Key Republican in Health Law’s Fate Hails From a State That Embraced It
by Robert Pear - NYT - February 25, 2017
ONTARIO, Ore. — When Representative Greg Walden of Oregon visits his expansive district, which swallows two-thirds of a very blue West Coast state, his constituents grouse amiably to their longtime Republican congressman about environmental regulations and federal lands policy.
And then the conversation shifts to the Affordable Care Act and what its repeal would mean for the struggling rural workers who have long voted for Mr. Walden, and for children like 11-year-old Rocco Stone. Because of the health law, Rocco has been able to live at home, attend school and have a nearly normal life despite having autism and a rare genetic disorder.
“Our life was completely changed when Oregon and the federal government partnered to provide home and community services through Medicaid,” Rocco’s mother, Dana M. Stone, told the congressman this past week. “We are deeply, deeply concerned about talk at the federal level about a complete repeal of the Affordable Care Act.”
Mr. Walden, the new chairman of the House Energy and Commerce Committee, is not just another backbench Republican dealing with suddenly energized supporters of the health law at town hall-style meetings. The lanky 60-year-old congressman will have a large role in drafting promised legislation to replace former President Barack Obama’s signature domestic achievement and a huge say in decisions about the future of Medicaid, which the health law greatly expanded.
As a former chairman of the committee responsible for electing Republicans to the House, Mr. Walden knows the politics of health care as well as anyone. But in his new role, he must reconcile the political goals of his party, which is committed to repealing the 2010 health law, and the interests of his state, where officials say the law has been a big success. In 2010, nearly one in five Oregonians lacked health coverage. Today, state officials say, 95 percent of Oregonians have coverage.
Since Oregon expanded eligibility for Medicaid under the health law in 2014, enrollment has increased more than 65 percent. Nearly one-fourth of the state’s four million residents are now on Medicaid.
In Mr. Walden’s district, the percentages are even higher. In some of his rural counties, more than one-third of the people are on Medicaid. President Trump easily carried those counties. Mr. Walden won a 10th term in the fall with 72 percent of the vote and was victorious in every one of the 20 counties in his district, which is about the size of New York, New Jersey and Connecticut combined.
But that does not guarantee that voters here endorse all the policies of his party. Hospitals are among the leading supporters and beneficiaries of Affordable Care Act. Mr. Walden was a trustee of a 25-bed hospital in his hometown, Hood River.
“We are very worried about what ‘repeal and replace’ might look like,” said David Underriner, who supervises the hospital, Providence Hood River Memorial, as Oregon’s regional chief executive for Providence Health and Services, the large Roman Catholic system that owns it.
Mr. Walden grew up on a cherry orchard, worked at radio stations owned by his family, and followed his father into the State Legislature. The political shifts that have turned all three Pacific Coast states reliably Democratic have begun to creep into a few of the conservative inland parts of Oregon. Hood River County, long known for fruit farming, windsurfing and the spectacular scenery of the Columbia River Gorge, has lately become a center for the production of surveillance drones, leading to an influx of software engineers, technology entrepreneurs and other young professionals.
Mr. Walden’s margin of victory in November in the county where he lives was just five votes — out of more than 10,590 cast.
“It’s just a little left-leaning,” Mr. Walden allowed. “It didn’t used to be that way.”
Unlike many Republicans in Congress, Mr. Walden has worked productively with Democrats. “I’m a problem solver,” he said in an interview after a town hall-style meeting here near the Idaho border. “I’m not an ideologue. I want to fix things.”
And in Oregon, some Democrats and health-law supporters are glad Mr. Walden is in his position.
“I’ve known Greg a long time,” said Andrew S. Davidson, the president and chief executive of the Oregon Association of Hospitals and Health Systems. “He is not interested in upending the progress we have made in this state.”
Representative Kurt Schrader, a Democrat whose district includes the southern suburbs of Portland and the capital, Salem, predicted Mr. Walden “will be mindful of the implications of any legislation for our state, which is leading the nation in the transformation of health care.”
Unlike Mr. Walden, Oregon has embraced the Affordable Care Act. State officials say many of the changes proposed by congressional Republicans, including a rollback of federal funds for the expansion of Medicaid, would reverse much of the progress they have made.
Oregon has a history of health care innovation that predates the Affordable Care Act. In the early 1990s, it ranked medical procedures according to their costs and benefits, and Medicaid uses this list to decide which services to cover. Under a federal waiver granted in 2012, Oregon treats Medicaid beneficiaries through 16 “coordinated care organizations,” which are governed by local citizen councils. The organizations have slowed the growth of health spending and improved the health of Medicaid beneficiaries, according to performance data collected by the state.
