JustCare

Tag: Congress

  • As the US population ages, how will people afford long-term care?

    As the US population ages, how will people afford long-term care?

    Americans are finding it increasingly difficult to meet their and their loved ones’ long-term care needs. Congress continues to sit on its hands, while some states are taking action. Mark Miller writes for the New York Times about the need for Congress to step in on behalf of all Americans who could need long-term care and, in the meantime, what some states are doing to help their residents.

    The vast majority of Americans will need some kind of long-term care as they age, be it help with bathing, dressing and toiletting, other activities of daily living, or full-time home care or nursing home care. Only about one in five Americans will not need long-term care. For now, there’s no hope of Congressional action, as ensuring people’s long-term care needs are met costs money, and Republicans have taken raising taxes to cover additional healthcare costs off the table.

    The average cost for one year of nursing home care was nearly $110,000 two years ago. Yet, nearly seven in ten Americans have done little if any planning and saving to cover the costs of their long-term care needs. Not even one in six Americans believe they are prepared financially, if they need long-term care. Those who are unprepared will likely have to count on family and friends to volunteer their time to care for them, if they do not qualify for Medicaid.

    Medicaid does cover long-term care. It is an invaluable benefit. But, in order to get Medicaid, your income and assets need to be extremely low. Thankfully, in many states, if your income and assets are above the eligibility level, your health care expenses can bring your income and assets down to the Medicaid eligibility level so you can qualify for Medicaid.

    Most people do not realize that Medicare does not cover long-term care. At best, people might qualify for 100 days of nursing home care, but that’s only if they’ve been hospitalized for at least three days in the 30 days prior to admission in a nursing home. And, people in Medicare Advantage plans rarely get coverage for more than a very short nursing home stay. People also might qualify for very limited Medicare-covered home care, and that’s only if they’re homebound and need either intermittent skilled nursing or therapy services.

    Washington State is the first state to launch its own publicly-administered long-term care program, the WA Cares Fund,  States such as California and Minnesota might do the same in time. The issue is that covering long-term care is not only expensive, but tricky to implement.

    In Washington State, long-term care benefits will be available to everyone beginning in 2026, and everyone will pay in for those benefits during their working lives through a 0.58 percent payroll contribution. The maximum benefit will only be $36,500, a fraction of the total amount most people will need to spend on home care. The Washing State benefit should help with a year of home care costs.

    Washington State might save on Medicaid expenses through this long-term care program. That’s what the state is hoping. Because of the program, some people will not need to spend down all their assets to qualify for Medicaid. But, nothing is clear at this point.

    Some questions still need to be answered. For example, what if people also have private long-term care insurance? And, will people who contribute to the program lose their right to benefits if they move out of Washington state?

    All this said, Washington State is doing its residents a major service. Private long-term care insurance has always been a gamble, with “level” annual premiums able to double out of nowhere; it becomes increasingly unaffordable over time and offers benefits that are generally more limited than people realize.

    Here’s more from Just Care:

  • FDA is confiscating some imported life-saving prescription drugs

    FDA is confiscating some imported life-saving prescription drugs

    NBC News reports on the Food and Drug Administration’s efforts to block importation of prescription drugs. The FDA is helping the pharmaceutical industry and harming Americans who can’t afford to buy the life-saving drugs they need in the US. Allegedly the FDA is trying to keep fentanyl and opioids from being shipped into the US. Really? The FDA found just 33 packages of these controlled substances out of 53,000 it intercepted in 2022.

    The quickest way to ensure drug prices in the US are fair and not two to four times higher than what people in other wealthy nations pay is to open our borders to drug imports from verified pharmacies abroad.  The pharmaceutical industry uses its considerable influence to prevent drug importation, claiming safety risks.

    There are always risks to importing prescription drugs from abroad, just as there are risks to importing food from abroad. But, on a risk benefit analysis, the danger of being harmed from a drug imported abroad–for which there are no reported cases–is far outweighed by the danger of preventing people from getting the drugs they need because they cannot afford them.

