It has been a busy 2017 at the Center for Senior Services (CSS), and we are pleased to report on our advocacy efforts. Throughout the year we have been advocating on a wide range of senior issues relating to health care (Medicare and Medicaid), Social Security and affordable housing. Our work included meetings on Capitol Hill, organizing tours of B’nai B’rith sponsored buildings and co-sponsoring rallies on affordable housing. During the year we were excited that our work was noted by the Jewish Telegraph Agency (JTA), The Times of Israel and the New York Jewish Week.

Our advocacy efforts went into high gear in March when the White House’s proposed 2018 “skinny” budget was released, which called for a 13 percent reduction in the Department of Housing and Urban Development’s budget. A few months later when the administration’s more detailed budget was announced, B’nai B’rith was severely disappointed that Section 202, which is housing that was developed for low-income seniors, was underfunded and the White House proposed a rental increase for residents. 

Staying on top of the issue, the CSS team started visiting senator and representative’s offices on Capitol Hill that represent B’nai B’rith sponsored buildings. Specifically, we met with offices that work on the House and Senate Appropriations Subcommittees on Transportation, Housing and Urban Development. These committees are responsible for writing legislation that funds rental subsidies for the Section 202 program.  During the course of these meeting we explained to staff members how damaging the White House’s budget would be for low-income Section 202 residents. While the 2018 budget has not been finalized we are hopeful that our advocacy efforts on Capitol Hill will lead to the Section 202 program being funded more. 

In addition, we followed up those visits by inviting members of Congress and their staff to tour B’nai B’rith Section 202 buildings throughout the country. We are pleased to report that Reps. Jamie Raskin (D-Md.), Matt Cartwright (D-Pa.), Grace Meng (D-N.Y.) and Charlie Dent (R-Pa.), representing both political parties, toured our sponsored properties.  Furthermore, three of the four members who visited B’nai B’rith sponsored buildings work on the Appropriations Committees. These tours were a fantastic opportunity for members of Congress to see the benefits of the Section 202 program, and gave residents a chance to speak with their elected representative. Residents were able to directly tell their member of Congress the vital role Section 202 housing plays in their lives.

B’nai B’rith was also pleased to co-host with LeadingAge the “Save HUD 202” Rally and partner with the National Low Income Housing Coalition for the “National Housing Day of Action” over the summer. These rallies took place on Capitol Hill and featured representatives and senators who spoke about the need for affordable housing. We were certainly delighted  members of Congress who represent B’nai B’rith sponsored buildings attended the event. 

Our advocacy during the course of the year didn’t just stop with affordable housing. We spoke out against the White House and Congress’ attempts to repeal and replace the Affordable Care Act (ACA). After analyzing various proposed bills, B’nai B’rith was very concerned how these policies could negatively impact seniors. For example, many of the proposed replacement bills would have cut critical funding to Medicaid, allowed older Americans to be charged more for insurance, repealed vital taxes that help fund Medicare and waive important regulations that protect health care consumers. We spoke out on these issues by releasing press releases, blogs and joined with liked minded organizations opposing this legislation in a full page advertisement in Politico.   

Recently, B’nai B’rith has been very vocal against the recently passed tax reform legislation. We expressed serious reservations about this bill because of the damaging impact it could have on funding for Medicare and Medicaid attributable to rising deficits that will give cover to members of Congress to slash spending. In addition, the negative consequences repealing the ACA’s individual mandate will have on older Americans. We brought our concerns straight to congressional offices during our regular scheduled Capitol Hill visits regarding Section 202. However, we certainly applaud Congress for not eliminating the Low Income Housing Tax Credit which is critical for affordable housing construction, and the medical expense deduction which is incredibly important to countless seniors with high health care costs.
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The CSS team embarks on 2018 looking to continue our success from 2017. We will certainly look to invite more members of Congress and their staff to B’nai B’rith sponsored buildings, and advocate for the Section 202 program and other policies that are vital to seniors. 

Medicare is our national health insurance program for individuals 65 and older and permanently disabled people under the age of 65. Created in 1965, Medicare has made health care for seniors significantly more affordable and given elderly people peace of mind regarding their medical expenses. Medicare can be broken up into Medicare Part A (hospital insurance, skilled nursing, home health services and hospice care) Part B (doctor’s visits, lab tests, surgeries, wheelchairs and walkers), Part C (private health insurance plans) and Part D (prescription drug coverage). Given how vital Medicare is for seniors, it’s important to analyze how legislative proposals in Congress can impact the health care program’s long-term financial viability.