Even as he writes legislation to unwind the Affordable Care Act, Mr. Walden takes pride in Oregon’s success under the law.
“Our state of Oregon has had quite a bit of innovation over the years,” Mr. Walden said. “We’ve got the coordinated care organizations in place that have actually brought better health care outcomes at lower cost. There are great ideas out there among the states, but right now, they have to come back and beg permission from a federal bureaucrat to be able to do much of anything innovative.”
When Mr. Walden first ran for Congress in 1998, conservatives called him too liberal. Since then, he has taken more conservative positions, and the party has moved to the right.
“Times change,” he said. “You get a terrorist attack. You have different administrations come and go. Culture changes. My bedrock principles have stayed the same. I favor more local decision-making and less Washington decision-making.”
Mr. Walden never wavered in his opposition to the Affordable Care Act. On the day the House passed the bill in March 2010, he and other Republicans stood on the Capitol balcony, before a throng of protesters, and held up signs with handwritten letters that spelled out their message: “Kill the Bill.”
A month later, on the House floor, Mr. Walden announced the goal that he hopes soon to achieve, using words that became the mantra for Republicans: “We need to repeal and replace this law.”
Over the last four years, Mr. Walden has been a genial attack dog for Republicans. As chairman of the National Republican Congressional Committee, he averted a political blood bath for his party and secured the election of Republicans in many districts that voted for Hillary Clinton in the presidential election. Many of those House campaigns revolved around attacks on the health law that he is now charged with replacing.
Oregon tried to run its own health insurance exchange, but had a disastrous experience and decided, after a year, to use the federal website, HealthCare.gov. The state has a competitive insurance market, but consumers have still seen substantial increases in prices, with the average premium for a popular benchmark plan on the exchange rising 27 percent this year and more than 20 percent last year, according to the federal government. (Subsidies cushion the impact for most consumers.)
“Medicaid did better than expected, and subsidized commercial insurance did worse,” said Dennis E. Burke, the president of the Good Shepherd Health Care System in Hermiston, Ore. “We have seen steep increases in premiums for commercial insurers, and as a result healthy people have dropped out.”
People newly covered under the health law “proudly present an insurance card,” Mr. Burke said, but in many cases their plans have high deductibles, and the hospital has difficulty collecting the patient’s share of the bill.
But Mr. Burke is not so quick as his congressman, Mr. Walden, to seek repeal.
“I think it could be fixed,” Mr. Burke said. “We need more of a retooling.”
House Republicans will be unveiling their replacement for the Affordable Care Act (a/k/a Obamacare) next week and the White House has been signaling that it may reveal its thoughts not long after.
But what is becoming increasingly clear is the extent to which Obamacare has become embedded in the American health care structure and how difficult it will be to craft an acceptable replacement.
Any attack on the A.C.A. must start with the recognition that at least 23 million Americans (the Obama White House estimate) and perhaps more than 26 million (some private experts) have been added to the health care rolls. As shown below, this has driven the percentage of Americans without insurance down to 9 percent, by a considerable margin the lowest in history.
Source. Council of Economic Advisors
Perhaps not surprisingly, after years of unpopularity, Obamacare now commands support from a majority of Americans, according to recent polls. And more anecdotally, many of the comments that elected officials have been receiving at town hall meetings this week have focused on preserving the A.C.A., not dismantling it.
Even former Speaker John Boehner said Thursday that a full repeal and replace of Obamacare is “not what’s going to happen” and that Republicans will instead just make some fixes to the health care law “and put a more conservative box around it.”
It’s important to understand how the new health care law has accomplished such a dramatic reduction in the number of uninsured. First, it provides money to participating states to expand their Medicaid programs; about half of the newly insured were brought onto the rolls in this manner.
Second, it offers subsidies to Americans further down the economic ladder (but above Medicaid levels) to buy insurance on the new exchanges that were set up by the Federal government and many states. This group accounts for about 36 percent of the newly enrolled.
Smaller numbers received their insurance by being able to stay on their parents’ plans until age 26 – a popular feature of the A.C.A. – and by buying unsubsidized insurance on the exchanges.
Source: ACASignups.net
The crux of the problem is that the Republicans want to repeal most — if not all — of the taxes that were put in place to finance the health care expansion, which would make maintaining the benefits mathematically impossible.
