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Affiliated with the Rhode Island AFL-CIO “Fighting for the future of our members.” “NOW, more than ever!!!” Publication 2018 Issue 09 Published in house by the RI ARA

March 4, 2018 E-Newsletter

All Rights Reserved RI ARA 2018©

Organized Labor Is In a Life and Death Struggle. Be Very Scared For an entire century, the corporate class in America has dreamed of destroying organized labor, which eats into their ability to amass endless profits. They’ve chipped away at unions for 40 years. Now, it is no exaggeration to say that they are two steps away from total victory. There are close to 15 million union members in America today. Those members are about evenly split between public employees, who hold government jobs, and employees of private companies. But nearly 35% of public employees are union members, while less than 7% of private employees are. If you are, say, a right wing industrialist who wants to gut the power of unions to increase wages for their workers—so that you and your fellow industrialists may instead keep that capital for yourselves—you have to gut public unions, and then you have to gut what’s left of private unions, and then you’re done. This is exactly what is happening now. I cannot overemphasize how perilous the situation is. “Right to work” laws are the most effective tool for destroying union membership, because such laws in essence allow any worker in a unionized workplace to enjoy the benefits of a union contract without paying any union dues. These laws are proven tools for draining unions of money and

membership and political influence. The majority of states in America now have right to work laws, and these states have weaker unions, and therefore stronger corporate influence and lower wages. Simple. The public sector, which is strongly unionized, is not right to work. That’s a problem if you want to destroy unions. The case that went before the Supreme Court yesterday, Janus v. AFSCME, is the solution. This case will almost certainly be decided against public unions, thanks to the presence of Neil Gorsuch on the court. When it is done, this ruling will make the entire public sector “right to work.” This will inevitably have the effect of destroying public union membership. Some unions are anticipating a drop of a third; others say they could lose up to half of their members and/ or dues money. What is certain is that this is going to happen soon, and it will smash the last stronghold of union membership in America, and have the aftereffect of making big unions less politically influential, which could exacerbate the fact that Republicans control federal politics today, which will make the legislative climate even more hostile to workers. This case is half the battle against unions. Once it happens, all that is left, if you want to truly strike the final blow against union organizing, is to make the remaining 23 unionfriendly states in the country “right to work.” Of course, since these laws are passed on the

state level, it is impossible to get solid blue states like New York or California to pass those laws. That would never happen. The solution, therefore, is for Republicans to pass a national “right to work” law, that would supersede the power of blue states and make the entire country hostile ground for union organizing. With Republican control of Congress and Donald Trump in the White House, now would be the perfect time for a well-financed group of right wing business interests to push hard for this last, crucial piece of the antilabor strategy. And so: The Intercept reports that the Koch brothers donor network, the single strongest financial force on the right, has a memo detailing plans “to press forward with the Employee Rights Act, legislation to extend right-towork laws nationally and set up new barriers for labor activists hoping to form new unions.” This is it. This is the other half of the plan. It is coming. Everyone (for obvious reasons) is focused on the Janus case now and its effect on public unions. Few are taking the threat of a national “right to work” law seriously. But it is time to think about it. It is time to get scared, and get mad, and get to work. Republicans have worked systematically to tighten labor law for decades, in an effort to make it harder for working people to unionize. Their work has gone well. But this is the death blow. Public unions are about to go “Right to work.”

That is a foregone conclusion. If a national law were to pass to make all the remaining states “right to work” as well, that would be game over for the traditional model of organized labor in America. It would require an entire reimagining of collective power in order for working people to even begin to try to win back what had been lost, at that point. The political situation now is very, very serious. The decline of union membership is already a crisis, even under current law. And the law is about to get much, much harder. And it could get so much harder that the game is lost. We are living in a time of economic inequality so great that it is slowly ripping the connective tissue of our society apart. The problem, simply, is one of distribution. We have enough wealth, but far too few people are hoarding it. And they are able to use that accumulated wealth to produce political power that allows them to hoard even more. Increasing the bargaining power of regular working people is one of the only ways to fix this dynamic. That means unions. So unions are targeted for systematic destruction. If you think that rich people have too much power now, you don’t want to see an America that takes those final steps towards the end of organized labor. This is a very scary time. Take it seriously. Note: As membership declines, so does pension contributions.