    If the FDA’s goal is keeping opioids from entering the US, its current strategy of seizing packages with drugs from abroad is misplaced. The data show that few opioids are in the shipments the FDA intercepts. Almost all of the drugs in these seized shipments were prescription drugs people had ordered from abroad for personal use. The FDA confiscated mostly drugs to treat asthma, diabetes, cancer and HIV, as well as a lot of drugs that treat erectile dysfunction.

    Still, the FDA continues its efforts, at a huge cost to the health and well-being to the Americans who need the drugs they import. The FDA has the right to confiscate drugs without US labeling or packaging.

    While it is technically not legal to import prescription drugs from abroad, millions of Americans do so every year. No one has ever been prosecuted for doing so.  What’s particularly interesting is that both Republican and Democratic governors in Florida, Colorado, New Hampshire and New Mexico want to allow drug importation.

    The Biden administration has not yet approved state applications to import drugs. It’s unclear why not. Pharma has tried through a lawsuit, and failed, to block this Trump administration initiative.

    Why is Congress giving the FDA $10 million to intercept controlled substances from abroad, when the vast majority of the drugs it intercepts are for personal use, to keep people alive? “The nation’s fentanyl import crisis should not be conflated with safe personal drug importation,” argues Gabe Levitt of PharmacyChecker.com. PharmacyChecker.com reports prices from verified pharmacies in dozens of countries for a wide range of drugs.

    In December, Congress told the FDA that it should focus on intercepting controlled and counterfeit drugs from abroad and drugs that pose “a significant threat to public health.” That alone is not likely to stop the FDA from confiscating drugs that Americans are importing to treat their cancer, asthma and heart drugs. As Koontz of the FDA said, “Importing drugs from abroad simply for cost savings is not a good enough reason to expose yourself to the additional risks,” he said. “The drug may be fine, but we don’t know, so we assume it is not.”

    The FDA claims, based on Pharma-supported congressional testimony, that imported drugs have an eight to ten percent chance of being counterfeit. It’s not at all clear this is accurate. And, based on the evidence, it is not at all accurate when it comes to drugs bought from verified pharmacies around the world. The  U.S. Customs and Border Protection data show that it found just 365 counterfeits out of  more than 30,000 drugs it inspected in 2022.

    So, is it safe to import drugs from verified pharmacies abroad? If you hear ads from the Partnership for Safe Medicines about the dangers of drug importation, ignore them. The Partnership for Safe Medicines is a pharmaceutical industry front group. The ads are paid for by Pharma, whose profits depend on keeping drug importation illegal.

    “We have never seen a rash of deaths or harm from prescription drugs that people bring across the border from verified pharmacies, because these are the same drugs that people buy in American pharmacies,” said Alex Lawson, executive director of Social Security Works. “The pharmaceutical industry is using the FDA to protect their price monopoly to keep their prices high.”

    Here’s more from Just Care:

  • Rural hospitals need government help to survive

    Rural hospitals need government help to survive

    No American should have to travel long distances to get to a hospital, especially in an emergency. But, as more hospitals are being swallowed up into hospital systems and profitability becomes a prime focus, rural hospitals are a dying breed. Now, David Muioio reports for FierceHealthcare that 14 Senators from rural states are asking the Centers for Medicare and Medicaid Services, CMS, the agency that oversees Medicare, to increase payments to rural hospitals.

    The money is there. All CMS really needs to do is move some of the billions in excess payments from Medicare Advantage plans into these rural hospitals. As it is, CMS is paying the Medicare Advantage plans to cover care in rural hospitals, and the Medicare Advantage plans too often are delaying and denying payments to these hospitals to maximize their own profits.

    There has been a policy in place since 2019 to help hospitals with low wages, which are generally rural hospitals. The policy has helped hundreds of hospitals in 23 states. The policy was intended to address disparities between hospitals providing care in low-wage areas and those providing care in high-wage areas. And, the policy helps ensure that rural residents have access to the care they need.

    The Senators say in their letter to CMS that this policy has been a “valuable lifeline” for low-wage hospitals. But, it is set to sunset this year at the end of September. The Senators are requesting a four-year extension.

    As it is, pandemic funds to rural hospitals are drying up. And, the data suggests that rural hospitals are at great risk of closing this year. If CMS continues the policy, low-wage hospitals will be able to bring on needed staff, ensuring that residents in their communities can continue to use their services.

