Federal Budget Deal Rolls Back Medicare Premium Increases and Social Security Disability Cuts

In a surprising piece of good news, the usually dysfunctional Congressional leadership came to an agreement with President Obama on legislation that would prevent a government default and enact an overall budget that increases some spending and raises revenues.  Ironically, this seemed only to be possible once House Speaker John Boehner had announced his resignation and his job was in jeopardy of an overthrow by the so-called Freedom Caucus of conservatives.  Those conservatives will likely vote against the deal but Boehner is free to bring it to the floor where he will get more than enough Democrats to support it to win easy passage.

I have previously reported on the threat to the Social Security disability trust fund which was schedule to run out of money in 2016.  It will now be allowed to borrow from the Social Security retirement funds and extend the disability fund until 2022.  There will be some minor cuts in the program resulting from changes to encourage disabled persons to work and requiring a doctor to examine applicants for the benefits.

The budget legislation also averts the large increase in Medicare Part B premiums for the 30% of beneficiaries who were going to see those premiums rise from $105/monthly to $159/monthly.   The legislation allows an increase to only $120/month.  This increase will not apply to most Social Security recipients who, by law, cannot see their benefits decrease because of increased Medicare premiums.  Since Social Security officials recently announced there will be no cost of living increase in 2016, the Medicare Part B premium cannot increase for 70% of beneficiaries.  Also, the annual Medicare deductible will increase from $147 to $167 rather than the $223 that was going to take effect without the new legislation.  General revenues will provide a “loan” to Medicare to pay for these changes which will be paid back with slightly higher premiums over five years.

All this shows that Congress can compromise and make changes that help people while also including some reforms that save money.  As Senator Harry Reid said “We did what we should be doing, sitting down and talking through our differences.”

Referring to the Social Security disability trust fund dilemma, Nancy Altman, the president of Social Security Works, said, “The hostage has been released.”

Village Movement Pushed in Capital District, Upstate

Representatives of grassroots senior neighborhoods and villages in the Capital District joined with experts leading villages in the Northeast and the national Village to Village movement in Albany yesterday.  They came together to discuss steps building successful local villages around the country.  Leaders of villages in Westchester and Cape Cod along with Natalie Galucia, the Village to Village Network national director from St. Louis, took part in the program sponsored by the Albany Guardian Society which is planning to facilitate and support local groups interested in villages and aging in place/community projects.  The village movement started with Beacon Hill Village in Boston as neighbors banded together to form self help, co-op type associations to provide services to dues paying older persons to help them to remain living in the community.  In New York State recent new villages have sprung up in Rhinebeck and Ithaca.  Here is a link to the villages operating or in formation in the state.

http://vtvnetwork.org/content.aspx?page_id=1905&club_id=691012#search_results

In the Capital District, representatives from a  existing village in the Glens Falls area attended along with others from several towns including Glenmont, Glenville, Guilderland and the City of Albany where Senior Services of Albany has just launched Livingston Village.  That village in north Albany is located in a renovated public school that has become apartments.

It is a very inspiring movement that is being run at the grassroots level to create a “new aging services network” according to Lois Steinberg, the director of the Center for Aging in Place in Westchester County.  She discussed how the nine villages in the county help to give meaning to older persons who become volunteers.  They create new friendships and connections at a time in life that is often characterized by losses of friends and a narrowing social network.  She said the villages help to keep people at home, out of nursing homes and paying taxes.   People are happier and healthier if they have a social support system offered by the villages.

For more information about future meetings, you can contact the Albany Guardian Society at (518) 434-2140.

Older Woman with Dementia Held in Albany County Jail for Violating Restraining Order

The plight of an older woman in her 60s  illustrates the need for change in how we deal with people with dementia.  It came to my attention a couple weeks ago that this woman who I know was in Albany County jail for violating a restraining order .  Apparently, she had become quite hostile and harassing of a local establishment which she tended to visit several times  a day.  Of course, the hostility is a symptom of the dementia.  The shop got a restraining order against the woman and when she violated it she was arrested.  Friends from church wrote to the judge urging him to have the woman’s case handled through the health system and not the criminal justice system.

As of the end of last week, she was still in jail and hopefully she will be placed somewhere else soon.  While in the mental health unit of the jail they did a mental health evaluation that concluded she has Alzheimers.  The hostility was out of character for her and certainly was responsible for her arrest.

In my mind, she should have been bailed out and put in a facility while the evaluation was done, but the county’s adult protective services said there was no place to take her to.  She has a son who is trying to understand and deal with all this and is going to seek guardianship for his mother.  His mother also has been scammed and apparently lost thousands of dollars.

Fortunately, the local Alzheimers Association chapter has caseworkers who can help the son and his mother.  They will help refer him for legal assistance regarding the guardianship.   And, they told me that if the scam losses were on a credit card, they may be able to have them eliminated  if the credit card had disability insurance.

I hesitate to make grand judgments on cases like this when I was not the one having to deal with it for the county.  However, I do feel that we must deal with people who have dementia and Alzheimers outside of the criminal justice system.  Of course, there was a concern about housing or being admitted to a facility and many don’t want someone who is disruptive.  So, there are issues related to medication but that begs the point that a geriatrician should be involved in these cases.  The geriatrician  can work with neurologists, and aging and health providers to make sure that these types of jail situations can be avoided or quickly addressed to provide the kind of treatment and care that this woman and others need.

No Social Security COLA Has Domino Effect on Medicare Premiums, Deductibles

The official news came from the federal government yesterday what has been mentioned for weeks:  there will be no cost of living adjustment (COLA) for Social Security beneficiaries in 2016 because the Consumer Price Index showed no increase in inflation.  That issue itself is subject to controversy because the measure used, ” a broad measure of consumer prices for urban wage earners and clerical workers,” does not fully reflect higher health costs, seniors and their organizations say.  In fact, it was the decline in gas and energy prices that led to the index determining that there is zero inflation.  However, ask any older or disabled person about the out of pocket costs for health care and prescription drugs and they will assure you that costs have not stayed flat but have escalated.

The lack of a Social Security COLA has big consequences for Medicare.  Most beneficiaries have Medicare premiums taken out of their Social Security paycheck.   The law protects them from having their monthly check go down; Medicare premium increases can’t exceed the Social Security COLA.  With no COLA, about 70% of Medicare beneficiaries are protected from higher Medicare Part B premiums.  However, the other 30% are new beneficiaries, higher income beneficiaries and those on Medicaid and Medicare whose premium increase will have to be paid by state Medicaid programs.  Since the Medicare law says Part B premiums have to cover 25% of costs, the 30% of beneficiaries not held harmless have to pay higher premiums to meet the 25% overall threshold.  That will mean large premium increases from $105 monthly to $159 monthly and even more for higher income beneficiaries who were required to pay more.  Some could pay over $500 per month from $335 per month now.  The Medicare Part B annual deductible could also rise from $147 to $223.

This domino effect is causing concern at the White House and Congress and the New York Times reports today that the Obama Administration is considering taking money from Medicare’s reserves to reduce the increases for the 30% of beneficiaries effected.  Some members of Congress are looking for a fix too but with the chaos in the House of Representatives about picking a new speaker and the need to pass budget and debt extensions, it is unclear what will happen.  Outgoing Speaker John Boehner could come up with a deal before he leaves though.

Heading into a Presidential and Congressional election year, action better be taken or lawmakers run the risk of being held responsible for rules that have led to big increases for some.  The Social Security cost of living index also needs to be changed to better reflect costs of seniors and the disabled.  Just a few years back, President Obama and others were considering support for a “chained CPI” or consumer price index that would have measured inflation in a way that would have reduced increases.  It used a method to say that people compensated in their spending habirts when costs go up.  However, now with Social Security not having to pay an increase for a whole year, the trust fund will grow.  The chained CPI should be thrown out and something more accurate used.  After all, if there had been a slight increase in the COLA this year, the effects on Medicare would have been minimized somewhat.  Now, if the government goes ahead and uses Medicare reserves, is going to be paying out more money anyway.  It’s time to adopt a more rational approach that doesn’t produce this kind of big 50% premium increase that could hit about a third of Medicare beneficiaries.

New York State is Top Target of Physician Assisted Suicide Lobby

Now that California Governor Jerry Brown has signed into law a bill approving physician assisted suicide, national advocates have indicated that New York State is their top state priority to enact similar legislation in 2016.  Compassion and Choices, the leading advocacy group for the bill has hired Corrine Corey as the new campaign director for the legislative session.

California is the fifth state to approve the use of doctor prescribe drugs to take one’s life.  A bill to allow it in New York is sponsored by Assemblywoman Amy Paulin and Senator John Bonacic.  The California bill passed despite the strong opposition of the Catholic Church, hospice advocates and the disability community.  The California Medical Society’s decision to switch from being opposed to being neutral is viewed by some as the key to the success of the bill which had not been approved in the past.

Opponents of the New York State bill are gearing up and a November 7th training and education day is being planned near Albany to discuss the issue and strategies to defeat legislative bill.  This is part of a national effort helping states to defeat physician assisted suicide.

Senator Flanagan Open to Support Paid Family Leave

State Senate Majority Leader John Flanagan, speaking at an event sponsored by Crain’s Business this week, said he supports paid family leave in concept and is open to considering legislation in the coming session.  He said, “The details on something like that are extraordinarily  important.  So in terms of discussion, we’ll have those.  I’m not afraid to engage in that internally or externally.”

The State Assembly passed a paid family leave bill in the spring which uses the state’s temporary disability program and employee contributions to pay up to two thirds of a regular salary for up to twelve weeks.   Employees who are caring for a newborn or a sick family member can take the leave with a doctor’s statement.  Of course, this would benefit many family caregivers of seniors.

Employees would pay the extra cost through payroll deductions to get the disability benefit.  However, that benefit is below $200 weekly right now and the push to raise that above the current level would be split with the employer. The Senate has concerns about the impact on business to provide greater contributions to raise the current benefit to over $600. Previously, Senator Jack Martins, chair of the Labor Committee expressed interest in paid family leave and held a hearing in Albany last spring.  He said he would like to hold more hearings.  Flanagan said the legislation should be thoroughly studied.

The political prospects of the bill are now somewhat related to the major push Governor Cuomo has announced to get legislation passed to raise the minimum wage to $15/hour.  A wage board he convened agreed to the raise to be phased in for fast food workers only.  The Governor plans a full court press on the minimum wage issue.  His office also is planning to have discussions with the Paid Family Leave Coalition and has expressed some interest in the bill. However, there is concern that the business community will object to being hit with two major bills like this that would increase their employee costs.  There is some thinking that the Senate may actually push ahead on paid family leave since it will be less of a burden than the raise in the minimum wage statewide to $15 which has more opposition as well.