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Affiliated with the Rhode Island AFL-CIO “Fighting for the future of our members.” “NOW, more than ever!!!” Publication 2018 Issue 17 Published in house by the RI ARA

April 29, 2018 E-Newsletter

All Rights Reserved RI ARA 2018©

Paul Ryan could get a pension of $84,930 A must read about the person that made it a priority to cut Social Security, Medicare & Medicaid and raise the retirement age because they are entitlements that the government couldn't afford. Some have pointed out that Ryan will potentially benefit from the kind of taxpayerfunded programs he has made efforts to do away with. Paul Ryan could get a pension of $84,930—here's how that compares to most people. House Speaker Paul Ryan announced that he will retire at the end of his term in January, giving up his prominent position and salary of $223,500 a year. But that doesn't mean the 48-year-old will have to start pinching pennies. When he turns 50, he's likely entitled to a pension plan that Vanity Fair describes as "a golden parachute." If he is enrolled in the program offered to Congress members, the Federal Employees Retirement

System (FERS), he could receive $84,930 a year, assuming he sticks it out through January. For most of America, by contrast, pension plans are only a memory: In total, only 23 percent of workers have one now, according to the most recent analysis from the Pension Rights Center, while in 2016 "pension benefits provided income to nearly one third of older adults." Many U.S. employers have shifted away from offering pensions in favor of encouraging personal retirement accounts. But 401(k)s, which in any event are only available to some, have proven to be an insufficient alternative, leading some to conclude that "the grand 401(k) experiment has been a failure." Overall, Amer icans between the ages of 55 and 64 have a median of $120,000 saved for retirement, according to a recent Bankrate survey. That's only 12 percent of the $1 million experts

recommend you have to count on once you've stopped working. A 2015 report from the U.S. Government Accountability Office, meanwhile, found that 30 percent of households headed by someone 55 or older don't have any retirement savings or a pension, reports the Washington Post, which adds that the Economic Policy Institute found that the wealthiest 20 percent of Americans older than 65 own just about all of the $25 trillion total in U.S. retirement savings. Among workers who do receive pensions, their allotment varies based on who they worked for and how long they worked. In 2016, the median pension for adults over 65 who worked in the private sector was worth $9,262 a year. The median federal government pension, meanwhile, was $22,172, and for state and local government pensions, it was $17,576, according to

the Pension Rights Center. Averages can run higher: For those who spent their career working at the state government level, for example, the average pension benefit is $36,131 a year, according to a 2014 report from the American Enterprise Institute. Ryan's pension is considerably more, in part thanks to his decision to leave office in January: "The annual payment to a retired member is determined in part by calculating the three highestpaying consecutive years of their career," Business Insider reports. At the end of 2018, Ryan will compete his third year as Speaker, his highest-earning role since he became a congressman in 1999. In addition, "of course, Ryan could also have other retirement savings from his time in the private sector or from the congressional Thrift Savings Plan, which functions like a 401 (k)."...Read More

Trump's revenge: U.S. oil floods Europe, hurting OPEC and Russia As OPEC's efforts to balance the oil market bear fruit, U.S. producers are reaping the benefits - and flooding Europe with a record amount of crude. Russia paired with the Organization of the Petroleum Exporting Countries last year in cutting oil output jointly by 1.8 million barrels per day (bpd), a deal they say has largely

rebalanced the market and one that has helped elevate benchmark Brent prices (LCOc1) close to four-year highs. Now, the relatively high prices brought about by that pact, coupled with surging U.S. output, are making it harder to sell Russian, Nigerian and other oil grades in Europe, traders said. "U.S. oil is on offer everywhere," said a trader with

a Mediterranean refiner, who regularly buys Russian and Caspian Sea crude and has recently started purchasing U.S. oil. "It puts local grades under a lot of pressure." U.S. oil output is expected to hit 10.7 million bpd this year, rivaling that of top producers Russia and Saudi Arabia. In April, U.S. supplies to Europe are set to reach an alltime high of roughly 550,000 bpd (around 2.2 million tonnes),

according to the Thomson Reuters Eikon trade flows monitor. In January-April, U.S. supplies jumped four-fold yearon-year to 6.8 million tonnes, or 68 large Aframax tankers, according to the same data….Read More (Yet we pay higher gas prices because we are tod there is a shortage of crude oil. Supply and demand.)

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New Committee Hears What Led to Multiemployer Plan Pension Crisis Witnesses for the Joint Select Committee on Solvency of Multiemployer Pension Plans said demographics, failing industries and market returns led to the insolvency of multiemployer pension plans. Witnesses for the newly formed J oint Select Committee on Solvency of Multiemployer Pension Plans spelled out for legislators the history of multiemployer pensions and how they got into the crisis they are in today. In his testimony, Thomas A. Barthold, chief of staff of the Joint Committee on Taxation, offered a very detailed history of the multiemployer pension plan system both before and after enactment of the Employee Retirement Income Security Act (ERISA). He identified four issues contributing to the underfunding of multiemployer pensions. He said that while the amount of employer contributions specified in bargaining agreements generally takes into account benefits to be earned under the plan, it historically has not been explicitly tied to the amount needed to satisfy Internal Revenue Code and ERISA funding requirements. Secondly, if the industry covered by the multiemployer pension plan has contracted (resulting in fewer active employees), the liabilities for benefits of retirees and other

former employees generally have become disproportionately large compared to liabilities for benefits of current employees. Barthold noted that liabilities under the plan include previously earned benefits for employees of employers that no longer participate in (i.e., contribute to) the plan. “Former participating employers may have withdrawal liability, but payments may not be sufficient to cover the unfunded amount,” he said. In addition, the former participating employer may no longer exist and is not able to pay the withdrawal amount. Finally, Barthold said, “Underfunding in many cases is too great to realistically cover with future investment income or ongoing contributions.” Ted Goldman, senior pension fellow with the American Academy of Actuaries, noted these same issues in his testimony. He pointed out that there are fewer unions and fewer young employees joining them, leading a lower proportion of active workers who contribute to their plans than inactive workers who do not contribute. He also noted that many withdrawn employers are bankrupt, meaning they are unable to pay their full withdrawal liability. Goldman explained that when the Employee Retirement Income Security Act (ERISA) was passed, it protected benefits

that plan participants had already accrued, often referred to as the “anti-cutback” rule. In addition, employers contributing to multiemployer plans became responsible not only for their negotiated contributions, but also for any funding shortfalls that developed in the plans. ERISA also introduced minimum funding standards, expanded participant disclosures, and fiduciary standards. An issue that led to the current state of multiemployer plan crisis was that during the late 1990s, very strong asset returns led many plans to improve benefit levels in order to share the gains with participants and protect the deductibility of the employer contributions, according to Goldman. However, these years were followed by a period of very poor asset returns that erased much of these investment gains. The increased benefit levels were protected by ERISA’s anticutback provisions. “This combination of temporary asset gains and permanent benefit improvements is a contributing factor in the challenges facing multiemployer plans today,” he said. Goldman added that plans have invested in diversified portfolios to try to achieve investment returns that can support higher benefit levels and lower contribution requirements

than would be possible if the assets earned risk-free rates of return. However, plans need additional contributions or reduced benefits if the anticipated investment returns are not achieved. He pointed out that the 2000 dot-com bust left some plans financially weakened and the 2007 to 2009 recession further strained the financial stability of most plans. “For decades, these plans worked much as expected, with little threat of insolvency. However, a combination of economic, demographic, and regulatory changes have placed a small but material segment of these plans at risk. Employees who negotiated for these benefits as part of wage and benefit packages were expecting to benefit from these arrangements at retirement. Now those expectations may not be met,” Goldman said. Tagged: DB plan funding, DB plans, defined benefit plans, multiemployer pension plans “We must find a solution to this problem,” said Richard Fiesta, Executive Director Rich Fiesta of the Alliance. “The retirees involved are in serious financial peril and we cannot allow them to lose the benefits they earned through a lifetime of hard work.”

The Trump stock market looks a lot like Ronald Reagan's, Ralph Acampora says — and that may mean trouble Donald Trump, like Ronald Reagan before him, is an outside -the-beltway president. That recently prompted longtime market watcher Ralph Acampora to investigate whether the two had anything else in common. What he found could be a warning to the stock market. "Ronald Reagan had a six-

month honeymoon," Acampora, director of technical research at Altaira Capital Partners, told CNBC's "Futures Now" last week. "The percentage gain was roughly about 10 percent." When Reagan was sworn into office on Jan. 20, 1981, the Dow Jones Industrial Average was trading at around 950. The index, which at the time

contained companies such as Eastman Kodak and Goodyear Tire, hewed to a close trading range until the middle of 1981, before trending downward. The Dow ended that year down 9 percent. "Most presidents, after their honeymoon, something happens because all of the things that they're planning to do politically

takes time to execute," Acampora explained. "Consequently, when the honeymoon period is over these presidents have a bear market," the market watcher added. "Most presidents have some kind of a difficulty in their second year, and Ronald Reagan was no different."...Read More

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Trump Moves to Gut the Post Office Some may be inclined to think that Donald Trump’s executive orderThur sday night establishing a task force to recommend reforms for the U.S. Postal Service reflects another salvo in the president’s war against Amazon. Trump’s attack on Amazon, a clear bypr oduct of Amazon CEO Jeff Bezos’s ownership of The Washington Post, included the suggestion that the online retailer was “ripping off the post office” by securing a special deal for the USPS to ship packages the last mile. By reviewing the finances of the post office, Trump’s task force could demand increases to that shipping contract, possibly costing Amazon billions of dollars. Whether Amazon actually is getting a special deal on shipping is open to intense debate. The company also happens to enjoy a discount on stamps, which

they then mark up to their own marketplace sellers, a pure arbitrage deal to earn profits from a publicly issued product. But these issues have almost nothing to do with the Trump executive order. The Amazon spat is a cover for the formal unveiling of a long-wished rightwing project to destroy the post office and have private industry take over its infrastructure, which taxpayers funded long ago. All the executive order really does is create a report; it would take a willing Congress to deliver the final hammer blow. But that report, with a government imprimatur, will become part of that right-wing wish list, living on for decades in think tanks and private shipping company boardrooms as a fervent dream. And sometimes dreams become reality.

Let’s look at the executive order, which is a bit deceptive in its intentions. The policy section manages to mention that the Postal Service routinely earns the highest public approval rating of any agency in the federal government. But then it layers on the bad news: the decline in first-class mail volume—$65 billion in losses since 2009, an “unsustainable fiscal path.” Amazingly, the policy section alludes to the inability of the USPS to fund retiree health and pension benefit obligations, without stating that it has the impossibly high statutory burden of pre-funding those obligations 75 years out, effectively having to pay today for future workers who have not yet been born. No public agency or private company has any

similar burden. It was placed on the Postal Service in the 2006 Postal Accountability and Enhancement Act to deliberately cripple the agency at the behest of UPS and FedEx, its two major competitors on package delivery. There should be no confusion: Without this completely anomalous pre-funding mandate, the USPS would be a moneymaking operation, regardless of the rise of email. But while alluding to “inflexible costs,” the executive order says that the USPS “must be restructured to prevent a taxpayer-funded bailout.” Yet, a true restructuring would require only one line of legislative text: “The 75-year pre-funding mandate is hereby repealed.” The fake crisis would be over. But that’s not what Donald Trump’s minders want….Read More

Drugmaker Group Sets Lobbying Record The drug industry set several quarterly records for lobbying spending in the first three months of 2018 as it faced pressure from President Donald Trump’s administration and lawmakers on drug pricing, generic medicines and trade. The Pharmaceutical Research and Manufacturers of America spent $9.96 million on federal lobbying, according to disclosures filed Friday with the government. The trade group increased its spending by nearly $2 million from the same period in 2017, when it also set a quarterly record. Bayer Corp., AbbVie Inc., Sanofi US, Novo Nordisk A/S and Celgene Corp all reached new highs in their spending as well. Spending on lobbying was reported twice a year until 2008. PhRMA lobbied against legislation to stop drugmakers from denying generic-drug companies the ability to study their products to bring low-cost competition to market. At one

point, the measure was close to being included in budget legislation passed by Congress in February. PhRMA won that battle but ended up taking a rare loss that will cost the industry billions. Looking for ways to raise funds for the budget measure, lawmakers changed a formula under Medicare’s prescription drug benefit that would require drugmakers to offer larger discounts to patients with high medical bills. Trump has repeatedly vowed to bring down soaring drug prices -- he said companies were “getting away with murder” -and has asked his administration to find ways to do it. A group of administration officials is working on a plan expected to be unveiled later this month, and lawmakers have also introduced bills to squeeze the industry. Trade Issues Secretary of Health and

Human Services Alex Azar, a former Eli Lilly & Co. executive, told reporters in March that the administration was considering regulatory actions and plans to seek input from companies, consumers and others. PhRMA also lobbied on intellectual property and trade as Trump renegotiates the North American Free Trade Agreement and other accords and threatens tariffs on imported Chinese products. On several issues, the group disclosed that it had lobbied the White House directly. Separately, several companies also reported their expenditures. Bayer spent $3.45 million, AbbVie $2.89 million, Sanofi $2.03 million, Celgene $1.22 million and Novo Nordisk $1.46 million. In addition to the records, Pfizer Inc. spent $4.65 million, up from $3.79 a year earlier. Merck & Co. spent $3.31

million, nearly double its spending in the first quarter of 2017. Eli Lilly & Co. spent $1.34 million, down from $1.39 million a year earlier. Abbott Laboratories spent $790,000 in the first quarter, the same as it had in the same period in 2017. Insurers’ Goals Insurers also stepped up their lobbying efforts. A trade group, America’s Health Insurance Plans, spent $2.28 million in the first quarter, up from $1.65 million a year earlier, according to the filings. Insurers were pushing hard for a legislative package to stabilize the Obamacare insurance market. They wanted Congress to offer states money to help pay for those with the most expensive care and finance subsidies Trump cut off in October that help insurers offset low-income consumers’ out-of-pocket costs. It became clear in March the package was unlikely to pass.

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How Medicare's Conflicting Hospitalization Rules Cost Me Thousands Of Dollars A few months ago, I wrote a check for $12,000 but couldn't figure out exactly why. The payment was to secure a place for my mother at Sligo Creek Center, in Takoma Park, Md. It's a nursing home and rehab center owned by Genesis Healthcare. My mother was about to be discharged from Holy Cross Hospital, in nearby Silver Spring, after a fall. Medicare wouldn't pay for her rehabilitation care. So before the Sligo Creek Center would let her through the door, I had to prepay for a month — $12,000 — or nearly $400 a night. Now, my mother had paid into Medicare her entire working life, and since she retired, the Social Security Administration has automatically deducted $130 for her basic Medicare premium from her $1,650 monthly check. On top of that, she pays about $300 a month for a prescription drug plan and supplemental "Medigap" insurance. But because of dueling rules and laws that have been wellknown to Medicare officials and members of Congress for years, none of that covered my elderly mother when she needed care. This is a story of how money,

outdated laws and federal budget rules can interfere with patient care and leave elderly patients vulnerable. The fall I found my mother lying on the floor of her apartment one evening in early January. I had stopped by because she didn't return my calls. It was Wednesday, and she had fallen sometime in the previous 24 hours. She was awake, but confused. Her lips were chapped, her skin was too pink, and her thick white curls were a mess on her head. I needed help getting her up and into bed. When my husband and I couldn't do it, we called the local fire department. There were no obvious injuries and she was speaking coherently, so I spent the night with her and tried to care for her the next day, thinking she just needed rest and food. But it soon became clear she needed medical help. She couldn't walk, couldn't even move her left leg. Her confusion was getting worse. Her doctor recommended I take her to the emergency room at Holy Cross Hospital in Silver Spring. An ER doctor there examined her, saw that she couldn't move her leg, couldn't really even hold her body upright and had trouble with her memory. He said he would admit her to the hospital's

observation unit to figure out what was going on. He mentioned she might need rehab care to get up and walking again. The word observation triggered an alarm deep in my brain. I had read that patients on observation statussometimes wer en't eligible for rehab care, and I told the doctor that I was concerned. He said he and the hospital "do all they can to be sure their patients' care is covered." I was reassured. My mother spent four nights at Holy Cross. She was on IV antibiotics for an infection. She got nine X-rays, two MRIs, scans of her carotid arteries and lungs, and a CT scan. Hospital staffers drew blood no less than six times because they were concerned she might have had a mild heart attack or stroke that had caused her to fall. Administrative maze On the day they decided to release her, a social worker named Jay called to say the doctors were recommending she go to an inpatient rehab center — and then he said Medicare wouldn't pay for it. My mother was caught in an administrative wonderland where she slept at a hospital for four nights, but the paperwork said she was an inpatient only one of those nights. Medicare's rules, dating back to

the 1960s, require people to spend three nights in a hospital before the federal program will pay for inpatient rehabilitative care. It would cost upward of $12,000 a month, Jay told me. I sped to the hospital in a rage. I demanded to know why they were releasing her when she still couldn't walk. Further, I wanted to know, why were they calling her an "outpatient" when she was sleeping in their bed, under their blankets, wearing their hospital gown and being cared for by their staff. Here were some of the things a parade of social workers and nurses told me that day.  The doctor couldn't admit her as an inpatient because she didn't have a qualifying diagnosis.  Her status was changed from observation to inpatient on the third day because Medicare requires that.  They could not change her status to inpatient for the entire stay because they didn't want to be audited.  She couldn't go to acute rehabilitation, which Medicare pays for, because there was no evidence she had had a stroke or heart attack. They didn't say much about her medical care. It was all about the rules….Read More

HUD Secretary Ben Carson to propose raising rent for low-income Americans receiving federal housing subsidies Housing and Urban Development Secretary Ben Carson proposed far-reaching changes to federal housing subsidies Wednesday, tripling rent for the poorest households and making it easier for housing authorities to impose work requirements.

Carson’s proposals, and other initiatives aimed at low-income Americans receiving federal assistance, amount to a comprehensive effort by the Trump administration and Republicans in Congress to restrict access to the safety net and reduce the levels of assistance for those who do qualify.

The ambitious effort to shrink federal assistance has been dubbed “Welfare Reform 2.0’’, after Bill Clinton’s overhaul of the welfare system in 1996. The proposals — affecting housing, food stamps and Medicaid — would require congressional approval. Trump earlier this month signed an executive order

directing federal agencies to expand work requirements for low-income Americans receiving Medicaid, food stamps, public housing benefits and welfare. The agencies are supposed to issue recommendations to the White House within 90 days…..Read More

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

April is Medicaid Awareness Month: New Resources on Medicaid and Older Adults This month, stakeholders and advocates across the country are observing Medicaid Awareness Month. Organized by the Protect Our Care coalition, the monthlong campaign is intended to enhance awareness of the many ways the Medicaid program strengthens American communities. To that end, the coalition is launching outreach and education

efforts on a different topic each week. These activities will culminate in a national Medicaid Day of Action on April 30. The campaign’s focus this week is on the critical role Medicaid plays in the lives of older adults, including people with Medicare and those nearing eligibility age. Among the newly released resources is a fact sheet on How Medicaid Works for Seniors and Older Adults that depict key statistics and elements of Medicaid coverage for older

adults. Next week, the coalition plans to highlight how the program serves people with disabilities. Previously covered topics include how Medicaid helps kids and families, and the program’s key role in fighting the opioid crisis. Throughout the month, advocates will engage and educate the public about current threats to the program. Threats to Medicaid include the President’s most recent budget request, which would slash Medicaid

funding by $1.4 trillion; ongoing Congressional leadership discussions of ‘entitlement reform’; and a ser ies of recent actions by the U.S. Department of Health & Human Services that encourage states to restrict Medicaid enrollment by imposing new restrictions and eligibility hurdles. For more information, please visit the Medicaid Awareness Month Resource Kit, which will be updated as new materials are available.

How Medicaid Work Requirements Could Hurt Older Americans For some lower-income Americans, Medicaid is their lifeline to health care. That includes "older nonelderly" adults from 50 to 64 – an age range when chronic health conditionsand mobility issues are common. Other people use Medicaid benefits so they can serve as family caregivers. On Jan. 11, the Centers for Medicare & Medicaid Services announced that states can apply for waivers to implement work requirements for people who receive Medicaid benefits. Some

older Americans will be affected. To date, waivers have been approved in three states and are pending approval in others. Age limits vary for who might have to fulfill work or "community engagement" requirements for up to 80 hours a month. In Kentucky, Medicaid recipients are exempt at 64. In Indiana, 60 is the cutoff age. In Arkansas, however, 50 is the cutoff. As of early April, other states seeking to implement work requirements include Arizona, Kansas, Maine, Mississippi, New

Hampshire, Utah and Wisconsin. Ronnie Maurice Stewart, 62, of Lexington, Kentucky, has always been a hard worker. If anything, his jobs became more physically demanding as he reached middle age and beyond. Stewart's early career as a social worker spanned two decades. However, he was laid off at the North Carolina agency where he'd been employed 10 years, along with other coworkers. He found short-term social-work employment but nothing permanent.

So Stewart moved on to Nashville. "Agencies in Tennessee did not want, it seems, to hire someone of my age," he says. With professional jobs unavailable, he took whatever came his way, including construction labor and work that involved driving with a rental car company. he turned 62, in July 2017. He also re-enrolled in Medicaid. ...Read More

Why More Than A Million Teachers Can't Use Social Security Teachers have staged protests in recent weeks in West Virginia, Oklahoma, Kentucky, Colorado and Arizona. Some are fighting lawmakers who want to scale back their pensions. It's no secret that many states have badly underfunded their teacher pension plans for decades and now find themselves drowning in debt. But this pensions fight is also complicated by one little-known fact: More than a million teachers don't have Social Security to fall back on. To understand why, we need

to go back to Aug. 14, 1935. That is when President Franklin Delano Roosevelt signed the original Social Security Act. "This Social Security measure gives at least some protection to at least 50 million of our citizens," Roosevelt intoned. But of those 50 million citizens, one big group was left out: state and local workers. That was because of constitutional concerns over whether the federal government could tax state and local governments, says Alicia Munnell, director of the Center for Retirement Research at Boston College. "So, in the 1950s," Munnell says, "there were amendments added to the Social Security Act

that allowed governments to enroll their workers." And many did, leading the Social Security Administration to trumpet in one 1952 promotional film that "most American families are now able to ensure for themselves an income that is guaranteed for life." Most American families ... except for a lot of teachers, says Chad Aldeman, editor of "Fifteen states do not offer all of their teachers Social Security coverage," Aldeman says, "and that means about 40 percent of the workforce is not covered." Forty percent of all teachers. That's more than a million

educators, in Alaska, California, Colorado, Connecticut, Georgia, Illinois, Kentucky, Louisiana, Maine, Massachusetts, Missouri, Nevada, Ohio, Rhode Island and Texas. Now, these teachers aren't benefit-less. The law requires that states that opt out of Social Security give teachers a pension that is at least as generous. "On the whole, teachers who don't get Social Security aren't necessarily disadvantaged if they work a full career and get a full pension," says Andrew Biggs, who studies retirement issues at the American Enterprise Institute…..Read More

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

Lawsuit Alleges Kentucky Medicaid Work Requirement Breaks Federal Law On January 11, 2018, the Centers for Medicare & Medicaid Services (CMS) issued guidance announcing a new policy that, for the first time, will allow states to make participation in a work or “community engagement” program a condition for Medicaid eligibility. The next day, CMS approved a Medicaid waiver in Kentucky that will allow the state to test this new policy. In addition to making employment an eligibility requirement, the Kentucky waiver program, called Kentucky HEALTH, encompasses several other changes never before approved by CMS. These changes include monthly premiums of up to 4% of income and coverage lock-out periods of up to six months for failing to timely renew eligibility, or for failing to report a change in circumstances. Kentucky HEALTH applies to most nonelderly adults, including low-income parents and expansion adults. The state

plans to implement Kentucky HEALTH by July 2018. Fifteen Kentucky Medicaid enrollees responded in January by filing a lawsuitin federal court challenging CMS’s authority to issue the work requirement policy and approve the Kentucky waiver. The plaintiffs allege that CMS is breaking the law by approving such plans and that only Congress has the ability to restrict Medicaid coverage in that way. Plaintiffs are asking the court to declare the work requirement and Kentucky’s wavier illegal because they violate the Administrative Procedures Act, the Medicaid provisions of the Social Security Act, and the President’s Constitutional duty to ensure laws are faithfully executed. States get permission to alter the Medicaid program by submitting waiver requests to CMS. Historically, such waivers have generally been used to

create new avenues for Medicaid eligibility. By law, such waivers are permitted only so long as they are “likely to assist in promoting the objectives” of the Medicaid program, are a temporary experiment, and meet other preconditions. The lawsuit alleges that CMS did not properly assess the state waiver requests and that Kentucky’s program does not meet these preconditions since it is a thinly veiled attempt to reduce costs by restricting coverage. Kentucky acknowledges the policy would reduce coverage, estimating 100,000 people would lose access to Medicaid coverage in the first year alone. Experts believe that number could be as high as 300,000. At Medicare Rights Center, we are very concerned by schemes that appear to be intended to push people out of the Medicaid program with no assistance to find work and no

chance of health coverage. Studies have shown that most of the targeted people with Medicaid are working in very low-wage positions, often with no job security and erratic hours that can be cut at any time. This means that workers who are doing their very best to work can find themselves on the wrong side of these rules and lose their health insurance. In addition, these schemes generally include complex bureaucratic steps that may lead to people who fit all of the eligibility requirements losing coverage through red tape. Though there are seldom work requirements for the Medicare population, such punitive rules can greatly impact family caregivers who are balancing work and providing care to older family members or family members with disabilities. Read more about the Kentucky lawsuit. Read more about our concerns about work requirements in Medicaid hereand here.

Hospitals Lure Diabetes Patients With Self-Care Courses, But Costs Can Weigh When a routine physical revealed mildly elevated bloodsugar levels, Michael Phillips was strongly encouraged to sign up for a diabetes selfmanagement class. Phillips never asked about the cost of the two half-day sessions he attended in a conference room at St. Mary’s Hospital in Athens, Ga., and doesn’t recall the instructor mentioning it. But the 64-year-old retired bank analyst was flabbergasted when he opened his bill after attending. “What, $1,044 for a class?” said Phillips, who fought the bill with the hospital and his insurer, Blue Cross Blue Shield of Georgia. “The hospital is charging an exorbitant rate, but BCBS is going along with it —

why aren’t they screaming about being gouged?” There are about 1.5 million Americans newly diagnosed with Type 2 diabetes each year. Unlike Type 1 diabetes, an autoimmune disease in which people produce no insulin that begins in childhood, Type 2 diabetes is a condition of adulthood, typically associated with weight and a sedentary lifestyle. Diabetes self-management programs teach patients how to monitor their blood sugars, what to eat and the importance of exercise as strategies to delay or avoid the disease’s serious complications. Patients like Phillips, with early or mild diabetes, can modify their habits so that their blood

sugar returns to normal. But the classes, targeting a disease that affects 30 million Americans, have also become a revenue generator for hospitals and an opportunity for marketing and branding. “If you can get 25 in the class and charge $500 each, you can make a lot of money,” said Gerard Anderson, a professor of health policy and management Johns Hopkins University Bloomberg School Public Health. An additional incentive is that the classes bring “people into the hospital that they expect will need the hospital in the future.” Phillips’ class had about a dozen students, who got a free lunch, free parking and a sample of Glucerna, a nutrition drink

formulated for diabetics. The instructor noted that St. Mary’s operates a gym that participants could join for a fee. Diabetes is among the costliest of medical conditions. The American Diabetes Association estimates that average medical expenditures for those diagnosed with diabetes are 2.3 times higher than those without. The classes, say experts, are a chance to rein in some of that spending. When Harvard Law School researchers ran the numbers in 2015, they found an estimated savings of $1,309 over three years for every Medicare Advantage patient who completed an education program. ...Read More