    Which senators are asking for the money? Mark Warner, D-Virginia; Marsha Blackburn, R-Tennessee; Tim Kaine, D-Virginia; Tommy Tuberville, R-Alabama; Joe Manchin, D-West Virginia; John Boozman, R-Arkansas; Shelly Moore Capito, R-West Virginia; Bill Hagerty, R-Tennessee; James Lankford, R-Oklahoma; Roger Wicker, R-Mississippi; Cindy Hyde-Smith, R-Mississippi; Tim Scott, R-South Carolina; Tom Cotton, R-Arkansas; and Katie Boyd Britt, R-Alabama.

    Congress has already helped rural hospitals a bit through some higher Medicare payments last year. Rural hospitals can also get a five percent increase in reimbursement for outpatient services if, among other things, they continue their emergency rooms, through a Rural Emergency Hospital designation. But, it is not clear whether the bump is worth the conditions.

    Here’s more from Just Care:

  • Will Republicans and Democrats agree to cut waste in Medicare Advantage?

    Will Republicans and Democrats agree to cut waste in Medicare Advantage?

    Republicans and Democrats in Congress claim that they don’t want Medicare cuts.  As we learn more, we find that  “cuts” can mean different things to Republicans and Democrats. Cutting waste is one thing, cutting benefits is another.

    President Joe Biden does not want to cut benefits or increase costs for people with Medicare. But, his administration, through the Centers of Medicare and Medicaid Services, “CMS,” has proposed only a one percent rate increase to Medicare Advantage plans in 2024 as a means to reduce waste in Medicare Advantage. According to MedPAC, the agency charge with overseeing Medicare payments and quality, excess payments to Medicare Advantage total $27 billion this year alone.

    The one percent payment increase should have no effect on benefits  or out-of-pocket costs in Medicare Advantage. As it is, Medicare Advantage plans receive between six percent and 15 percent more in payments from the government per enrollee than traditional Medicare. And, they receive rebates from the federal government of $196 a month per enrollee on average.

    To level the playing field on per enrollee spending with Traditional Medicare, the federal government would need to reduce per enrollee payments to Medicare Advantage plans significantly more than the Centers for Medicare and Medicaid Services is proposing.

    Speaker Kevin McCarthy says that he wants to cut waste in federal programs “wherever it is.” The question is will he and his fellow Republicans agree to cut the tens of billions of dollars in annual waste in Medicare Advantage. Or, is that the kind of cut–one that saves taxpayer dollars and cuts into Medicare Advantage profits–that McCarthy and his fellow Republicans oppose?

    For every year that Republicans and Democrats don’t agree to cut waste in Medicare Advantage, Medicare Part B premiums rise and the Medicare Trust Fund is depleted, driving up costs in Medicare for older adults and taxpayers alike and weakening the Medicare program.

    Here’s more from Just Care:

  • Congress should eliminate the cap on Social Security contributions in 2023

    Congress should eliminate the cap on Social Security contributions in 2023

    In an opinion piece for Bloomberg News, Teresa Ghilarducci explains why Congress should eliminate the payroll contribution cap on Social Security. The current cap is $160,200, which means that at least 500 Americans make their full contribution to Social Security in the first few days of this year. Most Americans, however, contribute to Social Security throughout the year.

    If Congress lifted the cap on Social Security, not only would it be fairer, but it would strengthen the Social Security Trust Fund significantly. The people who make their full contribution to Social Security in the first days of January can well afford to continue to contribute. They represent only five percent of the population.

    How do Social Security contributions work? They are generally split between employers and workers. Each contributes 6.2 percent of their income up to $160,200 in 2023. But, that payroll contribution is not as large as it once was because the 12.4 percent of income contribution does not include non-taxed benefits like health insurance. And, over the last several decades these non-taxed benefits have risen faster than wages.

    At this moment, Social Security has enough money in its Trust Fund to pay full benefits until 2033. And, it has never not been able to pay full benefits. But, to keep Social Security paying full benefits, Congress must act.

    Congress could increase contributions from 12.4 percent to 15.87 percent, a contribution increase of about 1.75 percent for employers and employees, to keep Social Security able to pay benefits for the next 75 years. But, that would be a very heavy and unlikely political lift.

