Sunday, February 19, 2012

President Obama has released his budget request for FY2013

President’s FY 2013 Budget Request: Implications for Healthy Aging

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February 16, 2012

Get the Numbers


Download our table of funding levels for aging programs.

President Obama has released his budget request for FY2013. The proposal includes investments in some programs for seniors, but cuts in others.
Overall, the proposal is projected to reduce the deficit by about $3 trillion over 10 years through a balanced package of spending cuts and revenue increases. According to the Administration's estimates, deficits would fall from 8.5% of Gross Domestic Product in 2012 to 3.0% in 2022.
Older Americans Act (OAA) funding would generally be frozen, and Medicare spending would be reduced by $302.8 billion over 10 years.
The news for programs that specifically promote healthy aging is mixed.

Status Quo for CDSMP and Falls Prevention

The Administration is proposing that another $10 million from the mandatory Prevention and Public Health Fund (PPHF) be allocated to the Chronic Disease Self-Management Program (CDSMP).
Level funding of $21 million is requested for OAA Preventive Health (Title III-D), supporting evidence-based prevention programs, healthy aging information, and outreach. The Administration also proposes to continue requiring that states use this funding only for evidence-based disease prevention and health promotion programs and activities that have been demonstrated through rigorous evaluation to be effective.
The CDC Center for Injury Prevention and Control and the Unintentional Injury activities are essentially level funded for FY13, and unlike the FY12 request, no allocations from the PPHF are proposed. Therefore, it is unlikely the request includes any new funding above the current $2 million for Falls Prevention.

No R&D Investment and Prevention Fund Cut

The Administration is not requesting the restoration of the $19 million that was eliminated for OAA Program Innovations this year.
Funding for the Prevention and Public Health Fund (PPHF), created by the Affordable Care Act, would be reduced by $4.5 billion over 10 years, although it would be fully funded at $1.25 billion in FY13. NCOA has been advocating for the Fund as a means to expand evidence-based self-management such as CDSMP and Falls Prevention programs.
Reports indicate that the Congressional deal to extend the payroll tax cut, unemployment insurance, and Medicare physician payment fix includes a $5 billion cut to the PPHF (out of $15 billion over 10 years) to pay for this package.

Reductions for Medicare and Medicaid

The President’s proposal also includes $358.5 billion in cuts to Medicare ($302.8 billion) and Medicaid ($55.7 billion) over 10 years. The reductions are similar to those the Administration proposed in September 2011 for consideration by the congressional “Supercommittee,” which was not able to reach a bipartisan deficit reduction agreement.
NCOA is particularly concerned about three proposals in the President’s budget that would shift additional costs onto Medicare beneficiaries. However, the cuts would only affect new, not current, beneficiaries, and would not occur until 2017:
  • Part B Deductible: New beneficiaries would pay a higher annual Medicare Part B up-front deductible for physician and other outpatient services. Currently $162, this fee is indexed for inflation. It would go up by $25 for new enrollees in 2017, 2019, and 2021 (a $75 total increase).
  • Home Health Copay: For the first time, new beneficiaries would pay a $100 copayment per treatment episode for home health services, unless they have been discharged from a hospital or skilled nursing facility.
  • Medigap Surcharge: New beneficiaries who buy certain first dollar Medigap supplemental insurance policies would pay a 15% additional surcharge on those policies, about $30 per month.
Out-of-pocket costs for Medicare beneficiaries as a share of income has increased from about 12% in 1997 to an estimated 19% in 2011, and they're projected to increase to 26% in 2020, assuming no changes in current law.
Overall, Medicare households spend three times more as a percent of income on out-of-pocket for health care compared to non-Medicare households.

