December 12

Ryan says Republicans to target welfare, Medicare, Medicaid spending in 2018

House Speaker Paul D. Ryan (R-Wis.) said Wednesday that congressional Republicans will aim next year to reduce spending on both federal health care and anti-poverty programs, citing the need to reduce America’s deficit.

“We’re going to have to get back next year at entitlement reform, which is how you tackle the debt and the deficit,” Ryan said during an appearance on Ross Kaminsky’s talk radio show. “… Frankly, it’s the health care entitlements that are the big drivers of our debt, so we spend more time on the health care entitlements — because that’s really where the problem lies, fiscally speaking.”

Ryan said that he believes he has begun convincing President Trump in their private conversations about the need to rein in Medicare, the federal health program that primarily insures the elderly. As a candidate, Trump vowed not to cut spending on Social Security, Medicare, or Medicaid. (Ryan also suggested congressional Republicans were unlikely to try changing Social Security, because the rules of the Senate forbid changes to the program through reconciliation — the procedure the Senate can use to pass legislation with only 50 votes.)

“I think the president is understanding that choice and competition works everywhere in health care, especially in Medicare,” Ryan said. “…This has been my big thing for many, many years. I think it’s the biggest entitlement we’ve got to reform.”

Ryan’s remarks add to the growing signs that top Republicans aim to cut government spending next year. Republicans are close to passing a tax bill nonpartisan analysts say would increase the deficit by at least $1 trillion over a decade. Trump recently called on Congress to move to cut welfare spending after the tax bill, and Senate Republicans have cited the need to reduce the national deficit while growing the economy.

“You also have to bring spending under control. And not discretionary spending. That isn’t the driver of our debt. The driver of our debt is the structure of Social Security and Medicare for future beneficiaries,” Sen. Marco Rubio (R-Fla.) said last week.

While whipping votes for the tax bill, Senate Finance Committee Chairman Orrin G. Hatch (R-Utah) attacked “liberal programs” for the poor and said Congress needed to stop wasting Americans’ money.

“We’re spending ourselves into bankruptcy,” Hatch said. “Now, let’s just be honest about it: We’re in trouble. This country is in deep debt. You don’t help the poor by not solving the problems of debt, and you don’t help the poor by continually pushing more and more liberal programs through.”

Trump has not clarified which specific programs would be affected by the proposed “welfare reform,” though congressional Republicans are signaling that they aim to impose work requirements on food stamps and direct cash assistance for the poor.

“We have a welfare system that’s trapping people in poverty and effectively paying people not to work,” Ryan told Kaminsky on Wednesday. “We’ve got to work on that.”

Liberals have alleged that the GOP will use higher deficits — in part caused by their tax bill — as a pretext to accomplish the long-held conservative policy objective of cutting government health-care and social-service spending, which the left believes would hit the poor the hardest.

“What’s coming next is all too predictable: The deficit hawks will come flying back after this bill becomes law,” said Sen. Ron Wyden (D-Ore.), the ranking Democrat on the finance committee, during a speech on the tax debate. “Republicans are already saying ‘entitlement reform’ and ‘welfare reform’ are next up on the docket. But nobody should be fooled — that’s just code for attacks on Medicaid, on Medicare, on Social Security, on anti-hunger programs.”

On the Senate floor during the tax debate, Sen. Bernie Sanders (I-Vt.) asked Rubio and Sen. Patrick J. Toomey (R-Pa.) to promise that Republicans would not advance cuts to Medicare and Social Security after their tax bill. Toomey said that there was “no secret plan” to do so, while Rubio said he opposed cuts to either program for current beneficiaries. However, neither closed the door to changing the programs for future beneficiaries.

“I am not going to support any cuts to people who are on the program and need those benefits. But I want this program to survive,” Toomey said. To which Sanders responded: “He just told you he’s going to cut Social Security.”

Many conservatives have long argued for cutting and changing social safety net programs, arguing that anti-poverty programs have failed and that Social Security spending is growing at an unsustainable rate.

Still, members of both parties have long been reluctant to cut benefits, especially for seniors, due in part to the potential political cost of doing so. In discussing changes, Republicans, including Rubio, have largely confined their ideas to plans that would affect new beneficiaries, rather than current ones.

