Since I started my job at B’nai B’rith International, I have written several blogs being critical of the Trump Administration and Congress’ proposals to cut funding from affordable housing. Over the past twenty months, there have not been many opportunities to applaud our elected representatives in Washington, D.C. for bi-partisan legislation that looks to tackle the severe shortage of reasonably priced homes in this country. Consequently, the recently introduced bipartisan Senate legislation, called the Task Force on the Impact of the Affordable Housing Crisis Act, should be positively recognized. The purpose of this task force is to study how affordable housing financially impacts other government programs (federal, state and local), different facets of people’s lives (i.e. health, nutrition, education, employment, etc.) and make policy recommendations to Congress on how affordable housing can strengthen additional federal programs.   
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Working at B’nai B’rith offers me the unique opportunity to see how housing is intertwined with other areas of senior’s lives, especially health care. One of the goals of B’nai B’rith is to “age in place” which we accomplish through our sponsored Department of Housing and Urban Development (HUD) Section 202 housing. Older Americans are able to “age in place” because service coordinators connect residents with community based services, which have demonstrated a greater likelihood of retaining residents in their existing buildings and therefore avoiding more pricey institutions like a nursing home.

The benefits of the Section 202 program go to the very heart of what this potential task force is hoping to accomplish, that is, to find ways affordable housing can help other federal programs. For example, the financial cost of three seniors in a Section 202 building with home and community-based services is about the same as one person in a nursing home. Keep in mind that Medicaid is a key subsidizer of nursing homes. According to HUD, 38 percent of Section 202 tenants are frail or near-frail, and consequently need help with daily activities, making them potential candidates for long-term institutional care. Therefore, the more Section 202 buildings that can be developed for frail or near-frail seniors, the less financial resources Medicaid will require for nursing homes.
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In addition, bi-partisan policy solutions generally have a better chance of becoming law, especially in the Senate. This legislation was introduced by U.S. Sens. Todd Young (R-Ind.), Maria Cantwell (D-Wash.) and Angus King (I-Maine), along with cosponsors from both political parties. Furthermore, the people who serve on the Task Force will be appointed by both Democrats and Republicans. These Senators should be commended for taking an important “first step” toward discovering how integral affordable housing is to other federal programs. 
 
Obviously, the introduction of this legislation is a far cry away from being sent to the president’s desk for his signature, and even further away from any policy recommendations from the task force to Congress. However, you have to walk before you can run. Hopefully, this legislation becomes a reality, and the policy proposals are Congress’ full sprint towards creating additional affordable housing in the country. 

Currently the Affordable Care Act (ACA) protects people with pre-existing conditions by outlawing health insurance companies from refusing to sell plans to individuals because of existing health issues. These protections are particularly important for older Americans who obviously are more likely to have a pre-existing condition. Unfortunately, these protections could be compromised by Department of Justice’s (DOJ) decision not to defend the ACA’s in a lawsuit brought by Texas and 19 other states. The basic premise behind the litigation is that because of last year’s tax reform legislation, the individual mandate has been effectively eliminated because people will no longer be taxed for not carrying health insurance. Taken one step further, these 20 states argue that because the individual mandate is so integral to the ACA, that the rest of the legislation should be found unconstitutional (it should be noted the administration is only arguing pre-existing protections and community ratings should be found invalid). Currently around 25 million older Americans (50 to 64) could be denied insurance in the individual market if the protections for people with pre-existing health conditions are eliminated.   

First the DOJ’s  decision is concerning because it runs contrary to its own long standing tradition of generally defending federal law in litigation, even if the current administration is ideologically opposed to the policy. Law professor Nicholas Bagley from the University of Michigan who used to work at the DOJ said, “I am at a loss for words to explain how big of a deal this is. The Justice Department has a durable, long-standing, bipartisan commitment to defending the law when non-frivolous arguments can be made in its defense. This brief torches that commitment.”
In addition, in a letter from Attorney General Jeff Sessions to House Speaker Paul Ryan regarding this litigation, Sessions argues that without the individual mandate, “individuals could wait until they become sick to purchase insurance, thus driving up premiums for everyone else.” Meaning people could go without insurance until they become sick, and because of pre-existing conditions protections insurance companies would be forced to sell sick people policies, thus driving up the costs for everyone else. If I understand this correctly, Congress and the White House repeal the individual mandate, which will likely drive up health insurance premiums, and their solution to this problem is to deny protections for people with pre-existing conditions. 

