Seniors – R&R – Reachout and Rebuild

Frustrations Boil at Pace of Vaccinations at Long-Term Care Facilities

David Posnett — Sun, 17 Jan 2021 20:24:55 +0000

Our local ‘Retirement’ facility

The Trump administration raised hopes of a speedy process for nursing homes and assisted living facilities. Patience is wearing thin.

By Rebecca Robbins

In mid-December, a top Trump administration official floated an enticing possibility: All nursing home residents in the United States could be vaccinated against the coronavirus by Christmas. “It’s really a remarkable, remarkable prospect,” Alex M. Azar II, the secretary of health and human services, declared.

It turned out to be a fantasy.

A month later, vaccinations of some of the country’s most vulnerable citizens are going more slowly than many state officials, industry executives and families expected. Their hopes had been buoyed when government officials said long-term care facilities would be at the front of the line for vaccines.

CVS and Walgreens, which are largely responsible for vaccinating residents and workers in long-term care facilities, are on track to make at least initial vaccination visits to nearly all nursing homes they are working with by Jan. 25. The two pharmacy chains have already given out more than 1.7 million vaccine doses at long-term care facilities.

But the progress is uneven across the country and not nearly as comprehensive for different types of long-term care. For example, thousands of assisted living facilities — for older people who need less care than those in nursing homes — do not yet even have an appointment for their first visit from the pharmacy teams, in large part because states have given such facilities lower priority in their vaccine-distribution plans.

“I’ve had facilities call me, and I’ve had people cry, I’ve had people curse, because this was the first sign of hope that they’ve had in many, many months,” said Betsy Johnson, who leads a group that represents Kentucky’s nursing homes and assisted living facilities.

“It’s just human nature to think, ‘OK, but I was supposed to be first — and I don’t even know when my clinic is going to happen,’” Ms. Johnson said.

In Pennsylvania, teams from CVS or Walgreens are not scheduled to visit some nursing homes until February, and the vast majority of the state’s assisted living facilities have not yet been scheduled for a first visit, said Zach Shamberg, president of the Pennsylvania Health Care Association.

“There’s a great deal of frustration, there’s a great deal of apprehension, as to when or if this vaccine will come,” Mr. Shamberg said.

The pace of the vaccination program has taken on greater urgency as the rapidly spreading virus continues to decimate nursing homes and similar facilities. The virus’s surge since November has killed about 30,000 long-term care staff and residents, raising the total of virus-related deaths in these facilities to at least 136,000, according to a New York Times tracker. Since the pandemic began, long-term care facilities have accounted for just 5 percent of coronavirus cases but 36 percent of virus-related deaths.

Even as the vaccination campaign accelerates, the suffering is unlikely to wane. The coming months could be “the deadliest of the pandemic” for people living and working in long-term care, according to an analysis released on Thursday by the Kaiser Family Foundation.

The Trump administration announced in October that it had teamed up with CVS and Walgreens to lead a federal effort to vaccinate residents and workers at long-term care facilities, among the first eligible groups.

On Friday, CVS said it had given out just over one million doses in more than 12,000 initial visits to long-term care facilities. Nearly 8,000 visits are scheduled for the coming week. Walgreens said it had given out nearly 750,000 doses in nearly 9,000 visits to facilities, mostly nursing homes. The number of visits that Walgreens has scheduled with assisted living facilities “continues to accelerate,” a company spokeswoman, Rebekah Pajak, said.

The vaccinations by CVS and Walgreens were always expected to take several months because of the need to visit tens of thousands of facilities three times. The first two visits are for most residents and staff to get the two doses of the vaccine, with the third visit as a backup for people who missed the first clinic.

The idea that all nursing home residents could get their first doses by Christmas was not a realistic prospect even when Mr. Azar, the health secretary, floated it 12 days before the holiday. By that point, some states had told the Centers for Disease Control and Prevention that they would not activate the federal program to vaccinate their nursing homes until Dec. 28. The logistics would have been challenging even if states had put a priority on getting their first doses to nursing homes.

Michael Pratt, a spokesman for the Health and Human Services Department, said Mr. Azar had been speaking only aspirationally about what states were capable of doing, since they had enough vaccine doses to cover all nursing home residents by Christmas. But that would have required that states place less of a priority on vaccinating high-risk groups like heath care workers.

T.J. Crawford, a spokesman for CVS, said the chain was making first visits to all facilities within four weeks of each state’s activating its vaccination program for nursing homes or assisted living facilities.

“This isn’t a drive-through or stadium vaccination effort,” Mr. Crawford said. “We’re visiting more than 40,000 facilities with an average of less than 100 residents, in some cases going room to room.” He said CVS was “on track and delivering on goals established and communicated early in the process.”

