An open letter to Washington's Congressional delegation

Dear Representatives & Senators:

On October 3rd, 2019, President Trump issued an Executive Order (EO) entitled “Protecting and Improving Medicare for Our Nation’s Seniors.”

Rather than protecting and improving Medicare, the EO threatens to do incalculable harm to present and future Medicare beneficiaries. Congress should take steps to equalize the two Medicare programs to assure that there is an end to discrimination against the Medicare recipients who choose the traditional Medicare program.

According to the Center for Medicare Advocacy, the EO “exacerbates an existing imbalance between traditional Medicare and the Medicare Advantage(MA) program, and demonstrates the Administration’s ongoing efforts to maximize enrollment and the scope of coverage in MA plans.”  The Center for Medicare Services (CMS) has demonstrated a preference for MA plans. By authorizing private MA plans to provide services unavailable to the majority of Medicare beneficiaries who are part of traditional public Medicare, CMS is creating significant incentives for beneficiaries to select MA over the traditional public Medicare plan.

The October 3, 2019, EO mandates that CMS should further expand and enhance the services private MA plans may offer – benefits unavailable to approximately 70% of Medicare beneficiaries who are in public traditional Medicare. This EO is another significant step in efforts to privatize Medicare, turning it over to private insurance corporations. This goal is achieved by allowing the private plans to offer and advertise these additional benefits. 

At the present time, private MA plans provide benefits that traditional Medicare cannot provide such as hearing, dental, and vision benefits, gym membership and transportation to and from appointments. Medicare beneficiaries are inundated with advertisements promoting private, and in most cases, for-profit MA plans that feature these additional benefits. The existing bias in favor of private MA plans discriminates against the majority of Medicare beneficiaries who choose coverage through traditional Medicare.

The Affordable Care Act, in response to MA plans being more costly to the Medicare system as a result of higher reimbursement rates, attempted to rein in excessive payments to MA plans. Unfortunately, these efforts have not stopped MA plans from costing the Medicare system more than traditional Medicare spends per individual.

A 2018 article in the Journal of the American Medical Association (JJAMA) stated that some studies comparing MA plans to traditional Medicare “suggest that Medicare Advantage does not serve certain beneficiaries well, such as those with the greater illness severity.” The article concluded, “Despite the important and increasing role of Medicare Advantage plans, there is fairly little insight into the relative value Medicare Advantage provides to beneficiaries or the funder, the US taxpayer.”

We urge you to advance legislation requiring services and coverage be provided equally for all Medicare beneficiaries. Both payments and coverage need to be equalized. If that fails to happen, the Medicare traditional public plan is in jeopardy of dying on the vine, as the oldest, sickest and most expensive among us will end up constituting the majority of beneficiaries in the public program, which will financially sabotage the traditional plan. Medicare recipients will have no choice but to enter the private market and the goal of privatizing Medicare will have been achieved. 

Thank you for your consideration of this critical issue,

Robby Stern, Chair, Social Security Works Washington

P.S. A more detailed analysis of the Executive Order of Oct. 3 can be found at the Center for Budget and Policy Priorities website.

Senate Bill Would Cut Social Security Operations Again

[Center on Budget and Policy Priorities] This summer’s budget deal between President Trump and congressional leaders offers enough total discretionary dollars to give the Social Security Administration (SSA) a much-needed funding boost in 2020, but the Senate majority plans to cut $2.7 billion in inflation-adjusted dollars from the appropriations bill that funds SSA operations. That bill, in turn, would reduce SSA funding by more than 2 percent in inflation-adjusted terms. The companion House bill would slightly increase SSA funding, but by barely enough to offset inflation in 2020 — and not nearly enough to offset years of underfunding before then. For SSA to provide high-quality service to a growing population, policymakers must boost funding substantially.

SSA’s years of cuts have taken their toll. From 2010 to 2019, its operating budget fell nearly 11 percent in inflation-adjusted terms — even as the number of Social Security beneficiaries grew by 17 percent. (See chart.) As a result, SSA has lost 12 percent of its staff since 2010, hampering its ability to perform its essential services, such as determining eligibility in a timely manner for retirement, survivor, and disability benefits; paying benefits accurately and on time; responding to questions from the public; and updating benefits promptly when circumstances change.

