June24 by RI ARA

RI ARA

Affiliated with the Rhode Island AFL-CIO “Fighting for the future of our members.” “NOW, more than ever!!!” Publication 2018 Issue 25 Published in house by the RI ARA

June 24, 2018 E-Newsletter

House GOP plan would cut Medicare, Medicaid to balance budget House Republicans released a proposal Tuesday that would balance the budget in nine years — but only by making large cuts to entitlement programs, including Medicare, that President Trump vowed not to touch. The House Budget Committee is aiming to pass the blueprint this week, but that may be as far as it goes this midterm election year. It is not clear that GOP leaders will put the document on the House floor for a vote, and even if it were to pass the House, the budget would have little impact on actual spending levels. Nonetheless the budget serves as an expression of Republicans’ priorities at a time of rapidly rising deficits and debt. Although the nation’s growing indebtedness has been exacerbated by the GOP’s own policy decisions — including the new tax law, which most analyses say will add at least $1 trillion to the debt — Republicans on the Budget Committee said they felt a responsibility to put the nation on a sounder fiscal trajectory. “The time is now for our

Congress to step up and confront the biggest challenge to our society,” said House Budget Chairman Steve Womack (R-Ark.). “There is not a bigger enemy on the domestic side than the debt and deficits.” The Republican budget confronts this enemy by taking a whack at entitlement spending. Lawmakers of both parties agree that spending that is not subject to Congress’s annual appropriations process is becoming unsustainable. But Trump has largely taken it off the table by refusing to touch Medicare or Social Security, and Democrats have little interest in addressing it except as part of a larger deal including tax increases — the sort of “Grand Bargain” that eluded President Barack Obama. “The time is now for our Congress to step up and confront the biggest challenge to our society,” said House Budget Chairman Steve Womack (RArk.). “There is not a bigger enemy on the domestic side than the debt and deficits.” The Republican budget

confronts this enemy by taking a whack at entitlement spending. Lawmakers of both parties agree that spending that is not subject to Congress’s annual appropriations process is becoming unsustainable. But Trump has largely taken it off the table by refusing to touch Medicare or Social Security, and Democrats have little interest in addressing it except as part of a larger deal including tax increases — the sort of “Grand Bargain” that eluded President Barack Obama. The budget also proposes a number of other cost-saving measures, some of which could prove unpopular if implemented, such as adding more work requirements for food-stamp and welfare recipients and requiring federal employees — including members of Congress — to contribute more to their retirement plans. It assumes repeal of the Dodd-Frank Act that regulated banks after the financial crisis 10 years ago, something Congress recently rejected in passing a banking bill into law that softened some of

the key provisions of DoddFrank but left its overall structures intact. And the budget proposes $230 billion in cuts from education and training programs, including consolidating student loan programs and reducing Pell Grant awards. The budget also relies on rosy economic-growth projections and proposes using a budgetary mechanism to require other congressional committees to come up with a combined $302 billion in unspecified deficit reduction. Overall, the partisan proposal is reminiscent of the budget released in 2011 by now-House Speaker Paul D. Ryan (R-Wis.), who was then the Budget Committee chairman and advanced a bold proposal attacking entitlements, slashing spending — and creating lines of attack for Democrats once Ryan became Mitt Romney’s vice presidential running mate on the GOP ticket the following year.

Trump to Propose Government Reorganization, Targeting Safety Net Programs President Trump plans to propose a reorganization of the federal government as early as Thursday that would shuffle key community development, housing and food programs to new departments, where they could be easier to cut or contain, according to administration officials briefed on the proposal. The plan, which will most likely face significant opposition in Congress from Democrats and

some Republicans, includes relocating many social safety net programs into a new megadepartment, which would replace the Department of Health and Human Services and probably include the word “welfare” in its title. Mr. Trump and his budget director, Mick Mulvaney, the architect of the plan, have sought to redefine as welfare subsistence benefit programs like the