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RI ARA HealthLink Wellness News


Pancreatic cancer: Some blood pressure drugs put women at risk New research suggests that certain blood pressure drugs may increase the risk of pancreatic cancer in postmenopausal women. Zhensheng Wang, a postdoctoral researcher at the Dan L. Duncan Comprehensive Cancer Center at Baylor College of Medicine in Houston, TX, along with his colleagues, set out to examine the effects of a class of drugs called calcium channel blockers (CCBs) on the risk of pancreatic cancer. CCBs are used to stop calcium

from entering the heart's muscle cells, which, in turn, relaxes the blood vessels. This relaxation makes them useful drugs for the treatment of hypertension. Previous studies, the authors of the new research explain, have shown that antihypertensive medication increases levels of a receptor called soluble receptor for advanced glycation end-product (sRAGE). sRAGE receptors help control the body's immune response and inflammation; Wang and team point out that

earlier research found that sRAGE reduces inflammation and lowers the risk of pancreatic cancer. Blood pressure drugs, on the other hand, raise sRAGE levels, so the authors started out with the hypothesis that, on the contrary, antihypertensive medication would lower the risk of pancreatic cancer. But the results of the study surprised the researchers. The findings were presented at the American Association for Cancer Research Annual Meeting, which took place in

Chicago, IL. CCBs may double pancreatic cancer risk Wang and colleagues examined the data on 145,551 postmenopausal women aged between 50 and 79 who were registered in the Women's Health Initiative (WHI) — a large, long-term study spanning more than 20 years. In addition to CCBs, three other types of blood pressure drugs were included in the analysis: beta-blockers, diuretics, and angiotensinconverting enzyme inhibitors….Read More

Aging Brains Gain More From Exercise With Good Hydration Older adults, drink up. You need plenty of water during exercise so your brain gets the full benefits of working out, researchers say. "Middle-age and older adults often display a blunted thirst perception, which places them at risk for dehydration, and subsequently may reduce the cognitive [mental] health-related benefits of exercise," said Brandon Yates, of Spaulding Rehabilitation Hospital in Boston, and colleagues. The researchers noted that

previous studies have shown that dehydration reduces exercise performance and brain function in young people, but less is known about its impact on seniors. The new study included recreational bicyclists, average age 55, who took part in a large cycling event on a warm day (78 to 86 degrees Fahrenheit). Before the event, the researchers tested the participants and divided them into two groups: dehydrated and normal hydration.

The cyclists took a timed thinking-skills test before and after the ride. Those in the normal hydration group completed the test much faster after the ride than before, while those in the dehydration group did not show much improvement. "This suggests that older adults should adopt adequate drinking behaviors to reduce cognitive fatigue and potentially enhance the cognitive benefits of regular exercise participation," the researchers wrote in a news

release from the American Physiological Society. The study was presented Sunday at the American Physiological Society's annual meeting, in San Diego. Research presented at meetings should be considered preliminary until published in a peer-reviewed journal. More information The U.S. National Institute on Aging has more on hydration.

Female pattern baldness: Treatment and genetics It is normal for women to shed some hair each day, but when bald patches or thinning occurs, it may be due to female pattern baldness. Shedding about 50 to 100 hairs a day is considered normal, but new growth will typically replace these hairs. If someone has female pattern baldness, however, the lost hair is not renewed. In this article, we look at the causes and risk factors for

female pattern baldness, as well as treatment and prevention. What is female pattern baldness? Female pattern baldness is a type of hair lossthat affects women. The medical name for the condition is androgenetic alopecia. Although both men and women may experience hair loss, it is not as widespread in women as in men and appears differently. Men who have hair loss tend to develop a receding hairline

and bald spots. Women with female pattern baldness usually experience general hair thinning, which affects the volume of their hair. In women, the first signs of female pattern baldness may be a widening part or a feeling that the hair does not feel as thick as usual. Although the scalp may be visible, the hairline usually does not recede. Female pattern baldness is characterized by excessive hair loss and thinning. Female pattern baldness is a

type of hair lossthat affects women. The medical name for the condition is androgenetic alopecia. Although both men and women may experience hair loss, it is not as widespread in women as in men and appears differently. Men who have hair loss tend to develop a receding hairline and bald spots. Women with female pattern baldness usually experience general hair thinning, which affects the volume of their hair….Read More

