Medicare For All – Protection for Your Retirement Plans

An unexpected medical emergency, a life-changing diagnosis, or a car accident are a number of countless situations that can land us in the emergency room, setting off a chain reaction of diagnostic tests, follow-up appointments, prescriptions, treatments, and more. Of course, this all has a significant implication on your pocketbook, and even if you have insurance, the bills can still be staggering.

Health insurance is supposed to be an investment, a sort of safety net to minimize your financial obligations in the event of a significant health illness or injury. But rising premiums, high deductible plans, and coverage exclusions have rendered comprehensive, quality, affordable insurance plans a thing of the past.

This can have significant implications for older adults nearing or at retirement age. A car accident, a cancer diagnosis, or any number of other health issues can quickly drain away savings, including retirement plans.

Health Care Costs Threaten Retirement Plans

Amassing a retirement savings large enough to provide a comfortable living for decades is no small feat. Because seniors tend to see increased health issues and health care costs in their latter years of life, a significant portion of their retirement plan needs to be able to cover those increased costs.

According to a study performed by Fidelity, a 65-year-old couple retiring in 2017 will need to cover approximately $275,000 in health care costs throughout their retirement. That amount reflects a 6% increase over the 2016 figure of $260,000. However, that estimate has increased more than 70% when compared with the initial estimate ever performed by Fidelity back in 2002.

Simply saving up enough money to be able to retire can be a challenge, especially when you encounter unexpected health issues and emergencies earlier on in life. According to a survey by Bankrate, only 41% of adults say that they have enough money in savings to be able to pay off an unexpected cost. However, 45% of survey respondents indicated that they’d had a major unexpected expense in the past 12 months.

And if a family has a high-deductible insurance plan, a single visit to the ER can cost tens of thousands of dollars. Families without adequate savings may feel pressured to reach into retirement savings to fund the emergency, leaving them with even less savings than they’d had initially.

A Compounding Problem

The issue of health care costs depleting retirement savings becomes even more urgent when you consider the seniors who can’t afford to retire at all. The U.S. Jobs Report indicated that the retirement age is increasing, with almost 19% of United States seniors aged 65 or older were working at least part time during the second quarter of 2017. Additionally, 19% of 70- to 74-year-olds were still working.

Working later into life leads to increased retirement savings, but this isn’t a practical option for many seniors. Health issues force many seniors to quit their jobs even if their retirement savings aren’t yet large enough to provide them with long-term security.

Simply finding a job can be a challenge, since employers may be more reluctant to hire seniors (despite age discrimination laws). Seniors may find themselves with fewer job options and may have to settle for lower-paying jobs with poor health insurance policy offerings.

Medicare for All: Protecting Retirement Savings

Medicare for All could be a solution to this growing problem. With single-payer health care, all Americans could enjoy protection against unexpected large medical bills. Americans wouldn’t need to dip into their retirement savings for health-related emergencies. And with reduced health care costs, they could put more earnings into their retirement plans.

If more Americans were able to put aside more retirement savings, they could retire at age 65 without having to worry about extending their employment into their senior years. They could enjoy reduced stress and could focus on healing after a health crisis, rather than worrying about the massive bills that would follow.

With access to the medications and treatments that they need, Americans could enjoy better health, happiness, and an improved quality of life. Isn’t that what we want for our seniors, our retirees, and all American citizens?

Why Work Requirements Will Not Improve Medicaid

One out of every five low-income Americans depends on Medicaid, the national insurance program for the poor jointly run by federal and state governments. Medicaid provides insurance coverage for a broad array of health services from pregnancy care and childhood immunizations to emergency hospitalizations. As the practice of health care has developed, states have applied for waivers under Medicaid’s “Section 1115” program to test new ways of delivering prenatal care, coordinated care for children, and specialized medical treatment for cancer patients.

But in 2018 the Trump administration signaled a major shift in the Medicaid waiver policy. Section 1115 waivers are now being used allow states to require people applying for Medicaid to work or engage in unpaid “community engagement” as a condition of eligibility. Currently, such work requirements for Medicaid are under consideration in twenty states.

Are work requirements for Medicaid a good idea – comparable to the kinds of improvements states have tried under waivers in the past? Medical and social scientific research actually suggests that imposing work requirements is unlikely to improve health outcomes. Even more worrisome, for the three-fifths of Medicaid beneficiaries who are already employed, administrative work requirements are likely to impose barriers to accessing needed healthcare. Because the new work requirements do not further Medicaid’s goal of providing healthcare coverage, they may well violate established Medicaid law.

My research reinforces prior findings that Medicaid work requirements will not make anyone healthier. These rules will create confusing bureaucratic red tape and prevent low-income Americans from getting the care they need. Millions of low-income Americans will pay the price for this attempt by the Trump administration to misapply federal law.

The History of Medicaid

Established in 1965, Medicaid provides health insurance coverage to the elderly, individuals with disabilities, and low-income families. The law as written was meant “to furnish medical assistance” to individuals “whose income and resources are insufficient to meet the costs of necessary medical services.” People who benefit from Medicaid are far less likely than their peers to forego necessary medical care, and a growing body of research shows that Medicaid coverage is associated with lower rates of mortality and increases in access to care and self-reported improvements in health.

Over the years, many improvements in the Medicaid program started at the state level. Under Section 1115, the Secretary of Health and Human Services can allow states to waive certain requirements to experiment with policies that are “likely to assist in promoting the objectives” of the Medicaid Act.

