Tag Archives: Medicare

Unfair Medi-Cal Test Removed!

No more asset test for Medi-Cal. Seniors and people with disabilities can get and keep free health coverage!

A provision in California’s newly approved state budget will eliminate the asset test for the 2 million Californians enrolled in both Medi-Cal and Medicare, the federal health insurance program for people 65 and older and people under 65 with certain disabilities. Instead, their financial eligibility will be based solely on income, as it is for the millions of other people in Medi-Cal.

The elimination of the test will be a game changer for aging or impaired Californians who need long-term care but are caught in a common conundrum: They don’t earn enough to cover the high costs of ongoing nursing home care and can’t rely on Medicare, which does not cover extended nursing home stays. They can get that care through Medi-Cal, but they would have to wipe out their savings first.

The 2021-22 state budget deal includes several provisions that will make it easier to get on and stay on Medi-Cal, including the elimination of the asset test. Everyone 50 and over will be eligible, regardless of immigration status. And new mothers will be allowed to remain on Medi-Cal for one year after giving birth, up from 60 days.

The budget also includes $15 million over the next three years, starting this year, to develop online enrollment forms and translate them into multiple languages, and $8 million for counties to help some people who get in-home care stay enrolled.

California has a strong Medi-Cal takeup rate, with 95% of eligible people enrolled, said Laurel Lucia, director of the health care program at the Center for Labor Research and Education at the University of California-Berkeley. But of the remaining uninsured people, about 610,000 qualify for Medi-Cal, she said.

“We are doing well, but so many people are eligible and not enrolled,” Lucia said. “The barriers to Medi-Cal enrollment and retention are really multifaceted, so the solutions have to be as well.”

This is an especially volatile moment for the program, which covers 13.6 million Californians. The state is trying to improve the quality of care by renegotiating its contracts with managed-care insurance companies. At the same time, Gov. Gavin Newsom and the state Department of Health Care Services are proposing a massive overhaul that would provide more services to homeless people and incarcerated people and boost mental health care.

Meanwhile, Medi-Cal enrollment continues to grow: State officials estimate enrollment will balloon to 14.5 million this fiscal year, which began July 1.

The changes to Medi-Cal that were approved in the budget include an expansion that Democratic lawmakers have been seeking for years: California already allows eligible unauthorized immigrants up to age 26 to receive full Medi-Cal benefits. Starting next spring, that will expand to people 50 and up.

State officials estimate about 175,000 people will enroll in the first year, with an additional 3,600 people signing up every year thereafter, eventually costing the state $1.3 billion annually.

And, starting next July, new mothers will be able to stay on Medi-Cal for up to one year after giving birth. By 2027, the additional coverage is expected to cost the state about $200 million a year.

Assembly Republican Leader Marie Waldron (R-Escondido), who said she supports expanding eligibility for the program in limited circumstances, was the author of a bill to allow incarcerated people to enroll before they’re released that was ultimately folded into the budget and will take effect in 2023.

But she said the changes in this year’s budget go too far.

“Expensive government-run health care doesn’t really work, and most voters don’t want to pay for it,” Waldron said. “But California Democrats seem to think everyone will love it once they are on it, which is not true. It’s creeping socialism.”

The elimination of the Medi-Cal asset test for older Californians and those with certain disabilities, which takes effect July 1, 2022, marks a dramatic change to the program. Officials estimate it will cost the state roughly $200 million a year once fully implemented because of the increased enrollment.

Right now, these people can’t qualify for Medi-Cal if they have saved more than $2,000. For couples, it’s $3,000. Complicated rules dictate what counts as an “asset” and what doesn’t: A house doesn’t count and neither does one car, but a second car does. Engagement rings and heirlooms are fine, but other jewelry counts toward the limit.

Ultimately, the test favors individuals and families who can navigate the rules and find ways to hide money in exempt accounts, said Claire Ramsey, a senior attorney with Justice in Aging.

“You create administrative hurdles, which keeps people artificially off the program,” Ramsey said. “If it’s hard for the lawyers to understand all the rules, what does that mean for the average person who’s just trying to have health insurance?”

The federal Affordable Care Act eliminated the asset test for most Medicaid enrollees, basing financial eligibility exclusively on income, but left out people who qualify for both Medicaid and Medicare.

This is especially important when it comes to expensive long-term care, like nursing homes, which can cost $10,000 a month, said Patricia McGinnis, executive director of California Advocates for Nursing Home Reform.

Medicare covers nursing home care only in limited circumstances and for up to 100 days. After that, patients must find another way to pay, either out-of-pocket or through Medi-Cal. Because many people don’t qualify for Medi-Cal if they have too much money or other assets, they have to spend through their savings and shed their belongings before they can get on the program.

“Thousands and thousands of people have become impoverished to afford nursing home care,” McGinnis said. “You want free medical care? You’re going to have to spend every penny you have to get it.”

A state Assembly analysis estimated that 17,802 additional Californians would have become eligible in 2018 if the asset test hadn’t been required. Of those, 435 were in long-term care, and over the course of the year, 263 spent their money or gave away their assets to qualify for Medi-Cal.

Assembly member Wendy Carrillo (D-Los Angeles), the author of the asset test bill that was folded into the budget, sees eliminating the requirement as part of a larger movement toward universal coverage, in line with efforts to expand Medi-Cal to older unauthorized immigrants or establish a single-payer system.

“We need to aggressively and proactively work on legislation that gives more people coverage,” Carrillo said. “And until we have universal health care, these are the steps necessary to ensure that.”

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

Photo by Pranav Kumar Jain on Unsplash

 

Seniors! Get Advice On Medicare Open Enrollment

If you’ve been watching TV lately, you may have seen actor Danny Glover or Joe Namath, the 77-year-old NFL legend, urging you to call an 800 number to get fabulous extra benefits from Medicare.

There are plenty of other Medicare ads, too, many set against a red-white-and-blue background meant to suggest officialdom — though if you stand about a foot from the television screen, you might see the fine print saying they are not endorsed by any government agency.

Rather, they are health insurance agents aggressively vying for a piece of a lucrative market.

This is what Medicare’s annual enrollment period has come to. Beneficiaries — people who are 65 or older, or with long-term disabilities — have until Dec. 7 to join, switch or drop health or drug plans, which take effect Jan. 1. By switching plans, they can potentially save money or get benefits not ordinarily provided by the federal insurance program.

For all its complexity and nearly endless options, Medicare fundamentally boils down to two choices: traditional fee-for-service or the managed care approach of Medicare Advantage.

The right choice for you depends on your financial wherewithal and current health status, and on future health scenarios that are often difficult to foresee and unpleasant to contemplate.

Costs and benefits among the multitude of competing Medicare plans vary widely, and the maze of rules and other details can be overwhelming. Indeed, information overload is part of the reason a majority of the more than 60 million people on Medicare, including over 6 million in California, do not comparison-shop or switch to more suitable plans.

“I’ve been doing it for 33 years and my head still spins,” says Jill Selby, corporate vice president of strategic initiatives and product development at SCAN, a Long Beach nonprofit that is one of California’s largest purveyors of Medicare managed care, known as Medicare Advantage. “It’s definitely a college course.”

Which explains why airwaves and mailboxes are jammed with all that promotional material from people offering to help you pass the course.

Many are touting Medicare Advantage, which is administered by private health insurers. It might save you money, but not necessarily, and research suggests that, in some cases, it costs the government more than administering traditional Medicare.

But the hard marketing is not necessarily a sign of bad faith. Licensed insurance agents want the nice commission they get when they sign somebody up, but they can also provide valuable information on the bewildering nuances of Medicare.

Industry insiders and outside experts agree most people should not navigate Medicare alone. “It’s just too complicated for the average individual,” says Mark Diel, chief executive officer of California Coverage and Health Initiatives, a statewide association of local outreach and health care enrollment organizations.

However, if you decide to consult with an insurance agent, keep your antenna up. Ask people you trust to recommend agents, or try eHealth or another established online brokerage. Vet any agent you choose by asking questions on the phone.

“Be careful if you feel like the insurance agent is pushing you to make a decision,” says Andrew Shea, senior vice president of marketing at eHealth. And if in doubt, don’t hesitate to get a second opinion, Shea counsels.

You can also talk to a Medicare counselor through one of the State Health Insurance Assistance Programs, which are present in every state. Find your state’s SHIP at www.shiptacenter.org.

Medicare & You, a comprehensive handbook, is worth reading. Download it at the official Medicare website, www.medicare.gov.

The website offers a deep dive into all aspects of Medicare. If you type in your ZIP code, you can see and compare all the Medicare Advantage plans, supplemental insurance plans, known as Medigap, and stand-alone drug (Part D) plans.

The site also shows you quality ratings of the plans, on a five-star scale. And it will display your drug costs under each plan if you type in all your prescriptions. Explore the website before you talk to an insurance agent.

California Coverage and Health Initiatives can refer you to licensed insurance agents who will provide local advice and enrollment assistance. Call 833-720-2244. Its members specialize in helping people who are eligible for both Medicare and Medicaid, the health insurance program for low-income people.

These so-called dual eligibles — nearly 1.5 million in California and about 12 million nationwide — get additional benefits, and in some cases they don’t have to pay Medicare’s monthly medical (Part B) premium, which will be $148.50 in 2021 for most beneficiaries, but higher for people above certain income thresholds.

If you choose traditional Medicare, consider a Medigap supplement if you can afford it. Without it, you’re liable for 20% of your physician and outpatient costs and a hefty hospital deductible, with no cap on how much you pay out of your own pocket. If you need prescription drugs, you’ll probably want a Part D plan.

Medicare Advantage, by contrast, is a one-stop shop. It usually includes a drug benefit in addition to other Medicare benefits, with cost sharing for services and prescriptions that varies from plan to plan. Medicare Advantage plans typically have low to no premiums — aside from the Part B premium that most people pay in either version of Medicare. And they increasingly offer additional benefits, including vision, dental, transportation, meal deliveries and even coverage while traveling abroad.

Beware of the risks, however.

Yes, the traditional Medicare route is generally more expensive upfront if you want to be fully covered. That’s because you pay a monthly premium for a Medigap policy, which can cost $200 or more. Add to that the premium for Part D, estimated to average $41 a month in 2021, according to KFF. (KHN is an editorially independent program of KFF.)

However, Medigap policies will often protect you against large medical bills if you need lots of care.

In some cases, Medicare Advantage could end up being more expensive if you get seriously ill or injured, because copays can quickly add up. They are typically capped each year, but can still cost you thousands of dollars. Advantage plans also typically have more limited provider networks, and the extra benefits they offer can be subject to restrictions.

Over one-third of Medicare beneficiaries nationally are enrolled in Advantage plans. In California, about 40% are.

The main appeal of traditional Medicare is that it doesn’t have the rules and restrictions of managed care.

Dr. Mark Kalish, a retired psychiatrist in San Diego, says he opted for traditional fee-for-service with Medigap and Part D because he didn’t want a “mother may I” plan.

“I’m 69 years old, so heart attacks happen; cancer happens. I want to be able to pick my own doctor and go where I want,” Kalish says. “I’ve done well, so the money isn’t an issue for me.”

Be aware that if you don’t join a Medigap plan during a six-month open enrollment period that begins when you enroll in Medicare Part B, you could be denied coverage for a preexisting condition if you try to buy one later.

There are a few exceptions to that in federal law, and four states — New York, Massachusetts, Maine, Connecticut — require continuous or yearly access to Medigap coverage regardless of health status.

Make sure you understand the rules and exceptions that apply to you.

Indeed, that is an excellent rule of thumb for all Medicare beneficiaries. Read up and talk to insurance agents and Medicare counselors. Talk to friends, family members, your doctor, your health plan — and other health plans.

When it comes to Medicare, says Erin Trish, associate director of the University of Southern California’s Schaeffer Center for Health Policy and Economics, “it takes a village.”

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

Why The Senior Vote Matters!