Throughout the year, Congress has spent time trying to repeal and replace the Affordable Care Act (ACA) through various health care proposals. One of the proposals, the American Health Care Act (AHCA), would have dissolved the .9 percent  Hospital Insurance trust fund payroll tax. This tax is directly responsible for helping fund the Medicare Part A Trust Fund. Recently, the Medicare Board of Trustees reported that Medicare Part A will be able to pay 100 percent of its obligations until 2029. However, had the ACHA become law, revenue for Part A would have been reduced by $59 billion, and caused the trust fund to be less solvent. 

When members of the House of Representatives voted for the AHCA, I often wonder how they could explain voting for a health care bill which makes Medicare more insolvent. Members of Congress are always talking about Medicare’s fiscal future, well, cutting off the program’s funding is a sure fire why to guarantee insolvency.
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Furthermore, Congress’ attempts to repeal and replace the ACA, whether through the AHCA or the Graham-Cassidy bill, would have been severely damaging for older Americans (55 to 64).  Some older adults could have found their private health insurance to be cost prohibitive. The Congressional Budget Office (CBO) estimated that older Americans would have suffered greatly if the AHCA became law. For example, a 64-year-old making $26,500 a year would have seen an increase in premiums by an astronomical $14,400 in 2026. Furthermore, a 60-year-old earning $40,000 would receive a tax credit under the AHCA of $4,000 compared to $6,750 under the ACA to purchase insurance.  

In addition, the recent proposals in Congress would have eliminated Medicaid expansion (ACA allows states to increase eligibility for people under 65 who were at or below 138 percent of the federal poverty line) which could have left low-income older Americans without viable health care. Evidence demonstrates that Medicare eligible seniors with prior health insurance as older adults require less expensive health care than people who were uninsured before they enrolled in Medicare. Whether it’s the ACHA or Graham-Cassidy, had these bills become law, Medicare spending across the board (Part A, B, C and D), could have seen an unnecessary spike.
 
A study published by the New England Journal of Medicine, entitled “Use of Health Services by Previously Uninsured Medicare Beneficiaries” found that uninsured persons between the ages of 50 to 64, were more likely to experience worsening health and die younger compared to persons of the same age who were otherwise uninsured. Consequently, once the uninsured population became Medicare eligible they required more expensive health care. The study found that the costlier care resulted from 23.4 percent doctor visits and 37 percent hospitalizations. In conclusion, the study stated, “These findings support the hypothesis that previously uninsured adults used health services more intensively and required costlier care as Medicare beneficiaries than they would have if previously insured.”   

To further the point, the United States Government Accountability Office published a similar study that examined the impact of having continuous health insurance prior to joining Medicare entitled, “Continuous Insurance before Enrollment Associated with Better Health and Lower Program Spending.” This report found that people with continuous health insurance coverage for about six years prior to being Medicare eligible were more likely to be healthier for their first six years on Medicare as compared to their insured counterparts. Financially during the first year on Medicare, people with prior continuous coverage had about $2,300, or 35 percent less in predicted spending than the previously uninsured population. 

Overall, Medicare helps 57 million people in America gain access to health care, with half of its recipients having incomes of less than $24,150 a year. Recent health care proposals would have purposefully defunded Medicare and made health care less accessible for the majority of older Americans. 
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While reasonable people can disagree on health care fixes to the ACA, I hope Congress does not champion policies that put Medicare’s long term financial future into question.  

​​Evan Carmen, Esq. is the Assistant Director for Aging Policy at the B’nai B’rith International Center for Senior Services. He holds a B.A. from American University in political science and a J.D. from New York Law School.  Prior to joining B’nai B’rith International he worked in the Office of Presidential Correspondence for the Obama White House, practiced as an attorney at Covington and Burling, LLP, worked as an aide for New York City Council Member Tony Avella and interned for Congressman Gary Ackerman’s office. Click here to read more from Evan Carmen.

