seven years ago, the SSA’s budget was cut by 10% (after adjusting for inflation), just as waves of Baby Boomers were beginning to retire and place a strain on the agency’s resources,” he says.

Richtman noted that while the numbers of Social Security beneficiaries were increasing, SSA was forced to implement a hiring freeze in 2016 and was not able pay its workers overtime. As a result, hold times on the SSA toll-free customer service number are now an average 15 minutes, more than 60 SSA field offices around the country have been shuttered, and the average wait time for a disability hearing has climbed up to 590 days.

Richtman points out that one million people are awaiting their scheduled disability hearing. “The disability case backlog and customer service will only get worse under the flat operating budget proposed by the President. To make up for previous cuts and restore vital services, the National Committee supports a 7% increase in the SSA’s operating budget,” he says.

NCPSSM’s Richtman warns that Trump’s “skinny budget” may keep millions of vulnerable seniors from participating in the Meals on Wheels program. As Meals on Wheels America has pointed out, Trump’s budget blueprint eliminates the U.S. Department of Human Development’s (HUD) Community Services Block Grant and Community Development Block Grant (CDBG), on which some local Meals on Wheels programs rely on to deliver nutritious meals, safety checks, and friendly visits to seniors who need these services. (The President’s budget blueprint does not mention the Older Americans Act, which provides 35 percent of Meals on Wheels funding nationally.)

Richtman calls on President Trump to ride along with a Meals on Wheels delivery van and see for himself how seniors thrive on the meals they receive and the much-needed human interaction that comes with the food. “Maybe then he would move to protect – rather than cut – this vital program for our nation’s seniors,” he says.

Budget Proposal Puts Food Delivery Program on Budgetary Chopping Block

Trump’s elimination of HUD’s CDBG program in his proposed budget proposal will drastically impact many Meals on Wheels programs across the nation, but, fortunately Meals on Wheels of RI (MOWRI) will not be hit as hard, says Heather Amaral, executive director of Meals on Wheels of RI. But, Rhode Island’s only non-profit home-delivered meal program, will be indirectly impacted by Trumps CDBG cuts, she worries, noting that other programs that support her work receive these HUD funds, specifically, community centers that house our Capital City Café sites or local drop-off sites for the Home Delivered program. The Senior Community Service Employment Program that provides staff for several of our Café sites is also slated for elimination in President Trump’s “Skinny Budget.”

Amaral also is concerned about Trump cutting the U.S. Department of Health and Human Services’ budget by 18 percent. “Our Older Americans Act Title III funding flows through this department. It is safe to assume that this significant cut will result in a reduction of our funding—funding that has remained at stagnant for over 10 years,” she says.

“It is impossible to predict any service cuts until a final federal budget is approved and any cuts to MOWRI are known. Any funding reductions will have a negative impact on her nonprofit agency’s ability to keep up with the increased demand of Rhode Island’s growing senior population,” says Amaral.

“Our programs directly address issues that are critical to Rhode Island’s vulnerable homebound seniors,” she says, noting that last year, MOWRI delivered 345,262 meals to over 2,560 homebound residents.

Last Thursday, White House budget director Mick Mulvaney defended the Trump budget proposal cuts to the widely popular Meals on Wheels program. He told reporters that the program “sounds great” but is “not showing any results.”

Amaral counters by saying that research is providing the tremendous benefits of participating in the meals and wheels program — for seniors, homebound, family members, municipalities and the Rhode Island

The Brown University “More than a Meal” Report (published 2015), a randomized, controlled study of Meals on Wheels Programs across the country, reported that those who received daily-delivered meals experienced the greatest improvements in health and quality of life indicators,” says Amaral. The most vulnerable of our recipients, those who live alone, were more likely to report decreases in worry about being able to remain in home and improvements in feelings of isolation and loneliness, she noted.

Meanwhile, a U.S. Administration on Aging (AoA) Study, published in September 2105, found that those receiving daily-delivered meals are more likely to report improvements in mental and physical health, reductions in feelings of isolation and anxiety about being able to remain at home, and lower rates of hospitalization and falls, adds Amaral.

“In that same report, AoA statistics show that a home delivered meal program can deliver a year’s worth of meals to a senior for the same cost as one day in the hospital, or one week in a nursing home, notes Amaral.

Speaking at the Hubert Humphrey Building dedication in Washington, D.C. on November 1, 1977, former U.S. Vice President (1965-69) Hubert Humphrey stated “the moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; those who are in the shadows of life; the sick, the needy and the handicapped.” A quick read of the Trump’s budget proposal revealing huge cuts for domestic programs, it’s clear to many that his Administration has failed it’s test.

If you want to learn more about MOWRI, sign up for meals, volunteer or donate, please visit http://www.rimeals.org or call 401-351-6700.