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Dark Money Union Busters The fight to overturn a decades-old Supreme Court precedent has been fueled by secret donors. By Senator Sheldon Whitehouse

Over the last decade, the fivejustice Republicanappointed majority on the Supreme Court has forged a RI Senator glaring pattern of Whitehouse 5-4 decisions that benefit Republicans at the polls and big corporations pretty much everywhere. In election-related rulings involving issues like gerrymandering and suppression of Democratic-leaning voters; in rulings where it’s corporations versus humans; and, of course, in letting corporate interests to flood our elections with money, it’s been a 5-4 rout in an unmistakable pattern. The upcoming Supreme Court arguments this week in Janus v. American Federation of State, County, and Municipal Employees will tell a lot about this pattern. At stake is a unanimous decision from 1977 called Abood v. Detroit Board of Education, which let unions collect funds called ”agency shop fees” to cover their cost of doing collective bargaining work that benefits members and nonmembers alike. The Supreme Court has reaffirmed Abood numerous times, more than 20 States have enacted statutes consistent with that case since it was decided, and public entities of all stripes have entered into multiyear contracts with unions following Abood’s guidance. Precedent, unanimity, reaffirmance, and reliance; all of this suggests that the Court would ordinarily uphold this 40-year-old decision. But Abood has been a thorn in the side of the union-busting right wing, who’ve been plotting its demise for years. Recently, in a case involving public employee unions, Justice Samuel Alito digressed from the issue at hand to raise questions about the constitutionality of these agency shop fees, apparently inviting a challenge to Abood. Justice Sonia

Sotomayor saw what was going on. “To cast serious doubt on longstanding precedent,” she wrote in a concurrence, “is a step we historically take only with the greatest caution and reticence. To do so, as the majority does, on our own invitation and without adversarial presentation is both unfair and unwise.” Michael A. Carvin, a perennial conservative advocate, picked up on the majority’s cue and in the name of a front group called the “Center for Individual Rights” promptly filed the challenge Justice Alito had invited. Carvin actually asked the lower courts to rule against his clients so they could hustle their case up to the Supreme Court (in real litigation, parties don’t often want to lose). That case was called Friedrichs v. California Teachers Association, and it was expected to be the death knell of Abood; but Justice Antonin Scalia unexpectedly died, the Court deadlocked 4-4, and Abood lived on. It took more procedural shenanigans, over in the Senate, to keep the far-right’s union-busting dreams alive. Friedrichs was certainly in the minds of Senate Republicans stonewalling confirmation hearings for Merrick Garland to replace Justice Scalia. The stakes were high, and Majority Leader Mitch McConnell’s strategy got a big assist from dark political money, including a $17.9 million contribution from a single unnamed donor. At least $7 million went to the campaign against Judge Garland, and later $10 million went to support Neil Gorsuch for that seat. With Gorsuch in place, it was time for another run at Abood. Janus is the case. As with the Gorsuch confirmation, dark money was a driving force behind both Friedrichsand Janus. The Fr iedrichs campaign was underwritten by the right-wing

Lynde and Harry Bradley Foundation, which openly states its political goal to “reduce the size and power of public sector unions.” The Bradley Foundation not only bankrolled the “Center for Individual Rights,” but also donated to eleven different organizations that filed amicus curiaebriefs. Many are back again in Janus. Some of these groups are backed by the so-called “State Policy Network”– also bankrolled by the Bradley Foundation, and the Koch brothers — which has an $80 million budget. Its CEO Tracie Sharp hasn’t been shy about her group’s plan: “To win the battle for freedom, we must take the fight to the unions, state by state.” The right-wing groups that are packing the Court to achieve these ends see a new Republican-appointed majority, and believe they can safely assume that their five conservative justices will come down against unions. In out-ofcourt statements several of the amici have trumpeted the outcome as pre-ordained. But there is a problem. Our American system of government establishes a system of checks and balances among the federal government’s three branches. One element of this balance is an array of principles demanding self-restraint by judges as they carry out their constitutional tasks (this selfrestraint is particularly important for the judiciary, which has lifetime tenure and is not subject to veto). Chief Justice John Roberts noted in a 1993 law review article that the Constitution’s Article III “case or controversy” clause, and related “standing” requirements, serve as “an apolitical limitation on judicial power.” Of course so does the American judicial tradition of respect for precedent. In Janus, the political desires of the sophisticated and

powerful interests who have appeared so often in this saga as parties and amici to attack unions run smack into these elemental principles of judicial self-restraint. The choice is stark. Earlier this term, during oral argument in the partisan gerrymandering case Gill v. Whitford, Chief Justice Roberts voiced concern about the Court’s “status and integrity” if it were to continually adjudicate political disputes. As he put it: [I]f you’re the intelligent man on the street, and the Court issues a decision, and let’s say, okay, the Democrats win, and that person will say: ‘Well, why did the Democrats win?’ … . It must be because the Supreme Court preferred the Democrats over the Republicans… . And that is going to cause very serious harm to the status and integrity of the decisions of this Court in the eyes of the country. Well, welcome to Janus. The Janus case presents itself to the public eye as part of a sustained political effort to overturn longstanding precedent in order to achieve anti-union political goals. While it is expected that a changing of the guard in the executive branch or in Congress may presage new policies, constancy and predictability are expected of the judicial branch. Overruling a precedent based on nothing more than a change in the composition of a court signals serious institutional harm. The pattern of consistent 5-4 pro-Republican and pro-corporate decisions, often marked by procedural irregularities and wellfunded and often anonymous interests bankrolling the litigation, at some point no longer looks to the “intelligent man on the street” like an exercise in impartial adjudication, but rather the exercise of raw political power. Janus will be telling.