But a growing number of governors and state health officials have voiced frustration with CVS’s and Walgreens’ speed.

In Mississippi, some long-term facilities won’t get their first visit until Feb. 11, the state health officer, Dr. Thomas Dobbs, said this month. “We’re clearly disappointed with the progress in the long-term care program,” he said.

Some states and cities are exploring ways to hasten the inoculations.

Seattle is using its Fire Department to vaccinate nearly 1,000 residents and staff at adult family homes, a type of long-term care, by the end of January. Florida hired an emergency services company, CDR Maguire, to give out doses at 1,900 assisted living facilities that had not been scheduled for visits by CVS and Walgreens teams before Jan. 24.

In Michigan, officials have asked the federal government to let them work with other pharmacies, such as the supermarket chains Meijer and Kroger, to speed up the vaccination effort in long-term care facilities, said Bobby Leddy, a spokesman for Gov. Gretchen Whitmer.

West Virginia is the only state that has not activated the federal program involving CVS and Walgreens, though Walgreens is separately working with West Virginia to vaccinate 32 of its long-term care facilities. Relying mostly on local independent pharmacies, the state said on Dec. 30 that it had wrapped up the first round at its 214 long-term care facilities.

Some of the initially feared problems that could slow down the vaccine rollout in nursing homes have not emerged as serious obstacles, at least so far, according to facility operators and industry researchers.

Despite widespread worries that the vaccines’ side effects — which can include fevers, chills and fatigue — would cause staff to miss work and residents to need more care, that has not happened to any significant degree. And while there was early confusion about how nursing homes should get consent from residents or their families, that process has largely gone smoothly.

But other things are slowing the campaign. A significant number of long-term care workers have balked at receiving the vaccine. The virus’s spread is also delaying the process. People should not be vaccinated while they still have Covid-19 symptoms or are isolating, according to the C.D.C.

Outbreaks and cases of Covid-19 in some long-term care communities have led Walgreens to delay scheduling initial visits or to reschedule them, said Rick Gates, an executive leading the company’s long-term care vaccinations.

CVS has encountered the same issue, though it has not been widespread. The company has left the decision about whether to proceed with visits in such cases to local clinic team leaders and officials at the facilities, Mr. Crawford said.

Another factor is that some states did not quickly activate their programs to vaccinate people at assisted living facilities and similar communities. In some cases, they waited until weeks after they began vaccinations at nursing homes.

But many long-term care facilities include both nursing homes and assisted living. In those cases, pharmacy teams have been able to vaccinate only a subset of residents.

In Prairie du Chien, Wis., for example, a team from Walgreens on Thursday made its first visit to the local nursing home, Prairie Maison, to inject nearly all of its roughly 50 residents with the Moderna vaccine.

But Prairie Maison is part of a larger senior community, which includes about 50 assisted living residents. Because Wisconsin did not activate its vaccination program for assisted living until Friday, those residents weren’t offered the vaccine — even though they are in the same building as the nursing home residents.

“Vaccinating one group and not the other doesn’t make a lot of sense,” said Dr. Mark Grunwald, the chairman of Prairie Maison’s board.

From Kristin Stephens

Assistant Vice President, Media Relations and Public Affairs, GREATER NEW YORK HOSPITAL ASSOCIATION

See prior blog posts relevant to Peconic Landing:

Zeldin is Lying about your Healthcare

David Posnett — Sat, 20 Oct 2018 05:33:34 +0000

In his robocalls Zeldin uses a local physician to assure patients and constituents that he and the Republicans are not about to

deny insurance for pre-existing conditions
will not touch medicare
will not abolish social security

The physician, Dr. Vacirca, identifies himself and his practice twice in the robocall. He said Zeldin supports care for patients with pre-existing conditions and supports Social Security and Medicare, while [the democratic oponent] Gershon supports “socialist-style, government control” health care that will drive up taxes and bankrupt Medicare.

Jessica Waterbury, a patient of Dr. Vacirca, said she found Vacirca’s relationship with the Zeldin campaign “troubling.”

“Now that this information has come to light, I am more than dismayed, and do not want the money that paid for my treatment going to someone who is willing to take away protections for pre-existing conditions (like my cancer), and who voted against the individual market for health insurance,” Waterbury said.

Mitch McConnell disaggrees with Zeldin:

Republicans Will Take on Obamacare and Entitlements if They Win in Midterms, Mitch McConnell Says. By Nicole Goodkind On 10/17/18 at 5:31 PM

“…after indicating that he would like to cut spending on Social Security, Medicare and Medicaid, Senate Majority Leader Mitch McConnell told Reuters that if Republicans win the Senate this November, they will once again take up their fight to repeal the Affordable Care Act, also known as Obamacare.