According to the Committee for a Responsible Federal Budget, the Medicaid expansion and the exchange subsidies will cost $2 trillion over the next 10 years. Some of that would be paid for by a variety of savings in the expenses of Medicare and Medicaid.
However, about $1 trillion – roughly half – of these costs are being paid for by a variety of taxes and fees that the Republicans want to repeal, provisions like the 3.8 percent levy on investment income, the 0.9 percent surtax on Medicare hospital insurance, penalties on individuals who do not buy coverage and so forth.
Estimates are for 2018-2027. Source: Committee for a Responsible Budget.
The Republicans seem to suggest that there are ways to restructure the program to allow for the elimination of most, if not all, of these taxes and fees and still not see material numbers of Americans become uninsured. I know of no serious expert who believes that is possible.
So as the new Republican health care proposals are unveiled, look beyond the flowery rhetoric to see what the real impact of these ideas would be.
For example, instead of Medicaid’s costs being tied solely to what benefits less well off Americans are entitled to, House Speaker Paul Ryan would like a fixed amount given to each state (known as a “block grant”). Particularly as time moves on, these amounts would almost surely be less than what is needed to maintain the current benefits.
Another favorite Republican idea is to replace the subsidies provided by Obamacare with tax credits. But the current subsidy program is tied to an individual’s income; those with less income get higher subsidies.
The Republican proposal would have the tax credits be a function of age, a regressive approach that would leave many poorer Americans less well off and result in millions losing insurance.
With all of these complications, I wouldn’t be surprised to see the essence of the Affordable Care Act remain intact. However, achieving that will still require fortitude; its enemies will surely be on the attack.
The replacement would be paid for by limiting tax breaks on generous health plans people get at work.
Five takeaways from the leaked Republican bill to repeal Obamacare
by Dylan Scott - STAT - February 26, 2017
WASHINGTON — A formal draft of the House Republican plan to repeal and replace the Affordable Care Act leaked out on Friday.
The final version is likely to be different — how much different, it’s hard to say. The draft obtained by Politico is dated two weeks ago, and rumors have been swirling here that Republicans received an unfavorable analysis from the Congressional Budget Office, the official scorekeepers on the cost and coverage implications of legislation.
But this is nonetheless an important milestone — real legislative text, prepared with an eye toward the complex parliamentary procedures needed to pass ACA repeal with only Republican votes, and presumably with the endorsement of House leadership.
Much attention will be paid to the proposed tax credits offered for people to buy health insurance and the changes to the tax treatment of employer-based insurance. Here are five provisions with big implications for health and medicine. It would dramatically overhaul Medicaid.
The bill would phase out by 2020 the Medicaid expansion that has covered millions of people under Obamacare. Instead, states would begin to receive a set dollar amount for each person covered by the program — with variations based on health status; more money would be allocated for the disabled — a change from the open-ended entitlement the program is now.
These proposals, long a goal of the GOP, have spurred a number of concerns. People with complex medical needs worry that, if spending is capped and states have more flexibility to decide what to cover, they could be at risk. There appear to be very few exclusions from the spending caps — some have theorized that if the plan exempted certain services from the caps, that could help mitigate the risks for high-cost patients.
The changes could also make it more difficult for the program to afford new breakthrough treatments, a challenge that the current iteration of Medicaid has already faced with the expensive hepatitis C drugs.
It would repeal Obamacare’s requirements for what health insurance must cover.
The legislation would repeal the ACA’s essential health benefits requirements, which mandated that health plans cover 10 categories of health care services. It would instead leave decisions about what coverage to require to the states, starting in 2020.
Among the services that the law required plans to cover were mental health and substance abuse treatment. In the midst of the opioid crisis, recovery advocates in Washington had been hoping to save that provision. It appears that that decision would now be in state officials’ hands, and the fear is plans might look to limit that coverage because people with addiction issues are expensive to treat and therefore cover.
It would repeal the Prevention and Public Health Fund.
The bill would repeal this funding stream, intended to support various prevention and public health activities, in 2019. Congress initially provided $15 billion over the fund’s first 10 years, and it was eventually suppose to increase to $2 billion per year in perpetuity.
The fund has been at perennial risk since its passage in 2010, pilfered at times for other programs, but it nonetheless remains an important source of public health funding. It has become an essential part of the Centers for Disease Control and Prevention’s budget — accounting for 12 percent of the agency’s funding by some estimates — and there would be no obvious replacement for those dollars without further congressional action.
It would repeal the tax on pharmaceutical manufacturers.