    It would be much easier for Congress to eliminate or raise the cap on Social Security contributions. According to the Congressional Research Service, if it eliminated the cap, the Social Security Trust Fund would be able to pay full benefits for 35 additional years.

    Requiring all Americans to pay into Social Security for the entire year would affect just five percent of the population and would add $150 billion to Social Security’s Trust Fund. Of note, Medicare does not have an income cap.

    Older Americans rely heavily on Social Security. More than six in ten depend on Social Security for at least half of their monthly income. One in three of them depend on Social Security for 90 percent of their income. Congress must help protect them and eliminate the cap on Social Security contributions.

    Here’s more from Just Care:

  • Five Medicare issues for Congress in 2023

    Five Medicare issues for Congress in 2023

    The new year is less than a month away and with it will come a Republican-led House of Representatives and a divided Congress. People hoping for improvements to Medicare should not be holding their breadth. Allison Bell reports for Think Advisor on Medicare issues policymakers might take up in the next Congress.

    It’s more than likely that the Republican-controlled House of Representatives will do its best to push reforms that cut Medicare spending. Of course, House Republicans will only succeed if they can find Democrats who buy into their agenda. But, that is very possible.

    Republicans in the Senate, for example, might find support from Senators Joe Manchin of West Virginia and Kyrsten Sinema of Arizona. Though they have been Democrats in name, they often do not support Democratic health care reform proposals. Indeed, Sinema has just announced that she is switching parts and will be an independent hereon in. Among the Medicare proposals with bi-partisan appeal are:

    1. Direct payments to physicians: It is currently illegal for physicians who are Medicare “participating providers” to charge patients privately out-of-pocket for their services on top of Medicare’s approved rate. “Non-participating providers” who see Medicare patients can charge no more than 15 percent above Medicare’s approved rate and the limit is less in some states. Only physicians who opt out of Medicare (who are few and far between) and have their patients sign waivers acknowledging that they must pay totally out of pocket for their services can charge patients what they please. For good reason. If it were legal for all physicians to charge Medicare patients whatever they pleased, people with Medicare would have no protection from large and unaffordable out-of-pocket costs. People in traditional Medicare would have to think twice before going to the doctor. As it is, people in Medicare Advantage often skip care because of out-of-pocket costs. People in traditional Medicare without supplemental coverage do as well. But, with supplemental coverage, they generally have no financial barriers to care.
    2. Health savings accounts: Some Republicans love the idea of giving people with Medicare cash to cover their medical costs, through health savings accounts. But, that is a recipe for discriminating against the sick, for whom the cash will never be enough to cover their care needs. It would likely keep people from getting needed care.
    3. Health care and prescription drug price transparency: It’s hard to find fault with this proposal. People should know what they are paying. But, the proposal sounds a lot better in theory than in practice. Prices fluctuate and depend on the services you receive, which you usually cannot predict in advance. Moreover, if you want to rely on referrals from your physicians, you have little choice as to who you see. For emergency care, transparency offers few if any benefits in keeping costs down.
    4. Physician assistants and nurse practitioners practicing without direct physician supervision: No question, there’s a shortage of primary care physicians. Many conservatives support expanding “scope of practice laws” to allow physician assistants and nurse practitioners to step in and care for patients without direct physician supervision. For a variety of basic needs, such as treating a cold or a wound, it makes sense. But, primary care physicians have far more training than these other providers and, at least in some cases, are better able to identify and address bigger issues. So, the devil is in the details.
    5. Expanding telehealth coverage: There’s some bi-partisan support for Medicare continuing its extended coverage of telehealth services. That could make a lot of sense, depending upon how the coverage is designed.

    All this said, Congress won’t be doing the Medicare work it should be doing. None of these proposals will bring down Medicare costs or address overpayments and barriers to care in Medicare Advantage.

    Here’s more from Just Care:

  • People with disabilities face undue delays getting Social Security benefits

    People with disabilities face undue delays getting Social Security benefits

    Lisa Rein reports for the Washington Post on the inability of Social Security offices to meet the needs of people who are applying for disability benefits. In some states, the backlog is staggering, preventing people from getting benefits to which they are entitled for a year or longer. Congress must step in and appropriate the funds needed to adequately staff Social Security offices.