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

Tips for Staying Healthy in Your 70s, 80s, 90s... Aging can be defined as: "progressive changes related to the passing of time." While physiological changes that occur with age may prevent life in your 70s, 80s and beyond from being what it was in your younger years, there's a lot you can do to improve your health and longevity and reduce your risk for physical and mental disability as you get older. Research shows that you're likely to live an average of about 10 years longer than your parents—and not only that, but you're likely to live healthier longer too. According to the U.S. Department of Health and Human Services, 40.4 million Americans (about 13 percent) were 65 years of age or older in 2010 and by the year 2030, almost 20 percent of the total U.S. population will be 65+. So how do you give yourself the best possible chance for a long, healthy life? Although you aren't able to control every factor that affects health as you age, many are in your hands.

Some keys to living a long, healthy life include:  Make healthful lifestyle choices—don't smoke, eat right, practice good hygiene, and reduce stress in your life  Have a positive outlook  Stay as active as possible— mentally and physically  Take safety precautions  See your health care provider regularly and follow his or her recommendations for screening and preventative measures One of the most important things you can do to stay healthy in your golden years is to maintain your sense of purpose by staying connected to people and things that matter to you. However, this isn't always easy—especially in a society that all-too-often views older people as a burden. Visit your local senior center. Spend time with at least one person—a family member, friend or neighbor—every day. Volunteer in your community, attend a local event, join a club or take up a new hobby. According to our sister publication REMEDY's Healthy Living Fall 2014, walking may

help prevent physical disability later in life. In a large study of older Americans, researchers focused on sedentary men and women between the ages of 70 and 89 who either met twice a week for a supervised walk around a track and received instruction to walk or do balance and flexibility exercises three to four times a week at home or attended weekly workshops on healthy aging. After an average of 2.6 years, the walkers were 28 percent less likely to have become persistently physically disabled than the non-walkers, suggesting that it's never too late to start. Stress and Aging Stress can have an enormous impact on your health and your quality of life at any age—and even more so as you get older. In fact, according to a recent study published in the Journal of the American Geriatrics Society, depression and anxiety are linked to physical decline in seniors. Concerns like: "Will there enough money now that I'm retired?" and "What will happen if I get a serious illness or become

disabled?" are common in older adults. As you age, you're also more likely to experience emotional trauma associated with loss— the deaths of people close to you (friends, family members, spouse), your own health, and/or your independence. For many seniors, dealing with the loneliness caused by multiple losses can lead to a diminished investment in life—especially when combined with other issues, like financial concerns. Try these tips to help deal with difficult changes:  Focus on being thankful. Appreciate and enjoy your life and don't take people or things for granted.  Acknowledge your feelings and express them. Talk to a friend, family member or health care professional, write in a journal or join a support group.  Embrace your spirituality.  Accept that some things are out of your control.  Try to keep your sense of humor. ...Read More

Living With Multiple Health Problems: What Older Adults Should Know As we continue to lead longer lives, we become more likely to develop different kinds of health problems. One challenge older adults in particular are likely to face is living with multiple health problems. More than half of all adults 65 and older have three or more ongoing medical problems, such as heart disease, diabetes, cancer, or arthritis. Figuring out the best course of treatment for multiple health problems can be tricky. For example, prescribing medications for a patient with multiple health problems is more complicated than it is when the patient has one health problem, because a drug that

may be useful in treating one health problem may make another worse. That is why both patients and healthcare providers have a role to play in figuring out the best solution to these problems. Here are some tips for working with your healthcare provider when you have several chronic health problems: Get as much information about treatment options as possible: You should work with your healthcare provider to understand all of your options for care and take an active role in deciding what kind of care you would like. For example, you should ask your provider to tell you how long each treatment

option may take to work because some treatments may take longer than others to show benefits. You should also decide if you want to make all of your care decisions on your own or include others in the decisionmaking process. These can include spouses, family members, or friends. And you should always let your healthcare providers know right away if you have questions or concerns, want to stop treatment, or want try something new. Make sure your healthcare provider understands your priorities for care: Decide what

treatment outcomes are important to you. For example, you may want to remain as independent as you can for as long as possible. Because of this, you may prefer a treatment with fewer side effects, even if this treatment may not prolong your life as long as other treatments. This is just one example—you should ask your healthcare provider how different treatment options will affect the aspects of your life that are most important to you, such as your level of independence, stamina, or pain...Read More

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

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RI ARA April 29, 2018 E-Newsletter


RI ARA April 29, 2018 E-Newsletter

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