March 2

Trump’s Social Security budget offers more work, less staff, longer waits

By Joe Davidson via The Washington Post

or the elderly and disabled who complain about poor Social Security assistance now, these might be the good old days.

President Trump’s proposed fiscal 2019 Social Security Administration (SSA) budget would cut staffing, a recipe for long waits in agency offices and on the telephone for those trying to navigate the often-difficult world of old-age, disability, survivor and Medicare benefits. Retirement and survivor benefits would not be hit.

Declining service is nothing new, but under Trump, there would be fewer federal employees to deal with an increasing number of people of retirement age. His budget request calls for almost 1,000 fewer full-time-equivalent work years in 2019 than this year. A full-time-equivalent work year is the amount of work a person toiling full time would do in one year. The amount of overtime allowed staffers to keep up with demand would be less than a third of that in 2017 and just over half the 2018 estimate.

The advocacy group, National Committee to Preserve Social Security and Medicare, provides these stats to illustrate the problem: About 10,000 baby boomers hit retirement age every day. The increase in workloads coupled with a decrease in staffing led to a 627-day wait for disability applicants’ hearings in 2017. The three-minute telephone wait that callers had for SSA’s 800 number in 2010 was six times longer last year. Despite SSA attempts to direct traffic to its website, there were 2 million more field office visits in 2016 than 2015. “More than 16,000 visitors were forced to wait more than hour for service each day in August 2017,” the committee said.

Promising to become “more efficient and effective” for the 71 million people who receive monthly benefits, Social Security Administration statements say Trump’s budget “will allow us to support our front line operations, such as our field offices, processing centers, and National 800 Number, by providing some critical hires and expanding our additional service delivery channels and online service options.”

Sure, there will be support, but at what level? The support was too low even before Trump’s proposed 2019 cuts.

At a Senate briefing last month, Julian Blair, a 70-year-old Silver Spring resident, spoke about the hardships that service cuts cause.

“I accompany a 92-year-old neighbor to the Social Security,” Blair said. “He’s not computer literate … so I’m going with him. We had to go three times before he could get the service he needs because the lines were so long, and he’s disabled he can’t stand there all day. There was no seats for him.”

He went on to talk about how his daughter “almost gave up and cried because she just could not get the service in a timely manner” for her son’s survivor benefit after his father died. “That’s a shame that should not happen.”

“I have a brother that worked 34 years, became disabled,” Blair added. “It took him two and a half years (to get a claim processed). What happens in that two and a half years? Savings gone, unemployment gone. So real people, this affects for real people.

“But it’s … more than just services. To us, it’s a continued effort to dismantle Social Security.”

The administration wants to push more recipients to the Internet, saying “most Social Security services do not require a visit to an office” and noting the many things that can be done online. But many elderly, like Blair’s 92-year-old neighbor, don’t do business online. And the availability of Web-based services hasn’t prevented long lines at Social Security offices.

Sue Bird, 66, of Wellington, Nev., told of driving 80 miles to a Social Security office in Reno. When she arrived for a 10 a.m. appointment, she estimated 20 to 30 people were standing outside, waiting to get in. Once she got in, she saw almost 150 waiting inside.

“The room was packed with people,” she said by telephone. “I was shocked.”

Blair doesn’t blame the employees.

“It’s not anyone’s fault who’s working there,” he said. “It’s just busy.”

He’s right. The blame is not on Social Security employees. But it is somebody’s fault. The staffers are too busy, and the waits are too long, because elected leaders aren’t providing enough money for the service the elderly and disabled deserve.

Declaring the Social Security Administration to be “in a dire state,” Witold Skwierczynski, president of the National Council of SSA Field Operations Locals, Council 220, of the American Federation of Government Employees, said “the FY19 budget request would cause further deterioration of service. More calls on the 800 number will result in busy signals and those who got through would have lengthy wait times. It will take longer to get appointments in field offices and walk in customers will wait longer for service and, in many cases, be sent home without obtaining service. SSA processing time for claims and appeals will increase.”

That’s not all that will increase. Expect a rise in staff strain.

“Employees stress levels will increase, and service will suffer,” Skwierczynski added, “since SSA employees will be forced to use short cuts to process claims that will likely disadvantage the public.”

March 2

Tens of thousands of Medicaid recipients don’t pay their premiums

by Phil Galewitz, Kaiser Health News

When Arkansas lawmakers debated whether to renew the state’s Medicaid expansion in 2016, many Republican lawmakers were swayed only if some of the 300,000 adults who gained coverage would have to start paying premiums.

This “skin-in-the-game” provision — endorsed by conservatives in Washington and in many statehouses — is designed to make Medicaid recipients value their government health insurance more and lead healthier lives.

It’s “to encourage more personal responsibility,” Arkansas Governor Asa Hutchinson told reporters in 2016. “We want to incentivize better, healthy living.”

Yet few enrollees are paying the $13 monthly premiums, which apply only to Medicaid recipients whose earnings surpass the poverty level. In 2017, just 20% of the 63,000 Arkansas enrollees paid. For now, Medicaid enrollees in Arkansas don’t lose coverage for lack of payment.

Arkansas is not the only state where Medicaid recipients who gained coverage under the Affordable Care Act disregard the new premiums. Tens of thousands of Medicaid enrollees in four other states that added premiums during the past four years— Indiana, Michigan, Iowa and Montana — have also opted not to pay, according to state records.

Under the ACA, states received millions of federal dollars to cover everyone with incomes under 138% of the federal poverty level (about $16,700 for an individual today). Previously, Medicaid mainly covered only low-income children, disabled adults and parents.

Premiums, which are routine obligations in private health insurance and Medicare, were not a part of Medicaid until that expansion in 2014. But in these five states, conservative lawmakers were hesitant to expand the federal-state program unless they secured fees from nondisabled adults.

Kentucky has received approval to add premiums in 2018.

“We believe the premiums are important to prepare these beneficiaries for what would be required of them if they move up the economic ladder and get coverage through an employer or the federal marketplace,” said Arkansas Medicaid spokeswoman Amy Webb. “It’s a small amount, especially considering the benefit they are receiving. Under an employer or at the marketplace, they would lose their coverage for failure to pay.”

Advocates for Medicaid say it is not surprising that significant numbers of Medicaid enrollees fall behind on their payments.

“Families have to make tough choices every day about whether they buy food, pay the electric bill, their rent, or pay premiums,” said Rich Huddleston, executive director of Arkansas Advocates for Children and Families. He notes that even the state’s $13 monthly premium is burdensome.

Still, the experience in the five states shows converting conservatives’ “skin-in-the-game” mantra into practice has many administrative challenges.

Michigan requires Medicaid enrollees with incomes above the poverty level to pay 2% of their income in monthly premiums, though the amount could be decreased if they engage in so-called healthy behaviors, such as getting a flu shot or trying to quit smoking.

A survey of enrollees last year in Michigan found nearly 88% said the amount they had to pay was “fair,” and 72% said they agreed that they would “rather take some responsibility to pay something for their health care than not pay anything.”

But from January through August last year, fewer than half of Michigan Medicaid recipients who owed a premium — about 77,000 of 175,000 — paid it.

And premiums were not the only new obligation that many these enrollees are failing to meet. The state’s Medicaid expansion also required them to fill out a health risk assessment form with their doctor and promise to improve their health. In return, members could lower their premiums or gain a $50 gift card.

Of the 900,104 beneficiaries who have been enrolled in Medicaid for at least six months, 19% have completed this chore, according to state records.

For most enrollees this is voluntary. But enrollees with incomes above 100% of the poverty level could lose Medicaid coverage if they don’t fill out the form to attest they will try to improve their health. Michigan, in particular, is getting tough: In February, it mailed letters to 13,550 beneficiaries informing them that they failed to meet this requirement and they will be moved off Medicaid. They will have to choose a private plan on the Obamacare insurance marketplace or will be automatically enrolled in one in June.

Dr. Renuka Tipirneni, a researcher with the University of Michigan Institute for Healthcare Policy & Innovation, said it’s unclear if these enrollees will be worse off in the private plans since many will get subsidies to help cover their premium costs. But they may face a larger cost-sharing portion or have to change doctors.

Michigan officials last year also sent 68,000 Medicaid enrollees who owed premiums a notice that they would garnish any state income tax refunds or lottery winnings. That led about 7,000 recipients to pay. The state last year collected premium money from 19,400 through their tax refunds and another 59 from their lottery winnings, according to a state report.

Arkansas officials also plan to intercept state tax refunds to recoup unpaid premiums, but not until 2019.

Other states have mixed records on collecting Medicaid premiums, according to state reports:

— Indiana is the only state to lock enrollees out of Medicaid for six months for failure to pay — and about 10,000 recipients fell into that category in 2016. Kentucky recently received federal permission to add a similar lockout provision this year.

— Iowa disenrolled more than 14,000 Medicaid enrollees from January 2016 to September 2017 for failure to pay a $10 monthly Medicaid premium, though they could re-enroll at any time. More than 40,000 Medicaid enrollees with incomes over 50% of the poverty level were subject to a premium in September 2017 and about three-quarters of them had not paid nor completed a health risk assessment form that would have waived the fee.

— Montana’s Medicaid program dropped 2,884 adults with incomes over the poverty level in 2017 for failing to pay a premium. The state charges 2% of the enrollee’s monthly income. Montana allows those dropped to re-enroll at any time without paying.

Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente.

March 2

What to do if your retirement savings fall short

By Steven Vernon via Money Watch CBS News.

With so many older workers approaching their retirement years with meager savings, the big question is: What can they do to improve their financial security in retirement?

Working longer is by far the best step they can take, according to “The Power of Working Longer,” a recent paper written by a team of researchers led by John Shoven at Stanford University.

If you’re in your 50s or older, working longer — even by a few months — has a much greater impact on your ultimate retirement income than saving more or achieving a higher net rate of return on your savings. Of course, ideally, older workers would take all these steps — the paper just helps you focus on the most important one.

The report offers several examples that illustrate the power of working longer, using hypothetical workers of various ages. For example:

Workers age 66 who earn at the national average wage could increase their ultimate retirement income by 7.75 percent by working one more year and retiring at age 67.
For these workers, the total value of the additional lifetime retirement income generated by working for one more year is equal to getting a bonus of over 40 percent (43.27 percent) of this average wage earner’s annual salary.
Workers age 62 who earn average wages could increase their ultimate retirement income by almost one-third (32.7 percent) by working four more years until age 66 and by almost three-fourths (74.6 percent) by working eight more years until age 70.

(The report estimates that average annual wages for workers age 55 to 64 are about $52,350.)

Here are three reasons working longer increases your retirement income:

Your Social Security income will increase significantly — by 8 percent for each year beyond your full retirement age that you start benefits.
Your savings have more years to grow with investment returns.
Your savings need to last for a shorter number of years in retirement.

The paper shows that delaying Social Security accounts for most of the total increase in your retirement income — roughly three-fourths of it.

For low-wage earners, delaying Social Security benefits is particularly powerful. For example, consider such an earner at age 56: Delaying retirement by seven months has roughly the same impact as saving an additional 10 percent of pay for 10 years.

Many older workers aren’t willing or able to keep working at their current rate of pay or for the same number of hours. But you may not need to do either. For instance, you could pursue a “downshifting” strategy during which you reduce your hours and responsibilities, and earn just enough to cover your current living expenses while you let your Social Security and savings grow until you ultimately retire.

This strategy might free some time to enjoy life more and take care of yourself, and you’ll still reap most of the benefits of working longer described above.

It’s important to acknowledge that working longer may be “easier said than done” for many older workers. They’ll need to be resilient and creative to find work opportunities, and working longer will most likely take some planning. While working longer may not be the ideal solution, it may be the best option that many older workers have.

March 2

Lawmakers seek information on curbing opioid addiction in Medicare

By Rachel Roubein – 02/27/18 06:10 PM EST via TheHill.com

Top Republicans and Democrats on the House Ways and Means Committee are requesting information from critical stakeholders on how to prevent and treat opioid addiction in Medicare, as the panel seeks to craft bipartisan legislation to curb the opioid epidemic.

Specifically, they’re asking insurers, benefit managers, providers and prescribers to submit information on how the Medicare program can help stem the opioid epidemic — noting that one in three beneficiaries in Medicare’s prescription drug program received a prescription opioid in 2016.

Chairman Kevin Brady (R-Texas) and ranking member Richard Neal (D-Mass.) — along with Health Subcommittee Chairman Peter Roskam (R-Ill.) and the top Democrat, Sandy Levin (Mich.) — sent the request Tuesday.

By March 15, they’re asking the stakeholders to provide information on overprescribing, data tracking, treatment, communication and education.

The Ways and Means Committee is one of several groups of lawmakers examining measures to clamp down on the opioid epidemic, which saw rates of overdose deaths jump nearly 28 percent from 2015 to 2016.

The House Energy and Commerce Committee is holding its first of three hearings Wednesday to discuss legislation. On the other side of the Capitol, a bipartisan group of eight senators introduced Tuesday a follow up to the Comprehensive Addiction and Recovery Act passed in 2016, dubbed “CARA 2.0.”

March 2

State Department budget and veterans service organizations

By Leo Shane III via militarytimes.com

WASHINGTON — State Department officials will make their first pitches for their fiscal 2019 agency budgets this week, even as lawmakers are still working out the details of the current fiscal year.

Secretary of State Rex Tillerson will make two appearances before Congress on Tuesday and Wednesday to talk about reorganization of the department, the president’s plans for future funding and criticism of the downsizing of some State Department missions.

Similar military budget hearings were also expected to begin this week, but several were postponed due to scheduling issues. Pentagon officials will be on Capitol Hill in force in weeks to come to lobby for a sizable increase in spending authority in the months ahead.

Also this week, the major veterans groups begin their legislative presentations to the House and Senate Veterans’ Affairs Committees. The American Legion and Disabled American Veterans will be the first to make their presentations on Capitol Hill, with about 20 more expected in coming weeks.

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