While a final resolution regarding this litigation is a ways off, currently the ACA has been instrumental in providing improved health care protection and coverage for older Americans. For example, according to the Commonwealth Fund in 2010, 43 percent of individuals between the ages of 50 to 64 who attempted to purchase health care coverage where either rejected, charged higher premiums or had certain health conditions omitted from policies. The ACA combats these problems by not allowing people to be denied for pre-existing conditions, limiting what insurance companies can charge older Americans compared to younger people and regulating individual’s insurance premiums through tax credits. The Commonwealth Fund reports between 2012 to 2016 older Americans between 50 and 64 saw the uninsured rate drop from 13 to 8 percent. Clearly older Americans have seen substantial improvements in health insurance access since the ACA was enacted; eliminating protections for pre-existing conditions will inevitably cause older adults health care costs to increase.

Furthermore, as I have reported in my previous blog, Repealing and Replacing The Affordable Care Act And Its Impact on Medicare, older Americans who don’t have health insurance prior to turning 65 are more likely to require more expensive health care once they enroll in Medicare.  The Justice Department’s decision not to defend pre-existing conditions in litigation will only make older adults less healthy before they enroll in Medicare by potentially limiting access to health insurance.  

Lastly, this litigation flies in the face of public opinion. According to a Kaiser Family Foundation poll, support for pre-existing protections is solid across the political spectrum with support amongst 84 percent of Democrats, 68 percent of Independents and 59 percent of Republicans.

Thankfully, the ACA is still standing and our elected officials in Washington, D.C. have been unable to repeal and replace the ACA. Realizing that a legislative repeal of the ACA might be unworkable, everything has been done to weaken this legislation. The administration has drastically reduced the ACA’s advertising budget, eliminated the cost-sharing subsidies and expanded short-term health plans which don’t offer key ACA protections.

Sadly, the current lawsuit’s end result could potentially strip away basic health care protections for older Americans. What happens if the court sides with the plaintiffs and gets rid of pre-existing conditions protections? Are older Americans expected to go back to a health care system where their plans are more expensive and protections are less stringent? Let’s hope for the sake of all Americans our court system protects safeguards put in place by the ACA for people with pre-existing protections.

Working at B’nai B’rith International during the past year has afforded me the opportunity to visit our sponsored Section 202 buildings across the country.  B’nai B’rith in partnership with Department of Housing and Urban Development (HUD) sponsors Section 202 housing for low-income seniors throughout the United States comprising 38 buildings that serve more than 4,500 people. While touring the properties, I have gotten to talk with residents and see exactly how seniors benefit from living there. Learning about affordable housing is always a humbling experience, never more so than visiting the food pantries in the buildings. Staff members in multiple buildings explained to me how residents, unfortunately, at the end of the month, often don’t have enough money for food. Consequently, these food banks provide vital nutrition for low-income seniors who now don’t have to choose between food and healthcare.
 
According to HUD, the average annual income for a Section 202 household is around $13,300 or $1,108 or a month. Clearly Section 202 residents are not a group of people from great wealth. Given the type of resident these buildings attract, I am saddened a proposal introduced by HUD may RAISE residents’ rental contributions. 

For people reading this blog, you have read correctly! The policy recently proposed by HUD could raise the rent on low-income seniors!   

First the proposal changes how HUD calculates Section 202 rental contributions from 30% of adjusted income to 30% of gross income. Simply put this change will subject more of low-income seniors very limited financial resources to rental contributions. Secondly, the bill is requesting $50 a month minimum for rental contributions. To put this in perspective, this impacts people who make less than $2,000 a year, the exact type of person who the government should be looking to shield from further financial hardship.    

The Administration and some members of Congress argue that government spending is out of control with our country’s debt reaching around $20 trillion dollars. There is no argument that our country’s debt needs to be tackled.  However, addressing our debt on the back of elderly Americans is not acceptable.  How is a better way of governing, one that leaves seniors without a roof over their head?          
                 