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KOCH DOCUMENT REVEALS LAUNDRY LIST OF POLICY VICTORIES EXTRACTED FROM THE TRUMP ADMINISTRATION seen progress on many regulatory priorities this Network has championed for years,” the memo notes. The documenthighlights Charles Koch David Koch environmental issues that the I N T H E B A C KD R O P of Koch brothers have long a chaotic first year of Donald worked to undo, such as the Trump’s presidency, the EPA Clean Power Plan, which conservative Koch brothers is currently under the process of have won victory after victory being formally repealed, and in their bid to reshape Trump’s withdrawal from the American government to their Paris Climate Agreement, interests. among their major Documents obtained by The accomplishments. The memo Intercept and Documented also highlighted administration show that the network of efforts to walk back planned wealthy donors led by rules to strengthen the estate tax billionaire industrialists Charles in a list of 13 regulatory and David Koch have taken decisions favored by the credit for a laundry list of network. policy achievements extracted The network’s political from the Trump administration operation includes a polling and and their allies in Congress. research outfit, Capitol Hill The donors have pumped lobbyists, several hundred field campaign contributions not staff, groups designed to air only to GOP lawmakers, but campaign ads, and an also to an array of third-party assortment of grassroots groups organizations that have set up to appeal to certain pressured officials to act swiftly constituencies. The LIBRE to roll back limits on pollution, Initiative is a network group approve new pipeline projects, geared toward selling Koch and extend the largest set of policy ideas to Latino upper-income tax breaks in communities. Generation generations. Opportunity works to reach out “This year, thanks in part to to millennials and college research and outreach efforts students; Veterans For America across institutions, we have

for veterans and militaryminded voters. To win support for the Republican tax legislation, the Koch network claims that it organized over 100 rallies in 36 states, contacted over 1.8 million activists, and knocked on over 33,000 doors. The group also spent freely on digital and television advertisements, with $1.6 million in TV spots to support the legislation in Wisconsin alone. As The Intercept previously reported, the Koch network told its surrogates to downplay concern over the deficit, a major issue they raised during the Obama administration, in order to convince lawmakers to support the package. Days after the tax bill passed, Charles Koch and his wife donated $500,000to Speaker Paul Ryan’s joint fundraising leadership PAC, which has a heightened threshold for donations. Despite some public antagonism over Trump — including flirtations with replacing him as the nominee with Ryan at the Republican National Convention — the

Koch brothers have enjoyed incredible access with his administration. The president’s lawyer, Don McGahn; the president’s chief liaison to Congress, Marc Short; and the president’s counselor, Kellyanne Conway all previously worked for the Koch network before taking their current positions in the White House. Ethics forms reveal that officialsacr oss the government, including at the Environmental Protection Agency and the Department of Energy, previously served at Koch think tanks or other Koch groups. Vice President Mike Pence also maintains a very close relationship with the Koch brothers. The Koch brothers are also hoping to fundamentally reshape other aspects of American society, including labor unions and the judiciary . The memo details efforts to weaken the power of labor unions, including a broad attack on private sector labor unions in states controlled by Republicans in 2017. ….Read More Note: We now have a Government by the rich, and for the rich.

Refusing To Work For Medicaid May Not Translate To Subsidies For ACA Plan Work requirements for Medicaid coverage. Insurance plans that don’t meet health law standards. Changes to Medicare drug lists. As the ground continues to shift on health care coverage, I answer readers’ queries this week about these three different types of plans. Q: I’m in a state that is looking into work requirements for Medicaid. At sign-up time, can I simply tell

the exchange that I intend to be ineligible for Medicaid by refusing to work and get the premium tax credit to buy a private plan on the insurance marketplace? Federal health law regulations don’t clearly address the situation you describe, but the short answer is probably not, said policy analysts. In general, people who are eligible for Medicaid — the federal-state health program for low-income people — or employer coverage can’t qualify

for federal tax credits that help pay for premiums on plans sold on the health insurance exchanges. This year, Kentucky and Indiana became the first states to receive federal approval to require some Medicaid recipients to put in 80 hours each month at a paid job, school or volunteer work, among other activities, to receive benefits. Nearly a dozen other states have made similar requests. If you refuse to work, does that make you ineligible for