Beginning in the 1990s, states like Minnesota, New York, and New Jersey used waivers to expand coverage to new populations of low-income Americans, control program costs, and improve the quality of care. Nevertheless, because Section 1115 waivers are supposed to promote the objectives of the original Medicaid law, federal officials prior to the Trump administration were reluctant to approve state modifications that would deny potential beneficiaries necessary access to medical care.

Work Requirements Mean More Bureaucracy and Less Health Care

Breaking with tradition, in 2018, the Trump administration advised states that it would approve Section 1115 waivers that required individuals to participate in “employment-related activities,” including paid employment or job training as well as unpaid volunteer work or community service. As of April, nearly 20 states are in the process of developing such waiver applications and the Centers for Medicare and Medicaid Services has already approved such waivers in Kentucky, Indiana, and Arkansas.

The results are likely to undercut Medicaid’s basic goals. Although three out of every five able-bodied Medicaid beneficiaries already work or participate in community engagement, new work requirements will create costly and confusing bureaucracy for millions of low-income Americans who will have to periodically recertify their work status with multiple state agencies. People suffering from intense poverty tend to struggle more than others with such burdens. Predictably, many will fail to meet the new paperwork requirements and fall out of the system, even though they still need health insurance. Not only will this outcome directly undermine the basic purpose of Medicaid, applying the new rules will consume time and resources administrators could devote to helping beneficiaries.

Busting the Myth that “Employment Leads to Better Health”  

Policymakers and civic leaders should push back against false Trump administration claims that existing research bolsters the case for new Medicaid work requirements:

  • Trump officials claim that a 2016 study showed that employment is associated with better health outcomes – but the researchers actually noted that unemployment rates “were not significantly associated with life expectancy… in the bottom income quartile.”
  • Officials say that a 2014 study published in Occupational and Environmental Medicine establishes a “protective effect of employment on depression and general mental health.” But those researchers said that they cannot establish a causal link because “positive health effects of employment can be affected by the fact that healthier people are more likely to get and stay in employment.”

Indeed, research supports the opposite of Trump administration claims. Instead of employment automatically improving health, better health actually improves people’s employment prospects. A research summary in Medical Care Research and Review finds that improved health would increase earnings by 15 to 20 percent. Some studies suggest that low-income jobs lead to higher rates of mortality and other bad health outcomes.

A recent Health Affairs report found that participants in a Florida welfare experiment whose benefits were conditioned on workforce participation had a 16 percent higher mortality rate than comparable recipients not subject to work stipulations.

Medicaid was designed as a program to improve the health of poor Americans – and available evidence suggests that it should continue to serve this core purpose – rather than being turned into a cudgel to deny care or force people into bad jobs.

Social Workers Can Now Learn Medicare Online and Earn Continuing Education Hours

Social workers can now earn continuing education hours while they learn Medicare at their own pace, anytime and anywhere with Medicare Interactive (MI) Pro, an online Medicare curriculum powered by the Medicare Rights Center.

MI Pro provides the information that social workers and health professionals need to become “Medicare smart,” so they can help their clients navigate the Medicare maze. The online curriculum contains information on the rules and regulations regarding Medicare—from Medicare coverage options and coordination of benefits to the appeals process and assistance programs for clients with low incomes.

“For over 25 years, social workers have been turning to Medicare Rights’ helpline counselors for clear and concise information on how to help their clients access the affordable health care that they need,” said Joe Baker, president of the Medicare Rights Center. “Now social workers can enroll in MI Pro and learn—or enhance—their Medicare knowledge at their convenience while fulfilling their continuing education requirements.”

The Medicare Rights Center, a national nonprofit consumer service organization, is the largest and most reliable independent source of Medicare information and assistance in the United States.

Licensed Master Social Workers and Licensed Clinical Social Workers can earn continuing education hours when they successfully complete any of the four MI Pro programs: Medicare Basics; Medicare Coverage Rules; Medicare Appeals and Penalties; and Medicare, Other Insurance, and Assistance Programs. Each MI Pro program is comprised of four to five course modules.

All MI Pro programs are active for one year following registration.

MI Pro courses are nominally priced. Additionally, social workers who purchase all four programs at once will receive an automatic 20 percent discount.

Medicare Rights Center is a national, nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities through counseling and advocacy, educational programs, and public policy initiatives.

Available only through the Medicare Rights Center, Medicare Interactive (MI) is a free and independent online reference tool that provides easy-to-understand answers to questions posed by people with Medicare, their families and caregivers, and the professionals serving them. Find your Medicare answers at www.medicareinteractive.org.

Stressed Out Caregivers Are Using ER Visits for Respite, Study Finds

Emergency room staff call it a “pop drop” – when a disabled older person comes in for medical attention, but it seems like the person who takes care of them at home is also seeking a break from the demands of caregiving.

It’s been hard to actually study the phenomenon. A new University of Michigan study suggests that tired family caregivers are associated with greater ER visits and higher overall health care costs for the person they care for.

In a paper in the new issue of the Journal of the American Geriatrics Society, the team reports their findings from a study of 3,101 couples over the age of 65, each with one spouse acting as caregiver for their disabled partner.

The researchers looked at the Medicare payments and emergency department visits for the disabled spouses in the six months after the caregiver spouses took standard tests to measure their fatigue, mood, sleep habits, health and happiness.

Even after they took into account many factors, the researchers found that in just those six months, emergency department visits were 23 percent higher among patients whose caregivers had scored high for fatigue or low on their own health status.

Patients with fatigued or sad caregivers also had higher Medicare costs in that same time period: $1,900 more if the caregiver scored high for fatigue, and $1,300 more if the caregiver scored high for sadness, even after all other factors were taken into account.

The cost of unpaid help

“Many of us who work in clinical settings feel that patients with high home caregiving needs, such as dementia, often rely on the medical system as a source of respite for their spouses or other caregivers, because other respite isn’t paid for,” says lead author Claire Ankuda, M.D., M.P.H. “But there hasn’t been a lot of data about it, and only recently has our society been talking about caregivers and potential ways to incentivize and support them as a way of keeping patients living at home.”

Ankuda, who led the study during her time at in the Robert Wood Johnson Clinical Scholars program at U-M’s Institute for Healthcare Policy and Innovation, is now training in palliative care at the Icahn School of Medicine at Mount Sinai.

“Informal caregivers, including spouses, enable older adults with functional disability to stay out of the nursing home and live at home where they’d prefer to be,” says senior author Deborah Levine, M.D., M.P.H., an assistant professor of internal medicine and neurology at U-M.

We need to do a better job of identifying and supporting caregivers experiencing distress, in order to help caregivers feel better and hopefully improve outcomes in older adults with disability.” Deborah Levine, M.D., M.P.H.

Long-term data gives key insights

The couples in the study were all taking part in the long-term Health and Retirement Study, conducted by the U-M Institute for Social Research on behalf of the National Institutes of Health. Ankuda, Levine and their colleagues probed HRS data because it allowed them to correct for factors that other, short-term studies can’t – such as the baseline level of Medicare costs, demographic differences including income and education, and even whether the couples have adult children living nearby.

The findings add hard new data about the link between caregivers’ own experiences and the amount the Medicare system pays to take care of those the caregivers take care of at home.

Nearly 15 million older adults get help with everyday activities from spouses and other family or friend caregivers. In the new study, the researchers included couples where one spouse got help from the other with activities such as bathing, dressing, walking, getting into or out of bed, shopping, cooking, and taking medications.

Helping with these tasks on a daily basis, without pay or respite, can take a toll on the caregiver’s own health, wellness and mental state – which can lead to burnout. Medicare does not offer payment or formal respite coverage for family or friends who take regular care of older adults – and only covers home care by certified agencies under certain circumstances.

More research & services needed

Ankuda notes that studies on the impact of supporting family caregivers more formally are just beginning to produce results.

Meanwhile, health policy researchers are beginning to suggest that it may make fiscal sense to incentivize home caregiving, to keep seniors from needing more expensive nursing home care.

“I definitely think there are specific services that could help caregivers, if we can identify those people who are highest risk and provide a basic level of support such as an around-the-clock geriatric care call line that could help caregivers feel less isolated and talk to a nurse about whether, for example, to go to the emergency department,” Ankuda says. “This is a high-cost, vulnerable population.”

Formal respite care, peer support groups and other options could also help stave off fatigue and sadness – and the hospital staff who notice “pop drop” practices could help steer caregivers to such options. So could the primary care clinicians who take care of both the disabled spouse and the caregiver.

Because the new study takes into account the level of Medicare spending for the disabled spouse in the six months before their caregiver was interviewed, it may actually underestimate the impact of caregiver fatigue, she notes.

Indeed, before the authors corrected for the full range of factors, they documented that Medicare costs were lower for patients whose spouse-caregivers who reported being happy or rested. They also saw higher costs among patients whose caregivers had higher depression scores on a standard mood questionnaire.

One factor that wasn’t associated with higher costs in the new study was the caregiver’s score on a standard measure of sleep habits. Sleep disruption is harder to quantify in older people, Ankuda notes. But the measurement of fatigue, which can result from both the strain of caregiving and poor sleep, was clearly associated with both higher rates of emergency department visits and higher overall costs.

The FCA and the American Health Care System: Finding the Balance

Medicare fraud, you see it in the news every day, but many believe it is individual recipients costing the government billions of dollars. When in fact, doctors and other health care professionals are billing the government for services they never performed or for services and tests that were unnecessary. Billions of taxpayer dollars that were meant to serve actual needs go into pockets of unscrupulous health care professionals. It often goes unnoticed for years before someone discovers fraud.

The False Claims Act (FCA) is a law that oversees government contractors and prosecutes any false claims submitted to the government. It was passed in 1863 in an effort to address rampant fraud, such as double-billing and other deceptive business practices. In 1986, it was amended to address the fraudulent military spending under the Reagan administration.

Is Disagreement Fraudulent?

Over the past eight years, the Department of Justice reports it has recovered $19.3 billion in fraudulent health care claims. This accounts for 57 percent of the total amount of money recovered over the past 30 years, leading many people to suggest that the FCA has overreached its authority.

Lack of medical necessity is often cited in claims that are deemed fraudulent, but who decides what is and is not necessary? Shouldn’t that be a doctor’s decision? Certainly doctors have filed egregious fraudulent claims, but do we want our health care professionals second-guessing their decisions because they are worried about being prosecuted for fraud? One doctor may choose one course of action or set of tests while another may disagree and choose another. Should either of these decisions be considered fraudulent?

Whistleblowers Must Be Protected

No one is pro-fraud. Even criminals don’t want others to defraud them. When it comes to stopping the wanton theft of taxpayer money, both Democrats and Republicans support the False Claims Act and have done so for the more than 30 years the act has been in place. While there are concerns about its scope and reach, politicians in general can cite its obvious merits.

One part both sides mostly agree on is the protection of whistleblowers, people from inside a business environment who see and report suspected fraud. Without them and without protecting them, taxpayer money would be fraudulently spent without ever being noticed.