    Today, more than a million Americans wait to learn whether they are eligible for disability benefits. People typically wait 214 days–more than seven months–for a determination of disability, up from 79 days three years ago. The delays mean vulnerable Americans are not receiving critical income, forcing them to forgo basic necessities.

    Social Security outsources many claims for disability benefits. State employees do the work, even though the benefits are federal. Pay is low and offices are seriously short-staffed.

    Decades ago, Congress gave states the authority to do the hiring of Social Security workers and make decisions about their terms of employment, including their pay. Pay varies wildly. And, many claims examiners lack needed training.

    Pay is more than twice as high in Washington DC than in Florida, $75,506 and $32,655 respectively. Puerto Rico staff are paid half as much as Florida staff, $16,128. And, states can implement hiring freezes!!!!

    When it comes to delays, some states are worse than others. In one Texas office, 130,000 disability benefit claims still need to be reviewed, and it is taking 214 days on average to review each one. Florida, Wisconsin, Georgia and Delaware have longer delays, 225, 227, 246 and 261 days respectively.

    Many people whose claims are reviewed are inappropriately denied benefits and must appeal those denials. The appeal process can take another year.

    What’s worse is that people under 65 are only eligible for Medicare if they qualify for Social Security Disability Benefits. So delays keep them from getting good health care coverage.

    Social Security is trying to fix the problem. But, Congress has too often not appropriated the money Social Security needs to operate effectively, even though these administrative funds, like Social Security benefits, all come from the Social Security Trust Fund. Social Security needs the money to hire more people, conduct appropriate staff training, upgrade its technology and better coordinate with the states. The Social Security acting commissioner explains that there is also a shortage of physicians available to make medical determinations and review cases.

    Here’s more from Just Care:
  • Congress should lift debt ceiling, protect against Republican threats to Social Security and Medicare

    Congress should lift debt ceiling, protect against Republican threats to Social Security and Medicare

    In an op-ed for The Hill, Nancy Altman, Chair of Social Security Works, speaks to the Democrats’ need to lift the debt ceiling during the lame duck session of Congress. If they don’t, the Republicans have made clear that they will refuse to raise the debt ceiling without cuts to Social Security and Medicare.

    The public supports strengthening and expanding Social Security and Medicare. Still, Republican policymakers have said and continue to say that they want to cut these programs. Medicare and Social Security demonstrate that government can be a force of good. Privatizing them, however, would be good only for Wall Street.

    It’s because the Republicans in Congress have claimed they want to cut Social Security that the so-called “red wave” turned into a “red mirage.”  For example, in Arizona, Mark Kelly prevailed against Blake Masters, who argued for turning  Social Security over to Wall Street during his campaign. Similarly, in New Hampshire, Maggie Hassan prevailed against Don Bolduc, whose campaign platform included cutting and privatizing both Social Security and Medicare.

    In Wisconsin, Ron Johnson nearly lost re-election. He had argued for cutting Social Security and Medicare in coded language. He said that he wanted to turn Social Security and Medicare into “earned benefits,” which is code for eliminating their guaranteed benefits.

    But, this all notwithstanding, the Republicans will hold a slim majority in the House in 2023. And, they plan to use that majority to prevent Congress from raising the debt ceiling, endangering the US and worldwide economy . . . unless Congress cuts Medicare and Social Security.

    Altman notes that Republicans have said explicitly and repeatedly that they plan to hold the economy hostage. The Republican candidates for the House Budget Committee all told Bloomberg of their intention to insist on cuts to Social Security and Medicare in exchange for their support for raising the debt ceiling.