The drug industry has not agitated to have its manufacturer tax repealed, in the same way that the medical device and health insurance industries have. But the Republican bill would nonetheless nix the tax starting in 2017. The industry still had$4 billion to left to pay in 2017, $4.1 billion in 2018, and $2.8 billion per year after that.
The taxes on medical devices, health insurance plans, and even tanning beds would also be repealed. Those revenue streams help to cover the cost of the ACA. Republicans are instead proposing changing the tax treatment of employer-based health insurance, which is currently not taxed, to pay for their plan. It is an idea popular with economists, but politically perilous. Major employer groups are already aligning against it.
It loosens restrictions on health plans’ ability to charge older people more.
One thing the bill doesn’t do is repeal the ACA provision that prohibits health plans from discriminating against people with preexisting conditions. That may be because it would be hard to justify under the procedural rules that Republicans need to use to pass the bill — plus that policy is among the law’s most popular elements and even President Trump has said it should be maintained.
But another key insurance reform meant to protect sicker people takes a hit: The GOP bill would allow insurers to charge older people five times more than younger people; the ACA had limited the difference to three times as much. The powerful AARP is already mobilizing against such a change, long expected to be part of the plan.
The bill appears to try to mitigate that change by basing its tax credits for purchasing insurance on age: Older people would receive a bigger tax credit.
Is that sufficient to keep people covered, as Trump and other Republicans have pledged to do? That’s one of the questions that the scorekeepers at the CBO will be expected to answer.
Republicans Want You in a Health Savings Account. So Now What?
by Ron Lieber - NYT - February 24, 2017
If you’ve been watching the debate in Washington over what is to become of our health insurance plans, you know that Republicans already disagree on a whole bunch of things. They’re not sure about what any new plan will cost. They’re not sure how any new tax credits should work or who should get them. They’re not sure about how Medicaid should operate.
But there’s one thing they do know for sure: They want a whole lot more of us to have health savings accounts.
There’s a great deal to like about these accounts, which you can open and contribute to only if you are enrolled in a health insurance plan that has a pretty high deductible. They offer a rare triple threat to the tax man: You get a tax break on the money that goes in. You pay no taxes on the money as it grows, potentially over decades. Finally, you pay no taxes when the money comes out, as long as you use it on a long list of health expenditures.
Seems like magic, right? Well, it works nicely just as long as you can afford to save in the first place and as long as you don’t skimp on necessary care to keep your account balance high. A high balance doesn’t help if you die because you did not want to spend your H.S.A. money to have a doctor check a mysterious lump.
For the lucky among us with at least a bit of money to spare, however, the biggest problem with these accounts is their maddening complexity. Even people who have followed personal finance for a while confuse them with the more popular health care flexible spending account, which — unlike an H.S.A. — does not allow you to invest the money and spend decades watching the earnings compound.
H.S.A.s and the campaign to goad more of us into them represent yet another step in the decades-long fetishization of private accounts in general. The big idea here is to shift more of the responsibility for our financial well-being away from employers and the government and directly toward us, whether we know a lot about money or not.
These “account-based solutions,” as government enthusiasts like to refer to them (sounds innocuous, right?) have been proposed so often — over the last 30 years or so — that we have wound up with a big bowl of alphabet soup. There are 401(k)’s, I.R.A.s, Roths, 529s, F.S.A.s, D.C.A.s and T.R.A.s — and that’s before you start filling out your annual Fafsa (student financial aid application) and 1040 (you know this one) to track all this stuff. None of it goes down easy, and it’s probably going to get worse.
To prepare yourself, begin with a quick review session on H.S.A.s. To qualify, you must be enrolled in a high-deductible health plan. This year, that deductible has to be at least $1,300 for individual coverage and $2,600 for family coverage. As for the health savings account itself, individuals can drop in as much as $3,400 (including any employer contribution), and families can deposit $6,750.
You can use that money in the current year for nearly any health care expense, which helps since you have that high deductible to cover. But again, the real win here comes from letting that money ride for a very long time in the account (and in whatever investments your H.S.A. administrator makes available to you). As always with alphabet soup accounts, there are quirks, exceptions and footnotes to the footnotes, so consult Internal Revenue Service Publication 969 for all the fine print.
So who benefits from H.S.A.s? Lorens A. Helmchen at George Washington University and three colleagues used federal tax data from 2004 to 2012 to figure it out. Their study, which appeared in 2015 in the journal Health Affairs, found that across all age groups, people with the highest incomes (over $100,000 or so) were several times as likely both to have H.S.A.s and to max out their contributions as people from low-income households.
New data from Devenir, a company that helps administrators pick and carry out investment options for H.S.A.s, shows that people with older accounts do indeed have larger balances that seem to grow incrementally over time, suggesting that at least some actual saving is going on here. Devenir estimates there are about 20 million H.S.A.s today.
Now, enter our elected representatives, with three major plans. Speaker Paul D. Ryan, Republican of Wisconsin, has been promoting a plan that would raise H.S.A. contribution limits to what in 2017 would be $6,550 for individuals and $13,100 for families. More tax breaks for everyone!
Two other Republicans in Congress, Senator Rand Paul of Kentucky and Representative Mark Sanford of South Carolina, go further. They would remove the requirement to have a high-deductible health plan before someone could contribute to an account. And just to keep things interesting, they have tossed in a requirement that an H.S.A. could not be used to pay for an elective abortion.
Finally, there is the proposal from Senator Bill Cassidy, Republican of Louisiana, Senator Susan Collins, Republican of Maine, and three other senators. It wins the complexity award, in that it combines Roth I.R.A.s (which people already have trouble distinguishing from their regular I.R.A. cousins) and H.S.A.s (confusing on their own) into a whole new thing called Roth H.S.A.s. Grants or tax credits would land directly in individual accounts, and people would use the money to purchase insurance.
Let’s step into a cold bath of realism before we go too much further here. The criticisms of the Affordable Care Act are overwrought. Of course anything that big and complicated would not be perfect — or anything close to it — for many years. Nor should we expect the Republicans who are in power now to have a quick and easy blueprint for the necessary repair work. It’s just too complex, and every proposal above is merely a starting point for negotiation. We will be at this for a very long time.
Still, one clear pattern is emerging. Rather than just letting the government directly buy and pay for the thing that we all seem to want more of — good, affordable health insurance — the politicians in power want to push us toward a system that uses the levers of the tax system and individual accounts to make this happen instead. It is not simple, and complexity usually adds costs. It also leaves the less educated and overly busy behind and tends to produce other consequences that we cannot predict and do not intend.
Decades into our 401(k) account-based experiments with people’s life savings and ability to retire one day (or not), we learned the following this week from a couple of United States Census Bureau researchers: Two-thirds of Americans are not saving money for retirement in their workplace plans at all. They are not eligible, do not have enough money, or are confused by — or unaware of — their options.
We shouldn’t expect things to work out any differently with H.S.A.s unless large piles of money go into them automatically, as they might under some of the proposed plans. If free money does show up through some kind of tax break, they’ll at least be difficult for people to ignore.
So as you watch and listen and wonder how the health insurance debates will unfold, consider the following as you decide if it’s worthwhile to lobby your elected representatives: Health savings accounts today are most useful for the affluent, who earn the most, have the most left over and have the most to gain by avoiding income taxes, given that they pay them at higher rates.
Is that something we wish to cement and perpetuate? Because if we do, our health care system will start to resemble a wealth care system, too.
If Obamacare Exits, Some May Need to Rethink Early Retirement
by Austin Frakt - NYT - February 27, 2017
Here’s another possible consequence of repealing the Affordable Care Act: It would be harder for many people to retire early.
Americans reaching 65 become eligible for Medicare. Before reaching that age, some can get retiree coverage from their former employers. But not very manycompanies, especially small ones, offer medical insurance to retirees. If early retirees are poor enough, they could turn to Medicaid. To retire early, everybody else would need to turn to the individual health insurance market. Without the subsidies and protections the A.C.A. put in place, health care coverage would be more difficult to obtain, cost consumers more where available, and provide fewer benefits than it does today.
That means that if the A.C.A. is repealed, retiring early would become less feasible for many Americans.
This consequence is called job lock — the need to maintain a job to get health insurance. One of the arguments in favor of the A.C.A. was that it would reduce or eliminate job lock. With repeal of the law on the agenda of Congress and President Trump, there is renewed concern about how health insurance could affect employment and retirement decisions.
Because people approaching retirement age are more prone to illness and high health care costs, employment-based insurance is particularly valuable to older workers — so much so that many studies document that it influences retirement decisions. One study found that workers whose employers offered retiree health benefits were 68 percent more likely to retire early than those who lack employer-based retiree coverage.
Another study found a smaller effect, 47 percent. But that study also found that workers in poor health who had retiree health benefits were 88 percent more likely to retire early compared with similar workers lacking retiree health benefits. Both those studies used data that are now several decades old. But a 2014 study that incorporated more recent data — though still pre-A.C.A. — also found that retiree health benefits encourage early retirement. The inference from these studies is that coverage options in the A.C.A. marketplaces would similarly encourage early retirement.
Deferring retirement because of health benefits is just one form of job lock. Another example: Many studies show that spouses are much more likely to work if their partners do not have employer-based family coverage. Other studies show that workers with cancer are more likely to continue working if that’s how they get health insurance.
Twostudies led by Cathy Bradley of Virginia Commonwealth University examined working women with breast cancer diagnoses. Both studies found that those who depended on their employment for coverage were more likely to remain working.
If not for job lock, we’d probably see greater job mobility and entrepreneurship. According to one analysis, two million more people would change jobs if it weren’t for job lock — presumably finding work that makes them happier or to which they are better suited. One study found that 25-to-55-year-old married men with no other coverage options are 22.5 percent less likely to switch jobs compared with those who have alternatives. Another study, examining 24-to-35-year-old married men, estimated smaller effects, between 10 and 15 percent.
The evidence of sticking with jobs instead of starting a business is mixed, but the preponderance of it suggests this kind of “entrepreneurship lock” exists, affecting up to four million people. Workers without coverage from a spouse — therefore, more reliant on their own employers’ coverage — are a few percentage points less likely to become self-employed, according to one study. Similarly, self-employment spikeswhen workers turn 65 and obtain Medicare coverage.
From the late 1980s to the early 2000s, tax deductibility of policies for self-employed workers was phased in, making those policies more affordable. Two studies provideevidence that this change increased self-employment. One found that it rose 10 percent among women without health coverage from a spouse versus those with such coverage. Another found that the tax change explained as much as half the total increase in self-employment between 1999 and 2004.
All of these studies suggest that job lock would be alleviated by more available and affordable coverage outside work. Whether Obamacare did that is less clear. Many policy experts expected the A.C.A. to reduce job lock. An analysis by the Urban Institute, conducted before the health insurance reforms were implemented, estimated that the self-employed would increase by about 1.5 million individuals as a result of the law. In 2014, the Congressional Budget Office anticipated that the A.C.A. would reduce the size of the labor force by at least two million people by 2024.
One post-A.C.A. study found that the prohibition of pre-existing condition exclusions for children increased job mobility for their parents. And in the months after the insurance market reforms rolled out, voluntary part-time work increased and the growth in the number of workers over age 55 slowed, both consistent with alleviation of job lock. But more rigorous studies of part-time work did not find an impact from the A.C.A.
According to a review of scientific papers by the economists Jean Abraham and Anne Royalty, for the University of Pennsylvania’s Leonard Davis Institute of Health Economics, few other studies have found solid evidence that the A.C.A. reduced job lock or had other effects on the labor market. For instance, studies have not foundthat allowing children to stay on their parents’ insurance until age 26 has influenced the labor market choices of young adults. Nor have they found that the A.C.A. increased early retirement or employment more generally.
One reason studies might not have found an impact on job lock could be because the law is relatively new, and there isn’t enough data available to researchers to tease out all its effects. It could also be because the law has been under siege on multiple fronts since passage, rendering its status uncertain. This may have raised doubts in workers’ minds about the wisdom of relying on it as a substitute for employer-offered coverage.
But it is clear that with A.C.A. repeal on the table, people contemplating early retirement may need to reconsider.
ACCORDING TO AARP, THE ADVOCACY ORGANIZATION FOR OLDER AMERICANS, MOST SENIORS WANT TO STAY IN THEIR HOMES AS THEY AGE. BUT THEY OFTEN NEED HELP TO MAINTAIN THEIR HOME AND STAY CONNECTED TO THEIR COMMUNITY.
As some municipalities make a concerted effort to be designated as “age friendly,” two Maine communities are teaming up to make “aging in place” a possibility for older residents.
This story is part five of our series “In This Life.”
Driving through downtown Richmond, Peter Warner and Dave Thompson don’t get far without passing by a house of a senior they’ve helped.
“This house here is where we helped with furniture and door locks, helped to move his furniture around so he could get around his house. He’s on oxygen all the time, and was having a hard time,” Warner says.
He and Thompson, both in their 60s, are part of the Village Lodge Handy Brigade, a group formed by the local Masons that does minor repair jobs and chores free of charge for seniors in Richmond and neighboring Bowdoinham.
