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January 21, 2018 E-Newsletter

Publication 2018 Issue 03 Published in house by the RI ARA

White House backs GOP's short-term spending bill — but Lindsey Graham says he's against it President Donald Trump supports Republicans' short-term spending bill and will pin the blame on Democrats if it fails to pass, press secretary Sarah Sanders said Wednesday. Democrats have threatened to oppose a continuing resolution to fund the government if they cannot also pass a plan to protect hundreds of thousands of young undocumented immigrants. But the White House may have blame to put on some of the majority Republicans, too. Sen. Lindsey Graham, R-S.C., said Wednesday that he is against a short-term funding measure. Sanders said the White House seeks twoyear spending legislation but would prefer a stop-gap measure to a government shutdown. "The president certainly doesn't want a shutdown, and if it happens I think you only have one place to look — and that's the Democrats," she told reporters on Wednesday. If Congress cannot pass a funding bill by the end of Friday, parts of the government

will run out of money. Republicans control the House, Senate and White House and can pass a funding bill with only GOP votes in the House. A funding plan will need some Democratic support to pass the Senate. Senate Majority Leader Mitch McConnell, R-Ky., said he expects the Senate to take up the continuing resolution as soon as the House can approve it. He said he thinks the Senate "has a good chance of passing it," especially because it reauthorizes the Children's Health Insurance Program for six years, a Democratic priority. Even some Republicans have threatened to vote against it, hurting its chances of passing this week. Graham said Wednesday that he would vote "no" on the measure, arguing that Congress has strung together too many short-term funding bills, according to NBC News. "We've just got to let folks in this body know enough is enough," he said. The bill introduced by House Republicans would extend government funding through Feb. 16. It would reauthorize CHIP for six years and delay some Affordable Care Act taxes. While Democrats have made extending CHIP a priority, the GOP does not plan to

move to pass a bill to shield the immigrants protected by the Obama-era Deferred Action for Childhood Arrivals. Trump ended the program in September with a sixmonth delay, and those immigrants could start to face deportation after March 5. Congressional leaders started to dole out blame earlier Wednesday. Senate Minority Leader Chuck Schumer, D-N.Y., argued that a shutdown "will fall squarely on the majority leader's shoulders and the president's shoulders." McConnell suggested Wednesday that Democrats were "manufacturing a crisis" on immigration before the March deadline. Ryan accused them of playing politics with immigration. Bipartisan senators reached a deal last week on protecting the young immigrants, increasing border security funding and revising extended family migration rules and the visa "lottery" system. Trump rejected the plan when they presented it to him.

Alex Azar Supports Drastic Medicaid Cuts .HHS Nominee Azar Supports Bill that would Lead to Drastic Medicaid Cuts President Trump’s nominee to be the Secretary of the U.S. Department of Health and Human Services, Alex Azar, formerly the head of pharmaceutical giant Eli Lilly's U.S. operations, faced his first confirmation hearing on Tuesday. Azar said he supports the Graham-CassidyHeller bill, legislation that failed in Congress earlier this year that would have converted Medicaid and the Obamacare marketplace subsidies into block grants

that would shrink over time. GOP leaders have vowed to bring this bill back in 2018, and it looks as if Azar would be a strong ally in the effort if confirmed. Alex Azar at his confirmation hearing States that expanded Medicaid under the Affordable Care Act (ACA) would be hardest hit, losing tens of billions of dollars. “Allowing Alex Azar to wield so much power threatens vital programs that many Americans need to maintain their health and standard of living,” said Robert Roach, Jr., President of the Alliance. “He

should not be confirmed.” Senate Democrats pressed Azar to say how he would fight skyrocketing drug prices — demanding to Alex Azar know why they should trust him to lower costs since he did not do so while at Eli Lilly. Azar disputed that Graham-Cassidy would cut billions in funding for Medicaid and insurance subsidies for low-income patients, saying he did not believe slowing the rate of growth to be a cut.