Medicaid? The rules aren’t clear, said Judith Solomon, vice president for health policy at the Center on Budget and Policy Priorities. States might argue that someone in your situation is eligible for Medicaid, you just have to fulfill the work requirements, said Timothy Jost, an emeritus professor of law at Washington and Lee University in Virginia who is an expert on the health law. ...Read More

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WARNING, WARNING, WARNING!! An old tax scam -- with a troubling new twist We know they are out there. They are the criminals who call and claim that you’ll be arrested if you don’t pay up on an old tax debt that you don’t actually owe. But the officialsounding calls can be scary. My 17-year-old daughter got such a call recently on her cellphone — and she doesn’t even pay income taxes. She suspected it was a scam, but she rushed to me to make sure. But because many more people have become aware of the telephone tax-payment trick and learned to ignore the threats, the schemers had to evolve. And the latest twist on this swindle is just pure evil. The IRS has issued a warning to taxpayers about a scam in which a fraudulently obtained tax refund is deposited into a victim’s actual bank account. Here’s how it works: Cybercriminals steal people’s data from tax professionals, including routing and bank account numbers. The crooks file fraudulent tax returns. Fake refunds are then direct deposited into taxpayers’ real bank accounts. In one version of this scam, the

criminals then contact victims claiming to be from a debtcollection agency, and they say the refunds were deposited in error. They claim they are now trying to get the refund back for the IRS. I can imagine how easy it is to panic and fall victim to this scam. Taxpayers can see money has been deposited. They know it isn’t rightfully theirs. And since nobody in their right mind wants to mess with the IRS, they are eager to cooperate to return the money. “It’s insidious,” said Eric Smith, an IRS spokesman, who added that thousands of taxpayers have been affected by this scam. In another version of this racket, a taxpayer gets a menacing recorded telephone message about the deposited refund. Someone claiming to be from the IRS threatens the person with arrest, criminal fraud charges and a warning that his or her Social Security number will be “blacklisted.” People are given a case number and then a telephone number to call to arrange the return of the refund, the IRS said. Obviously, do not call back any number left by anyone claiming to work for the IRS or

on the agency’s behalf. The IRS would not call you. It’s definitely the crooks calling. “You need to return the money — just not to them,” Smith said. In addition to having to figure out how to properly give back the refund to the IRS, you need to close your bank account and contact your tax preparer. As for returning the fraudulent refund, you should go to and search for “Topic Number: 161 — Returning an Erroneous Refund — Paper Check or Direct Deposit.” Then follow the steps. If the fraudulent refund was direct deposited into your bank account, contact the “Automated Clearing House” (ACH) department of your financial institution. See if you can have the deposit returned directly to the IRS. You’ll also need to call the agency to explain why the refund is being returned. Individuals should call 800-8291040. If you’re a business, call 800-829-4933. If the erroneous refund came as a paper check, write “void” on the back where you would normally endorse it. You’ll have to send the check to the IRS location based on the city listed on the refund check. You should include a note explaining why

you’re returning the refund. And, if I were you, I’d make a copy of the check and return it via certified mail just to be on the safe side. Return the money as soon as you can. By law, interest may have accrued on the fraudulent refund, Smith said. This is another reason why you shouldn’t procrastinate in filing your return. But if you do find that you’ve fallen for a tax scam, read the IRS’ “Taxpayer Guide to Identity Theft” at One thing I did to protect myself was to sign up for an IRS online account. If you’re still putting together your tax return, as I am, it’s one way to monitor your tax records. Here’s the link to set up an account: click here You may not be able to immediately set up an account because of security measures. If you have a credit freeze on your Experian credit file, you’ll have to temporarily lift it. I had to wait for the agency to mail me an activation code to finish the process. But once your account is set up, you can see what return has been filed and get a payment history. When it comes to your tax return, just be careful out there.