But it may be particularly difficult for Republicans to push those measures ahead of the 2018 midterm elections, in which many in swing states and districts face well-funded Democratic challengers hoping to ride an anti-Trump wave into office.

Ryan said he’s optimistic, adding that Republicans could target the Affordable Care Act and Medicaid next year in addition to Medicare, despite their failure to repeal the health care law in 2017.

“What it is we really need to convert our health care system to a patient-centered system, so we have more choices and more competition. Choice and competition brings down prices and improves quality; government-run health care is the opposite of that,” Ryan said. “So I think these reforms that we’ve been talking about, that we’re still going to keep pushing, that will help not just make Medicaid less expensive … but it will help Medicare as well.”

Article By Jeff Stein via The Washington Post

December 11

Bill would make it easier for workers to bring age discrimination cases

By Lois A. Bowers, Senior Editor

A bipartisan group of senators introduced legislation aimed at making it easier for older Americans to bring work-related age discrimination cases as the United States marks the 50th anniversary year of the passage of the Age Discrimination in Employment Act.

The Protecting Older Workers Against Discrimination Act, sponsored by Sen. Bob Casey (D-PA) and co-sponsored by Sens. Susan Collins (R-ME), Chuck Grassley (R-IA) and Patrick Leahy (D-VT), would amend the ADEA to restore plaintiffs’ burden of proof to where it had been before a ruling in a 2009 Supreme Court case (Gross vs. FBL Financial Services) established a more stringent standard. The ADEA prohibits employment discrimination against those aged 40 or more years.

Casey discussed the newer legislation Wednesday in his opening remarks during a Senate Special Committee on Aging hearing at which the committee also issued a report on opportunities and challenges related to the aging workforce. He is the ranking member of the committee, and Collins is the chairman.

“As baby boomers were turning 65, a U.S. Supreme Court decision weakened ADEA protections,” Casey said. “We’ve got to fix that.”

The bill’s prospects are uncertain, however. Casey introduced it at the end of February and it was referred to the Committee on Health, Education, Labor and Pensions, but the committee has not taken action on it.

But regardless of the fate of the legislation, the government and employers can take steps to try to meet the needs of an aging workforce, according to the Aging Committee.

“Exemplary” employers “are instituting policies and programs such as flexible schedules, family caregiving information and referral services, and retirement planning,” Collins said. “Others are providing ergonomic office designs and changing cultures to welcome workers across the spectrum of age and disability levels.”

The importance of doing so will become even more evident over the next decade, Collins said.

“While the labor force as a whole is projected to grow by an average of just 0.6 percent per year between 2016 and 2026, the number of workers ages 65 to 74 is projected to grow by more than four percent annually, and the number of workers ages 75 and above is projected to grow by nearly seven percent annually,” she said.

Policies that can benefit workers, employers, their communities and the country, according to the committee’s report, should:

Allow for the flexibility of individuals to carve their own career paths and determine for themselves when and how they retire.

Value and respect the decisions of older adults to continue working, to volunteer or to find another way to achieve their personal and professional goals.

Help workers remain financially secure while confronting challenges that may arise with age, such as caregiving responsibilities or health conditions.

Allow employers the flexibility to creatively meet the individual needs of their workers while ensuring that employees are provided ample opportunities to grow and thrive in the workplace.

Health-related industries are among those that would benefit from a revised outlook, according to the report, which cited 2015 research by the Society for Human Resources Management.

“Even though the health and social service occupations (e.g., registered nurses, personal care aides) are projected to be among the fastest growing in the next decade, human resource professionals from these industries were not any more likely to formally consider the aging of the workforce than any other industry,” the authors said of the study. “They also were less likely to offer apprenticeship programs to recruit and retain aging workers.”

December 8

National long-term care spending hits all-time high at $163 billion

Americans spent nearly $163 billion on nursing care facilities and continuing care retirement communities in 2016, according to a new federal report.

The Centers for Medicare & Medicaid Services’ National Health Care Spending report for 2016, published Wednesday in Health Affairs, found that total healthcare spending in the United States increased 4.3% in 2016, reaching $3.3 trillion.