Social Security Administration Faces Increased Workload with Fewer Resources

As workloads and costs have grown — and budgets and staffing have shrunk — SSA’s service delivery has worsened:

  • Most callers to SSA’s national 800 number don’t get their questions resolved; as callers are on hold for longer periods, nearly half hang up before connecting. And a growing number get busy signals.
  • Due to understaffing, field office wait times have risen in every region of the country since 2010, with millions of visitors waiting longer than an hour.
  • SSA has been forced to close 67 field offices and shorten office hours in the rest, making it harder for taxpayers and beneficiaries to access service.
  • The average wait for a disability appeal is 16 months, causing hardship for hundreds of thousands of workers already struggling with a life-changing disability.
  • SSA has stopped mailing Social Security statements to most workers as legally required, citing budget constraints.
  • Millions of beneficiaries await benefit adjustments due to the agency’s backlog on its behind-the-scenes work, such as awarding benefits to widows when spouses die, issuing back payments, resolving complex claims issues, and adjusting benefits for early retirees and disabled workers with earnings. Some 3.2 million of these actions are pending, causing unnecessary hardship — and often overpayments.

SSA’s extremely tight budgets have been driven by two factors: (1) the 2011 Budget Control Act’s tight annual caps on total discretionary funding, and (2) policymakers’ failure to give SSA its fair share of funding increases from past budget deals that raised those caps on a temporary basis. For example, the budget deal for 2018 provided a 9 percent increase in non-defense discretionary (NDD) funding from the previous year in inflation-adjusted terms, but SSA’s budget rose only 2 percent. NDD spending rose nearly 1 percent in inflation-adjusted terms in 2019, but policymakers cut SSA’s budget by almost 2 percent, which helped convince SSA Commissioner Andrew Saul to impose a partial hiring freeze.

Annual funding bills for the departments of Labor, Health and Human Services, and Education, which also include SSA’s administrative budget, have faced large cuts since 2010. The President and Congress should provide sufficient funding in the final 2020 appropriations bill to cover SSA’s essential services.

Don’t be fooled: increasing the retirement age is a benefit cut — unless you’re rich

[Washington Post] Poorer Americans are much less likely to survive into their 70s and 80s than rich Americans, a stark life-expectancy divide compounded by the nation’s growing disparities in wealth, according to a federal report.

Over three-quarters of the richest 50-somethings in 1991 were still alive in 2014, the report found. But among the poorest 20 percent of that cohort, the survival rate was less than 50 percent, according to the analysis by the Government Accountability Office, a nonpartisan congressional research agency.

The report finds that while average life expectancy increased over that period, it “has not increased uniformly across all income groups, and people who have lower incomes tend to have shorter lives than those with higher incomes.”

“Over time, the top fifth of the income distribution is really becoming a lot wealthier — and so much of the health and wealth gains in America are going toward the top,” said Harold Pollack, a health-care expert at the University of Chicago who was not involved in the creation of the report. “In these fundamental areas — life expectancy, health — there are these growing disparities that are really a failure of social policy.”

Full story: Washington Post »

Watch out, seniors: Trump just launched a stealth attack on Medicare

President Donald Trump signs an executive order about Medicare at the Sharon L. Morse Performing Arts Center, Thursday, Oct. 3, 2019, in The Villages, Fla. (AP Photo/Evan Vucci)

[] This article was produced by Economy for All, a project of the Independent Media Institute.

Watch out, older Americans and people with disabilities! President Trump just announced a plan to give corporate health insurers more control over your health care. His new executive order calls for “market-based” pricing, which would drive up costs for everyone with Medicare, eviscerate traditional Medicare, and steer more people into for-profit “Medicare Advantage” plans.