Ten ERs In Colorado Tried To Curtail Opioids And Did Better Than Expected DENVER — One of the most common reasons patients head to an emergency room is pain. In response, doctors may try something simple at first, like ibuprofen or acetaminophen. If that wasn’t effective, the second line of defense has been the big guns. “Percocet or Vicodin,” explained ER doctor Peter Bakes of Swedish Medical Center, “medications that certainly have contributed to the rising opioid epidemic.” Now, though, physicians are looking for alternatives to help cut opioid use and curtail

potential abuse. Ten Colorado hospitals, including Swedish in Englewood, Colo., participated in a six-month pilot project designed to cut opioid use, the Colorado Opioid Safety Collaborative. Launched by the Colorado Hospital Association, it is billed as the first of its kind in the nation to include this number of hospitals in the effort. The goal was for the group of hospitals to reduce opioids by 15 percent. Instead, Dr. Don Stader, an ER physician at Swedish who helped develop and lead the study, said the hospitals did much better: down 36 percent on

average. “It’s really a revolution in how we approach patients and approach pain, and I think it’s a revolution in pain management that’s going to help us end the opioid epidemic,” Stader says. The decrease amounted to 35,000 fewer opioid doses than during the same period in 2016. The overall effort to limit opioid use in emergency departments is called the Colorado ALTO Project; ALTO is short for “alternatives to opioids.” The method calls for coordination across providers, pharmacies, clinical staff and

administrators. It introduces new procedures, for example, like using non-opioid patches for pain. Another innovation, Stader said, is using ultrasound to “look into the body” and help guide targeted injections of non-opioid pain medicines… Rather than opioids like oxycodone, hydrocodone or fentanyl, Stader said, doctors used safer and less addictive alternatives, like ketamine and lidocaine, an anesthetic commonly used by dentists. .Read More

Rhode Island Alliance for Retired Americans, Inc. • 94 Cleveland Street • North Providence, RI • 02904-3525 • 401-480-8381 •

Evaluations Of Medicaid Experiments By States, CMS Are Weak, GAO Says With federal spending on Medicaid experiments soaring in recent years, a congressional watchdog said state and federal governments fail to adequately evaluate if the efforts improve care and save money. A study by the Government Accountability Office released Thursday found some states don’t complete evaluation reports for up to seven years after an experiment begins and often fail to answer vital questions to determine effectiveness. The GAO also slammed the federal Centers for Medicare & Medicaid Services for failing to make results from Medicaid evaluation reports public in a timely manner. “CMS is missing an opportunity to inform federal and state policy discussions,” the GAO report said. Joan Alker, executive director of the Georgetown University

change payment systems to improve care. Medicaid demonstration programs often run for a decade or more. Several states that expanded Medicaid eligibility under the Affordable Care Act did so through a demonstration program, including Indiana, Iowa, Arkansas and New Hampshire. Nearly three-quarters of states have Medicaid demonstration programs, such as those testing providing services through private managed-care firms and Center for Children and These experiments are often requiring enrollees to pay Families, called the report’s called “demonstration projects” monthly premiums. About a findings “troubling but not or “1115 demonstration third of the federal government’s surprising.” waivers” — based on the section $300 billion a year in Medicaid “It has been clear for some of the law that allows the federal spending goes to these test time that evaluations of Section government to authorize them. programs, the GAO said. 1115 waivers are not adequate,” They allow federal officials to The study, requested by top she said. “There is some good approve states’ requests to test GOP lawmakers including Sen. work going on in this space at new approaches to providing Orrin Hatch (R-Utah), reviewed the state level, for example in coverage. They are used for a demonstration programs in eight Michigan and Iowa, but as the wide variety of purposes, states — Arizona, Arkansas, report makes clear state’s including efforts to extend California, Indiana, Kansas, evaluations are often incomplete Medicaid to people or services Maryland, Massachusetts and and not rigorous enough.” not generally covered or to New York….Read More

New Threats to the ACA: Administrative Changes Together with Medicare and Medicaid, the Affordable Care Act (ACA) builds health security for people of all ages. Repealing or undercutting the ACA without a meaningful replacement would jeopardize the health and wellbeing of millions. Accordingly, we are concerned that several recent proposals from the Trump administration could undermine the health law and destabilize the public and private insurance markets. Yesterday, the U.S. Department of Health and Human Services released a proposed rule to expand the availability of short-term, limited-duration health insurance plans. These short-term policies are free from the ACA’s insurance regulations – including the mandate to cover essential health benefits like

maternity care, prescription drugs, and mental health treatment – as well as from the health law’s consumer protections that prevent insurers from charging sick people more than healthy people, excluding coverage of pre-existing conditions, and denying coverage based on medical history. Because these short-term plans can cover fewer services and deny coverage for serious medical needs, they typically offer lower premiums than traditional insurance, which may attract healthier people to them and away from the ACA’s individual market. This would raise costs for those who remain in the more comprehensive, ACA-compliant plans. This policy change comes on the heels of the administration’s

proposal to expand Association Health Plans, which would similarly allow people to purchase less robust insurance coverage outside of the ACA. Together, these proposals would have the effect of drawing healthy consumers away from ACA plans, leaving behind an older, sicker, and costlier market. In response, health insurers would likely raise premiums or exit the market altogether, destabilizing coverage for those who need it. This could leave people approaching Medicare eligibility with limited coverage options, and may force some to go without care – ultimately resulting in worse health outcomes and increased program costs. While these potential changes to the ACA have received less

attention than last year’s efforts to repeal-andreplace the law in its entirety, they are nevertheless significant. We must stay vigilant about proposals that would undermine health security for American families. The Medicare Rights Center continues to oppose legislative and regulatory changes that would erode consumer protections or limit access to comprehensive health coverage. Comments on the Short-Term Limited Duration proposed rule are due by April 23. Read and submit comments. Comments on the Association Health Plan Proposed rule are due March 6. Read and submit comments.

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The Time has Come for Medicare Dental Benefits This week, economist Austin Frakt outlined the economic and health impacts associated with Medicaid’s lack of dental coverage for adults in many states. These associations range from an increased risk of cancer and heart disease, to complications for pregnancy, to social stigma and difficulty finding work. While Medicaid requires dental coverage for children, coverage for adults is optional. Currently, there are 17 states that offer comprehensive adult dental

benefits. Medicaid’s lack of a comprehensive adult dental benefit in most states makes the health and well-being of people with Medicaid less robust. But Medicaid’s sparse dental coverage is still superior to the coverage Medicare offers most beneficiaries. Traditional Medicare only pays for a limited number of dental services, and only under a limited number of circumstances. For example, Medicare might cover dental services if a beneficiary has oral

cancer and needs services in preparation for radiation treatment. But dental services outside of these narrow coverage lanes is not available in traditional Medicare. The program is permitted to cover “medically necessary” care but has chosen not to do so. Medicare Advantage, the form of the program that can be accessed through private insurance plans, can include dental coverage at the discretion of the plan sponsor. It is unclear how many beneficiaries have access to comprehensive dental

services through their Medicare Advantage plans. The lack of a comprehensive dental benefit in Medicare is one of the gaps in the program that must be addressed, especially as lawmakers consider extending Medicare eligibility beyond older adults and people with disabilities. Medicare Rights has long advocated for dental benefits to be included fully in both traditional Medicare and Medicare Advantage plans. No time like the present to better support and protect our nation’s health!

Medicare Advantage, Part D Updates to Provide New Benefits in 2019 CMS also proposing new protections in opioid crisis Changes for the Medicare health and drug programs have been proposed for 2019 that increase flexibility in Medicare Advantage to allow more options and new benefits to Medicare beneficiaries, meeting their unique health needs and improving their quality of life, says the Centers for Medicare & Medicaid Services (CMS). The proposal also includes important new steps to ensure new patient-doctor-plan communication in combatting the opioid crisis, according to the CMS announcement. As a part of these changes, CMS is redefining healthrelated supplemental benefits to include services that increase health and improve quality of life, including coverage of non-skilled inhome supports, portable wheelchair ramps and other assistive devices and modifications when patients

need them. “Our priority is to ensure that our seniors have more choices and lower premiums in their Medicare health and drug plans,” said CMS Administrator Seema Verma. “We are focused on addressing the specific needs of beneficiaries and providing new flexibilities for Medicare Advantage plans to offer new health-related benefits. This is a big win for patients.” CMS has previously not allowed an item or service to be eligible as a supplemental benefit if the primary purpose included daily maintenance. Under the new policy announced today, CMS would allow supplemental benefits if they compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room utilization. CMS also announced new action to combat the nation’s

opioid epidemic through its effective oversight of programs that have successfully reduced opioid overutilization by Part D enrollees. The agency is also designing the framework of several new policies that would give health plans additional tools to better manage chronic overuse among beneficiaries by ensuring patient-doctor-plan communication regarding opioid use. Medicare Advantage remains a popular choice among beneficiaries and has high satisfaction ratings. In 2018, Medicare Advantage and Part D premiums decreased and the number of Medicare Advantage plans available to choose from across the country increased from about 2,700 to more than 3,100 – and enrollment in Medicare Advantage is at an all-time high as approximately one-third of all Medicare

beneficiaries are enrolled in a plan. The proposed updates will result in a payment increase that promotes stability and insures that resources will be available to support beneficiaries enrolled in private Medicare plans. For a fact sheet on the 2019 Advance Notice, Part II, and the Draft Call Letter, please visit: click here. CMS released Part I of the Advance Notice on December 27, 2017. The 2019 Advance Notices (Part I and Part II) and Draft Call Letter may viewed by going to: here and selecting “2019 Advance Notices.” Comments on the proposed Advance Notices and Draft Call Letter are invited from industry, seniors, consumer advocates, and the public and must be submitted by March 5, 2018. The 2019 Final Rate Announcement and Call Letter will be published on Monday, April 2, 2018.

Rhode Island Senator Jack Reed Introducing Measure to Overturn Net Neutrality

Senator Reed

Dear Mr. Pernorio: Yesterday, I joined 49 of my Senate colleagues in introducing a measure to overturn

the Federal Communications Commission's partisan decision on net neutrality. You can view my full statement on this legislation at click here and a video on why net

neutrality is so critical at click here. I appreciate your passionate advocacy, and I encourage you to continue to exercise your right to free speech and help keep the

internet fair, open, and free. You can also be assured that I will stay focused on promoting policies that protect consumers and ensure access to the internet.

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RI ARA HealthLink Wellness News


What is pneumococcal meningitis? Meningitis is an infection of the meninges, the membranes that cover the brain and spinal cord. Once infected, the membranes swell. Viruses are responsible for most cases of meningitis, but pneumococcal meningitis is caused by a bacteria called Streptococcus pneumoniae. Pneumococcal meningitis is a rare but very serious illness that can develop into a lifethreatening medical emergency. The infection may have longterm consequences and can even

be fatal. Prompt treatment is necessary to minimize the risk of adverse outcomes. Streptococcus pneumoniae (S. pneumoniae) is a widespread bacteria responsible for many illnesses, including meningitis, pneumonia, and sinus infections. The bacteria spread easily and quickly from person to person through coughing and sneezing. S. pneumoniae is the most common cause of bacterial meningitis in adults. It is also among the leading causes of bacterial meningitis in children under 2 years old. The incidence of severe

pneumococcal infection, including meningitis, has decreased significantly since the introduction of the pneumococcal vaccine. In this article, we take a look at the causes, symptoms, and treatment options for this condition. Causes Pneumococcal meningitis occurs when S. pneumoniae enter a person's bloodstream and infect the fluid surrounding the brain or spine. When a person has this bacteria in their system, they do not always contract meningitis. However, it causes many other

illnesses, including:  ear infections  blood infections  sinus infections  pneumonia According to the Meningitis Research Foundation of Canada, up to 40 percent of people may carry S. pneumoniae. In the majority of these people, the bacteria is not growing or active and will not cause illness. However, anyone who carries this bacteria can transmit it to others, potentially causing any of the illnesses above or pneumococcal meningitis….Read More

What are the health benefits of being social? Humans are born into social groups and live their entire lives as a part of society, so the social element can't easily be removed from the evolution of an individual. But how does social contact affect our health? As human beings, we dream, learn, grow, and work as part of society. The society that we're born into and the societies that we navigate throughout our lives shape our personal identities. And in fact, so keen are we to communicate with each other — even beyond geographical

limitations — that we've developed a plethora of tools to help us achieve that, including pen and paper, telegraph, telephone, and the Internet. When I asked my colleagues in the Medical News Today office what benefits — if any — they thought that they derived from social connection, most of them said that they found some measure of comfort in social interaction. Some colleagues said that they enjoyed the shared experiences, whereas others explained that

friends kept them motivated to do "some healthful activities from time to time." Others said that being around friends helped them to "destress and put things into perspective." Even the most introverted among us crave social contact from time to time. But why is that, and does being social bring us any actual health benefits? In this Spotlight, we investigate why humans thrive in society, and how social interaction impacts our mental and physical well-being.

Why are we a social species? It may be intuitive to say that being social has helped our species to not only survive but also thrive over millions of years. But why is that so? .A study from 2011, which was published in the journal Nature, argues that being social became a key strength .Read More

Trump’s Perfect Score On Brain Test Spawns DIY Cognitive Exam When Donald Trump aced a cognitive test in January, scores of people tried to take it, too, based mostly on media reports that invited them to match wits with the president. Casual users puzzled over line drawings of animals, while others wondered what it meant if they were bad at subtracting by sevens. That was a mistake, according

to the scientist who created the Montreal Cognitive Assessment, or MoCA, a popular screening tool designed to spotlight potential problems with thinking and memory. The MoCA was never meant for general use and it requires a health professional to monitor the test and interpret the results. Media coverage challenged people “to test yourself to see if you fare as well as Mr. Trump, but that wouldn’t give them the

accurate response,” said Dr. Ziad Nasreddine, the LebaneseCanadian neurologist who holds the copyright to the MoCA. “You need a trained person to administer this test.” But with interest in the test so high, Nasreddine and his colleagues saw an opportunity. Weeks after Trump posted his perfect MoCA score (30/30), the researchers started working on a new tool, dubbed the “miniMoCA,” an online, self-

administered exam for people worried about possible cognitive decline. “We thought, ‘OK, why shouldn’t we take the lead and develop the test?’” said Nasreddine, who had been pondering such a move for several years. “It’s good timing to offer something for families and concerned individuals that they can self-test themselves.”...Read More