When it comes to long-term care, $162.7 billion was spent last calendar year. That marks the highest point in total nursing care and CCRC spending to date, compared to $140.5 billion in 2010. The annual growth rate for nursing care facilities and CCRCs hit 2.9% for 2016, down from 3.7% the prior year.

All Medicaid-related goods and services experienced slower growth in 2016 than in previous year, save for nursing homes and CCRCs, according to the report. Total Medicaid expenditures for 2016 increased 3.9% to reach $565.5 billion. In total, Medicaid spending made up 17% of the nation’s total health expenditures for last year.

Medicare spending made up 20% of total healthcare spending in 2016, at $672.1 billion. Medicare fee-for-service spending growth slowed down in 2016, due in part to declines in spending on nursing home, the report found. That drop in Medicare spending for long-term care was driven by a lower use of services and a smaller increase in the Medicare reimbursement rate.

The overall slower growth of healthcare spending in the U.S. in 2016 is likely due to a deceleration of the “major changes” experienced by the industry in previous years, such as provisions of the Affordable Care Act that expanded insurance options. For that reason, 2016 may mark “a return to the more typical relationship between annual rates of growth in healthcare spending and growth in nominal GDP,” researchers wrote.

A recent report from Health Affairs projected long-term care spending to continue to climb over the next decade, driven by the rapidly aging U.S. population. That report predicted that nursing facilities and CCRC spending would grow at an average rate of 5.2% per year until 2024, reaching $274 billion in total spending.

Article Courtesy of McKinights Long Term Care News
By Emily Mongan

December 7

Restructured tax code would unduly burden people with disabilities

By Peter Wilderotter, opinion contributor — 11/24/17 via The Hill

As Congress looks at ways to restructure and overhaul the tax code, it is clear there is at least one demographic that will not benefit: people with spinal cord injuries or other disabilities. And yet in its current form, the bill contains two highly onerous provisions that would result in undue burdens for the larger disability community.

First, the bill passed on Nov. 16 by the U.S. House of Representatives would eliminate a valuable deduction used by millions of people, including thousands with spinal cord injury, who face high medical bills. This allows taxpayers to deduct medical expenses for themselves and dependents that exceed more than 10 percent of their adjusted gross income.

Under the House’s plan, unreimbursed costs for expenses that make it possible for people with disabilities to maintain the quality of life they deserve would no longer be deductible.

This includes:

Wheelchairs, including operation and maintenance costs

Money paid for transportation – including bus, taxi, train, plane or ambulance services – for medical care for people with disabilities, as well as their caregivers

Installing specialized medical equipment in a patient’s home or vehicle

Physical therapy


Expenses related to the costs of buying, training and maintaining a service animal

Improvements to a property rented by a person with a disability, such as special plumbing fixtures

Bills from out-of-network doctors

About nine million people used the medical expense deduction in 2015 (the latest year information is available), claiming an estimated $87 billion in deductions.

This means that those who utilized the deduction — it’s only available to taxpayers who itemize their deductions — have extraordinarily high out-of-pocket health care costs. Additionally, many disabled Americans who file their own taxes may not realize the deduction even exists and, therefore, have not taken advantage of it.

For those who utilize it, however, the deduction is incredibly important to ensuring their financial well-being. The majority of those who claim the deduction have incomes of less than $75,000. They’re also the most vulnerable Americans: people already carrying catastrophic medical issues and the accompanying expenses, often with this deduction serving as the only barrier between them and poverty.

Shirking ADA compliance

A second provision would reduce the progress made over the last few decades to improve public access for people with disabilities.

Currently, small businesses can get a tax credit — the Disabled Access Credit — on any improvements they make to their facilities to make them more accessible. This credit has been vital for pushing back against (while providing a financial incentive to) businesses that claim it’s too expensive to comply with the Americans with Disabilities Act (ADA), despite having more than 26 years to become compliant.

The House bill eliminates this credit. Even worse, it comes on the heels of the House introducing legislation that would weaken the rights afforded by the ADA.

In a perfect world, disabled Americans wouldn’t have to rely on tax credits and medical deductions to achieve their basic medical needs and keep their families from going bankrupt.

But in the current fiscal climate, tax deductions are a workable alternative. Ideally, businesses would take into account the needs of all people before (and after) opening their doors, and tax incentives provided to simply adhere to existing law wouldn’t be necessary. However, this is not a perfect world.

What Congress and you can do

Congress might not be proactively trying to place additional burdens on mobility-impaired Americans, who already face obstacles to employment, disproportionate medical expenses and financial hardships. And it might not intend to exacerbate compliance issues with the vital laws that protect people with disabilities.

The reality, though, is that the needs and basic rights of people with disabilities aren’t being considered at all, a problem this population has experienced for a very long time.

There is hope. The Senate can change that by making sure that the removal of these two important tax credits is not included in its version of the bill and proving that it truly values the members of a community that is regularly overlooked. I encourage people with disabilities, as well as anybody who knows someone living with a disability, to call their representatives and educate them on the debilitating effects that will inevitably result from these provisions.

December 6

Medicare surcharge notices are shocking retirees

Selling a home or securities can push clients into a higher income tier, triggering premium increases

By Mary Beth Franklin

There’s a new Grinch in town and her name is IRMAA. That’s shorthand for the Income-Related Monthly Adjustment Amount notices that the Social Security Administration sends at the end of each year to inform Medicare enrollees how much they will pay in premiums the following year.

This year’s IRMAA notices are dampening the holiday spirit of a lot of retirees.

One reader wrote to me about the “unconscionable” increase in the Medicare premiums that his 84-year-old father will have to pay next year resulting in a 23% reduction in his net Social Security benefit in 2018. Unfortunately, the premium amounts cited in his IRMAA notice are correct based on new income tiers that take effect next year.


In 2018, most Medicare enrollees will pay $134 per month for Medicare Part B, which covers doctors’ visits and outpatient services. In most cases, Medicare Part B premiums are deducted directly from monthly Social Security benefits.

For many retirees who had been paying a $109 per month premium for each of the past two years, the new Medicare Part B premium represents a $25 per month increase. The premium hike will virtually wipe out the 2% cost of living adjustment in their Social Security benefits next year.

Some Medicare enrollees who were not protected by the “hold harmless provision” have already been paying $134 per month for Medicare Part B in 2017 so their premiums will remain the same in 2018. They will see a net 2% increase in their Social Security benefits next year.

But high-income retirees, defined as individuals with incomes above $85,000 and married couples with incomes topping $170,000, will pay even more next year for Medicare Part B and Medicare Part D prescription drug coverage. These are the people who receive IRMAA notices.

There are five income tiers based on modified adjusted gross income (MAGI), which includes adjusted gross income from the latest tax return plus any tax-exempt interest. Medicare Part B and D premiums in 2018 are based on 2016 tax returns. If MAGI exceeds the top limit of an income bracket by just $1, clients will be catapulted into the next tier.

Premium surcharges in 2018 range from an additional $53.50 per month to an extra $294.60 per month per person—the same level as in 2017. That is on top of the standard $134 per month Part B premium.

But upper income tiers that trigger those premiums have changed, meaning some retirees will pay even more for Medicare Part B and D next year even if their income remained the same. Those affected by the higher surcharges in 2018 include individuals with incomes that topped $133,500 in 2016 and married couples with incomes that exceeded $267,000 in 2016.


In the case of the reader’s elderly parents, the sale of a house in 2015 increased their income from $70,000 to $267,000. The higher income boosted the Medicare Part B and D premiums in 2017 which were deducted from their Social Security payments. As a result, the father’s net Social Security benefit declined from $1,554 per month to $1,361.80 per month in 2017—a loss of more than $2,000 a year in net Social Security benefits.

The following year, the father sold some bonds, boosting his income to over $276,000 in 2016. With the new income triggers, that pushed him in the fourth income tier, triggering even higher premiums for Medicare Parts B and D in 2018. His net Social Security benefit will drop to $1,193.20 per month—a decline of more than $4,300 per year since 2016.

In some cases, clients can appeal a Medicare premium surcharge if they have experienced a life-changing event that caused their income to decrease or if they can prove that the income information that Social Security used to determine the IRMAA premium is incorrect or outdated.

The Medicare Rights Center offers a free downloadable guide for financial advisers to help their clients appeal Medicare premium surcharges.

However, a one-time boost in income due to the sale of a vacation home or large portfolio distribution does not qualify as a life-changing event and would boost the client’s Medicare premium for at least a year.