    The incoming House Majority Leader, Kevin McCarthy has not explicitly said he wanted these cuts. But, he has made clear that he wants big policy changes–implying cuts to Social Security and Medicare–in exchange for Republican support for lifting the debt ceiling. Representative Buddy Carter of Georgia said that Republicans’ “main focus” was on “entitlements,” code for Medicare and Social Security.
    If you have doubts that Republicans would follow through on their threat, you need only look to 2011 and 2013 when they attempted to carry it out. Fortunately, they failed to cut Social Security and Medicare as a result of grassroots opposition. However, they did succeed at cutting some discretionary spending programs.
    The wisest course for Democrats would be to act now to raise the debt ceiling or end it altogether, before the Republicans take control of the House in the new year. That way, they could be sure to protect Social Security and Medicare.
    Here’s more from Just Care:
  • Senate Republicans introduce bill to undo Democrats’ prescription drug cost-cutting legislation

    Senate Republicans introduce bill to undo Democrats’ prescription drug cost-cutting legislation

    Congressional Democrats’ Inflation Reduction Act (IRA) will lower health care costs for people with Medicare, capping their out-of-pocket drug costs and allowing Medicare to negotiate prices for some of the highest cost brand-name drugs, among other things. Oliver Willis reports for the American Independent that Senate Republicans have introduced a bill to undo the drug price negotiation provision in the IRA, apparently valuing Pharma’s financial interests over the health and well-being of their constituents.

    Senator James Lankford, Oklahoma, Marco Rubio, Florida, Mike Lee, Utah, and Cynthia Lummis, Wyoming, want to stop Medicare from negotiating prescription drug prices. The Protecting Drug Innovation Act argues against “price controls.” Its sponsors seemingly fail to appreciate that the Inflation Reduction Act requires drug price negotiation; moreover, people with Medicare today currently are subject to price controls because pharmaceutical manufacturers effectively hold monopoly pricing power as a result of the patent protections the government gives them.

    The Republican Senators also curiously argue that their goal is to not shorten lives, even though drug price negotiation is designed to make drugs affordable in order to enrich and extend lives. Every other wealthy country negotiates drug prices on behalf of their residents, and all of them have populations with longer life expectancies than the US.

    The three Republican sponsors of the bill are all up for reelection next month. Given that voters have as a top policy priority reining in health care costs, these Senators’ opposition to lower drug costs should lose them votes. Four in five voters support Medicare drug price negotiation, and nearly seven in ten Republicans support it. By one estimate, drug price negotiation will save a couple with Medicare more than $2,400 a year.

    Republican policymakers also do not support strengthening and expanding Social Security benefits, another policy the vast majority of Americans support.

    Here’s more from Just Care:

  • California lawmakers ask Congress to expand Social Security

    California lawmakers ask Congress to expand Social Security

    CNBC reports that California lawmakers just approved a resolution asking Congress to expand Social Security. The California legislators support Congressman John Larson’s Social Security 2100: A Sacred Trust bill. If passed, the Social Security 2100 Act would require people with annual incomes over $400,000 to contribute more to Social Security.

    Congressman Larson’s bill, H.R. 5723, would strengthen Social Security, ensuring that it remains solvent until 2038, and that it provides better benefits, about a two percent increase in benefits on average. The minimum benefit would increase to 25 percent above the federal poverty level. The bill was last introduced in October 2021, with widespread Democratic Congressional support, including 202 co-sponsors.

    All but two California Democratic members of the House of Representatives are co-sponsors of Social Security 2100, Nancy Pelosi and Scott Peters.

    Until 2035, Social Security has enough money in its Trust Fund to pay full benefits. After that, it would only be able to pay 80 percent of benefits, unless Congress shores it up. Because Social Security is a national treasure, beloved by Democrats and Republicans alike, Congress has always ensured its solvency.

    But, Social Security payroll contributions are capped at $147,000 in annual income this year. They rise every year. Workers and their bosses each pay 6.7 percent of income towards Social Security up to the limit.

    The Social Security 2100 Act would require people with incomes over $400,000 to pay into Social Security on wages up to $147,000 and. again, on wages over $400,000. It’s an equitable way to strengthen Social Security. Today, billionaires and millionaires pay no more into Social Security than people earning $150,000 a year.

    Senators Bernie Sanders and Elizabeth Warren have their own bill in the Senate that would strengthen Social Security. It would extend the solvency of the Social Security Trust Fund 75 years. It would also increase benefits about $200 a month. This year, it would have required people with incomes of $250,000 and more to contribute into Social Security like everyone else, up to $147,000 in income and, again, on income of $250,000 and above.

    Here’s more from Just Care: