Tag Archives for President Obama

“Doc Fix” Law Brings Permanent Changes to Medicare Physician Payments

Published in Woonsocket Call on April 19, 2015

Congress put aside its fierce partisan bickering and came together to pass H.R. 2 – the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). This week President Obama took the opportunity to sign the legislation package into law.

The Congressional fix repeals and replaces the flawed Medicare physician reimbursement system known as the sustainable growth rate or Sustainable Growth Rate (SGR). For the past 13 years, physicians have faced the possibility of an arbitrary cut in their Medicare payments unless Congressional lawmakers passed a so-called “Doc.fix” Medicare bill. Since 2003, Congress has passed 17 short-term bills to block these cuts in Medicare doctors’ fees that were called for under the existing law.

On April 14, the U.S. Senate passed the MACRA by a whopping 92 to 8 (the House passing its version of the bill in late March by a large margin, 392-37). Two days later, at an outdoor signing ceremony in the Rose Garden, President Obama signed the legislation into law, with the House bill brokers, Speaker John Boehner (R-Ohio) and House Minority Leader Nancy Pelosi (D-Calif.) in attendance. .

A Permanent Fix Prevents Payment Cuts

Just hours before a cut in reimbursement that would take place this week, a rare bipartisan Congressional effort prevented a 21 percent cut in Medicare payments to occur. It’s a permanent fix. And the new law extends the Children’s Health Insurance Program, which has provided coverage to millions of American children.

At the signing, Obama called the passage “a milestone for physicians, and for the seniors and people with disabilities who rely on Medicare for their health care needs,” noting that it would also strengthen the nation’s health care delivery system for the long run.

Obama stated this new law “creates incentives to encourage physicians to participate in new, innovative payment models that could further reduce the growth in Medicare spending while preserving access to care.”

According to the Center for Medicare Advocacy (CMA), a national nonprofit, nonpartisan law group that provides education, advocacy and legal assistance to older people and people with disabilities, the estimated cost of the new law is roughly $214 billion over 10 years. CMA says roughly half (approximately $35 of the total $70 billion over 10 years) will come from Medicare beneficiaries through changes that will increase their out-of-pocket costs for health care.(through means testing of higher-income Medicare beneficiaries, increased Part B premiums, and added deductibles to Medigap plans purchased in the future.”

CMA adds that the nation’s pharmaceutical and insurance industries were not required to pay for any of this law, although doing so would have paid for a major portion of the SGR replacement.

On the Back of Medicare Beneficiaries

Aging advocacy groups, including the Center for Medicare Advocacy and AARP, failed in their attempts to improve the Senate bill Medicare beneficiaries, including a repeal of the annual therapy caps, raising eligibility standards for low-income programs and permanently extending outreach and education funding for critical programs aimed at low-income beneficiaries. The Senate bill passed without amendments.

While many gave thumbs up to the new law, Max Richtman, President and CEO of the Washington, DC –based National Committee to Preserve Medicare and Medicaid, sees big problems with MACRA. “The Senate ‘Doc Fix’ vote has traded one bad policy for another, shifting the costs of Congress’ failed Medicare payment formula for physicians to seniors who can least afford to foot that bill. Contrary to claims by supporters, on both sides of the aisle, this ‘doc fix’ will hit millions of seniors who aren’t ‘wealthy’ by any stretch of the imagination. Seniors at all income levels who are already paying steep premiums for Medigap plans to help control their health care costs will now be hit with even higher costs. Forty-six percent of all Medigap policy holders have incomes of $30,000 or less.”

Richtman added, “Medicare beneficiaries will also be forced to contribute nearly $60 billion in premiums over the next decade thanks to passage of this so-called ‘fix.’

It’s no surprise that conservatives applaud this legislation as ‘the first real entitlement reform in two decades’ because it fulfills their political goal of shifting costs to seniors, cutting benefits and expanding means-testing to push Medicare further and further away from being the earned benefit seniors have long valued and depended on.”.

“Trading a bad deal for doctors for a bad deal for seniors is not a legislative victory and it is a surprising move from so many in Congress who have previously vowed to protect Medicare from harmful benefit cuts and seniors from cost-shifting,” says Richtman. .

AARP CEO Jo Ann Jenkins also expressed strong disappointment in the Senate not passing an amendment that would have removed Medicare’s arbitrary cap on physical therapy, speech language pathology, and occupational services. “Many Medicare patients, particularly stroke victims and people with Parkinson’s and Multiple Sclerosis would have benefited,” says Jenkins. With a majority of the Senate agreeing with this amendment, Jenkins says that AARP will continue to lobby to remove the arbitrary coverage cap.

But, Jenkins sees the positives. “Passage of MACRA moves Medicare in the right direction toward better quality health care and greater transparency for patients. These changes will benefit Medicare beneficiaries, as well as physicians and other providers, hospitals, and the overall health care system,” she says.
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Through the enactment of MACRA Congress put aside its political differences that made a permanent fix to a flawed law. If you can do it once, let’s see our lawmaker do this again, to provide improved programs and services to our nation’s older population.

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

Protecting Retirement Savings Should Be a Priority

Published on March 7, 2015 in the Pawtucket Times

Last month, President Obama used his presidential bully pulpit to publicly support a proposed U.S. Department of Labor (DOL) rule, endorsed by a coalition of aging, labor and consumer groups, that reportedly limits conflicts of interest, increases accountability, and strengthens protection for Americans receiving retirement investment advice.

At the February 23 press conference held at the Washington, D.C.-based AARP headquarters, attended by Obama, Save Our Retirement Coalition members and lawmakers, the President called for the issuing of the proposed rule, still awaiting Office of Management and Budget (OMB) review and final DOL action. The updating of DOL rules and requirements would require higher standards for financial advisors, requiring them to act solely in their client’s best interest when giving financial advice, said Obama.

The Save Our Retirement Coalition says that the final rule is “needed to help protect Americans’ hard earned retirement savings from advisers who recommend investments based on their own interest – such as those that pay generous commissions – not because they serve their clients’ best interest.”

Existing Rules Outdated

In his remarks at AARP, Obama called the rules governing retirement investments written over 40 years ago “outdated,” filled with “legal loopholes,” and just “fine print,” needing an overhaul.  The existing rules governing retirement investments were written “at a time when most workers with a retirement plan had traditional pensions, and IRAs were brand new, and 401ks didn’t even exist,” the President explained.

At the event, Secretary of Labor Thomas E. Perez., claimed that his agency has substantially reached out to “a wide range of stakeholders,” to craft the proposed rule that was sent to OMB.  “The input we have received to date has been invaluable, but we’re not even close to being done. We have a lot more listening to do, and once the Notice of Proposed Rule Making is published in the coming months, I look forward to hearing from as many stakeholders as I can. We’re going to get this right, because the strength of the middle class depends on a secure retirement,” he says.

“We know the people we represent have worked hard to save for retirement, and we believe that they deserve to have financial advisers who work just as hard to protect what they’ve earned,” said AARP CEO Jo Ann Jenkins, in her remarks.  AARP is a member of the Save Our Retirement Coalition.

“AARP, a major consumer advocate, has been fought for this consumer regulation for over five years to ensure that Americans of all ages get the best financial advice when planning for their retirement,” says Jenkins. “Recently AARP also found that 9 out of 10 employers who sponsor retirement savings plans support holding advice to such a ‘best interest’ standard,” she adds. .

“In today’s world, it’s hard enough to save for retirement and achieve your financial goals” added Jenkins. “We don’t need to make it more difficult by allowing some on Wall Street to take advantage of hard-working Americans. Bad financial advice is just wrong,” she says.

According to Save Our Retirement Coalition, “the need for the proposed rule was made starkly apparent in a White House report released showing that conflicts of interest are costing middle class families and billions of dollars annually. The 30 page report, released last month, details the current regulatory environment for financial planners, providing evidence on the negative financial impact of conflicted professional investment advice draining older American’s retirement saving accounts.

The White House report, issued by Council of Economic Advisors, cited evidence pulled from the literature, showing that “conflicted advice reduces investment returns by roughly 1 percentage point for savers receiving that advice” The report also found that “a retiree who receives conflicted advice when rolling over a 401 (k) balance to an IRA at retirement will lose an estimated 12 percent of the value of his or her savings if drawn down over 30 years.  For those receiving conflicted advice “takes withdrawals at the rate possible absent conflicted advice, his or her savings would run out more than 5 years earlier.”

Holding Wall Street Accountable

“Many investment professionals do what’s right,” said AARP Rhode Island State Director Kathleen Connell. ”But loopholes in the law are allowing some on Wall Street  to take advantage of hard-working Americans, recommending investments with higher fees, riskier investments, and lower returns to make even higher profits for themselves. Last year alone, hidden fees, unfair risk and bad investment advice robbed Americans of as much as $17 billion,” she states.

“AARP agrees that financial professionals of all types serve a valuable role in building the wealth and security of the investing public,” added Connell. “We simply want to achieve some consistency in the standards across the industry. Here is Rhode Island, many retirees are very concerned about their investment savings and they deserve protection. Our position is that retirement accounts managed by a broker should receive the same protections as regular investment accounts held with an advisor,” she says.

“Rhode Islanders have who have worked hard for their money and deserve a new standard that holds Wall Street genuinely accountable for helping them choose the best investments for themselves, their family and their future,” she adds.

Security Trade Group Concern

             The Securities Industry and Financial Markets Association (SIFMA), a trade group representing securities firms, banks and asset management companies, is waiting to see the details of the proposed rule.  SIFMA CEO Kenneth E. Bentsen, Jr., stated: “While we cannot comment on a proposal we have not yet seen, we have ongoing concerns that the DOL regulation could adversely affect retirement savers, particularly middle class workers.  The new regulation could limit investor choice, cause inconsistencies as different regulators would apply different standards to the same regulatory accounts, prohibit guidance, and raise the costs of savings for retirement.”

But, both Obama and the Save Our Retirement Coalition strongly disagree with SIFMA’s assessment of the potential impact of DOL’s proposed rule, which has not yet been issued and is ultimately subject to change after the public comment period.

A large majority of financial planners put their clients first when giving them investment advice. But, as you know a few bad apples can truly spoil the barrel.  If trade groups representing financial planners fail to act to rein in financial planners who give conflicted advice to pad their pockets, than federal regulations can quickly do that job by applying “simple, commonsense standards.”

It makes practical and political sense to me.

Here is a linked to President Obama’s comments at the AARP Press Conference: http://www.whitehouse.gov/photos-and-video/video/2015/02/23/president-obama-speaks-aarp.

Herb Weiss, LRI ’12 is a Pawtucket-based writer who covers aging, health care and medical issues.  He can be reached at hweissri@aol.com . Or call 401/ 742-5372.

President’s Budget Addresses Issues of Interest to Seniors

Published in Pawtucket Times on February 27, 2015
President Obama released his 141 page ‘policy and wish list” when he unveiled his politically ambitious FY 2016 budget on Feb 2, not having to worry about running for president in the upcoming 2016 presidential election cycle.

Yes, even inside the Washington Beltway a picture is truly worth a thousand words. Gone is the budget’s plain blue cover replaced by a black and white photo of the Tappan Zee Bridge in New York, an image that projects one of the President’s spending priorities of rebuilding the nation’s infrastructure to create jobs and improve the transportation system.

The $4 trillion presidential budget, a political campaign document outlaying his policies and priorities, would cancel automatic sequestration cuts to domestic and military programs over a 10 year period. According to the New York Times, Obama’s budget proposal would add $6 trillion to the national debt, and the single-year deficit would rise to $687 billion by 2025.

Obama’s FY 2016 budget puts more funding into education, rebuilding the nation’s infrastructure, increased defense spending, along with providing tax relief for America’s middle class while increasing the taxes for corporate America and the wealthy. Political insiders say that Obama’s budget, one that gives to the middle class and assesses higher taxes from corporate America and the wealthy, sets the issues to be surely debated in the upcoming presidential election. .