Wednesday, February 8, 2012

States Should Expect Less Federal Medicaid Matching in 2014


| February 8, 2012 | Comments (0)
Based on preliminary projections of fiscal year 2014 FMAPs (Federal Medical Assistance Percentage—the share of each state’s Medicaid costs that the federal government covers), a majority of states should expect a decline in how much they will receive from the government, according to a report conducted by the National Association of Medicaid Directors.
About 30 states are projected to experience a decline, and only between four and seven could experience an increase, says the report.
“This reflects personal income shifts among the states as well as an unusual population growth pattern reported by the Census Bureau for 2009-2011,” it says. “Overall, the shifts are estimated to decrease federal Medicaid grants in FY 2014 by $1.1 to $1.9 billion when compared to the FMAPs for the current FY 2012, with decreases of $2 to $3 billion offset by somewhat more than $1 billion of increases for gaining states.”
Additionally, adjusting for Medicaid eligibility expansion under the Affordable Care Act could cause “financial and program disruptions, as the federal government attempts to derive blended FMAPs for the two parts of the program.”
This is bad news for nursing homes, many of which rely heavily on Medicaid reimbursements. A study released in 2011 revealed a $6 billion Medicaid funding shortfall to nursing homes that year.
Click here to view the report, which includes a table of possible changes in 2014 FMAPs and potential financial impacts for all 50 states.
Written by Alyssa Gerace

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Howard McGowan's avatar
Howard McGowan · less than 1 minute ago
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Wednesday, November 23, 2011

automatic cuts starting in 2013

Dear Howard,

The past few days have been bittersweet for the health care justice movement. On Monday, the 12-member, bipartisan “super committee” announced a failure to reach agreement on further reduction of the deficit. The Medicaid program was a primary target in negotiations, and cuts would have been devastating to seniors living in nursing homes, people with disabilities who receive home- and community-based services, and children for whom the program is a lifeline.

Thanks in large part to your hard work—district office visits, phone calls, emails, tweets, and sign-on letters—people on Medicaid and Medicare were spared from harmful cuts. In the end, the impasse was a fundamental difference in philosophy over revenues. Republican members were determined to use the process to extend tax breaks for the wealthiest Americans at a time when income inequality is on the rise and families are struggling to make ends meet. Unfortunately, the super committee’s failure to reach a deal means many programs important to low-income people (although not Medicaid) will see automatic cuts starting in 2013, on top of the $900 billion in cuts that Congress agreed to earlier this summer.

We all also received bad news yesterday that the National Association of Insurance Commissioners passed a resolution that would urge Congress and the Administration to exempt insurance agents and brokers from medical loss ratio calculations under the Affordable Care Act. Essentially, this recommendation would transfer more of consumers’ premium dollars away from actual medical care and weaken the protections that are a cornerstone of the law.

The events of this week foreshadow the battles we will see in the coming months. The news media and public dialogue will continue to be dominated by a conversation over our country’s values and our broader vision for the future. Will we, as a country, recommit ourselves to the American people and the essential elements—including access to health and health care—of the American dream? Or will we continue to protect tax breaks for the wealthiest 1 percent and corporate tax loopholes at the expense of the most vulnerable among us?

When I sit down with my family tomorrow at the Thanksgiving table, I will be giving thanks for my loved ones, most especially my 27-month-old grandson, and for you. Your efforts—your dedication, hard work, and sacrifice—have been and will continue to be critical to protecting Medicaid, Medicare, and the Affordable Care Act. There is a tremendous amount at stake in the coming year, and Families USA looks forward to working with you every step of the way.

In gratitude,

Ron Pollack
Executive Director

Tuesday, November 22, 2011

OLDER AMERICANS ACT

The stated purpose of the OAA is to ensure equal opportunity to the fair and free enjoyment of: adequate income in retirement; the best possible physical and mental health services without regard to economic status; suitable housing; restorative and long term care; opportunity for employment; retirement in health, honor, and dignity; civic, cultural, educational and recreational participation and contribution; efficient community services; immediate benefit from proven research knowledge; freedom, independence, and the exercise of self determination; and protection against abuse neglect and exploitation.[4]

Saturday, November 5, 2011

Joint Select Committee on Deficit Reduction (Deficit "Supercommittee").

Developments:

Nov. 3 Mitch McConnell, the Senate Republican leader, said that he saw no possibility of extending the deadline for a powerful joint committee of Congress to recommend ways of reducing the federal budget deficit. He spoke a day after a leading Democrat suggested that the committee could ask for more time if the current stalemate persists.

Background

The Joint Select Committee on Deficit Reduction is a bipartisan, 12-member panel created by the deal struck by President Obama and Congressional leaders in late July 2011 to allow the government to raise the federal debt ceiling.

The agreement called for at least $2 trillion in deficit reduction over 10 years to offset the $2.4 trillion increase in the amount the Treasury Department is authorized to borrow. The reductions were to come in two steps, with $900 billion being decided upon immediately, based on spending cuts negotiated between Republicans and Democrats in the months of talks that led up to the pact.

The second round of reductions is the business of the Joint Select Committee, which some in Washington have taken to calling the “supercommittee.”

The stated goal of the panel — evenly split between Democrats and Republicans, the House and Senate — is to reduce federal budget deficits by a total of at least $1.2 trillion over 10 years. It was given a deadline of Nov. 23, 2011. Any recommendations it makes are to be voted on immediately by both chambers of Congress, with no filibusters or amendments allowed.

If the committee cannot agree on a plan, or if Congress does not enact its recommendations by Dec. 23, the result would be $1.2 trillion in automatic spending cuts — called “trigger’' cuts — in January 2013, half of which would come from Pentagon programs. Medicaid and Medicare benefits would be exempt, although provider payments could be reduced.

The committee got underway in September under a cloud of pessimism. In late October, with less than a month till its deadline, a majority of Democrats on the panel offered up a plan that built on President Obama’s “grand bargain’' proposal that had been rejected by Republicans during the debt ceiling talks. It would cut a total of $2.5 trillion to $3 trillion, through cuts in the growth of federal entitlement programs, including Medicare, and more than $1 trillion in new tax revenues.

The proposal, which came after weeks of silence, has virtually no chance of winning approval from Republicans on the committee, who have repeatedly said they would not accept a package that included tax increases.




Democrats had concluded earlier in the fall that they might have — for the first time in many months — some sorts of advantages in the bargaining ahead.

Under the terms of the deal that created the committee, Republicans cannot threaten a default again to get their way, because the deal increased the debt limit enough to cover borrowing through 2012. Also, the automatic cuts in 2013 would hit military programs hard — an outcome Republicans are more eager than Democrats to avoid. And a stalemate could also lead to the expiration of the Bush tax cuts; Mr. Obama has vowed to sign an extension only for households with taxable income under $250,000.

Mr. Obama’s preference remains the “grand bargain” that eluded him with Mr. Boehner — with short-term stimulus measures and long-term deficit reduction greater than mandated for the committee, including higher revenues and savings from entitlement programs.

The slim hopes for a grand bargain rest on the parties’ mutual interest in overhauling the tax code to rein in tax breaks and using the new revenues to lower taxpayers’ rates. But Democrats and many budget groups say some of the new revenues should go to reduce deficits, while many Republicans insist that all must go to cutting tax rates.

Obama’s Deficit Plan

In September, President Obama outlined a plan for reducing the deficit by more than $3 trillion over 10 years.

His proposal called for $1.5 trillion in tax increases, primarily on the wealthy, through a combination of letting the Bush-era tax cuts expire for the most affluent taxpayers, closing loopholes and limiting the amount that high earners can deduct. The proposal also includes $580 billion in adjustments to health and entitlement programs, including $248 billion to Medicare and $72 billion to Medicaid. Administration officials said that the Medicare cuts would not come from an increase in the Medicare eligibility age. Tthe plan also counts a savings of $1.1 trillion from the ending of the American combat mission in Iraq and the withdrawal of American troops from Afghanistan.