Whistleblowers can report suspected fraud directly to the government and not have to go through channels at their place of employment, where they could be ignored, or even worse, face retaliation. Even good, honest people might choose to keep quiet or turn a blind eye if they fear losing their job or being otherwise retaliated against.

Whistleblowers Reap Rewards?

A criticism of this is that people who report suspected fraud are legally protected and often end up receiving large financial settlements. This may unintentionally create a financial incentive to report fraud even when it may not exist. Disgruntled employees may report fraud that does not exist just to cause their employer trouble. The people who suffer most from this are those on government health care whose doctors may undertreat them or not treat them all out of fear of prosecution.

Costs Continue to Rise

Guess who pays for all of this: You do. Fraud and the prosecution of suspected fraudulent claims cause health care providers and insurance companies to raise their prices. These price increases are passed on to the consumer.

Health care costs continue to rise, putting financial pressure on employers and business owners. Health care spending in the United States is expected to grow from $2.9 trillion in 2013 to $5 trillion in 2022. Prescription drug costs have increased 10 percent, partly due to marketing and increased specialty of treatment. The government has done little to stop the increase in drug prices.

The FCA is necessary in order to protect taxpayer money from being fraudulently spent. Everyone can agree to that. However, let’s give doctors and other health care providers some leeway and support how they decide to treat a patient. We need that. Otherwise, costs and insurance premiums will continue to rise, and patient care will suffer.

Encourage whistleblowers to support suspected fraud, but let’s rein in the bountiful cash settlements they may receive in order to sustain honesty in the FCA. Let’s be as strict about fraudulent claims of fraud as we are about fraudulent medical claims. Protect the whistleblowers, but establish strict penalties for abuse. It’s all about ensuring quality care while protecting our tax dollars.

HHS Announces Major Initiative to Help Small Practices Prepare for the Quality Payment Program

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Over the last few weeks, the Department of Health and Human Services (HHS) has made several important announcements related to the Quality Payment Program, which has been proposed to implement the new, bipartisan law changing how Medicare pays clinicians, known as the Medicare Access and CHIP Reauthorization Act of 2015, or MACRA. Today, we are announcing $20 million to fund on-the-ground training and education for Medicare clinicians in individual or small group practices of 15 clinicians or fewer.

These funds will help provide hands-on training tailored to small practices, especially those that practice in historically under-resourced areas including rural areas, health professional shortage areas, and medically underserved areas.

“Doctors and health care providers in small and rural practices are critical to our goal of building a health care system that works for everyone,” said Secretary Burwell. “Supporting local health care providers with the resources and information necessary for them to provide quality care is a top priority for this administration.”

As required by MACRA, HHS will continue to award $20 million each year over the next five years, providing $100 million in total to help small practices successfully participate in the Quality Payment Program. In order to receive funding, organizations must demonstrate their ability to strategically provide customized training to clinicians. And, most importantly, these organizations will provide education and consultation about the Quality Payment Program at no cost to the clinician or their practice.

“The bipartisan MACRA legislation gave us the tools to improve Medicare and make it modern and sustainable by improving the incentives for and lowering the burden on clinicians,” said Dr. Patrick Conway, acting principal deputy administrator and chief medical officer for the Centers for Medicare & Medicaid Services. “Real change must start from the ground up, and today’s announcement recognizes this reality by  getting doctors the resources they need to provide better, smarter care.”

Organizations receiving the funding would support small practices by helping them think through what they need to be successful under the Quality Payment Program, such as what quality measures and/or electronic health record (EHR) may be appropriate for their practices’ needs. Organizations would also train clinicians about the new clinical practice improvement activities and how these new activities could fit into their practices’ workflow, or help practices evaluate their options for joining an Alternative Payment Model.

“Providing these tools to help physicians and other clinicians in small practices navigate new programs is key to making sure they are able to focus on what is most important: the needs of their patients,” said B. Vindell Washington MD, MHCM, FACEP, principal deputy national coordinator. “As with the Office of the National Coordinator for Health IT’s funding for Regional Extension Centers, this assistance will help health care providers leverage health information technology to enhance their practices and the care they deliver.”

Awardees will be announced by November 2016.  HHS encourages all qualified organizations to apply for this funding.

To learn more about today’s announcement and how to apply, please contacthttps://www.fbo.gov/index?s=opportunity&mode=form&id=57766996f8ecd4749cd4b18e60f63a8e&tab=core&_cview=1.

For more information on the Quality Payment Program, please visit:https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/Quality-Payment-Program.html

Barbara Lee’s Bill Expands the Role of Social Workers in Medicare

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Congresswoman Barbara Lee (D-CA-13), chair of the Congressional Social Work Caucus, introduced a bill last week addressing several critical issues confronting clinical social workers providing mental health services to Medicare recipients. The Improve Medicare Beneficiaries’ Access to Mental Health Services Act of 2015, if it becomes law, would add clinical social workers to qualified service providers for Medicare recipients in skilled nursing facilities. It would increase the Medicare reimbursement rate for clinical social workers from its current rate of 75 percent to 85 percent. And, it would also allow clinical social workers to be reimbursed for Health and Behavior Assessment and Intervention (HBAI) services that may not be directly related to mental health treatment. Senator Debbie Stabenow, one of two social workers serving in the Senate, introduced a companion bill.

The National Association for Social Workers (NASW) has been working to remove these regulatory barriers that have limited Medicare recipients’ access to quality services provided by clinical social workers—the nation’s largest group of mental health service providers. There are about a quarter million licensed clinical social workers in the United States. Rep. Lee’s bill addresses the three areas of concern by amending language in Title 18 of the Social Security Act. According to NASW, in order to be certified as a Medicare provider, a social worker must have a Master in Social Work (MSW) degree or doctorate from an accredited school of social work and two years or 3,000 hours of supervised post-graduate clinical experience. She or he must have a clinical license or certification from the state of practice, must obtain a National Provider Identifier Number, and have malpractice insurance.

The Clinical Social Work Association (CSWA) points out that participation in Medicare can be confusing for clinical social workers. Once CSWs sign up as Medicare providers they must accept all referrals unless they “opt out” which would allow them to privately contract with Medicare beneficiaries. According to the CSWA, the “opt out” period is generally for two years. There are a number of reasons CSWs may decide to “opt out” of being a Medicare Provider. One reason is the Medicare reimbursement rate for CSWs is just 75 percent that of psychiatrists and psychologists. Increasing the rate to 85 percent, increases the likelihood more clinical social workers will participate in Medicare.

Currently clinical social workers are reimbursed through Medicaid Part B and cannot be reimbursed for services provided to beneficiaries in skilled nursing facilities (SNF) under Medicaid Part A. This limits Medicare beneficiaries’ access to mental health services provided by clinical social workers including services that could be interrupted if the beneficiary is transferred to a SNF while receiving treatment from a clinical social worker. The bill would amend language in Title 18 of the Social Security Act to include clinical social workers among providers of services in skilled nursing homes.

The bill would also fix another problem. While the Social Security Act provides reimbursement for the diagnosis and treatment of mental health problems, it does not specify reimbursement for behavioral health services covered by the Health and Behavior Assessment and Intervention(HBAI) codes such as emotional and social problems that may occur due to medical conditions such as diagnoses of cancer or Alzheimer’s disease. Currently payments to CSWs are left to the discretion of each local Medicare Administrative Contractor. Rep. Lee’s bill would include HBAI code services in those that can be provided by clinical social workers.

As the nation’s population ages, it is critical that licensed clinical social workers participate as Medicare providers and have the widest possible latitude to provide billable services. For more information regarding the Improve Medicare Beneficiaries’ Access to Mental Health Services Act of 2015 and issues related to clinical social workers and Medicare, contact Dina Kastner at NASW (dkastner@naswdc.org).

When Basic Living is Considered a Utopia for the Poor

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With our fast paced lives in a technological age of instant gratification and easy distraction, it’s no wonder news channels are beginning to advertise “distractify” sections on their web pages. It’s not difficult to see how quiet unassuming people may get pushed aside, and their needs relegated to the back burner. We assume that they’ll get social security which will provide some basic living. After all, we are told that all Americans can get social security once they retire. Right?

But, retiring means that you have worked, and social security is based on earnings over your lifetime. For homemakers, this doesn’t help much. We assume that they’ll receive Medicare, and yes we might even hear about the problems and costs associated with what Medicare doesn’t cover. We might even assume that the elderly will get food stamps without realizing just how meager food stamp grants really are. In an age of cuts to social programs, not only are all of these so-called entitlements at risk, programs such as food banks, meals on wheels, and utility assistance are also at risks which leads me to tell you about Mrs. Jones.

Mrs. Jones* is a vibrant and lovely elderly woman, free with stories of years gone by and quick with an ear for friends and neighbors. She loves working in her garden and sitting on her porch chatting with passers-by. Many in her community in Atlanta look forward to the spritely older woman and her tales. Many more loved her homespun wisdom and down home recipes, both of which she’s quick to share.

So, it was with great shock and profound sadness that the community witnessed its first day without the fixture that was Mrs. Jones and the loss was palpable. The shock and sadness only increased as the story behind Mrs. Jones’ absence spread.

In all the time she was cornerstone of the community, the very bedrock that most communities seek to cultivate, no one guessed she might have a secret. Mrs. Jones was used to being relied upon in her community and never thought to ask for anything in return. While her neighbors were friendly, caring, and even supportive of her, no one thought to inquire into how this lovely elderly woman, a widow who’d largely been a homemaker, was fairing. Sadly though, Mrs. Jones is one of countless citizens in an unenviable position. She is one of the 3.4 million citizens aged 65 and over in our country who live in poverty making her part of an extremely vulnerable population and one that is often forgotten in our society.

As a widow she did qualify for survivor’s benefits, but as someone who was largely a homemaker, her social security was meager at best. She did happen to qualify for Medicare, but was judged to be over the resource limit for food stamps. Living alone without dependent children reduced her benefits limit to the point that she was deemed to make too much. In short, after a lifetime of raising children, keeping house, and being a good and supportive wife to her husband all things lauded as family values to be protected, the system failed Mrs. Jones.

On the night where we pick up Mrs. Jones’ story, the night before her community witnessed the absence of its cornerstone, Mrs. Jones dialed 911 in a panic. She was having incapacitating abdominal cramps coupled with vomiting. When she arrived at the emergency room she was quickly diagnosed with a bowel obstruction and raced into emergency surgery. Afterward she was admitted to the ICU to recover from surgery and to stabilize her condition. A few days after she was admitted, a concerned friend came to visit and that’s when the true tragedy of Mrs. Jones case was revealed.

Her neighbor, perhaps one of her closest friends, knew that Mrs. Jones had been diagnosed with a heart condition, and that the treatment course was not covered by her insurance. This is not uncommon among the elderly who frequently have too many medical bills and not enough money or insurance. Many Americans think that supplemental insurance like Medicare part D picks up the rest, but the truth is it doesn’t cover everything and creates what some call the Medicare donut. In this position, Mrs. Jones was left to decide between medication and other necessities like food, which also is not uncommon among the elderly.