Seema Verma, the Trump appointee who heads the Centers for Medicare and Medicaid Services (CMS), may not have warned Trump about the slew of government audits revealing that many Medicare Advantage plans pose “an imminent and serious risk to the health of… enrollees.” They also overcharge taxpayers to the tune of $10 billion a year.

In the last few years alone, CMS’ limited audits have highlighted major issues with Medicare Advantage plans. Reports from the Department of Health and Human Services Office of the Inspector General (OIG) and Government Accountability Office (GAO) have underscored these issues. They have recommended that CMS increase its oversight of Medicare Advantage plans and its enforcement efforts.

A Medicare Payment Advisory Commission report indicates that the problems with Medicare Advantage may be even more far-reaching than the government audits indicate. The Medicare Advantage plans have failed to turn over reliable and complete claims data, as required by law. Without this data, it’s not possible to know whether they are covering the health care services they are paid to provide or to oversee them to the extent necessary.

Last month, Senators Sherrod Brown, Amy Klobuchar, Chris Murphy, Richard Blumenthal, Bernie Sanders and Debbie Stabenow laid out several serious malfeasances by these corporate Medicare insurers — including UnitedHealth Group, Aetna, Cigna and Humana — in a detailed letter they sent to Verma.

The insurers’ wrongdoings are systematic. They are ongoing. They endanger the health and financial well-being of millions of people. They undermine the financial integrity of the Medicare program and harm the U.S. Treasury. Yet, to date, CMS has failed to develop, let alone execute, a plan to hold these insurers accountable for violating their legal obligations and to ensure their members get the health care to which they are entitled.

Read More »

Everyone should care about this report on Social Security

Writing for the Washington Post, Henry Aaron highlights a report recently released by the Social Security Administration which contains a comprehensive menu of actions that Congress can take to shore up the program’s finances and change benefits:

If you think that the best way to fix Social Security’s long-run financial shortfall is to cut benefits, the agency’s report shows ways Congress could do that. If you think that the way to close the long-term funding gap is to raise taxes while maintaining benefits, you will find a couple of dozen ways to do that, too. If you think that Social Security should give benefit credits to those who stay home to care for children, the elderly or people with disabilities, or that the very old should receive additional benefits because they suffer from higher poverty rates than the not-so-old, this is the place to go for a menu of ways to do those things and make a lot of other changes that you might not have thought of.

You’ll learn what those measures cost or save. You’ll be able to read brief and understandable explanations of each of them. The options come with color charts that show graphically how each change would affect Social Security’s finances. And, if you can’t tell the program without the players, you’ll be able to see which member of Congress or organization proposed them.

This is must-read material for anyone paying attention to the Democratic candidate debates now — or later, to the debates between the Republican and Democratic nominees. Understanding what the candidates propose to do about the nation’s No. 1 domestic program could help you decide which candidate you support.

Full column: Washington Post »

Republican senators compete for leadership of “Department of Bad Ideas” with new plans to cut Social Security to finance paid parental leave

[CBPP] At some point in their lives, most workers in the United States will experience a major life event or emergency requiring them to take time off work, such as a serious illness, the birth of a child, or caregiving responsibilities for an aging parent.[1] A national, comprehensive paid family leave policy that is responsibly financed would provide much-needed economic support to workers during these times and ensure equitable access to paid leave for low-income people and people of color, who often do not have significant paid leave from their employers.

However, two recent paid leave proposals — the New Parents Act from Senators Marco Rubio and Mitt Romney[2] and the CRADLE Act from Senators Joni Ernst and Mike Lee — fall short of this standard in important ways:

  • Unlike the paid leave programs of several pioneering states (and the federal Family and Medical Leave Act, which provides for unpaid leave), both bills would provide paid leave only to parents caring for newborn or newly adopted children, leaving out workers who need to care for their own serious health issues or those of a family member.
  • Instead of pooling risks and resources across the entire workforce, as the rest of Social Security and the state paid family and medical leave programs do, these bills would ask individual parents to bear the cost of their parental leave benefits by cutting the Social Security retirement benefits they would receive decades later. This would weaken Social Security’s near-universal social insurance protection by treating the program’s guaranteed benefits like a private account from which individuals could draw. Essentially, both bills ask parents to choose between their current caregiving needs and their future retirement security.