McConnell … clarified his desires to cut spending on Medicare, Medicaid and Social Security programs,”

Nothing surprising about these devious maneuvers. The Republican mojo has been clear for a while:

1st hand out a huge tax cut for the super rich that fund the Rep. party.

2nd complain about the deficit they created and blame it on Medicare, Medicaid, Obamacare and Social Security

3rd repeal Obamacare and cut all the social programs drastically

Promises Broken

David Posnett — Mon, 14 May 2018 19:11:46 +0000

Trump campaign promises (which some liberals supported) remain largely ignored. He ran as an economic populist and bucked the GOP’s economic brand, contributing to his appeal. But he has violated every one of his promises.

Donald Trump promised to negotiate the price of prescription drugs covered through Medicare. “we’d save $300 billion a year,” “We don’t do it. Why? Because of the drug companies.” “We’re going to negotiate like crazy.” On May 11th, Trump announced the federal government would NOT directly negotiate lower drug prices for Medicare. And he chose not to allow American consumers to import low-cost medicines from abroad.
there will be no infrastructure bill this year. Contrast that with promises of hard-hat jobs modernizing roads and airports across the country. Instead we got a regressive tax cut, with a huge increase in the deficit.
Trump promised over and over to pull out of Nafta and renegotiate a much better deal. Nafta was the ultimate culprit for declining blue-collar wages. He promised a better deal: “I don’t mean just a little bit better, I mean a lot better.” But, there is no easy “better” trade deal to be negotiated.
Trump also repeatedly promised universal health care. “Everybody’s gotta be covered. … I am going to take care of everybody, I don’t care if it costs me votes or not” But he never compromised with Democrats and sabotaged the existing program. And now the rate of uninsured is climbing again.
“Draining the swamp” … Trump promised to enact reforms to reduce the power of lobbyists and business. He specifically
promised:

A constitutional amendment imposing term limits on members of Congress
A ban on federal employees lobbying the government for five years
A ban on members of Congress lobbying for five years
Tighter rules about what constitutes a lobbyist, instead of letting people call themselves consultants
Campaign finance reform limiting what foreign companies can raise for American political candidates
A ban on senior government officials lobbying for foreign governments

All empty promises!

In stead Trump embraced Washington sleaze with unprecedented gusto. This includes lobbying for foreign governments: Michael Cohen was a conduit for business interests to buy their way into Trump’s good graces.

Trump also promised, to raise taxes on the rich, including on himself.
“It’s going to cost me a fortune, which is actually true,” he said. Instead, the only promises he has kept are the ones that put money in the pockets of Trump and his cronies.

Broken Promises should represent a guide for the 2018 campaigns across the country to turn Congress blue. Sitting Rep. congress members that have backed Trump, like Lee Zeldin, are all complicit in these lies to their constituents.

Why are Drug Prices Going Through the Roof?

David Posnett — Fri, 01 Dec 2017 01:51:41 +0000

By Francesca Rheannon, Journalist

Writer’s Voice with Francesca Rheannon, Producer and Host

Twitter Accounts: @WritersVoice

On Facebook & LinkedIn

http://www.writersvoice.net/2017/11/wendell-potter-gerald-friedman/

Why are drug prices going through the roof? We talk with Wendell Potter about Big Pharma and what his new investigative journalism site, Tarbell, is finding out about it.

Critics say single payer health insurance would be too expensive. We talk with economist Gerald Friedman, who developed Bernie Sanders’ Medicare for All plan. He answers his critics point by point.

Wendell Potter

Are Americans getting swindled at the pharmacy? We pay an average of 300% more for medications than people in other major countries. And the costs just keep going up.

And of course, it’s not just drugs. We pay far more for all aspects of health care — insurance, doctors and hospital fees, tests and drugs — than other nations. But we aren’t getting our money’s worth.

Wendell Potter is a former health insurance industry executive turned whistleblower. We spoke with him several years ago about his book DEADLY SPIN, about how the health insurance industry skews the playing field in its favor, making sure to kill efforts at reform while getting laws passed that fatten its bottom line. His book NATION ON THE TAKE showed how corporate America in general does the same thing.

Now Potter has started a nonprofit investigative journalism site, Tarbell, to expose the inner workings of the healthcare industry. Tarbell went online in November with a series of investigative articles by different journalists about the influence of Big Pharma over our political process. We called up Wendell Potter to learn about the results of those investigations and to find out more about Tarbell itself.

How Big Pharma Keeps Drug Prices High

Gerald Friedman

During the presidential primary season last spring, we spoke with University of Massachusetts economist Gerald Friedman about Bernie Sanders’ Medicare for All plan. Friedman was the architect of that plan.