What makes this story less common, but by no means unheard of, is how Mrs. Jones decided to solve the problem. With too many financial needs and too few dollars at her command, Mrs. Jones decided that she would have to resort to eating dog food to afford her medications. That’s right, as she was trading recipes with her neighbors, offering an ear to all and being the foundation of her community, Mrs. Jones had resorted to eating dog food.

Mrs. Jones had been failed by the very society of whom she was a bedrock. Even more tragically, she is now saddled with even more medical debt which lead to her illness in the first place. Only time will tell how Mrs. Jones’ story will end. With her grown children having moved away and her husband  now deceased, it is very likely her community will forever lose its cornerstone. The debt she’s incurred will drive her to even more austere measures and ultimately lead to her being placed in assisted living.

Mrs. Jones’ story and the stories of millions like her doesn’t have to end this way. It doesn’t have to be a story of poverty, increased health care costs, and increased demand for limited assisted living spaces. The only solution that eliminates poverty and corrects societal tragedies like Mrs. Jones story is a universal basic income.

Had Mrs. Jones lived in a country that provided a guaranteed basic income for its citizens, Mrs. Jones would not live in poverty. She’d receive a stipend that guaranties her a comfortable existence where she could afford food and adequate health insurance. Insurance where her medication is covered, thus eliminating the strain of poverty on our health care system.

Clearly our current system, which leaves 3.4 million of our elderly in poverty, estimates as many as 44% of seniors would be living in poverty if it were not for social security. As stated in the findings by Center for American Progress, the system is broken, and it’s time to find a solution. 

Editors Note: *Mrs. Jones and staff at Emory University Hospital spoke to me on condition of anonymity. Mrs. Jones name was changed to protect her privacy.

Ageism In The Workplace

If we are not welcome in the workplace and we are expected to live well into our nineties and beyond, how can we ever hope to be able to sustain ourselves financially?

Can you imagine a workforce made up of 3 generations?  I am 68, my children are in their forties, and my oldest grandchild is 17. I am one of the fortunate aging boomers who is still part of the American workforce. I have no problem envisioning a workplace where my granddaughter, my son, and I will all be participating in the growth of our nation’s economy. Yet, there is one major obstacle to achieving this goal. It is the oldest, most entrenched form of discrimination in this country. Ageism!

agediscriminationintheworkplace02Nowhere is it easier to identify ageism than in the workplace. As older workers are staying longer and younger workers enter the field, more often than not they will find themselves part of a multigenerational workforce. By the middle of the next decade, the United States will be an aging society, with more Americans over age 60 than under age 15.

What this means for an evolving job market is that there will not be enough young workers to fill entry level jobs. We will then have two choices. We can import young workers from other countries, or we can prepare ahead by accommodating older workers and encouraging them to remain or re-enter the workplace. This would be a welcoming departure from the cold shoulder that older workers receive when applying for jobs today.

Our country’s leaders are always a day late and a dollar short when it comes to planning ahead. For years and years people have been writing about the “graying of the American workforce” and the “aging tsunami”. The boomers are not coming; we have arrived!

We are healthier than previous generations, and we are living longer–in many cases, as much as 20 years longer. Yet, when we leave our career jobs, whether by choice or not by choice, we step into a void. We discover that there is no role for us in society. We become invisible. The invisible man today is not a bandaged wrapped non-body. He is an invisible somebody.

Here’s the dilemma: If we are not welcome in the workplace, and we are expected to live well into our nineties and beyond, how can we ever hope to be able to sustain ourselves financially? We have the intelligence, skills and wisdom to become one of society’s greatest assets.  Yet, without the opportunity to earn our own way, we will certainly become society’s burden. Most salient is our position as repositories of historical and cultural history and our ability to solve long term problems that younger people do not have the time for.

One excuse I hear for not keeping or hiring older workers is the fear that it will be too expensive. “They will be sick too often and, therefore, be less productive.” Not true. Older workers come with an innate work ethic. We take less sick days than our younger co-workers. We also come with our own health insurance, namely, Medicare. And, older workers are often willing to work for lower salaries as a supplement to our Social Security.

Mainly, we want to be valued and be seen as contributors to a better society, not as a drain. I wonder if those who would shut older adults out of the workforce are ageists who drank the youth-obsessed Kool-Aide that the media hands out. They probably do not even recognize their own internalized ageism. Have they thought about why they do not want a workplace filled with grey haired people? Could it possibly be the threat of having a workforce who reflect the true life process of aging that they would rather deny?

Ageism does not only affect the old. It affects our entire society. It deprives one generation the opportunity to pass on knowledge to the next, while depriving the younger generation the opportunity to learn and build on that knowledge.  It deprives an older generation the opportunity to keep growing and learning new skills for which the young are our best teachers.

The stereotypes of older people that we all own do not match up with the reality of today.  They are out of date.  It’s time for an upgrade.

 

The Good, the Bad, and the Ugly of Medicare

by Britney Wiggins, BSW Candidate

One of the most important steps when enforcing any type of intervention, especially in social work practice, is to examine how effective the program is in accomplishing its goals.  Federal legislation, particularly social welfare programs, must also be examined in terms of strengths and weaknesses so that the policy can be modified to better accommodate the beneficiaries that are often heavily dependent on these programs.  A program’s weaknesses can also result in its own demise if left untreated.  Exploring how an intervention can be improved is critical if any program is going to survive in the American political system.  Given our current political atmosphere and the focus on budget cuts, it is imperative that Medicare determine what areas it can improve on.

Medicare-Policy-Making-198x198Arguably one of Medicare’s greatest successes is in the overall support and approval it receives from its beneficiaries.1 Medicare has changed the way older adults approach retirement.  The financial support made available for medical costs allows older adults to use their monetary resources for other necessities.  Another reason that Medicare is heavily favored among eligible older adults is because of the portability of the program.  Regardless of where a beneficiary resides, their eligibility and benefits remain the same because the program is federally regulated.  The benefits, in fact, are responsible for much of Medicare’s glory.  It was originally designed to provide affordable healthcare to seniors and it has succeeded in that effort.  Despite the rising cost of Medicare throughout the years, the increase in the cost of private insurance has continued to ensure that Medicare is the better deal.2 With Medicare acting as a healthcare safety net, it is no surprise that Medicare continues to be one of America’s more popular social welfare policies.

Medicare’s popularity does not negate the fact that there are problems present.  While the program does help cover many healthcare costs, it also has relatively high deductibles, no limit on out-of-pocket spending, and a coverage gap – the “donut hole” – in the prescription drug plan that will exist until 2020.3 Medicare also fails to cover long-term care costs.4 While these issues do represent some of the weaknesses currently present in the program, they are not the focus of recent political talks.  Congress is far more concerned with addressing growing concern over how Medicare will continue to be funded in light of the federal deficit.

It has become almost impossible to talk about Medicare without also mentioning the Baby Boomers.  It is estimated that there are over 70 million Baby Boomers – individuals born between the years 1946 to 1964 – expected to enter into the Medicare system throughout the next decade.5 As the number of beneficiaries grows at an unprecedented rate, there is a reasonable fear that funds from taxpayers will not be able to keep up with the growing demand.  The national government will be forced to pick up the slack during a time when the country is already facing a trillion dollar deficit.  Politicians are racing to find a balance between maintaining a popular welfare program and reducing the national debt.  While Medicare is not in danger of being completely demolished, there are concerns over how changes to the policy will impact consumers and taxpayers.

The issue over Medicare funding is made more complicated by disagreements between the two main political ideologies over how the deficit should be corrected.  Republicans tend to favor cutting government spending, which could result in less federal monetary support for Medicare.  Democrats, on the other hand, favor an increase in taxes.  This alternative places a heavier burden on the taxpayer during an economic period that still finds many people recovering from the recent economic downfall.  Neither solution offers a comprehensive solution.  Rather, the two groups will have to reach a compromise if Medicare is going to continue providing cheaper insurance options for the growing elderly population.

14Wessel, D. (2013, January 24). Whose budget fix is more popular?. The Wall Street Journal. Retrieved from

2Dugan, J. (13, June 2011). Private insurance vs. Medicare: truth in numbers. Retrieved from

3The Henry J. Kaiser Family Foundation. The Kaiser Foundation, Medicare Policy. (2012). Medicare at a glance. Retrieved from The Henry J. Kaiser Family Foundation website:

4Centers for Medicare and Medicaid Services. (3, August 2012). Long-term care: what is long-term care?. Retrieved from

5 Haaga, J. (2002, December). Just how many baby boomers are there?. Retrieved from

Finding the Consumer in the Midst of Medicare

The consumer is often caught in the middle when it comes to a provider presenting a reasonably priced product while striving to stay out of the red.  The American government is no different when it comes to Medicare and its beneficiaries.  The Medicare program provided assistance to over 49,000,000 people in 2012,1 and this number is expected to continue to increase as Baby Boomers become eligible for the federal program.  Our government is currently struggling with how to assess this growing demand with limited financial resources.  In all the budget and deficit debates, it can be easy to forget the most important part of the equation which is the medicare beneficiaries.

Medicare recipients currently pay different premiums for each of the four parts of Medicare.  Most individuals do not pay a monthly premium for Medicare Part A if they or their spouse have paid into the Medicare system via payroll taxes.  Individuals that do not meet this criteria can purchase Part A for $441 per month.

Many people pay the standard premium of $104.90 per month for Part B, but some individual’s will have to pay more if their income from the previous two years is above $85,000.2  Premiums for Parts C and D differ depending on the individual plan that a consumer decides to purchase.  The four parts are designed to offer beneficiaries the most comprehensive insurance program that they can afford.

What if you can’t afford Medicare premiums and deductibles?  Federal assistance, in the form of Medicaid, is available for low-income individuals.  Medicare also has an Extra Help program available to assist with prescription drugs.  Some states also help their Medicare beneficiaries by means of two state programs:  the Medicare Savings Programs pays Part A and Part B deductibles while the State Pharmacy Assistance Program provides financial assistance for prescription drugs.3

Both federal and state governments have options available for Medicare beneficiaries who are limited by their financial resources.  However, the state programs are not offered in every state and some lower-income seniors may still find themselves receiving few health care options while individuals with more money have the ability to pick and choose an insurance plan that best fits their medical needs.  The federal plan that was originally created to help all seniors and other eligible citizens does not help all recipients equally.

Regardless of any underlying inequalities, Medicare is still a more affordable and efficient health insurance provider than many private companies.  In fact, Medicare is viewed quite favorably among the general public.  While more than half of Americans agree that the federal deficit should be corrected with a combination of increased taxes and decreased spending, 58% oppose any spending cuts to Medicare or Social Security.  Three quarters said the deficit could be cut without any major reductions to Medicare.4

The overall general approval of this welfare policy ensures, to a certain degree, that the program will continue to assist the elderly and the disabled in the struggle to have affordable health care.  General opinion also encourages politicians and policy makers to take a more unique approach when considering how to make the program easier on the government’s wallet without directly cutting funds.