It started about a year ago, after one member helped a senior with a small project. Warner decided to develop into a program to help other in the community who need it.
“That aren’t necessarily big jobs, the whole-day jobs, but might be something simple that a handy man might have to charge them $50 or $100 to do, but we could just help them out,” he says. “It has been things like putting a hasp on a door to keep it from flying open.”
Or installing storm windows, or carbon monoxide detectors. After spreading the word through the local senior’s group, Warner says the Handy Brigade has assisted about 30 households.
Warner and Thompson have come to the home of the Ragsdales in Richmond to do some work on the bathrooms. They knock, but the couple isn’t home right now.
Geoff Ragsdale, 78, is currently in rehab, recovering from a medical issue that left him temporarily unable to walk and talk. He’s due to return home tomorrow, and Thompson says the bathrooms need adjustments.
“We’re taking the shower head off and installing a wand hose. This will be able to switch so they can use it for him, and then when she takes a shower, she can stand up,” he says.
“He’s unable to stand, so he needs the wand on the shower,” Warner says.
After testing the wand for leaks, they apply grip tape on the side of the shower, then head to another bathroom to prepare it for the installation of a grab bar. Within 30 minutes, they’re done.
And that means Geoff Ragsdale can come home.
“These guys are a blessing in disguise for anyone who needs their service,” Ragsdale says, sitting at his kitchen table a week later.
Without the Handy Brigade, he thinks it would have cost a few hundred dollars to hire someone to do the work, which his wife, Nancy, says they can’t afford.
“Right now, we’re retirees and we live off our Social Security. And you can’t go very far with that even. You have to plan different things. You can’t just go out and spend like you’d like to,” she says.
It’s small efforts like the Handy Brigade that make a big difference in helping seniors like the Ragsdales stay in their homes, even though they are reluctant to seek favors.
“If there’s anything out there we need, it’s there. All we have to do is ask, and we’re not one of those people,” Nancy says. “I don’t like to ask. I’ve always done it on my own.”
The Ragsdales are active in their church. Nancy used to work as a caregiver for seniors in their homes. Before Geoff landed in the hospital, he volunteered at the food pantry, for Meals on Wheels, and gave rides to other seniors.
“It’s a community where people care about each other. They’ve got a strong church ethic in the town, as well as neighbor helping neighbor. And that’s basically what helps the senior population,” says Laurie Saunders, director of the Golden Oldies Senior Center in Richmond.
Saunders says there are many models for making communities age-friendly, but Bowdoinham and Richmond have found a way to work with existing organizations to provide things like the Handy Brigade, a ride program, exercise classes, and social meet-ups.
In fact, Bowdoinham is one of the nearly 30 AARP-designated “Age Friendly Communities” in Maine, the most of any state in the country. Bowdoinham was also elected by the World Health Organization in 2014 to help develop age-friendly community indicators.
Saunders says these two communities have had success in part because they cultivate local volunteers, many of them seniors, to help people age in place.
“It’s their comfort zone, and to take them out of that, or have to remove them from that, I think is a burden to them as well as their families, and the community as a whole. It doesn’t matter how old you are in a community, you still have something to offer,” she says.
Geoff Ragsdale is eager to get back to volunteering as soon as he’s able. And he and Nancy are happy that he could return to his home to recover, worry-free, after help from the Village Lodge Handy Brigade.
Maine Public Radio’s series “In This Life” is made possible by a grant from the Doree Taylor Charitable Foundation.
Letter to the editor: Sen. Collins must stand against efforts to harm Medicare
I recently sent a letter to Sen. Susan Collins, urging her to resist efforts by her party to tamper with Medicare. She is one of a handful of Senate Republicans who could serve as a firewall against harmful changes to a program that 306,000 Maine seniors and people with disabilities rely upon.
The majority in Congress has proposed to privatize Medicare, raise the eligibility age from 65 to 67 and repeal the Affordable Care Act, which made important improvements to Medicare. These actions will reduce health care coverage and increase out-of-pocket costs for beneficiaries already struggling to make ends meet.
Maine’s Medicare beneficiaries have a lot to lose if the ACA’s improvements to Medicare are repealed. The ACA provided Medicare beneficiaries with annual wellness visits and preventive screenings with no out-of-pocket costs. In 2016, 70 percent of Maine seniors took advantage of these free screenings.
The ACA also shrank the Part D prescription drug “doughnut hole.” Repealing that provision will cost seniors an average $1,000 per year. A new study by our foundation revealed that raising the Medicare eligibility age from 65 to 67 would result in 1.9 million more uninsured seniors nationwide.