At the time, some mainstream economists published an op-ed in the New York Times saying the plan was too expensive. Then the Urban Institute came out with a study claiming that the Sanders’ plan would cost an extra $32 trillion. And candidate Hillary Clinton declared that single payer health care would “never, ever happen.”

Since then, Sanders has come out with a Medicare for All Senate bill that has actually garnered the support of sixteen Democratic senators, including some potential presidential hopefuls. Among them are Elizabeth Warren and Cory Booker.

With the GOP continuing its assault on health insurance coverage — the latest being the so-called Tax Reform bill that would collapse Obamacare and take billions out of Medicare — a push for single payer by an outraged electorate might actually gain steam.

So, would single payer really break the bank? We called up Gerald Friedman to ask him to address criticisms of his plan so we could make up our own minds. To listen to the interview on a podcast click on this link http://www.writersvoice.net/2017/11/wendell-potter-gerald-friedman/ and then click on the player to hear both interviews.

A Catholic Nun Schooled Paul Ryan in Humility Last Night

David Posnett — Wed, 23 Aug 2017 19:53:04 +0000

From Esquire.com

It was a Biblical beatdown.

Getty

While the president* was fastening on his Serious World Leader face Monday night, Speaker Paul Ryan, the zombie-eyed granny-starver from the state of Wisconsin, was facing a carefully tailored audience at a CNN “town hall” in Racine. Because Ryan is the biggest fake to hit Congress since the King of the Cranks, Ignatius Donnelly, there was the usual nonsense and prevarication. (Chait puts paid here to Ryan’s outright mendacity concerning healthcare. Alas, Jake Tapper, who otherwise did a good job, whiffed on this one.) But my favorite moment came when Ryan was confronted by a Dominican nun who challenged him to square his zombie-eyed granny-starving with his Catholicism. What followed was pure Ryan, which is to say dishonest, cowardly, patronizing, and totally unmoored from either self-awareness or actual reality. Gaze in awe.

(This, by the way, is the second time this year that CNN has handed Ryan this kind of platform. I do not know why that is.)

QUESTION: Good evening, Mr. Speaker. I know that you’re Catholic, as am I, and it seems to me that most of the Republicans in the Congress are not willing to stand with the poor and working class as evidenced in the recent debates about health care and the anticipated tax reform. So I’d like to ask you how you see yourself upholding the church’s social teaching that has the idea that God is always on the side of the poor and dispossessed, as should we be.

RYAN: Spoken like a great Dominican nun. Look…

Patronizing? Check.

Sister, you may — this may come as a surprise to you, but I completely agree with you. Where we may disagree is on how to achieve that goal. As you know, we all exercise prudential judgment in practicing our faith. And for me, the preferential option for the poor, which is something that’s a key tenet of Catholic faith, that means upward mobility, that means economic growth, that means equality of opportunity. That to me means working with this guy over here at Gateway Tech to make sure that we can close the skills gap, to make sure that every person who wants a career and job can get the benefits.

The budget produced by the House Of Representatives—Paul Ryan, Speaker—would cut education and job training programs by 25 percent.

We actually just passed this bill in July. Before that, we passed another skills bill. That means to me taking this 20th century poverty program that we have, which is — we’re in the 32nd year of the war on poverty. Trillions spent, and guess what? Our poverty rates are about the same as they were when we started this war on poverty 32 years ago.

No outside events have occurred since 1985 that might account for this. Also, Lyndon Johnson declared a war on poverty in his State of the Union address in 1964, which is 53 years ago. Again, nothing has happened in the intervening years that might account for the difficulty in waging this war.

So the status quo isn’t working, Sister. And what I think we need to do is change our approach on fighting poverty instead of measuring success based on how much money we spend or how many programs we create or how many people are on those programs, you know, measuring on inputs. Let’s measure success in poverty on outcomes. Is it working? Are people getting out of poverty?

CNN

Well, since, for example, the House budget cuts food stamps by almost $200 million from the food stamp program, one way people might get out of poverty is by starving to death. You will note, by the way, that we are now a loooooonnnng way from the 25^th chapter of Matthew.

And what I believe, when you look at it that way — actually, I have a commission that Patty Murray and I set up that’s underway right now to focus on these measurements. We need to make sure that we bring people into the workforce. The poverty — the poor are being marginalized and misaligned in many ways because a lot of the programs that we have, well intended as they may be, are discouraging and dis-incentivizing work.