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Trump’s Work-For-Medicaid Rule Puts Work On States’ Shoulders The Trump administration’s watershed decision Thursday to allow states to test a work requirement for adult Medicaid enrollees sparked widespread criticism from doctors, advocates for the poor, and minority and disability rights groups. Conservatives, however, hailed the change to the federal-state program for lowincome people. Stephen Miller, the Medicaid commissioner for Kentucky, which received authority Friday to implement a work requirement, said the new policy will “allow states the flexibility to pursue innovative approaches to improve the health and well-being of Medicaid beneficiaries.” Yet states considering whether to enact the controversial strategy face major hurdles. They will have to figure out how to define the work requirement and alternative options, such as going to school or volunteering in some organizations; how to enforce the new rules; how to pay for new administrative costs; and how to handle the millions of enrollees likely to seek exemptions. Take Arizona, one of the 10 states that have applied for federal approval for a work requirement. The state must settle basic questions, including whether people would have to meet the new conditions at the time of enrollment, at the annual renewal of their Medicaid coverage or at another time.

Jami Snyder, deputy director of the Arizona Medicaid program, said a key goal for the state is to help people find jobs — not to reduce its Medicaid enrollment, which stands at 1.9 million. “Infusing the requirement into our eligibility requirements acts as a nice incentive for enrollees in their effort to seek out employment and job training,” she said. But the state today doesn’t know how many of its enrollees are already employed, said Snyder. “We are still working through all the operational details,” she explained. Seema Verma, administrator for the Centers for Medicare & Medicaid Services, said she hopes the new work requirement will improve enrollees’ health while reducing Medicaid rolls. The policy change should help people find jobs that offer health coverage or make enough money to afford private plans, she said. Critics expressed skepticism. They say the work requirement proposal — which was repeatedly rejected by the Obama administration on the argument it would interfere with providing health coverage — is a more subtle way to reduce the number of non-disabled adults added to Medicaid under the Affordable Care Act. That Medicaid expansion was sharply criticized by conservatives, and Republicans in Congress tried to add work requirements in their unsuccessful bid last year to overturn the health law. “This is an effort to walk back the Medicaid expansion,” said Judith Solomon, vice president of the Center on Budget and

Policy Priorities, a Washington-based research organization. CMS said states would have to test whether the work requirement improves enrollees’ health — a point Solomon ridiculed. “What health outcome will be improved if we take away health care from those not able to work?” she asked. Dr. Richard Pan, a California state senator and pediatrician in Sacramento who sees Medicaid patients, said the idea just “doesn’t make sense.” By making it harder for people to have health insurance, “you’re going to make it less likely for them to work,” he said. Pan, a Democrat, said the proposal would create more bureaucracy and “feeds into a fiction” that Medicaid enrollees don’t work — or don’t want to work. More than 4 in 10 non-disabled adults with Medicaid coverage already work full time….Read More

Mr. Jones, here are your two work applications mandated by Medicaid.

Kentucky Is First State Granted Approval For Medicaid Work Requirements Thousands of poor adults in Kentucky will have to find jobs and pay monthly premiums to retain their Medicaid coverage as a result of drastic changes to the state’s health insurance program approved Friday by the Trump administration. With the long-expected decision, Kentucky becomes the first state to win federal approval to test a new work requirement in Medicaid, a contr over sial policy shift likely to result in a court battle over whether the administration overstepped its legal authority. “I was raised by a father who said, ‘Don’t take something that is not earned,’” said Republican Gov. Matt Bevin in announcing the approval of Kentucky’s Medicaid

waiver. “The vast majority of able-bodied men and women, able-bodied Kentuckians, they want the dignity associated with being able to earn and have engagement in the very things they are receiving, and an opportunity not to be put in a dead-end entitlement trap but given a path forward and upward.” Conservatives say the work requirement can help lead people to employment and off the state-federal health program. Democrats, health providers and patient groups say the measure adds another stumbling block for people to keep their coverage. “By lessening dependence on government assistance and promoting individual self-

sufficiency, Kentucky’s efforts should also help to promote the fiscal sustainability of the program to better protect services for the Commonwealth’s most vulnerable,” Demetrios Kouzoukas, principal deputy administrator of the Centers for Medicare & Medicaid Services, wrote in his Kentucky approval letter. “Over all, CMS believes that Kentucky HEALTH [Helping to Engage and Achieve Long Term Health] has been designed to empower individuals to improve their health and well-being.”

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Health Spending Growth Slowing, More on Pace with Economic Growth nearly double economic growth, while it has been closer to on pace since 2010. The major payers of health Last month, two health policy nonspending—Medicare, Medicaid, profits released detailed and private insurance—are also information and graphs about seeing less growth in spending per health spending in the U.S. The enrollee, with Medicare and Peterson Center on Healthcare Medicaid showing more partnered with the Kaiser Family improvement than private Foundation to create a Health insurance. Surprisingly, the growth System Tracker for health in prescription drug spending, as spending and other quality and cost well as hospital and physician trends in the health system. spending, has also slowed in this One section of the website decade. details how U.S. spending on health care spending has far outpaced general economic These data do not prove the ACA has has changed over time. While health car e growth. However, the Health System contained health spending growth, but they costs have risen dramatically over the past Tracker shows that health spending growth are a positive sign that something has few decades, since the passage of the has slowed and the gap between health caused a change. How lasting these Affordable Care Act (ACA), there has been spending and economic growth is closer improvements may be and whether recent a slight slowdown in the rate of growth that than it has ever been within the tracker’s changes to the ACA and within the Centers might bode well for future cost containment. data set. By comparison, in the first decade for Medicare & Medicaid Services will Until recently, the growth of health of the 2000s, health spending growth was affect health spending are yet to be seen.

HHS Requests Information on Medicare, Medicaid On December 26, the Office of the Assistant Secretary for Planning and Evaluation (ASPE) within the U.S. Department of Health and Human Services (HHS) quietly issued an informal request for information (RFI) with significant implications for Medicare and Medicaid. The basis of the RFI is an October 2017 Executive Order (EO) which largely focuses on “promoting healthcare choice and competition” in the private commercial insurance market. In part, the EO directed the Departments of Treasury, Labor, and HHS to expand the availability of association health plans (AHPs), short-term limited duration insurance (STLDI), and health reimbursement arrangements (HRAs). It also directed HHS to produce a report identifying “the extent to which existing State and Federal laws, regulations,

guidance, requirements, and policies” limit choice and competition. The ASPE RFI was issued to inform this report and to “lay the groundwork for future action.” Notably, the RFI dramatically expands the EO’s private market scope by asking about “barriers to choice and competition” within Medicare and Medicaid. These are the only two programs specifically named in the RFI’s five questions, all of which are framed to gather input on how Medicare and Medicaid laws, regulations, and policies could be revised to better align with the administration’s priorities. The questions are available here. Comments are due January 25. The Medicare Rights Center will be providing input, and we encourage all stakeholders to weigh in as well. In addition to responding to the

substantive issues raised in the RFI, we plan to address the manner in which it was released. By classifying this important feedback opportunity as “informal,” ASPE was not required to comply with the public notice requirements that are part of the standard federal rulemaking process. As a result, we are concerned the RFI may not receive the broad attention and meaningful input needed to constructively inform both the HHS report and the administration’s resulting Medicare and Medicaid policy actions. Comments can be submitted via email to through January 25, 2018. For more information from ASPE on the RFI, please click here.

Home Care Agencies Often Wrongly Deny Medicare Help To The Chronically Ill Colin Campbell needs help dressing, bathing and moving between his bed and his wheelchair. He has a feeding tube because his partially paralyzed tongue makes swallowing “almost Colin Campbell impossible,” he said.

Campbell, 58, spends $4,000 a month on home health care services so he can continue to live in his home just outside Los Angeles. Eight years ago, he was diagnosed with amyotrophic lateral sclerosis, or “Lou Gehrig’s disease,” which relentlessly attacks the nerve cells in his brain and spinal cord and has no cure. “We feel Medicare coverage laws are not

being enforced and people are not getting the care that they need in order to stay in their homes,” said Kathleen Holt, an attorney and associate director of the Center for Medicare Advocacy, a nonprofit, nonpartisan law firm. The group is considering legal action against the government. ...Read More

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RI ARA HealthLink Wellness News


Postcard From Sacramento: Alzheimer’s ‘Looks Like Me, It Looks Like You’ SACRAMENTO, Calif. — Until last year, Jackie Coleman was a disability rights lawyer — a good

Coleman, dressed in purple — the official color of the Alzheimer’s advocacy movement — recounted those awful days while attending an Alzheimer’s panel discussion last week at the California Museum, near the state Capitol. A small, one, too. soft-spoken woman with shoulder-length “I was an excellent attorney,” recalled the hair and round glasses, she attended with her 63-year-old Rancho Cordova, Calif., more talkative friend and roommate, Joyce resident who loved her job and was proud of Irwin, 60. the work she did. The women said they’d cared for each But a little over a year ago, she started to other for the past three years. Irwin, a threeforget appointments and details from time cancer survivor, said her late husband meetings, and began to depend heavily on had dementia and mother likely did, too, her secretary. Then she started making though she wasn’t diagnosed back then. mistakes. Ultimately, one got her fired. Sponsored by Northern California and Two weeks later, she got a diagnosis: Northern Nevada Chapter of the early onset Alzheimer’s disease.

Alzheimer’s Association, the event was part of an initiative to highlight the disease’s impact on women, who account for twothirds of people living with Alzheimer’s and two-thirds of those caring for them. About 630,000 people have Alzheimer’s disease in California, and women in their 60s have a 1 in 6 chance of developing the disease — almost twice as high as the risk of developing breast cancer. Before the formal discussion got started, one of the speakers, Pam Montana, told a reporter a story not unlike Coleman’s: She had been a sales director at Intel Corp. before being forced to retire early because she couldn’t keep up with workplace demands….Read More

When You Need A Breast Screening, Should You Get A 3-D Mammogram? When I went to the imaging center for my regular mammogram last year, the woman behind the desk asked me if I’d like to get a “3-D” mammogram instead of the standard test I’d had in the past. “It’s more accurate,” she said. What do you say to that? “No, thanks, I’d rather have the test that gets it wrong?” Of course, I agreed. A growing number of women are likely to face a similar choice in coming years as imaging centers across the country add three-dimensional (3-D) mammography, also called digital breast tomosynthesis, to the two-dimensional (2-D) screening women customarily receive. What’s not yet clear is whether this newer, more expensive technology is better at catching cancers that are likely to kill. So should it be widely recommended? And who

should pick up the extra cost involved? According to the Food and Drug Administration, there were 3,915 certified mammography imaging facilities that offered digital breast tomosynthesis in January. That’s a sharp increase over the previous January, when the total was 3,011. Some facilities have switched over entirely to 3-D imaging, but many practices have both, experts said. “There’s a lot of marketing pressure to offer these new machines,” said Robert Smith, vice president of cancer screening at the American Cancer Society. “There’s a lot of marketing pressure to offer these new machines,” said Robert Smith, vice president of cancer screening at the American Cancer Society. Both types of tests use X-ray technology to create images of the breast. The 2-D digital

mammograms that most women receive typically provide front and side images, while for the 3-D test the Xray arcs across the breast, creating multiple images of breast tissue. The experience is the same for women, though, because both scans involve compressing the breast between two plates extending from the machine. Studies have generally shown that the 3D test is slightly better at detecting cancers than the 2-D test, and women typically have to return less often to have additional images taken. But the jury is still out on whether the newer technology is any better at identifying the advanced cancers that will become lethal….Read More

Air Pollution Can Be Deadly for Seniors Even levels of air pollution deemed "safe" by U.S. government standards may shorten the life spans of seniors, new research suggests. In fact, hundreds of older Americans may die prematurely each year due to the effects of dirty air, the study found.

The finding stems from a computer prediction analysis that correlated fine particle and ozone pollution levels between 2000 and 2012 with death rates on roughly 93 percent of all Americans who were covered by Medicare at the time. "This is the most comprehensive study of short-term exposure to pollution and mortality to date," said senior study author Francesca Dominici, co-director of the Harvard Data Science Initiative in Boston.

"We found that the mortality rate increases almost linearly as air pollution increases. Any level of air pollution, no matter how low, is harmful to human health," Dominici said in a Harvard news release. During the study period, 22 million people covered by the investigation died. ...Read More

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Severe Flu Season Slams All But One State: CDC The worst flu season in years is only getting worse, with 49 states now seeing widespread misery, U.S. health officials report. "Flu is everywhere in the U.S. right now," Dr. Daniel Jernigan, director of the U.S. Centers for Disease Control and Prevention's influenza division, said during a media briefing Friday. On a map of the United States tracking flu activity, "this is the first year that we have had the entire continental U.S. be the same color," he noted. Only Hawaii and the District of Columbia have been spared widespread flu infection so far, according to the CDC. "There has been a very rapid increase in the numbers of people coming in to see their doctors. The season has started early, and it is probably peaking right about now," Jernigan added. Not only that, but "there is also a rapid rise in the number of people being hospitalized for laboratory-confirmed flu," Jernigan said. In just the past week, hospitalizations have almost doubled, going