At the committee’s first meeting on Sept. 8, several Republicans said that entitlements like Social Security, Medicare and Medicaid were the main cause of annual deficits and should be the panel’s focus. Democrats have long resisted cuts to those programs, but during the debt ceiling talks President Obama said he was willing to make changes in them in return for increases in tax revenue.

And members of both parties were feeling pressure to address the long-term costs of programs like Medicare before the baby boom generation moves into retirement and starts consuming more benefits.

Going Beyond the Mandate

By mid-September, more pressure was building on the committee to “go big” — beyond its mandate to shave as much as $1.5 trillion from budget shortfalls over 10 years — even as doubts remained about the panel’s ability to find enough bipartisan agreement to meet even the original goal.

A group of at least 57 prominent business executives and former government officials signed a petition in support of a greater deficit reduction. Among them were former treasury secretaries, budget directors and economic advisers to eight presidents from Richard M. Nixon to Mr. Obama; former Congressional leaders; and executives of top companies. The letter reflects a broad sense of urgency in both parties, and among economists and businesses, that the nation must put in place long-range measures to shrink future deficits. At current spending levels, those deficits are expected to balloon over the next decade as the population ages and as health care costs rise.

The letter did not call for short-term job-creation measures like the tax cuts and infrastructure spending Mr. Obama proposed on Sept. 8, which would add to deficits initially. Even so, many of the signers, liberals and conservatives, called for such steps.

Who’s Who on the Panel

The committee’s members were appointed by the Senate majority and minority leaders, the speaker of the House and the House minority leader.

Senate majority leader Harry Reid named Senator Patty Murray, Democrat of Washington, co-chairwoman of the new committee and appointed two other Democratic senators, Max Baucus of Montana and John Kerry of Massachusetts, to the panel. Ms. Murray is chairwoman of the Senate Democrats’ campaign arm, the Democratic Senatorial Campaign Committee.

Speaker John A. Boehner chose three senior Republican House memebrs: Jeb Hensarling of Texas, and Dave Camp and Fred Upton, both from Michigan. Mr. Hensarling, who is chairman of the House Republican Conference, will be co-chairman of the new panel. The Senate Republican leader, Mitch McConnell of Kentucky, chose Senators Jon Kyl of Arizona, Rob Portman of Ohio and Patrick J. Toomey of Pennsylvania.

Representative Nancy Pelosi of California, the House minority leader, named three members of her caucus’s leadership: Representative James E. Clyburn of South Carolina, the No. 3 House Democrat; Representative Xavier Becerra of California, vice chairman of the Democratic Caucus; and Representative Chris Van Hollen of Maryland, the senior Democrat on the House Budget Committee.

The deal that created the committee was criticized by some liberals in Congress as a “heads they win, tails we lose’' proposition, guaranteeing that a Republican refusal to consider tax increases would result in the spending cuts that Republicans consider the best approach to deficit reduction.

It was criticized by some conservatives — and by all but one of the 2012 Republican presidential candidates — for allowing the possibility of tax increases, and for not cutting into entitlements. Social Security, Medicaid and Medicare benefits were all exempted from the automatic cuts.

Some members of both parties complained that the panel would usurp their authority to write legislation.

Within days of the deal being struck, both sides began to maneuver for advantage. A fight broke out specifically over whether the amount of deficit reduction should be calculated by comparison to current law, under which all of the Bush tax cuts would expire in 2012, or in comparison to proposals to extend most of the tax cuts, as Democrats want, or all of them, as Republicans propose. If current law is used, more cuts elsewhere would be needed to offset the loss of the revenues that would follow the expiration of the tax cuts.

Commissions in the Past

The options on the table have been studied by numerous expert panels, including several in the past year. The problem is not so much determining how to align the government’s revenues and spending; it is in reaching a compromise on the specific elements of a plan and then finding the political will to enact the necessary spending cuts, tax increases or both.