Many different ideas are being tossed around in Congress when it comes to making Medicare more affordable.  Some propose adjusting the age requirement from 65 to 67.  Others argue that Medicare should be a means-tested program with higher income individuals testing out.  Some also argue that spending cuts can be removed from the equation all together if the issue of Medicare fraud is thoroughly corrected.  Consumers should expect to hear more about major changes to the Medicare program within the next few months but should not expect to see a decrease in their premiums or deductibles.

Medicare is a complex federal program and this complexity sheds some light onto how challenging it can be for consumers to afford health care in America.  This leads to an interesting debate on how to more effectively serve American citizens.  Should the focus be on reducing Medicare costs or on reducing the cost of health care as a whole?

There is a growing opinion that health care is an overall wasteful, inefficient, and poor quality institution that is in need of reform.  Such a reform could have huge implications for eligible Medicare beneficiaries and other Americans.  Unfortunately, it is much easier for politicians and Congress to discuss how to change Medicare rather than how to improve the entire American health care system.  In the meantime, consumers continue to get caught in the crossfire between the debate over Medicare coverage and Medicare cost.

Photo Credit: Medicare Prospective Payment System

1The Henry J. Kaiser Family Foundation. (2013). Total number of Medicare beneficiaries, 2012. Retrieved from

2Social Security Administration. Social Security Administration, (2012). Medicare premiums: rules for higher-income beneficiaries (SSA Publication No.05-10536). Retrieved from Social Security Administration website:

3Medicare Resource Center. (n.d.). Frequently-asked medicare questions. Retrieved from

4Wessel, D. (2013, January 24). Whose budget fix is more popular?. The Wall Street Journal. Retrieved from

The Evolution and Implementation of Medicare

Since Medicare was created over 45 years ago, it has continuously evolved to meet the changing needs of society.  This has resulted in a system that strives to be more efficient, but in the process has become somewhat complicated if you are unfamiliar with the program.  The program is currently funded by a portion of payroll taxes, monthly premium deductions from Social Security checks, and Congress.  It is divided into four parts:

MedicarePart A: Hospital insurance – helps pay for inpatient care in a hospital or skilled nursing facility, some home health care and hospice care.

Part BMedical insurance – helps pay for doctors’ services and many other medical services and supplies that are not covered by hospital insurance

Part CMedicare Advantage – people with Parts A and B can choose to join a Medicare Advantage plan as offered by private companies and approved by Medicare.  You may have to pay a monthly premium for Medicare Advantage because of the extra benefits it offers.

Part DPrescription drug coverage – helps pay for medications doctors prescribe for treatment.1

The Medicare system that is in place today is not the same as it was in 1965.  As additional needs and concerns have become evident, the government has modified the social welfare policy to better fit the needs of the targeted population.  Originally, the program was only created to serve adults 65 and older with health insurance.  In 1972, the policy was expanded to include individuals younger than 65 with long-term disabilities and end-stage renal disease.

Medicare Part C was not implemented until 1997 under the Balanced Budget Act (BBA) and Part D was not legalized until 2003 under The Medicare Prescription Drug, Improvement, and Modernization Act.2  The program also originally paid for the entire costs of services as determined by the individual physician.  As Medicare costs began to grow, Congress decided to change the reimbursement system to provide fixed-rate paybacks for services.

Another prominent way in which Medicare has changed throughout the years is in regards to its cost to the consumer.  Medicare Part A and B have seen changes in the deductibles and premiums that individuals are responsible for paying.   Since Medicare’s creation, the deductible for Part A has increased from $40/year to $1,184/year in 2013.  The premium for Part B has increased from $3/month to $104.90/month for individuals with a yearly income of less than $85,000 in 2011.3 The rise in Medicare costs sheds some insight into how Medicare has had to evolve as medical costs increase and as the need for health insurance among the elderly and the disabled has increased.

As Medicare has changed over time, one thing remains constant. The program was established to help all eligible beneficiaries as a universal welfare policy.  An eligible individual can receive benefits regardless of which state they live in because Medicare is a federally operated program and the states are not involved in the program’s administration.4  However, there are some differences in how states approach Medigap services. Medigap, also known as Medicare supplemental insurance, refers to various private supplemental health insurance plans that are designed to assist Medicare beneficiaries with health care costs that are not covered by Medicare.

Insurance companies can only sell you standardized Medigap policies as they are regulated by federal and state laws.  In all but three states – Massachusetts, Minnesota, and Wisconsin – there are 10 standardized Medicare Supplement plans.  The three states that offer slightly different coverage had their own standardized Medigap plans prior to the enactment of the federal standardized regulations.5  For the most part, however, these three states offer Medigap plans that are very similar to those offered by other states.

Other social welfare policies, such as Medicaid, can differ dramatically from state to state because the federal government gives the states the freedom to distribute the money as they see fit.  As a federally operated program, Medicare exists to serve beneficiaries universally.  While the program has been expanded to cover more individuals, it has consistently covered individuals equally across state lines.

1US Social Security Administration. (2013, January 25).Medicare benefits. Retrieved from

2The Henry J. Kaiser Family Foundation. (2010). Medicare: a timeline of key developments. Retrieved from

3Centers for Medicare and Medicaid Services. Centers for Medicare and Medicaid Services, (2012). 2013 Medicare costs (Product No. 11579). Retrieved from Centers for Medicare and Medicaid Services website:

4Health Assistance Partnership. (2012). Overview of the medicare program. Retrieved from

5Rapaport, C. Congressional Research Service, (2012).Medigap: a primer (Report No. R42745). Retrieved from Congressional Research Service website:

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