from 13.7 per 100,000 to 22.7 per 100,000. The highest rates of hospitalizations are among those over the age of 65, but hospitalizations for those 50 to 64 is also high and increasing, Jernigan noted. And 20 children have died from the flu so far this season. An imperfect vaccine and a long bout of cold, wintry weather have conspired to turn this flu season into a very severe one, health officials have said. It's no secret by now that the flu vaccine is not a good match with the H3N2 flu strain that is dominating the season. At this point, 80 percent of reported flu cases are this more severe strain, according to the CDC. And Jernigan said he expected this year's vaccine to be about 30 percent effective against H3N2 when all is said and done. Unfortunately, the end of this flu season is nowhere in sight. "There are at least 11 to 13 more weeks of influenza to go," Jernigan said. "In addition, there are still other strains of influenza yet to show up. We know that B viruses will be showing up later in the season. We are also

seeing H1N1 starting to show up in states that have already had H3 activity." Still, H3N2 is the far nastier strain, and tends to be very bad news for the very young and the very old. The vaccine may be less effective against H3N2 strains because it's manufactured in chicken eggs, which some recent research has shown interact with H3 strains, making them less like the circulating strain and therefore less effective. Even though the vaccine may not be well matched, it doesn't mean you shouldn't get a flu shot, CDC officials say. It's still the best protection against H3N2 flu and other flu strains, such as H1N1 and B viruses. According to CDC director Dr. Brenda Fitzgerald, "While our flu vaccines are far from perfect, they are the best way to prevent getting sick from the flu, and it is not too late to get one." So far, more than 151 million doses of vaccine have shipped, Fitzgerald said at the media briefing. For more on the flu, visit the U.S. Centers for Disease Control and Prevention.

Professional Help: 5 Tips for Senior Citizens on Simple, Healthy Living To slow down the physical and mental new and be willing to learn. disease, diabetes, decline that comes with age, drugs and arthritis, COPD, or  Take control of your health. Appreciate exercise aren't enough. According to a study the relationship between what you do, cataracts. Don't let these out of the University of Southern California, how you feel, and their impact on your impede your progress. a lifestyle makeover is necessary. Before a big game, elite well-being. Our research suggests that This week on Professional Help, athletes visualize their social and productive activities are as professor and occupational performance in their important as physical ones for staying therapist Florence Clark shares five tips minds' eye. So too should you be healthy. As we age, even deceptively for seniors on sustainable, successful aging prepared for the potential ways you might simple or downright mundane pursuits from her Journal of Epidemiology and have to adapt or improvise. And, of like reading the newspaper, cooking a Community Health paper (PDF). course, consult your physician in advance potluck dish, walking the dog, or going to Thankfully, her method, while backed by about any new activities. church have a powerful influence on our rigorous research, is also surprisingly physical and mental health.  Living longer can also mean living simple: walk outside, meet up with friends,  Know thyself. The guiding principle of better. Our research demonstrates that go to church, and just be as active as maintaining a mix of productive, social, Socrates rings just as true today as it did possible. physical, and spiritual activities as you in ancient Athens. Lifestyle changes are age can lead to increased vitality, social  It's never too late to go most sustainable when they fit into the healthy. Anybody, young or old, can function, mental health, and life fabric of your everyday life -- your successfully redesign the way they live to satisfaction, along with decreased interests, schedule, and self-concept. be healthier. While we don't have a say in symptoms of depression and self-reported Identify supports on your journey that are our own genetic makeup, greater than 50 bodily pain. Even better, activity-centric strong enough to counterbalance the percent of our mental and physical health lifestyle interventions to ward off illness obstacles you face. Set goals that are status is related to lifestyle. You can even and disability may also be more costchallenging but still realistic enough to be start small: ride public transportation, effective and have fewer negative side achieved. reconnect with a long-lost friend, join a effects than prescription drugs.  Anticipate how chronic conditions may ballroom dance class, or follow guidelines affect your plan. Over 70 percent of on how to safely move around the seniors age 65 and older have a chronic community. The point is, try something condition, such as hypertension, heart Rhode Island Alliance for Retired Americans, Inc. • 94 Cleveland Street • North Providence, RI • 02904-3525 • 401-480-8381 •


RI ARA January 21, 2018 E-Newsletter


RI ARA January 21, 2018 E-Newsletter