Using Social Security partly as a piggy bank rather than an insurance policy is central to the design of these proposals. Carrie Lukas, president of the Independent Women’s Forum — which first developed this approach — has written that getting workers to see Social Security as assets “to be used now or at retirement” is a first step toward partially privatizing Social Security.[3]

Moreover, under the two bills, parents opting for parental leave would face permanent cuts to their Social Security retirement benefits that would ultimately exceed their parental leave benefits. The cuts would amount to their parental leave benefits plus interest, as well as an additional reduction to cover the cost of the parental benefits provided to other parents who die or become disabled before they reach retirement and can’t repay their own leave benefits. Leave-taking parents with moderate incomes, for example, would receive about $5,300 in benefits for each three months of parental leave, on average — and then lose about $15,100 in lifetime retirement benefits for each three months of leave, after adjusting for inflation, according to the Urban Institute.[4] All told, this amounts to losing about 3 to 4 percent of lifetime Social Security retirement benefits for each three months of leave, meaning that parents who take three periods of parental leave (after three births or adoptions) would lose roughly one-tenth of their lifetime Social Security retirement benefits.

Under both bills, parental leave benefits would essentially be treated like loans that accrue interest. For a typical worker who has her first child at age 26 and claims Social Security retirement benefits at about 65, interest would accrue for about 40 years.[5] Over such a long period, the amount of interest would ultimately exceed the amount of the benefit; in fact, the Urban Institute estimates that leave-takers would eventually pay back nearly four times as much as they received in leave benefits, on average.[6] These cuts would weaken retirement security and impose the greatest hardship on women and workers of color, as they already face less secure retirement than others.

At a time when many workers face shaky finances in retirement, policymakers shouldn’t weaken Social Security, which is most workers’ only source of guaranteed retirement income. Policymakers can provide paid leave without asking parents to sacrifice some of their retirement security. In fact, that’s what every existing state program does, by financing benefits with modest payroll tax contributions. It’s also what the overwhelming majority of workers prefer: when polled about the best funding mechanism for a national paid family and medical leave policy, just 3 percent of voters preferred drawing from the Social Security trust funds.[7]

Future proposals should not force workers to choose between the paid leave they need and their hard-earned retirement security, but should instead finance a national paid family and medical leave program through modest payroll tax contributions or other sources of revenue. A broad-based financing mechanism would recognize that paid leave programs are an asset not only to those taking leave, but also to society at large.

Full analysis continues at »

How do the leading plans to expand and improve Social Security stack up?

Comparing three different plans to expand benefits and improve the system’s finances.

Sen. Elizabeth Warren (D-Mass.), Rep. John Larson (D-Conn.), and Sen. Bernie Sanders (I-Vt.) have each introduced plans to expand Social Security benefits and improve the system’s finances.

The Los Angeles Times’ Michael Hiltzik takes a look the just-released plan from Sen. Elizabeth Warren (D-Mass.) and how it differs from two proposals introduced in Congress, the Social Security 2100 Act, introduced by Rep. John B. Larson (D-Conn.), and the Social Security Expansion Act, filed by Sen. Bernie Sanders (I-Vt.) — one of Warren’s rivals for the presidential nomination — and Rep. Peter A. DeFazio (D-Ore).

Hiltzik correctly notes that “all three proposals take aim at some of the same issues, such as the chronic shortchanging of women who spend their career years caring for dependents at home and the need to extract more tax support from the wealthiest Americans, but offer somewhat different solutions.”

Even with their differences, all three plans are “a solid rebuff to Republicans and conservatives whose hand-wringing about Social Security leads to proposals to cut benefits. Warren’s entry into the lists as a presidential candidate ensures that the debate will take place in the public sphere — not, as Sen. Joni Ernst (R-Iowa) advocated recently, ‘behind closed doors.'”

Full story: Los Angeles Times