Supplemental Nutrition Assistance Program, or SNAP, and housing aid. It is part of a rebranding effort, championed by conservative think tanks and House Republicans, to link them to unpopular direct-cash assistance programs that have traditionally been called welfare. “They have been using the word welfare because it is pejorative,” said Elaine Waxman, a senior fellow in the Income and

Benefits Policy Center at the Urban Institute, a nonpartisan Washington think tank. “The programs you can call welfare are actually very small in comparison to SNAP, which is an income support necessary to help families, workers and millions of kids.” ...Read More

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Tax Changes, Demographics, and Costs Trigger Changes in Medicare’s Financial Future In its annual report to Congress, the Board of Trustees for Medicare said the program’s Hospital Insurance Trust Fund (Part A) could lack funds to pay full benefits by 2026—three years earlier than projected in last year’s report. Despite this finding, the Medicare program itself remains strong and sustainable. The trustees report identifies several factors that impact the balance of program funds:  projected lower payroll taxes because of lower wages for several years;  December’s Tax Cuts and Jobs Act, which lowers tax rates and therefore reduces

the flow of revenue to the hospital trust fund; and  an aging population and general increases in healthcare costs, which put pressure on the program’s finances. The trustees also identify the elimination of two provisions of the Affordable Care Act as harmful to Medicare’s financial future: the rollback of the individual mandate—which requires all Americans to purchase health coverage or pay a tax penalty—and the repeal of an independent board charged with reining in Medicare spending if certain financial

targets were reached. In particular, the change to the ACA’s individual mandate, which takes effect next year, is expected to lead to millions more people going without health insurance. That in turn will leave hospitals with higher rates of uncompensated care; some of those expenses are covered by a special Medicare fund paid to hospitals with larger numbers of uninsured patients. It will also lead to higher costs for the Medicare program as newly eligible people seek care for untreated conditions. Notably, MedicarePart B and Part D remain on firm financial footing, as they draw from

general revenues and premiums paid by enrollees, rather than a separate trust fund. Furthermore, spending growth in the Medicare program has been slower than for the rest of the health care sector. It is essential that these policydriven changes not provide cover for drastic changes to Medicare benefits or cost shifting to beneficiaries. Instead, adequate funding for the program and the promises we have made as a society to our older adults and people with disabilities must be maintained. Read the Medicare Trustees report.

Beware of hidden taxes in retirement Social Security taxes depend on combined income Your taxes in retirement may be a lot more complicated than taxes while you’re working. Social Security checks may or may not be taxed, depending on your income. You’ll pay federal income taxes on most retirement plan withdrawals, but additional state taxes depend on where you live. Tax rates on investments can vary as well. Here’s what to expect when you hit retirement age. Whether and how much of

your Social Security benefit is taxed will be determined by “combined income.” That’s your adjusted gross income, plus any nontaxable interest, plus half your Social Security benefit. If your combined income is below $25,000 and you’re single, your benefit won’t be taxed. If your combined income is between $25,000 and $34,000, you may pay tax on up to half of your benefits. Over $34,000, up to 85% of your benefits may be

taxable. For joint filers, the 50% range is $32,000 to $44,000, and the 85% range is over $44,000. The tax calculations are fairly complex so you’ll want to use software, or a tax pro, to figure yours. Note that you won’t lose half or more of your benefit to taxes. Instead, up to 85% could be subject to income taxes at your ordinary income tax rates. (There are currently seven tax brackets, ranging from 10% to 37%.) State taxes could take

another bite In 13 states, you also could owe state income tax. Colorado, Connecticut, Kansas, Minnesota, Missouri, Montana, Nebraska, New Mexico, North Dakota, Rhode Island, Utah, Vermont and West Virginia all tax Social Security benefits to some extent. Seven states don’t tax income: Alaska, Florida, Nevada, South Dakota, Texas, Washington and Wyoming. New Hampshire and Tennessee tax only dividends and interest….Read More