The proposed legislation slashes assistance for our most needy seniors by reducing their assistance for affordable housing.  If taking away basic necessities for low-income seniors is required to return our country to greatness, I think the Administration’s definition of greatness is in my humble opinion morally bankrupt! 

​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.

​In December, the Federal Communications Commission (FCC) voted (3 to 2) to repeal net neutrality. Net neutrality is the concept that internet service providers (ISPs) like Verizon, Comcast and AT&T should treat all internet content equally. For example, net neutrality ensures that ISPs cannot charge more money or vary internet speeds based on the type of content you are trying to access. That could be news, social media, streaming video or the website of a business or friend. 
 
Unfortunately, the FCC’s recent decision to repeal net neutrality could completely undue basic fairness for consumers by allowing ISPs to charge higher rates or vary internet speeds based upon the content users are trying to access. This means ISPs will be able to charge for content you currently receive for free or lower speeds for competitors’ products. 
 
Furthermore, the FCC’s decision flies in the face of the public’s support for net neutrality which has surprising bi-partisan approval. A recent poll conducted by the University of Maryland indicated that 83 percent of respondents favored net neutrality. Breaking down the numbers even further, support for net neutrality was discovered amongst 89 percent of Democrats, 75 percent of Republicans and 86 percent of Independents. 
 
While many associate this problem with younger individuals, older Americans will also feel the negative impact from the FCC’s decision. Research demonstrates that seniors actively use the web, with 67 percent of Americans 65 or older using the internet regularly. Taken one step further, 76 percent of seniors who use the internet do so at least once a day. Given how vital the internet is for so many seniors, it’s clear that the FCC’s decision to repeal net neutrality will have an impact on their daily lives.
           
Most importantly, older Americans have started to use the internet to gain better access to health care. Telemedicine and telehealth allows for patient monitoring, video chatting with doctors and an easier ability for physicians and their patients to transfer medical information. People are able to get the medical attention they need without having to travel long distances, which can too often be a daunting challenge for seniors in rural communities. According to the 2015 American Hospital Association report, 20 percent of Americans are from rural areas “where many do not have access to primary care or specialist services.” Older Americans in rural areas with chronic health conditions might find it challenging to travel to physician’s offices because of transportation or mobility issues. The internet has allowed people the ability to get medical attention without the hassle of long travel. However, the FCC’s decision regarding net neutrality could permit ISPs to play favorites between websites; resulting in web based health care services with slower internet times, or leave their customers with costlier bills. 
           
According to Leslie Lenert, chief research information officer at the Medical University of South Carolina, the benefits to telehealth such as direct consultations, medical education and the transfer of medical information from patients personal devices (i.e. heart rate monitors) to physicians, “could be constricted if they were treated differently than preferred traffic .”  Consequently, older Americans might have to spend more money on internet fees to get the identical medical care they received before the FCC’s decision. 
 
The internet has also helped seniors deal with social isolation by giving them an inexpensive way to stay in touch with family and friends. Tragically, eight million individuals over the age of 50 are impacted by isolation. Services like Facebook, FaceTime and Skype allow seniors to stay connected through the internet instead of traditional telephones. Seniors can video chat with grandchildren through FaceTime and Skype, and view pictures of family on Facebook. The FCC’s decision to repeal net neutrality will allow ISPs to potentially charge consumers additional money to use this content which could place an unnecessary financial strain on older Americans for that valuable connection.
 
Too often, low-income seniors have to save pennies just to pay for health care, rent and food.  Seniors living on a limited income should not be forced to absorb another unnecessary hike in their monthly expenditures stemming from more costly internet access. Whether it’s receiving vital medical care or simply staying in touch with family, the internet has made life easier and more enjoyable.
 
However, all is not lost for seniors! Senator Ed Markey (D-Mass.) recently introduced a bill that would overturn the FCC’s decision to repeal net neutrality. The legislation has bi-partisan support in the Senate, and should be endorsed by the White House and members of the House. 
 
Sadly, the FCC’s decision regarding net neutrality may place roadblocks on older Americans ability to access the content they often need and use on the internet. Hopefully Congress and the Trump administration can build on Markey’s legislation and work together to ensure elderly Americans affordable access to the internet.  