Recently the “The Over-the-Counter Hearing Aid Act of 2017” was introduced in the Senate by Sens. Elizabeth Warren (Massachusetts), Chuck Grassley (Iowa), Maggie Hassan (New Hampshire) and Johnny Isakson (Georgia) with companion legislation introduced in the House by Reps. Joe Kennedy III (Massachusetts) and Marsha Blackburn (Tennessee). The purpose of this bill is to assist seniors with low-to-moderate hearing loss, access hearing aids by making them available over the counter. If seniors are allowed to get hearing aids over the counter, it would eliminate the onerous requirement that people get a medical examination or sign a waiver—bypassing the examination prior to receiving a hearing aid. In addition, the law would instruct the Food and Drug Administration (FDA) to write regulations to ensure the hearing aid’s safety and proper labeling.
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This legislation is badly needed because Medicare often does not cover the cost of hearing aids, and the third most widespread chronic health condition confronting seniors is hearing loss. This Medicare coverage hole has caused an unacceptable 70 percent of Americans with a hearing loss between the ages of 65 and 84, to forgo the benefits of these devices because they are too cost prohibitive. With the average cost of a hearing aid at $2,400, paying for this device out of pocket for older Americans, especially low-income seniors, is not a viable option on their limited budgets.

According to Consumer Reports, the average retail markup for hearing aids is 117 percent because the market is controlled by only a select group of companies. Proponents of the bill argue that this legislation would create more competition for hearings aids and therefore decrease the cost. Opponents of the bill are skeptical this would lead to additional people purchasing hearing aids, and believe this legislation could cause people to self-diagnose hearing loss, and consequently not seek the guidance of medical professionals. However, according to Sen. Hassan, “Allowing certain hearing aids to be sold over the counter, just like reading glasses are, is a common-sense step that bring real cost savings to older Americans.” In addition, the National Academies of Science, Engineering, and Medicine states, “No evidence that the required medical evaluation or waiver of that evaluation provides any clinically meaningful benefit” and advocates “removing this regulation to serve consumers’ best interests.”

Increasing access to hearing aids will also improve seniors’ mental health. According to Dr. Frank Lin (assistant professor at Johns Hopkins University and an otologist and epidemiologist who focuses in the impact of hearing loss on older adults), hearing loss is a consequential part of aging. For example, he conducted studies that demonstrated hearing loss caused seniors to lose cognitive abilities and increased their chances of getting dementia. In addition, far too many seniors over time are losing one of their basic senses, the simple ability to hear. Can you imagine having a difficult time listening to music, watching TV or conducting a basic conversation? Until Congress expands Medicare to cover all costs associated with hearing aids, “The Over-the-Counter Hearing Aid Act of 2017” could provide seniors with more financial security by driving down the cost of hearing aids, and improving their quality of life. 

Medicare Open Enrollment is happening now and continues through Dec. 7, 2015.  Anyone with Medicare can change health plans, switch from Original Medicare to a  Medicare Advantage plan (MA) or from MA to Original Medicare. You can also switch from one MA plan to another during this time.  People with Original Medicare (or an MA plan that doesn’t include prescription drug coverage) can also add or change their Part D (prescription drug) plan selection at this time. 

If you are happy with what you had last year you can usually just do nothing and you have the same plans for next year.  However, since plan details can and do change, it’s important to first check that your plan still suits you.  For both Medicare Advantage and Part D plans, it’s important to check on plan changes through the Medicare.gov website.  Remember to think about not only plan changes but about how your life, health, location, preferences and prescriptions may have changed—is the same plan still right for you?  Tools at the Medicare website will ask you to enter your prescription medications so you can compare Part D plans and make sure yours is still a good deal for you, so write down a list before you go to the website. 

Location, Location, Location
Some MA plans and some Part D plans are only available in certain areas of the country—if you are planning to move, give the tool your new location and let it tell you what plans work there, too.

Don’t miss open enrollment
For the most part this is the only time you can switch your Medicare choices.  There are a couple of exceptions though: 

1. Certain life events including moving can qualify you for a special enrollment period (SEP) (see links below).
2. Because MA plans are privately run, there is also something called a Medicare Advantage Disenrollment Period (MADP), which you may be able to access if you are genuinely unhappy with a Medicare Advantage plan.  That goes from New Year’s Day to Valentine’s Day 2016 (Jan. 1 – Feb. 14).  It’s not a full open enrollment.  You can leave your MA plan and return to original Medicare, and you can add a part D plan, but most other changes are not allowed at this time, like switching from one MA plan to another.  That has to happen before December 31. 

For more information about selecting the right plan, or about special enrollment periods, see the resources below. 

> Sign up or change plans by click here.

> Information on Special Enrollment Periods can be found here.

> Click here for Medicare Supplement plans “Medigap” information.