Trump’s health chief suggests ‘massive’ drug price cuts not imminent President Donald Trump’s top health care official is lowering expectations that drug companies will soon announce huge price cuts, undercutting Trump’s recent claims that his drug pricing plan would produce immediate results. Trump on May 30 said some of the largest pharmaceutical companies would announce “voluntary massive drops in prices” within two weeks in response to his drug pricing plan released in mid-May. Wednesday will mark two weeks since Trump’s remarks, which drugmakers at the time said

caught them by surprise. HHS Secretary Alex Azar told the Senate HELP Committee Tuesday morning that there are “several drug companies that are looking at substantial, material decreases in drug prices,” but he indicated it could take time for the cuts to happen. Azar did not say which companies were considering cuts or how deeply they would slash prices. The White House did not immediately respond to a request for comment Tuesday afternoon.

A spokesperson at HHS declined to name which companies the department had spoken with, saying that HHS is working with various health care groups. Azar claimed pharmacy benefits managers and drug distributors have held up efforts to reduce prices, and he blamed the drug pricing system for incentivizing high list prices. Drug companies are worried that if they cut list prices, these drug supply chain middlemen will no longer prioritize their products,

Azar said. That’s because these companies sometimes make more money when a drug’s list price is higher. Sen. Elizabeth Warren (DMass.) said during the hearing that she and Sen. Tina Smith (DWis.) sent letters surveying the top 10 drug manufacturers on the day Trump made his remarks. No company said they had lowered prices, and no company indicated that they plan to do so, Warren said. One of the companies said that its prices will go up later this year, she said.

3 Social Security Myths You Can't Afford to Believe Millions of seniors collect Social Security and depend on those benefits to cover the bills in retirement. But there's a lot of misinformation circulating with regard to Social Security, and if you don't learn to recognize fact from fiction, you won't make the most of those benefits. With that in mind, here are three glaring myths it pays to get to the bottom of. Myth #1: Social Security will soon be bankrupt Reality: It's true that Social Security is facing a future shortfall that, if left unaddressed, could cause benefits to get slashed as much as 23% come 2034. But there's a big difference between that worst-case scenario and the program running out of money completely, and buying into the latter might cause you to act hastily with regard to your benefits. The fact of the matter is that Social Security can never truly go broke because its funding comes from payroll taxes. Therefore, as long as we have a workforce and continue to collect those taxes, it will remain standing. Furthermore, Congress has a good 16 years to step in, address the aforementioned shortfall, and prevent benefits from getting slashed. Therefore, if you're thinking of filing for Social Security as early as possible to ensure that you get

some of that money while it's still available, don't do it. Filing early will slash your benefits, and that's a good way to ensure a lower income stream for the remainder of your golden years. Myth #2: It doesn't matter when you file for benefits Reality: Social Security is technically designed to pay you the same amount in lifetime benefits whether you file at the earliest possible age of 62, the latest age of 70, or somewhere in the middle. The logic is that any reduction you receive in your monthly payments by filing early will be offset by the greater number of individual payments you collect. Similarly, holding off on benefits will boost your payments, but you'll collect fewer individual payments as a result. This formula, however, assumes that you live an average life expectancy, so if you have reason to believe you won't live a very long life, you're actually better off filing as early as possible. On the flipside, if your health is great and you have a strong family history of longevity, you'll generally come out ahead financially by waiting as long as possible to file. Here's an example. Imagine you're looking at a full

retirement age of 67, at which point you'd collect $1,500 a month. Claiming benefits at 62 will reduce your monthly payments to $1,050 each, but you'll collect 60 more of them. If you live until age 78 1/2, you'll wind up with roughly the same total lifetime benefit under either scenario. But if you pass away at 75, you'll come out nearly $20,000 ahead by filing early. Similarly, if you delay benefits until 70, you'll increase each individual payment you get from $1,500 to $1,860. If you live until 82 1/2, you'll break even under either filing scenario. But if you live until 90, you'll come out over $32,000 ahead by taking benefits at 70 rather than 67. The point is that it does matter when you file for benefits, so think long and hard about the state of your health and use that to help guide your decision. Myth #3: Social Security's cost-of-living increases will help you keep up with your expenses Reality: Since 1975, Social Security recipients have been getting automatic annual cost-ofliving adjustments, or COLAs, to help their benefits keep pace with inflation. Therefore, you might think you can rest easy knowing that the amount you start out collecting will slowly

but surely go up over time. The problem, however, is that COLAs in recent years have failed to match the rate of inflation, thereby putting seniors at an automatic disadvantage. Furthermore, most COLAs get swallowed by Medicare premiums as a result of Social Security's "hold harmless" provision, which means senior s frequently see little to no extra money in their hands once those COLAs are put into place. The "hold harmless" provision states that Social Security recipients can't see their benefits go down due to Medicare premium increases, and while it's designed to protect seniors, it also means that they typically don't benefit from COLAs in the form of disposable, accessible income. Therefore, if you want a shot at retaining your buying power in retirement, invest your savings wisely so that your IRA or 401(k) returns are able to well outpace inflation and compensate for Social Security's flawed COLAs. The more you know about Social Security, the greater your chances of maximizing your benefits. So do yourself a favor and read up on how the program works. This way, you'll be in a better position to separate myth from reality going forward.

President Roach: Corporations Are Investing In Executives, Not Employees’ Following the corporate tax cuts passed last December, many large companies are investing in Robert Roach, Jr their bottom line instead of their workers. Using the various loopholes and special interest tax breaks granted to them by changes in the tax code late last year, companies that were already enjoying historically high profits are using their cash to buy back their own stock shares. Since the

tax cuts became law, companies have announced over $400 billion in cor por ate buybacks, setting a new record high. U.S. Securities and Exchange (SEC) Commissioner Robert Jackson Jr. pr esented his personal research on the topic at a Center for American Progress panel on Monday. The commissioner explained that buybacks are benefitting companies by increasing their stock prices and letting top executives personally cash out, while hurting long term

shareholders and workers. Commissioner Jackson feels that the rules should be changed to deny safe harbor protections to companies who allow their executives to personally cash out their shares. The SEC safe harbor regulations have not been updated since 2003. Alliance President Roach brought up the issue of companies that utilize buybacks without fully funding their pension plans, a major issue for current and future retirees. See video footage of the exchange

here. While the SEC commissioners are currently not looking into pensions, Jackson stated that issues such as failing pension systems are the exact reason why buyback rules need to be reviewed and updated. “Companies promised to invest the returns they received from massive tax cuts back into their employees,” said President Roach. “As it turns out, they are simply investing in their top executives while leaving the workers behind.”

RI ARA HealthLink Wellness News

A New Shingles Vaccine: Prepare for Harsher Side Effects recently approved Shingrix vaccine. Side effects can last two or three days, and the injection site in the upper arm can hurt. The upside is Shingrix provides stronger protection against shingles – a painful condition that wreaks havoc on the nervous system – than IF YOU'RE 50 OR OLDER, you're advised to get previous vaccines. As people get immunized to protect yourself older, they become from shingles. If the new increasingly vulnerable to shingles vaccine made you feel developing shingles. Temporary worse than you expected, you're vaccine side effects pale in not alone. Skin rash, joint pain, comparison to shingles' longflu-like symptoms, headaches, lasting effects on the body, and fatigue are some complaints experts say. from patients who've had the One of every three people in

the U.S. will eventually develop shingles, according to the Centers for Disease Control and Prevention. Caused by the varicella zoster virus – also responsible for chickenpox – shingles is notoriously painful. Once someone has chickenpox, the inactive virus dwells in the body. Decades later, the virus can become active again, now causing shingles. Early shingles symptoms include numbness, tingling or burning, and touch sensitivity. A red rash, usually affecting just one side of the body, and itching comes next. People may develop

blisters that fill with fluid, burst open and crust over. Fever and problems such as a headache, fatigue and light sensitivity can also occur. Weighing Vaccination Anecdotal reports of Shingrix side effects don't come as a surprise, says Dr. Kathleen Dooling, a medical officer and shingles expert with the CDC's Division of Viral Diseases. "In clinical trials that have studied this vaccine, we knew that it caused more side effects than perhaps some of the other adult vaccines that are recommended."...Read More

Why Mental Illness Is So Hard to Spot in Seniors While mental illness is underdiagnosed in older patients, the good news is treatments are typically effective once it's discovered. THE INSTITUTE OF Medicine (now the National Academy of Medicine) issued a report in 2012, "The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?" that said 14 to 20 percent of U.S. adults over age 65 have one or more mental health or substance use conditions. That’s about 8 million people. Yet a number of studies also indicate that mental illness in older adults is underrecognized and underdiagnosed. For instance, a telephone survey of nearly 10,000 adult households, published in 2003 in the American Journal of Geriatric Psychiatry, found that half of adults over age 65 with a probable mental illness were significantly less likely to be receiving any mental health treatment than younger adults. Of those, only 7 percent had used specialty mental health

care. “Indeed, compared with younger adults and middle-aged adults, adults over age 65 were much less likely to be asked by their primary care physician if they felt tense or anxious and were much less likely to be referred by their primary care physician for mental health specialty care,” says Dr. Susan W. Lehmann, clinical director of the division of geriatric psychiatry and neuropsychiatry and director of the Geriatric Psychiatry Day Hospital at the Johns Hopkins University School of Medicine. A more recent study of seniors receiving home health services found that 23 percent screened positive for depression, yet less than 40 percent of those people were receiving treatment for depression, she says. Diagnosis Is Challenging There are a number of reasons why mental illness is underdiagnosed among seniors. An interesting finding of the telephone survey, Lehman says, was that older adults themselves were much less likely to perceive a need for mental

health care than younger adults, so they may be less likely to bring up concerns with their primary care provider. Ageism and perceived stigma about mental health care may play a role as well. “Many older adults and their family members may incorrectly believe that depression is normal with aging,” she says. “Given the time constraints of outpatient medical appointments, the primary care provider may feel challenged to review these ongoing health conditions in a short time frame and may not feel there is time to discuss mental health concerns unless the patient brings it up.” There also may be confounding issues that confuse clinicians. “Older people grew up in an era when talking about a psychiatric issue was certainly frowned upon, so there may be a generational issue,” says Dr. Philip R. Muskin, a professor of psychiatry at Columbia University Medical Center and a member of the American Psychiatric Association’s Scientific Program Committee. Elderly patients also may

ascribe their moods to physical impairments or other illnesses. And many of the symtoms of depression and anxiety – poor sleep, low appetite, memory and concentration problems – are also markers of simply being older. “We can confuse complaining about sleeping and appetite that may not be depression,” Muskin says. “Is that memory loss from depression or mild cognitive impairment? All of that makes it tougher to make the diagnosis. If a young person is not sleeping, has no appetite, no energy, the first thing I think of is depression. An 85-year-old with those same things, depression is not going to be high on my list.” Lehman agrees: “Too often, changes in mood, interest, activity level and personality are incorrectly attributed to aging, and the possibility of a mental illness is not considered.”...Read More

Supporting Older Patients with Chronic Conditions Approximately 85 percent of older adults have at least one chronic health condition, and 60 percent have at least two chronic conditions, according to the Centers for Disease Control and Prevention. For many older people, coping with multiple chronic conditions is a real challenge. Learning to manage a variety of treatments while maintaining quality of life can be problematic. People with chronic conditions may have different needs, but they also share common challenges with other older adults, such as paying for care or navigating the complexities of the healthcare system. Clinicians can play an important role in educating patients and families about chronic health conditions and can connect them with appropriate community resources and services. Try to start by appreciating that people living with chronic disease are often living with loss—the loss of physical function, independence, or

general well-being. Empathize with patients who feel angry, sad, lost, or bewildered. Ask, "Is it hard for you to live with these problems?"From there you can refer patients to community resources that may meet their needs or, when available, recommend a disease management program or case managers in the community. Educating the Patient Most older patients want to understand their medical conditions and are interested in learning how to manage them. Likewise, family members and other caregivers want this information. Physicians typically underestimate how much patients want to know and overestimate how long they spend giving information to patients. Devoting more attention to educating patients and their caregivers may seem like a luxury, but in the long run it can improve patients' adherence to treatment, increase

patients' well-being, and save you time. The following tips can help you inform patients and their caregivers about medical conditions and their treatment:

 Doctors' advice generally

addition to talking to the patient, you can use fact sheets, drawings, models, videos, or audio. In many cases, referrals to websites and support groups can be helpful.

 Encourage the patient or caregiver to take notes. It's helpful to offer a pad and pencil. Active involvement in recording information may promote your patient's retention and adherence.

receives greatest credence, so the doctor should introduce treatment plans. Other medical team members have an important role, including building on the original  Repeat key points about the instructions. health problem and treatment at every office visit.  Let your patient know you welcome questions.  Check that the patient and his Provide the name of someone or her caregivers understand on your staff whom the patient what you say. One good can call to have questions approach is to ask that they answered later. repeat the main message in their own words.  Remember, some patients won't ask questions even if  Provide encouragement. Call they want more information. attention to strengths and ideas Be aware of this tendency and for improvement. Remember think about making to provide continued information available even if it reinforcement for new is not requested. treatment or lifestyle changes. …..Read More  Provide information through more than one channel. In

Hot Weather Safety for Older Adults Too much heat is not safe for anyone. It is even riskier if you are older or have health problems. It is important to get relief from the heat quickly. If not, you might begin to feel confused or faint. Your heart could become stressed and stop beating. Being hot for too long can be a problem. It can cause several illnesses, all grouped under the name hyperthermia (hy-perTHER-mee-uh):  Heat syncope is a sudden dizziness that can happen when you are active in hot weather. If you take a heart medication called a beta blocker or are not used to hot weather, you are even more likely to feel faint. Rest in a cool place, put your legs up, and drink water to make the

dizzy feeling go away. doctor.  Heat cramps are the  Heat exhaustion is a painful tightening of warning that your body muscles in your can no longer keep itself stomach, arms, or legs. cool. You might feel Cramps can result thirsty, dizzy, weak, from hard work or exercise. uncoordinated, and nauseated. Though your body You may sweat a lot. Your temperature and pulse usually body temperature may stay stay normal during heat normal, but your skin may feel cramps, your skin may feel cold and clammy. Some moist and cool. Find a way to people with heat exhaustion cool your body down. Rest in have a rapid pulse. Rest in a the shade or in a cool cool place and get plenty of building. Drink plenty of fluids. If you don’t feel better fluids, but not those soon, get medical care. Be with alcohol or caffeine. careful—heat exhaustion can progress to heat stroke.  Heat edema is a swelling in Heat Stroke—A Medical your ankles and feet when you Emergency get hot. Put your legs up to If you have heat stroke, you help reduce swelling. If that need to get medical help right doesn’t work fairly away. Older people living in quickly, check with your homes or apartments without air

conditioning or fans are at most risk. People who become dehydrated or those with chronic diseases or alcoholism are also at most risk. Signs of heat stroke are:  Fainting (possibly the first sign) or becoming unconscious  A change in behavior— confusion, agitation, staggering, being grouchy, or acting strangely  Body temperature over 104°F (40°C)  Dry, flushed skin and a strong, rapid pulse or a slow, weak pulse  Not sweating even if it is hot ...Read More How Can I Lower My Risk? What Should I Remember?