We are delighted to report that Rep. Cheri Bustos (D-Ill.) recently visited B’nai B’rith Covenant Apartments in Peoria, Illinois. This visit was a great opportunity for the Congresswoman to learn about the Section 202 program and see firsthand how seniors benefit from affordable housing. B’nai B’rith’s long history with Section 202 housing started in 1971 when we formed a partnership with Department of Housing and Urban Development (HUD) to sponsor housing for low-income seniors. The B’nai B’rith Senior Housing Network in the United States comprises 38 buildings and serves more than 8,000 people. B’nai B’rith International is the largest national Jewish sponsor of low-income housing for seniors in the country.

B’nai B’rith Covenant Apartments, like many of our sponsored buildings, are more than just apartment units. It is a residential community where seniors can age in place. The Congresswoman learned about the wonderful amenities the building offers such as low cost meals, salon, gift shop, grocery store, community rooms and libraries.

After taking a tour of the property, the Congresswoman gave remarks, took questions from residents and shared her positions on important topics that touch their everyday lives, such as Social Security, Medicare, rental subsidies and nutrition assistance. In addition, Bustos offered to help the residents with getting federal benefits from agencies like the Social Security Administration and the Department of Veterans Affairs.

Bustos said, “I had a great discussion with the seniors of B'nai B'rith Covenant Apartments today about all of the issues affecting them and their families. Our seniors worked hard all of their lives and they deserve to retire with dignity, and that includes providing them with affordable housing options through the Section 202 program. I believe that all seniors should be able to retire with peace of mind which is why I'm fighting hard to protect the Social Security, Medicaid and Medicare benefits they've earned.”

We thank Bustos for all her hard work to protect critical programs for seniors that enable them to retire with dignity. Too often Congress and the White House are debating policies that will inevitably cut important funding from federal programs that impact the lives of ordinary older Americans. Congressional visits like this allow B’nai B’rith residents the opportunity to be their own best advocate by speaking directly with the representative and making them aware of the human faces and stories behind federal programs that benefit seniors.
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It was great that Bustos’ visit kicked off our 2018 congressional outreach efforts. We are thankful we were able to show off B’nai B’rith Covenant Apartments and most importantly all the great residents who call the building home. 

​​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.

An esteemed neurologist, 72-year-old Harvard University professor Dr. Howard Weiner has devoted his life to the treatment of serious diseases like Alzheimer’s and Multiple Sclerosis (MS) — his primary area of expertise — both at the University and at Boston’s Brigham and Women’s Hospital, where he directs the department of immunology. Given the life and death nature of his profession, the doctor was able to approach his next career move — that of filmmaker—with an attitude of nonchalance.  His award-winning documentary “What is Life?” premiered in 2011.

Perhaps contemplating his own future scenario as one of the ranks of the elderly, Weiner began working on a literary treatment of what could be best designated as a “bromance,” the touching and funny story of the offbeat camaraderie that develops between two very different men who meet in a nursing home. Finally brought to fruition as a film script, the project and its potential for success were linked to two important elements, the portrayal of the yin and yang that drives the friendship, and the ability to convey an authentic experience of life in a nursing home, in its sometimes mundane, and often fearful, aspects. The location, inside and out, had to be a real one. 

“If you look at old people from above, you make them children; if you look at them from below, you put them on a pedestal. These are real people. I mean, teenage boys talk like [the characters in the movie.] There’s nothing wrong with older people talking like that. Tolstoy said when he was 80, ‘I’m 80, but inside I feel 20,’” Weiner said when interviewed about the film, which was selected as a 2017 entry at the Tribeca Film Festival.

With a bit of tweaking from Weiner’s son, a successful screenwriter with well-known credits to his name, the script was polished, and in 2016 the filming of “Abe and Phil’s Last Poker Game” commenced, directed by Weiner himself. Among its financial backers were a number of his medical colleagues, who stepped up to the plate even after being warned that they would probably lose their shirts.

Filmed on the premises of an assisted living facility close to Boston, the movie shines a light on the talents of its two seasoned co-stars, the late Martin Landau and Paul Sorvino, both of whom were able work with Weiner to enhance character development, and illuminate the metamorphosis of their onscreen relationship. Landau was cast as the home’s most recent inmate, retired physician Dr. Abe Mandelbaum, who is resigned to going gently into that good night, but whose plans are detoured by the life-affirming personality of his blue collar pal, lusty fellow resident Phil Nicoletti (Sorvino). The friendship they form provides each with a renewed perspective. After a new employee attempts to locate her long lost father at the home, the boys, both eager to indulge in the joys of having a daughter, jockey for the role. As to be expected, the narrative is greased with a pound or two of schmaltz, and is punctuated by a few over the top high jinks, and perhaps too much detail on the specifics of geriatric medical conditions. With Landau’s final performance reviewed by Variety as “a thing of beauty,” “Abe and Phil” can be described as one of a handful of brave and engaging films that compassionately recognize the emotional consequences of the losses inevitable to the aging process. 

RECAP OF JEWISH FILM FESTIVALS

Co-sponsored with Manhattan’s Jewish Museum, The Film Society of Lincoln Center’s eagerly anticipated 27th annual New York Jewish Film Festival, which took place from Jan. 10-23, showcased a wide variety of offerings from around the world, many of which were announced as New York, American or international premieres. Catering to a diverse audience, the screenings included “Across the Waters,” a World War II drama about the ferrying of Danish Jews to Sweden, during the time of Nazi persecution, and a newly restored version of the haunting 1937 Yiddish classic “The Dybbuk.” The film festival also included “The Cousin,” an Israeli thriller in Hebrew and Arabic about a Jewish actor who comes to the defense of his Palestinian handyman, after he is accused of a violent crime. Sam Pollard’s “Sammy Davis Jr: I’ve Gotta Be Me,” a 2017 documentary about the life of the multi-talented entertainer who converted to Judaism during the height of his career was also shown.
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Jewish film festivals will soon open in Atlanta and San Diego.

This piece originally appeared in B'nai B'rith Magazine's Winter 2017 issue. To read this and other stories from the issue, visit our magazine online here.

I’ve always thought of myself as a caring person, considerate of others and always thinking that we have a duty to be part of a society in which we respect and help one another where and when we can. Call me a do-gooder if you will, but please know that I am proud to wear that label.

With Congress back in session, I continue to be baffled by its continued attempt to turn back the clock in the face of such overwhelming evidence of the number of aging Americans who require assistance with finding a safe, secure place to live.

The United States used to have a national housing policy focusing in part on creating affordable housing for older persons of limited means. Section 202 of the Housing Act of 1959 was the only federal program that provided safe, affordable housing exclusively for low-income elderly.

The program was envisioned as a partnership between government and community-based nonprofits like B’nai B’rith to supply housing to these individuals. The government would supply the financial means to build the property, while the nonprofits would oversee the initial development and ongoing operations. Subsidies, such as Section 8 vouchers, would bridge the gap between what the tenant could afford and the cost of that apartment.

Over time, the funding mechanism for the program changed from a direct loan, with interest payments to the federal government, to a simple advance of funds for construction.
 
Since 1971, B’nai B’rith has been a partner with the U.S. Department of Housing and Urban Development (HUD) in constructing and overseeing such properties. With 38 properties in 26 communities nationwide, we are the largest national Jewish sponsor of HUD-assisted senior housing. Our network comprises nearly 5,000 apartments available to more than 8,000 seniors.

In the 1960s and 1970s, the eligibility criteria were slightly refined. During the 1980s, “cost-containment” became the focus, and there was a shift to reducing the number of units being built and the overall construction cost. While budget driven, many of these decisions had an opposite effect. Having to replace and maintain systems cost more in the long term.

During the mid 1990s the program began to recognize and incorporate the physical and emotional needs of the residents, and the use of service coordinators become more prevalent.

With the aid of these professionals, residents were better able to obtain the support and services they might need to make aging-in-place more possible. HUD finally understood that providing some level of service support within the property often precluded a premature move to a more institutional setting for a resident, at a tremendous overall cost savings to society in general.
 
Even the definition of a well “independent” senior had changed. As these properties were basically apartments without medical or basic service supports when the program was initiated, one of the criteria for admittance into a HUD-assisted property was the ability to vacate your apartment in the event of an emergency. Today, residents are able to remain as long as they can direct the service supports around them to assist in vacating their apartment in the case of an emergency. Yet, today, nearly 40 percent of residents are considered frail and require assistance with some of the basic activities of daily living.

But, remaining in their homes with support beats having to move to a skilled-care or institutional facility many years before actually needing that level of medical support.

So, for a period of time, the program evolved and — despite severe budget cuts during the congressional efforts to reduce overall federal domestic spending — survive. Politicians from both sides of the aisle have taken pride in visiting these properties and publicly marvel at what they say is their tremendous value, not just for the individuals but for the whole community.

So, where do we stand now?  

We know the country is growing older. The percentage of persons 65 and up is a larger percentage of the total population, growing from 35 million (12.5 percent) in 2000 to 49.5 million in 2016 (15 percent) to an expected 71.5 million (19.4 percent) by 2030. Compounding the issue is the increase in the number of persons 85 and older — 6.2 million in 2016, projected to grow to 6.9 million by 2020 due to our increased longevity.

But, the senior population’s sustained growth has not been matched by a corresponding growth in affordable housing. Currently, data show that there are at least 10 to 12 people on a waiting list for every available subsidized unit. The funding to create more of these properties has dried up. Currently, there are no federal dollars available to create new housing for this most vulnerable, growing population.

Where we housing advocates need to expand our efforts is to combat proposals currently being introduced in Congress that would charge current residents even more of their very low income to simply stay put. Even worse are attempts to cut subsidies completely, which could effectively throw current residents out of their apartments, and potentially into the street.

Remember, older persons must already have very low-incomes to qualify — below half of the area median income. Once deemed “income eligible,” they must pay 30 percent of their adjusted gross income for rent. If they have no income, they pay no rent. And we have a number of those individuals residing in our senior housing network. Bottom line is that these applicants were either homeless, near homeless, or at best, very low-income individuals.

Congress has recently debated amendments to the Transportation, Housing and Urban Development Appropriations Bill that would reduce these subsidies while increasing tenants’ contributions from 30 to 35 percent of their meager incomes and require them to pay a minimum amount of rent, or lose the apartment entirely.

And, taking this even further, 139 House members voted for an amendment to reduce funds for project-based rental assistance by $266 million in the current fiscal year, thus jeopardizing approximately 3,000 apartments which could be affected by this action. Fortunately the amendment failed, but the threat remains.

The numbers are alarming, and the White House is threatening to make a bad situation worse. The administration’s budget proposals include the most dramatic cuts to HUD programs since the 1980s, gutting federal housing assistance and redirecting the savings to “higher priority areas.”  What could be of higher priority than making certain that vulnerable older persons of very low income status have access to safe, affordable and adequate housing?

The House of Representatives in Congress recently introduced legislation called the “Tax Cut and Jobs Act,” which makes drastic changes to our country’s tax code. Unfortunately, some of the proposed changes might have a negative impact on the Low Income Housing Tax Credit (LIHTC). The LIHTC is an affordable housing program administered by the Internal Revenue Service that awards tax credits to the private sector to spur construction that benefits low-income individuals. The LIHTC is responsible for around 90 percent of all current affordable housing construction in the United States, and has help create around 3 million apartments since it was established. 

In particular, the LIHTC has benefited seniors in the B’nai B’rith Housing Network in St. Louis at Convent Place Apartments, and in Massachusetts at the Coolidge at Sudbury Apartments. The U.S. has an affordable housing shortage, particularly amongst seniors. It is predicted that by 2025, 12.2 million seniors will spend more than half of their incomes on housing.

While the tax reform legislation has no direct changes to the existing LIHTC, the other proposed changes could have unfortunate indirect consequences for affordable housing. First, the legislation lowers the corporate tax rate from 35 percent to 20 percent which means that corporations will have less incentive to purchase the tax credits. After the 2016 presidential election, the mere threat of tax reform caused the value of the LIHTC to go down.  Tax reform that brings the corporate tax rate down to 20 percent without other modifications could be problematic for the tax credit.
 
Secondly, the tax reform proposal could threaten affordable housing by eliminating the use of private activity bonds that utilize the four percent credits from the LIHTC. Private activity bonds help finance around half of all LIHTC construction, therefore eliminating these bonds will have very serious consequences on the creation of new affordable housing, and the rehabilitation of existing stock.  

Tax reform legislation should be viewed as a golden opportunity to strengthen the LIHTC, and it’s a shame that the current proposal does not accomplish that goal. For instance, the House’s bill could include parts of LIHTC legislation in the House and Senate that would fortify this affordable housing program. In addition, both these affordable housing bills have broad bi-partisan support in the House and Senate, which only increases their likelihood of passage if included as part of the greater tax reform effort.  

The LIHTC is critically important to making sure that older Americans have a place to call home, and the tax reform legislation should not include proposals that could potentially make affordable housing for seniors more difficult to come by.   
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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.

By Breana Clark

Achieving greater recognition of the needs of our homeless population has become an undeterred focus of mine. Professionally, I am connected to the residents who call B’nai B’rith sponsored, low-income senior housing home, and through volunteering with a local United Methodist Church, I help address local homelessness in the District of Columbia. Through these organizations, I have witnessed a devastating national trend: the apparent aging of our nation’s homeless population.
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On the surface, the current proportion of homeless individuals who are seniors represents a failure of our society to take care of our oldest citizens. Though, it is also an expensive problem to ignore. An older person who has not yet reached “retirement age” (those ages 50-64) represents a group which frequently falls between safety nets that are age based. Programs that are meant to intercept the part of our population that, generally speaking, are cycling off the workforce are generally reserved for those who have reached the magical age of 65 (or 62 for subsidized senior housing). Thus, many folks who have lost jobs, lost income or who do not have enough savings, find themselves stuck between the gap, and enter their “senior years” having expensive untreated conditions and deteriorating health.

It should come at no surprise that navigating the conditions of living on the street or experiencing insecure housing (this includes nighttime shelters, a couch at a friend or relative’s home, or frequent relocation because of unreliable conditions) exacerbates physical and/or mental health conditions, poor nutrition and untreated chronic illness. It’s imperative to point this out, as we see that health care needs by those aged 50-64 who lack housing are awfully similar to housed individuals 65 and older. Premature aging and shortened life expectancies are inevitable when one lacks the basic of human necessities in order to survive.

Simply put, seniors have the steepest housing challenge. This should come at no surprise if we look at increasing poverty amongst retirees as well as the decreasing availability of affordable housing. In fact, more than four million people above the age of 65 live in poverty, according to the U.S. Department of Health and Human Services. Of those individuals, only 1.6 million receive rental subsidies from the United States Department of Housing and Urban Development (HUD).

About 10,000 people turn 65 every day in U.S. Based on demographics alone, Justice in Aging, a national nonprofit legal advocacy organization that fights senior poverty, estimates that this will result in nearly 93,000 homeless seniors, doubling the 44,000 in 2010. This number becomes even more significant when economic factors are taken into consideration. While many may hold a stereotyped version of who is included among our homeless and home insecure, it’s important to remember a myriad of economic occurrences that have proven to be especially burdensome in the last decade: the Great Recession, mortgage debt accumulation following the housing crisis, wage stagnation, skyrocketing underemployment, the rising cost of medication and goods and the increasing lack of affordable housing.

Furthermore, in light of recent natural disasters having required evacuation, hunkering down and taking shelter, we have witnessed how quickly circumstances can change for someone depending on their very meager earnings or assets to survive. The recent tragedy of several seniors dying at a Florida nursing home that found itself in the wake of Hurricane Irma illustrates a true reminder that we need to be able to provide safe, quality care and housing for seniors regardless of whether they can live independently or not. ​

In my capacity as a volunteer, with a mission to serve our homeless in Washington, D.C., I’ve learned a lot about the unique needs of those in our community who lack housing. What has become obvious is the need to address the significant number of folks who have reached their older years but lack housing, health care and an income that can support their basic needs. We are living in a time where our lack of commitment to seniors’ well being, as they age, is not just appalling; the circumstances are dire. Every day, seniors die from a lack of resources in a country that saw economic, social and political progress as a result of their contributions.

If Congress and the current administration want a society that is great, it has to start simple: we must prioritize health and housing for ourselves and our neighbors as we age. We must strive for a society that does not allow housing insecurity and plummeting health to be inevitable part of aging into poverty. We must commit to taking care of the oldest among us.