In the last six decades, Washington has turned to more than a dozen blue-ribbon panels to grapple with fiscal problems. These include the 1947-49 Hoover Commission, the 1982-84 Grace Commission and most recently, the Simpson-Bowles Commission, a bipartisan panel President Obama created by executive order in 2010 that included 12 sitting members of Congress.

The panels were often devised as a way to give political cover to policy makers so they could make unpopular changes to things like entitlements and tax rates. In most cases, though, Congress ignored the proposals or deferred action.

Even the panel usually held up as the exception that proved the rule, the 1981-83 Greenspan Commission set up to revamp Social Security, was largely a failure.

According to an unpublished memoir written by one of the now-deceased members of the commission, the panel deadlocked and then splintered. President Reagan and the House leadership were able to eke out a deal to save Social Security only by engaging in separate negotiations just as the entitlement program was about to go bankrupt.

Tuesday, September 20, 2011

Debt Ceiling Compromise and Super Committee

Legislative Update

At the beginning of August, President Obama and Congressional leaders passed a bipartisan debt ceiling compromise. This package gives the President the authority to raise the debt ceiling by $2.1 trillion and eliminates the need for another increase until 2013. This was an important political move for those who wanted to avoid another vote until after 2012 election.

The measure cuts $1 trillion in domestic and defense spending over 10 years. While this legislation does not include any upfront cuts to Medicaid, there are still serious lingering threats. The proposal creates a bipartisan committee of 12 members of Congress, tasked with identifying an additional $1.5 trillion in cuts through entitlements (including Medicaid, Medicare, and Social Security) and tax reforms. This “super committee” will need a majority vote to pass a recommendation along to Congress before Thanksgiving of this year. Congress will be required to vote on the committee’s recommendations before Christmas. If the committee comes to a gridlock, an enforcement mechanism will trigger automatic across-the-board cuts, split evenly between domestic and defense spending. However, the enforcement protects low-income programs, such as Medicaid, as well as Social Security and Medicare from cuts. For more information, click here.The super committee held its first logistical meeting on September 8, and its first public hearing on September 13.

The 12 members are Senators Max Baucus (D-MT), John Kerry (D-MA), Patty Murray (D-WA), Jon Kyl (R-AZ), Rob Portman (R-OH) and Pat Toomey (R-PA), as well as Representatives Chris Van Hollen (D-MD), Jim Clyburn (D-SC), Xavier Becerra (D-CA), Fred Upton (R-MI), Dave Camp (R-MI), and Jeb Hensarling (R-TX). If one of the members is from your district or state, you can reach them by setting up visits in his or her local district offices, making phone calls, and/or writing a letter

Sunday, June 19, 2011

CLASS ACT

When will the CLASS Act begin?

While provisions of the CLASS Act become effective in 2011, there are so many details to be worked out that most experts don't expect the plan will actually become available until 2013. (The law says details are not due until the final months of 2012.

Costs have to be determined. Employers must be given sufficient time to educate employees and prepare to start withholding premiums from employee paychecks. Systems have to be in place to accept and keep track of monies withheld from participants.

Following implementation and withholding of the first payments from employees' paychecks, there is a five-year waiting period during which premiums must be paid before the participant becomes eligible to receive benefits. As a result, the earliest anyone could be receiving CLASS benefits may be as late as 2018.

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Who will pay - will it cost me money?

CLASS is intended to be a voluntary plan primarily offered by employers and paid for by employees. Or simply stated, money will be withheld from individual paychecks -- similar to the way Social Security (FICA) tax payments are withheld from paychecks.

There are provisions to make the CLASS offering available to others who may be self-employed or who may not have access to the plan through an employer. These also will have to be defined and systems established.

Congress made CLASS an "opt out" plan. This is an important point that people need to be aware of. Unlike Social Security or Medicare that are mandatory, CLASS is a "voluntary, opt-out" plan. If that sounds confusing, it is. Read the question below regarding "opt out".
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