OK, so here is what I don’t get. First of all, a great many poor people work their asses off, and in the private sector, too, and they’re being patronized by a guy who hasn’t spent 15 seconds in the private sector since he went away to college. His family got rich building roads on government contracts. His father died, and he went through high school on Social Security’s survivor benefits, a program that the budget proposed by the president* would eviscerate. Since then, he’s been a congressional aide and a congressman. My question is that, when he was going through high school on my nickel, and the nickels of millions of other Americans, including the poorer ones, why wasn’t he “disincentivized”? How did he avoid the terrible trap of the government “hammock”?

We were just — no, it’s true. We were just talking about it. We were just talking about tax reform. And I was telling you about these successful small businesses in Wisconsin, they got a 44.6 percent tax rate. That’s not the highest tax rate payer. I mean, Aaron Rodgers, who deserves every salary, is not the highest tax rate payer in this state. You know who it is? It’s a single mom getting $24,000 grand in benefits with two kids who will lose 80 cents on the dollar if she goes and takes a job.

Surely you recall that passage from the gospels where Jesus talks about lowering the top rate and doing away with estate taxes. (It was in the small print, and in Aramaic, at the bottom of the scroll.) And, anyway, the budget proposed by the House of Representatives—Paul Ryan, Speaker—would cut programs that would benefit that “single mom” by over $3 trillion.

We have to fix that. And that is why we have to fix it not by just kicking people off callously…

I’m sorry, but I have to stop here. This guy is still fighting for a policy that the Congressional Budget Office says would kick 30 million Americans off their health insurance. Maybe Ryan plans not to do this “callously.” Maybe he’s going to hand out balloons and lollipops. And, anyway, wasn’t this supposed to be about the gap between his policies and the teachings of his faith? I wish that nun had a ruler.

New Senate health bill shows no love for New York

David Posnett — Mon, 17 Jul 2017 12:13:58 +0000

http://buffalonews.com/2017/07/15/new-senate-health-bill-shows-no-love-new-york/

By Jerry Zremski | Published July 15, 2017 | Updated July 15, 2017

WASHINGTON – To hear New York health care experts tell it, the Republican senators’ new plan to replace Obamacare is the legislative equivalent of a grave pre-existing medical condition, made worse through a haphazard quack treatment.

They say the bill is largely a status quo measure that preserves the quadruple whammy that could cost the state billion dollars more per year than a House-passed measure that leaves the state $7 billion short annually. But they also say the new Senate bill is worse in one way in that it threatens to eat away at a key consumer protection provided under state law.

Higher-income New Yorkers would be losers, too, under the measure, as the bill restores some of the taxes that would have been eliminated under the earlier version of the bill. That tax money would go instead to expanded health care subsidies for lower- and middle-income people who buy health insurance on their own.

One unlikely New Yorker emerges as a winner in the new legislation: Rep. Brian Higgins, a Buffalo Democrat who waged a lonely battle against tax breaks for insurance executives – and saw Senate Republicans drop those tax breaks in the revised bill.

Overall, though, the new bill is much more similar to the Senate’s previous version than it is to the law it aims to replace: the 2010 Affordable Care Act, commonly known as Obamacare.

“So far, I’m not seeing much that changes for New York,” said Bill Hammond, health-care analyst at the conservative-leaning Empire Center, an Albany think tank.

Just like its predecessor, the new Senate bill whacks New York’s Medicaid program – which serves everyone from poor children to seniors in nursing homes who spent all their assets on health care – in four ways. It would:

Reduce federal Medicaid payments to states over time by changing the way they are tied to inflation.
Trim payments to states with expensive Medicaid programs by including an “equity adjustment.”
Curb federal funding for states such as New York that expanded Medicaid under Obamacare in a way that will cost New York more than $7 billion more annually starting in 2024.
Keep in place the House’s controversial Collins-Faso amendment that ends New York’s practice of charging counties for part of the cost of Medicaid, pushing at least another $2.3 billion in costs annually onto the state.

Not surprisingly, Gov. Andrew M. Cuomo appeared unimpressed with the new Senate legislation.

“The token changes to the Senate health care bill are a thinly veiled attempt to disguise the same cruel bill,” he said. “Far from improving our health care system, the Senate Republican health care bill is still a death trap for New York.”

Cuomo once again made his case against the Collins-Faso amendment, saying it could lead to cuts that would cripple hospitals, nursing homes and home care providers.

But Rep. Chris Collins, the Clarence Republican who sponsored the amendment with Rep. John Faso, R-Kinderhook, has said Cuomo is more likely to try to raise state taxes instead of finding savings in the state’s huge and costly Medicaid program.

“Through the Collins-Faso amendment, we’re on the verge of delivering the largest property tax reduction ever,” Collins said on Facebook. “Instead of making tough decisions, Governor Cuomo has threatened to push for new taxes on New York families.”

