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The 2019 New York State legislative session will get underway in less than a month with a major change in the cast of characters including the new Democratic Majority in the Senate. Senator Andrea Stewart-Cousins was elected the Majority Leader and she will have a big job trying to set the tone with fifteen new members of the Democrats 40 members. They will be able to move many bills that have been stopped by the Senate Republicans in the last several years. The Majority Leader will have to make key decisions about who will lead various committees. Senator Sue Serino who had been chair of the Aging Committee will be replaced by a Democrat. Long-time Senator Kemp Hannon who chaired the Health Committee for many years was defeated. Senator Gustavo Rivera was the ranking Democrat on that committee but it is unclear if ranking members will all take over to chair their committees.
A big concern for lobbyists and advocates will be the new faces on the Senate staff. There is a big turnover of staff who are the people they have been dealing most on a day to day basis. Many staffpersons who have worked on the Senate majority staff are losing their jobs and Democrats have to quickly hire many new staffpersons for committees and for central staff including budget and finance staffpersons.
Democrats will continue to have the majority the Assembly and there will be just the normal turnover with some new members. Program and budget staffpersons in the Assembly do not know now who all their counterparts will be on the Senate staff who they will need to interact with on a daily basis.
Advocates and lobbyists as well as the media and public are trying to figure out how the Assembly, Senate and Governor Cuomo are going to interact, especially if the two houses stake out more liberal positions than the Governor. Cuomo will be tested to see if he will support many of the reform measures new members and both majorities in the houses want including voting and ethics reforms. Democrats are expected to push for legislation to enact early voting and ending a loophole allowing corporations to donate huge amounts of money. Democrats led by Assembly Health Chair Richard Gottfried will again push hard for a state single payer health system with his NY Health bill.
What is the relationship between artificial intelligence and emotion? That is a big question that is the subject of much discussion in Silicon Valley as big technology companies are on the cusp the next sweeping change in society that could transform everyday life as much as the computer and internet did in the 1980s and 1990s. This subject was also discussed by a group of seniors and professionals in Albany recently following a workshop some had attended at the national meeting of the Village to Village Network in San Diego in October. Presenters there described how robots in the form of pet animals are keeping older people company as well as other robots providing reminders throughout the day to take medications at certain hours and other inquiries. Nursing homes are beginning to use the robots too to assist with some tasks.
Of course, the most recognizable form of artificial intelligence for many persons is the personal assistant such as Alexa from Amazon which answers questions and gets information with a voice command. Robots though can be super Alexas and personal assistants who have the ability to be programmed to do things that humans sometimes can’t do, such as helping an immobile older person in a wheelchair being able to more quickly retrieve something or finding something for a person with limited vision.
The issue of emotion though is one that is getting a lot of attention. In the group discussion in Albany, some were uncomfortable with the idea that a robot would replace human contact. After all, a robot cannot assess a living environment or a person’s full social and service needs. Yet, many older persons who have been using the robot animals became attached to them as they would a pet because the robot was always there and had been programmed to provide conversation.
Many of us want to learn more about this evolving technology and it is probably a good idea in every community to arrange workshops with local health providers and technology companies representatives to discuss issues. We probably should all keep an open mind. We probably are all uncomfortable with the idea that machines will be able to replace humans with many tasks but human contact and human direction remains most important while using technology as an aid not a master.
Today is Giving Tuesday, a day of charitable giving that was developed in recent years to follow Black Friday and Cyber Monday. In a few short years, giving has topped $300 million nationally to national and local charities which are now gearing their publicity and outreach to the event. The Albany Times Union is running two full pages of ads for local charities that paid for them. The ads ran in the paper on Monday and Tuesday. The paper is also running ads on December 13 and 14 for year end donations to charities.
Charities are concerned though about the first year of impact of the federal tax bill passed last year which significantly raised the standard deduction to $24,000. This change is a disincentive to charitable giving since previously, charitable donations were able to be deducted with a lower standard deduction if they were itemized. Now that the standard deduction has been doubled, taxpayers would have to give substantially more money to itemize deductions. And, with the change limiting state income and property taxes to $10,000, there is less likelihood most taxpayers will be able to reach the new $24,000 standard deduction. So, most middle and upper income taxpayers will simply be taking the new standard deduction and giving to charities without a tax benefit. Wealthy taxpayers will still probably itemize if they have been giving substantial amounts to charity.
Despite the threats to fundraising, charities are getting more adept at using email and social media to push for volunteers and donations, setting goals online and promoting the drive. Online fundraising has become the key medium for charities. And political candidates like Beto O’Rourke who ran for the Senate in Texas have proven the ability to raise huge amounts of money online.
We are in the Medicare open enrollment period until December 7th and seniors and persons with disabilities are getting a barrage of advertising in their mail, email and in television and newspaper ads. Medicare has become more profitable for these private and nonprofit health plans in Medicare with the government boosting their payments by 3.45% for 2019. There are now 3700 such local and regional plans across the nation. The Trump Administration is predicting up to 50% of beneficiaries will soon choose these plans. About 23 million Medicare beneficiaries are predicted to be in Medicare Advantage in 2019. This has become a very confusing exercise for many beneficiaries unless they decide to simply stay with original Medicare and can have their choice of doctors and providers.
The Advantage plans though are trying to entice beneficiaries with $0 monthly premiums, gym memberships and some dental and hearing aid costs covered along with other perks. How do they do this? They try to attract healthier persons and have a restricted network of providers. They also have prior authorization rules for some treatments In fact, a recent report from the Office of Inspector General at the Department of Health and Human Services says it has found “widespread and persistent problems related to denials of care and payment” in the Medicare Advantage program. It found that 75% of appeals were overruled though most people do not appeal or know how to.
The Medicare Care Advantage market nationwide is dominated by Aetna, Humana and United Healthcare but there are many smaller and more regional insurers. 10,000 persons are turning 65 every day and they are more accustomed to having managed care coverage from private employers. With government funding increasing many insurers are entering the Medicare market and the three dominant companies plan to expand into 97 more counties nationwide. The for profit companies are reportedly making a profit margin that is double that of other nonprofit Medicare Advantage plans.
Progressive activists are continuing to push for a Medicare for All single payer plan nationwide to extend health coverage to all Americans and cut into the overhead and profit of private insurers.
New York State turned a deeper shade of blue on Election Day as Democrats, which needed one seat to take over the New York State Senate won eight seats. They now will have a majority of 40 members with Republicans having only 23. About one fourth of the Senate members will be new after the election. It will be very difficult for Republicans to regain control of the Senate anytime soon.
Assembly Democrats continue to hold a dominant majority. Governor Cuomo and Comptroller Thomas DiNapoli were re-elected easily along with the new Attorney General, Democrat Latitia James. Senator Kirsten Gillibrand won 66% in her re-election bid and she already said she is considering running for President in 2020.
Victories for the Democrats mean that Senator Andrea Stewart-Cousins of Westchester will become the new Senate Majority Leader, the first woman and African American in that position. Outgoing Majority leader John Flanagan may face competition for the position of Minority Leader. The Republicans had nine members in the Senate from Long Island but will have only three now so upstaters may want one of their own to lead the GOP.
Many familiar faces who have been in Albany for decades will be gone including Senators Kemp Hannon, Martin Golden and Carl Marcellino who were all defeated. Others including Jeff Klein, Tony Avella, David Valesky, Marisol Alcantara and Jose Peralta, who were members of the Independent Democratic Caucus were defeated in September primaries after a rebellion by progressive Democrats. Others who retired and not coming back are John DeFrancisco, John Bonacic, Bill Larkin and Kathy Marchione. The new Senate Democratic Majority will be much more diverse than the Republicans who ran the chamber.
Hannon had chaired the Health Committee for many years and now there will be a new Democratic chair. Senator Gustavo Rivera has been the ranking member of that committee but it is unclear if he will become Chairman of the committee. Others with more seniority may want that high profile position. Senator Sue Serino who has been chair of the Aging Committee was re-elected but will no longer be chair. Usually, a Senator without a lot of seniority becomes chair. It would be ironic if new Senator Alessandra Biaggi, who defeated Jeff Klein becomes Aging Chair. Her grandfather, Congressman Mario Biaggi, was the legendary first Chair of the Aging Committee in the US House of Representatives forty years ago.
Meanwhile, Democrats won three seats in Congress in New York, leaving Republicans with only six of the state’s 27 seats. Democrat Antonio Delgado defeated John Faso in a seat in the Mohawk and Hudson Valleys. Assemblyman Anthony Brindisi ousted Claudia Tenney in central New York and Max Rose defeated Daniel Donovan on Staten Island, meaning there will no longer be any Republicans from New York City in the House of Representatives Indicted Congressman Chris Collins was re-elected in western New York. Other remaining Republicans are Peter King and Lee Zeldin on Long Island and Elise Stefanik from northern New York, John Katko from central New York and Thomas Reed of the Southern Tier.
As he campaigns in Congressional races, President Trump has ramped up his rhetoric and his plans to lower prescription costs, a position he took during his presidential campaign but has yet to deliver on in a big way. Now, he and the Health and Human Services Secretary for the first time are proposing using prices from other countries as a basis for determining costs for drugs in Medicare. However, this plan only relates to drugs under Medicare Part B given in doctors’ offices rather than the broader Part D drug program for medicine received at a pharmacy.
Trump is also proposing that drug companies be forced to advertise the cost of their drugs publicly. The pharmaceutical industry is pushing back saying listed prices are not paid by most consumers since rebates are given to insurance plans which then charge co-pays to customers to pay part of the costs. Another bill that has passed both houses ends the gag rule imposed by pharmacy benefits managers which forbids pharmacists from telling patients they can get lower prices at the pharmacy counter by paying cash and not using their insurance for some low cost drugs. This bill does not cover prices for generic drugs though.
Democrats have been pushing for years for Medicare to negotiate systemwide on the price of drugs. The Trump Administration and Republicans in Congress have rejected that approach as hurting pharmaceutical companies research and developments costs. Trump’s fixation on international trade deals has made drug prices a target because he sees the US footing the entire bill for development costs and not getting the cost break that other countries do through negotiated prices by their national health plans.
It is really unclear if Trump will work hard to push these new pricing and advertising plans beyond the election. He seems to be offering many different ideas like a new tax cut, this drug plan and others just to get attention for voters during the campaign. However, even if he doesn’t push his own plans, the pharmaceutical industry is worried that Trump will team up with Democrats if they take control of the House of Representatives and agree on a broad plan to lower prices related to other countries or allow negotiation on drug prices for Medicare.
I have said for a long time that the pharmaceutical industry only has itself to blame for this predicament as it has engaged in setting exorbitant prices for insurance plans and customers by charging whatever they can get away. Politicians have been literally paid off by huge campaign contributions and they have refused to intervene to protect the public. There are too many sweetheart deals and loopholes that allow higher profits to be shared by pharmacy benefits managers and drug companies. Some in Congress say that government should not interfere in the pricing of drugs but they forget that the government is one of the biggest payers of health care in the country and it already negotiates prices for the Veterans Administration and other programs.