Sen. Collins should also oppose plans to privatize Medicare, which would provide seniors with vouchers to buy private insurance. While healthier seniors might opt for private coverage, older and sicker beneficiaries would likely remain in traditional Medicare – resulting in a death spiral for the program.
Seniors only need three Senate Republicans to vote against these harmful changes. Sen. Collins has stood up to her party in the past, when the interests of working Americans were at stake. In Maine, 306,000 seniors and people with disabilities are counting on her to have the courage to do that once again.
Max Richtman
president and CEO, National Committee to Preserve Social Security and Medicare
Without using the dreaded T word, Governor Charlie Baker has proposed a stiff hikein the fees that some businesses must pay to state government. Semantics aside, the proposed $2,000-per-employee assessment is essentially a tax, and it’s sent ripples of consternation through the business community that once thought they had an ally in the Republican governor.
Baker’s office is now discussing modifications to the plan. But with the state’s health care bills rising at unsustainable rates, Baker’s fee — or something strongly resembling it — will be necessary to steady the state’s budget.
The state’s health care bills have been skyrocketing as more Massachusetts residents enroll in MassHealth, the state’s Medicaid program for low-income residents. The Baker administration attributes some of that shift to workers choosing not to enroll in workplace plans, which may have high deductibles or lower quality, coupled with the expanded eligibility for Medicaid under the federal Affordable Care Act (aka Obamacare). The bottom line is that Massachusetts taxpayers are taking a financial burden off many employers of low-wage workers by providing subsidized insurance to those employees. The administration estimates that the number of full-time employees who do not receive employer-sponsored insurance has gone up by 118,000 workers since 2011. Last year, 379,000 employed Massachusetts residents were also on MassHealth.
The $2,000 fee is intended to address the fiscal consequences of that shift. The proposal would apply only to businesses that have 11 or more full-time employees and provide insurance to fewer than 80 percent of their workers. The assessment would be on a sliding scale, and shrink as businesses approach the 80 percent figure. Baker’s proposed assessment resembles, in some respects, the original “fair share” provision of the Massachusetts health care reform that was repealed in 2013 to harmonize the state’s law with the Affordable Care Act.
Overall, the outline of Baker’s proposal is sound, and reflects the guiding principle that insurance is a shared employer responsibility. The details, though, need some work to focus more narrowly on the right group of employers.
A reasonable criticism voiced by the Associated Industries of Massachusetts, among others, is that Baker’s proposal doesn’t take into account the many reasons an employee may not sign up for coverage through their employer. For instance, some workers may be offered perfectly good insurance but still choose to get health coverage through a spouse’s employer. Why should an employer be punished for the employee’s choice in that scenario? What about employees under age 26 who are offered insurance but choose to stay on a parent’s plan, or veterans who get care through the VA? The Baker administration has a good reason to be strict: Officials rightly fear creating a perverse incentive for employers to provide inferior insurance in order to push employees onto their spouse’s or parent’s insurance plan instead. But there should be a middle ground, and as the Baker administration mulls changes, it should seek a way to accommodate employers who can demonstrate that they made a bona fide effort to offer quality insurance but fell short of the 80 percent uptake rate for reasons outside their control.
Additionally, Baker’s initial plan didn’t take into account how much employees make, which could lead to some bizarre outcomes: a hedge fund or law firm might be subject to the tax, even though it is unlikely that any of its highly paid employees are even eligible for MassHealth. The proposal should be specifically tailored to employers who pay low wages.
The $2,000 figure in Baker’s plan — a huge increase over the old $295 fair-share fee — also needs scrutiny. The Baker administration points out that the average cost of insuring a MassHealth enrollee is $6,737, but it would be helpful to know exactly how much of the marginal increase in overall spending can be attributed to workers leaving employee plans.
The debate in Massachusetts plays out against uncertainty over the future of the Affordable Care Act, which Republicans in Congress and President Trump nominally remain committed to repealing. Critics of Baker’s plan argue that any state action should wait for resolution on the federal level. But that could take years, given the new presidential administration’s general ineptitude.
For now, the state has to operate within the reality of the Commonwealth’s employer-based health insurance system and the Affordable Care Act. When a minority of employers choose not to offer adequate health insurance to low-wage workers, it doesn’t make the cost of covering their employees go away — it just sticks someone else with the bill. That someone else is MassHealth, and Baker and his administration deserve credit for confronting the resulting fiscal problems head first.