Beyond its impact on Medicaid, Hammond said the Senate bill – like the earlier version and the health bill passed by the House – threatens to eviscerate the state’s Essential Plan, which is aimed at state residents who earn just a bit too much to qualify for Medicaid, the state-federal health program for the poor and lower middle class.

And like its predecessor, the new Senate bill conflicts with existing state law in several ways. It bars people from using federal subsidies to buy insurance plans that cover abortion – yet New York law requires health plans to cover abortion. And the new Senate bill allows insurers to charge older people more for insurance, while New York law does not.

The new Senate measure also adds one new conflict with state law that could totally alter the market for individuals who have to buy insurance on their own – or that could amount to nothing.

The bill includes a provision offered by Sen. Ted Cruz, R-Texas, that allows the sale of bare-bones insurance policies with low premiums and gigantic deductibles, all in an effort to make health coverage more affordable for people who probably wouldn’t buy insurance otherwise.

“I am encouraged that the revised bill ensures consumers have the freedom to choose among more affordable plans that are tailored to their individual healthcare needs,” Cruz said.

New York health experts such as Bea Grause are by no means so encouraged. The president of the Healthcare Association of New York State, Grause said the offering of the Cruz-backed cheap insurance plans would start “a race to the bottom for coverage and consumer protection.”

Higgins agreed, saying that those inexpensive plans are “junk health care” that could upend the insurance market. If healthy people flocked to those plans instead of buying more comprehensive insurance, anyone buying more traditional insurance plans would inevitably have to pay more, given that fewer healthy people would be subsidizing the cost of those better plans.

It’s unclear, though, whether such bare-bones insurance plans would be available in New York, given that current state law bans them from sale in the state. Federal law typically supersedes state law, though, which is why Grause and others fear that court action could open New York’s market to those new health plans.

“I think New York, like a few other states, has a robust regulatory infrastructure,” Grause said. “It would be a question of how or whether the Cruz amendment would apply.”

Despite Higgins’ concerns about the Cruz amendment, the new Senate health bill includes one change that the Buffalo congressman was happy to see. The bill no longer includes a provision that would have given health insurance executives tax breaks valued at as much as $500 million in total.

Higgins was one of the strongest voices in opposition to those tax breaks, railing against it in a committee hearing and on the House floor, calling it a giveaway to corporate executives who don’t deserve it.

He said Senate Republicans stripped that provision from the bill knowing that UnitedHealth, one of the nation’s largest insurers, is facing a Justice Department lawsuit accusing the company of Medicare fraud – and knowing that other insurers could end up in the same trouble.

“They’re saving themselves from further embarrassment,” Higgins said.

Then again, Republican senators were also looking for savings in the bill that allowed them to slightly expand the health insurance tax credits the bill will offer to help the lower middle class to buy insurance.

The new version also preserves taxes on high net worth individuals that were instituted under Obamacare but that were set for repeal under the original Senate health bill. But other Obamacare taxes on medical device companies and health insurers would be repealed, just as they would have been under the Senate bill’s first iteration.

Those changes were by no means enough to satisfy Senate Minority Leader Charles E. Schumer, D-N.Y. He urged Republicans to abandon their current health care effort and instead work with Democrats to improve the current health care system.

“Any Republican who votes to proceed on this bill next week will have to look constituents square in the eye and explain why,” Schumer said. “Why did they move forward on such severe cuts to Medicaid? Why did they cut taxes for special interests? Why did you send my out of pocket costs skyrocketing?”

Meantime, though, Senate Majority Leader Mitch McConnell argued that Democrats were making the-sky-is-falling arguments that have no connection with reality.

“I’m sure we can expect many of the same tired and predictable attacks from the defenders of Obamacare’s failed status quo,” McConnell said. “It hardly matters what the draft says, they would launch the same kinds of attacks anyway.”

McConnell also noted that Democrats wrongly said Obamacare would lower costs and expand health care options while allowing everyone to keep their longtime policy if they chose to do so.

“They were wrong before,” he said. “They’re wrong again today.”

Related stories from the Buffalo News:

What’s at risk if Medicaid is scaled back under health bill? By Henry L. Davis | Published July 2, 2017 | Updated July 3, 2017

Senate bill a quadruple whammy to New York Medicaid program. By Jerry Zremski | Published June 24, 2017 | Updated June 26, 2017

See also the following related recent posts on R&R:

Rural hospital association representative: ‘This bill will close hospitals. … People will die’

Health of Suffolk County Hospitals?

Millions More Uninsured Could Impact Health Of Those With Insurance, Too

Senate’s health care bill will cost New York’s Medicaid program billions

Medicaid Cuts Will Drive Up Cost Of Private Coverage, Montana Insurers Say

Report: BCRA would mean more than 900K healthcare jobs lost

Zeldin’s Approval of Senate Healthcare Bill Reveals His Lack of Concern for Veterans

CONGRESS: KEEP AMERICANS COVERED

You’re Probably Going to Need Medicaid

David Posnett — Tue, 13 Jun 2017 14:49:53 +0000

I could not say it any better… Mr.Zeldin’s vote will directly affect you and your family and you wont like it!

By DAVID GRABOWSKI, JONATHAN GRUBER and VINCENT MORJUNE 13, 2017

in the NYTimes Opinion Section

Photo Niko J. Kallianiotis for The New York Times

Imagine your mother needs to move into a nursing home. It’s going to cost her almost $100,000 a year. Very few people have private insurance to cover this. Your mother will most likely run out her savings until she qualifies for Medicaid.This is not a rare event. Roughly one in three people now turning 65 will require nursing home care at some point during his or her life. Over three-quarters of long-stay nursing home residents will eventually be covered by Medicaid. Many American voters think Medicaid is only for low-income adults and their children — for people who aren’t “like them.” But Medicaid is not “somebody else’s” insurance. It is insurance for all of our mothers and fathers and, eventually, for ourselves.The American Health Care Act that passed the House and is now being debated by the Senate would reduce spending on Medicaid by over $800 billion, the largest single reduction in a social insurance program in our nation’s history. The budget released by President Trump last month would up the ante by slashing another $600 billion over 10 years from the program. Whether the Senate adopts cuts of quite this magnitude or not, any legislation that passes the Republican Congress is likely to include the largest cuts to the Medicaid program since its inception.Much focus has rightly been placed on the enormous damage this would do to lower-income families and youth. But what has been largely missing from public discussion is the radical implications that such cuts would have for older and disabled Americans.

Medicaid is our nation’s largest safety net for low-income people, accounting for one-sixth of all health care spending in the United States. But few people seem to know that nearly two-thirds of that spending is focused on older and disabled adults — primarily through spending on long-term care services such as nursing homes.

Indeed, Medicaid pays nearly half of nursing home costs for those who need assistance because of medical conditions like Alzheimer’s or stroke. In some states, overall spending on older and disabled adults amounts to as much as three-quarters of Medicaid spending. As a result, there is no way that the program can shrink by 25 percent (as under the A.H.C.A.) or almost 50 percent (as under the Trump budget), without hurting these people.

A large body of research, some of it by us, has shown that cuts to nursing home reimbursement can have devastating effects on vulnerable patients. Many nursing homes would stop admitting Medicaid recipients and those who don’t have enough assets to ensure that they won’t eventually end up on Medicaid. Older and disabled Medicaid beneficiaries can’t pay out of pocket for services and they do not typically have family members able to care for them. The nursing home is a last resort. Where will they go instead?

Those who are admitted to a nursing home may not fare much better. Lowering Medicaid reimbursement rates lead to reductions in staffing, particularly of nurses. Research by one of us shows that a cut in the reimbursement rate of around 10 percent leads to a functional decline of nursing home residents (that is, a decline in their ability to walk or use the bathroom by themselves) of almost 10 percent. It also raises the odds that they will be in persistent pain by 5 % and the odds of getting a bedsore by 2 %.

Finally, these cuts would just shift costs to the rest of the government. Lower-quality nursing home care leads to more hospitalizations, and for Americans over 65, these are paid for by another government program, Medicare. One-quarter of nursing home residents are hospitalized each year, and the daily cost of caring for them more than quadruples when they move to the hospital. Research shows that a reduction in nursing home reimbursements of around 10 percent leads to a 5 percent rise in the odds that residents will be hospitalized. So care for seniors suffers, and the taxpayer pays.

Mr. Trump and the Republicans would lower spending on the frailest and most vulnerable people in our health care system. They would like most Americans to believe that these cuts will not affect them, only their “undeserving” neighbors. But that hides the truth that draconian cuts to Medicaid affect all of our families. They are a direct attack on our elderly, our disabled and our dignity.

Medicaid Caps Pitched By GOP Could Shrink Seniors’ Benefits

David Posnett — Tue, 21 Mar 2017 15:50:22 +0000

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

By Stephanie O’Neil

Before Medicaid Caps Pitched By GOP Could Shrink Seniors’ Benefits
nursing home patient Carmencita Misa became bedridden, she was a veritable “dancing queen,” says her daughter, Charlotte Altieri.

“Even though she would work about 60 hours a week, she would make sure to go out dancing once a week — no matter what,” Altieri, 39, said. “She was the life-of-the-party kind of person, the central nervous system for all her friends.”

A massive stroke in March 2014 changed all that. It robbed Misa, 71, of her short-term memory, her eyesight and her mobility — and it left her dependent on a feeding tube for nourishment. Altieri, who has two small children, is unable to provide the 24-hour care her mother now gets at a Long Beach, Calif., nursing home three miles away — all of it paid by Medi-Cal, California’s version of the Medicaid program for low-income people.

But advocates for the elderly now worry that Misa and other low-income seniors who receive long-term care in facilities or at home could see their benefits shrink or disappear under Republican-proposed legislation to cap federal Medicaid contributions to states. The proposal is part of a broader GOP plan to repeal and replace former President Barack Obama’s Affordable Care Act.

“My mom is getting the basic of basic care,” Altieri said. “If they cut it, I don’t know what to do.”

Nationwide, Medicaid provides long-term care and support to more than 2 million low-income seniors. The program, funded jointly by the federal government and the states, pays more than half of all long-term care in the country — “more than Medicare, private long-term care insurance and out-of-pocket spending combined,” said Matt Salo, executive director of the National Association of Medicaid Directors.

And, he said, it’s the only public program that offers such care on an ongoing basis. The Medicare program — for people 65 and older — provides only limited long-term care to those who need it after being hospitalized.

The GOP bill, scheduled for a vote on the floor of the House on Thursday, would transform Medicaid from an open-ended system, in which the federal government matches state spending, to one in which it pays a fixed, per-capita amount to each state. In that scenario, the federal contribution would rise only if a state’s Medicaid enrollment grew, though it would be adjusted for medical inflation. There has also been talk among Republicans in recent days of allowing states to take lump-sum payments instead.

Critics say such caps on funding would not accommodate inevitable spending hikes from the introduction of expensive new treatments or other cost variables.

“The problem with the per-capita caps is that they are really set up to starve the Medicaid program,” said Eric Carlson, a directing attorney in the Los Angeles office of the nonprofit group Justice in Aging. “It’s really a form of rationing where you have the care based on the money that’s been budgeted rather than on the needs of the people, and that’s entirely backwards.”

Carlson is co-author of a paper released by Justice in Aging that says capping federal Medicaid spending, with either per-capita funding or lump-sum payments — known as block grants — would harm older Americans, in part by forcing states to cut services for them “to the bone.”

“Federal payment for Medicaid would drop sharply, resulting in fewer services for everyone who relies on Medicaid, including older adults who account for over 22 percent of all Medicaid spending,” the report predicted.

In 2015, Medicaid spending topped $552 billion nationwide, including more than $85 billion spent on Medi-Cal enrollees, according to the Kaiser Family Foundation. (California Healthline is produced by Kaiser Health News, which is an editorially independent service of the foundation.)

Under the GOP proposal, nursing care in a facility would remain a guaranteed Medicaid benefit, though states could reduce how much they spent on it if they were forced to economize. And Republicans might well attempt to loosen or undo federal program requirements with subsequent legislation that would give states more control.

Such a shift would “decimate Medicaid’s current guarantee of adequate and affordable care,” according to the Justice in Aging paper.

In the meantime, states could do away with benefits not guaranteed under federal law, which include at-home nursing, personal care — which Medi-Cal covers for qualified beneficiaries — and even inpatient and nursing care in mental health facilities for the elderly.

A report released last week by the nonpartisan Congressional Budget Office suggests states might cut provider payments or eliminate some of their optional services to fill the funding gap left by the restricted flow of federal money.

Oren Cass, a senior fellow with the Manhattan Institute who specializes in anti-poverty law, doesn’t believe that means the GOP plan would necessarily harm elderly Medicaid beneficiaries.

“A state that wants to continue the spending it does on the elderly can do that if it would rather make cuts elsewhere,” he said. “Or it can put up more of its own money.”

Cass said that having more flexibility might appeal to California legislators and health care leaders.

“If you ask California today whether it would rather have Donald Trump run its Medicaid program or run it itself, I think most people there, especially liberal people, would say they would rather have the state making the rules,” he said.

For now, however, the debate over the GOP bill is largely speculative, since there may be enough Republicans with serious concerns about the legislation to sink or significantly amend it.

The CBO report shows the bill would reduce federal budget deficits by a cumulative $337 billion over a decade. The CBO also projected that the bill, if passed, would leave 14 million more people uninsured next year than under current law and 24 million more by 2026.

The cost savings may not be enough to overcome the reluctance of many conservative Congress members who call the bill “Obamacare Lite” because it retains some of the most popular features of the Affordable Care Act.

As the debate heats up in Washington, Charlotte Altieri of Long Beach remains hopeful that her mother’s nursing home care will be spared any cuts.

“We’re not at some grandiose nursing home right now,” she says, “Where are we going to find one that costs less than this one?”