A Look at Aging Priorities

On her Feb. 3 blog post, Nora Super, executive director of the upcoming White House Conference on Aging, details how the recently released budget proposal will “ensure that older Americans enjoy not only longer but healthier lives.”

As to retirement security, Super notes that the Obama Administration strongly opposes any legislative measures that would privatize the nation’s Social Security program, or slash benefits for future generations or reduce basic benefits to current beneficiaries. Super says that half the nation’s workforce, that’s about 78 million, does not have a retirement savings plan at work. “Fewer than 10 percent of those without plans at work contribute to a plan of their own. The President’s FY 2016 Budget expands retirement opportunities for all Americans to help families save and give them better choices to reach a secure retirement,” she says.

According to Super, Obama’s Budget proposal supports healthy aging by strengthening the Medicare program by “aligning payments with the costs of providing care, along with encouraging health care providers to deliver better care and better outcomes for their patients, and improving access to care for beneficiaries.”

To put the brakes to rising prescription drug costs, Super notes that the President’s Budget proposes to close the Medicare Part D donut hole for brand drugs by 2017, rather than 2020, by increasing discounts from the pharmaceutical industry. The Budget proposal also gives the Secretary of Health and Human Services new authority to negotiate with drug manufacturers on prices for high cost drugs and biologics covered under the Part D program.

Linking nutrition to healthy aging, Super says that Obama’s Budget provides “over $874 million for Nutrition Services programs, a $60 million increase over the 2015 enacted level, allowing States to provide 208 million meals to over 2 million older Americans nation-wide, helping to halt the decline in service levels for the first time since 2010.” Also, Obama’s budget ratchets up funding for supportive housing for very low-income elderly households, including frail elderly, to give these individuals access to human services, she adds. .

Protecting older persons from elder abuse, neglect and financial exploitation, Super blogs that the President’s budget proposal includes $25 million in discretionary resources for Elder Justice Act programs authorized under the Affordable Care Act. “Funding will “improve detection and reporting of elder abuse; grants to States to pilot a new reporting system; and funding to support a coordinated Federal research portfolio to better understand and prevent the abuse and exploitation of vulnerable adults,” she says.

Here’s Super’s take on the Obama budgetary blueprint: “Taken together, these and other initiatives in the Budget will help to change the aging landscape in America to reflect new realities and new opportunities for older Americans, and they will support the dignity, independence, and quality of life of older Americans at a time when we’re seeing a huge surge in the number of older adults.”

In a released statement, AARP Executive Vice President Nancy LeaMond gives thumbs to the president’s efforts to “lower the cost of prescription drugs, promote better care, reward improved outcomes and make health care programs more efficient and less wasteful.” She also expresses her nonprofit group’s support for the President’s budgetary priorities to “create opportunities for the middle class” and his goal “to make saving for retirement easier.”

But, LeaMond expresses concerns that higher premiums, deductibles and copays might shift costs to older Americans. “As the federal deficit continues shrinking, we must find responsible solutions for strengthening critical programs and improving the retirement and overall economic security of current and future generations. We must also look for savings throughout the entire health care system, as the rising cost of health care threatens people of all ages,” she says.

In his statement, President/CEO Max Richtman, of the Washington, DC-based National Committee to Preserve Social Security and Medicare, agrees with LeaMond’s concerns of higher premiums, deductible’s and co pays, too. “While some tout increasing means testing in Medicare as a way to insure ‘rich’ seniors pay their share, the truth is, the middle-class will take this hit as well,” he predicts.

Political pundits say that Obama’s 2016 budget was dead-on arrival at Capitol Hill the day it was released at the beginning of February. In the shadow of the upcoming 50th Anniversary of Medicare, Medicaid, and the Older Americans Act, as well as the 80th Anniversary of Social Security, GOP leadership in both chambers of Congress must work with the Democratic President to hammer out a bipartisan compromise. Putting budgetary proposals that strengthens the nation’s programs and services for older Americans on the chopping block for purely political reasons is not acceptable, especially to a nation that opposes political gridlock.

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