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Macular Degeneration: Managing This Vision Condition Early treatment and vision rehabilitation help people stay independent and see as well as possible. Helyn Guerry, 88, of Houston, looks around her room but struggles to make out the objects directly in front of her. Macular degeneration, a common eye condition among older adults, seriously blurs her central vision. Driving is no longer possible for Guerry. Fortunately, she has a support system in place. "I

have a grandson who's very near and dear, and he comes once a day," she says. He helps her catch up with paperwork and takes her to the grocery store because she can't read labels now. She also has occasional professional help from an aide who accompanies her on visits to the doctor. Guerry can't read print books anymore. When she recently picked up her Kindle, she noticed her eyesight had deteriorated a bit more. Now she uses a machine that reads books aloud. Fortunately, she says,

her hearing is still good. Age-related macular degeneration is the leading cause of visual loss in the U.S., according to the National Eye Institute. As the population ages, it will only become more common. In 2010, among adults ages 50 and older, nearly 2.1 million people had macular degeneration. By 2050, that figure will more than double, according to NEI projections. Macular degeneration is a disease of the retina. The retina records any images you see and transmits them to your brain

through your optic nerve. The macula is the central portion of the retina and it's responsible for your central vision. The ability to recognize faces, read, write, watch TV, cook, drive and do other tasks depends on the macula. If it deteriorates, blurred areas can appear in the middle of your visual field. If the condition progresses, blurred areas may grow larger or blank spots may develop. Whatever you see may appear darker or distorted. ...Read More

Health Tip: Balance Moves for Older Adults Balance exercises can help the floor. You can modify by keep the toes within view to parallel to prevent falls, especially among raising just the heel of the minimize how much the knees the floor. older adults. But before you right foot. Bring the hands project forward. Lean against With the begin any exercise program, together in a prayer position, a wall while lowering, being right hand always consult your doctor. then point the fingers forward, sure to start with the feet far behind the The American Council on away from the body. Twist to enough away from the wall so head and the elbow flexed and Exercise mentions these the right and left making a that the knees still stay behind pointing to the side, twist to common balance exercises for large infinity design with the the toes in a lowered position. the left, trying to keep the active older adults: hands. Bring the hands behind the spine as extended as possible. head so the elbows are flexed,  Standing "X" Skating  Side X Balance Reach - Raised Hinge -- With the feet pointing to the sides. Stand on the right leg and lean placed about hip-width Balance Reach -- Stand with the body toward the right. distance apart, raise the left  Active Lat Stretch -- Sit back the feet about shoulderPoint the right shoulder heel and decrease contact into the squat position distance apart with a chair in toward the sky. The body points with the floor. With the described in the Squat and front for support, if necessary. makes half of an "X" shape. hands at the hips, slowly fold Twist exercise, using the wall Flex the left shoulder forward Touch down as needed with forward over the hands, for support. Slide the arms and up, and simultaneously the left toes. Continue flexing at the hips but not at and thumbs up and down the extend the right hip, making a balancing on this side for up the spine. Keep the spine as wall slowly for one minute. contralateral half of the letter to two minutes, then change extended as possible. Flex the  Standing Twist Lunge -"X." Slowly lower to a sides. knees if the hamstrings are starting position and repeat on Place a chair to the side for tight. the other side. Continue this  Stand and Twist -- Begin support, if needed. Start with movement for up to two standing on the left leg and  Squat and Twist -- Start with the feet together and step minutes. raise the right knee up until the feet set hip-width apart. forward with the left foot to the upper thigh is parallel to Lower to a sitting position; bring the left upper thigh

Health Tip: Friendships May Stem Cognitive Decline in Seniors Institute on Aging says. For seven years, researchers at Northwestern University studied a group of so-called "superagers" -- people 80 and older who had maintained longstanding friendships. Forging new friendships and The researchers found that the maintaining old ones may help group collectively had memories slow cognitive decline among of past personal events that seniors, the U.S. National rivaled people up to 30 years

younger. What's more, the area of the brain called the anterior cingulate -- important for emotions and attention -showed less cognitive decline among superagers than among others of a similar age group. Participating in social activities such as visiting friends, volunteering and going

on trips has been associated with better brain function, while older people who don't socialize as much have been found to be at increased risk of dementia, the Institute says.

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RI ARA March 4, 2018 E-Newsletter


RI ARA March 4, 2018 E-Newsletter

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