Senior citizens have always been a very reliable voting bloc in the United States.  We assume that this is because they have the time to go vote.  While that might be somewhat true, the fact is that retired people are most vulnerable to any policy changes made by the government.  When Social Security constitutes a sizable part of your income and Medicare is your only option for health care, voting is much more than just your civic duty – it becomes the most important thing you must do to maintain your quality of life.

Just like all older voters, older Asian Voters are more likely to be registered and to vote. They reliably show up to the polls to vote in larger numbers than their younger brethren.  Infact, in presidential elections, voter turnout is even higher for foreign born Asians than those that are U.S. born.

According to the National Survey of Older Voters During COVID-19: Asian Americans, conducted by the Harris Poll on behalf of AARP, although 86% are “very likely” to vote in 2020, the majority of Asian American voters 50+ are not being engaged or contacted by either party affiliation (61%) or community organizations (74%), according to (AAVS).

This data is so puzzling but what does this mean and how does this impact this large voting bloc?  It means that this group is invisible.

When you think of a Asian American voter, your mind immediately conjures up a 30 something year old, highly educated person with a good paycheck; painting a picture of a young, educated, middle class person.  This image belies the fact that many of these voters are senior citizens or at least 50+ and this is the demographic that AARP  (American Association of Retired Persons) is interested in.

Turning 50 is life changing in many ways, but the significance of that particular number becomes even more acute when you receive your welcome package from AARP.  I am not old and I am certainly not retiring anytime soon you think and you are right.  But AARP is not just for old, retired people.

AARP is working to have your (50+)  voice heard on the issues that matter to this demographic.  Protecting social security and medicare, lowering prices of prescription drugs, and ensuring your right to vote safely among many other issues. While these might not be issues that are top of mind for you at 50, you know it will be very soon.

Speakers at the Oct 21 AARP briefing released new findings from recent national surveys exploring the key priorities and concerns of Asian American voters aged 50 and older. Results from the 2020 Asian American Voter Survey (AAVS), conducted by AAPI Data on behalf of AARP, APIAVote and Asian Americans Advancing Justice-AAJC, show that 93% of Asian Americans 50-plus view health care as important heading into the election, making it the top most important issue. Jobs and the economy follow as the second most important issue, with 89% of respondents citing them either as “extremely” or “very” important.

With over 50k+ nursing home deaths and the disproportionate vulnerability of our elders to the current pandemic, these survey results are not surprising. COVID-19 has underscored the importance of healthcare as a voter issue and has caused a sense of insecurity related to the economy, health, freedom from discrimination, elections and voting.

Additional findings from the survey on 50+ AAPI (Asian American & Pacific Islander)  – which is the category under which South Asians voters are aggregated include:

  • Plurality of older Asian voters identify as Democrat but the majority describe themselves as moderate.  They are more united around ideology than around a party affiliation.

  • Older asian voters value opportunity and freedom.  They also value entrepreneurial spirit, respecting people with different ideologies and have a greater willingness to accept refugees.

  • Majorities of older Asian American voters support action for equality and equity and agree that there is racial and ethnic discrimination in this country.

  • 50+ Asian voters have become more progressive since the 2016 elections.

  • Over 75% of the older Asian voters get their election information from traditional media and about 42% from talking to their family.

If the 50+ Asian voter is so engaged and likely to vote, why are they not on the radar for either party? 

One piece of data that is striking is this :  85% of 50+ Asian American voters are foreign born. One reason for this opportunity gap is the need to reach out in different languages in order to communicate effectively with this community.

But the larger reason for this lack of engagement is education about the numbers and their impact.  “They don’t pay attention if there is no data,” says Daphne Kwok of AARP.  “But now we are proving that this cohort is an important part of the electorate.  For the political parties, it is so key that they start to hear from AAPI 50+” continues Kwok.  Our issues and concerns have to be raised and addressed.

“We have seen over the past election cycles, more and more AAPIs getting involved politically, voting, and hopefully our voice is starting to become louder.”  Kwok is also optimistic because it has also been proven in the last election that AAPIs have become the margin of victory in many races. Hopefully this is the incentive both parties see to reach out to this voting bloc that could make a difference for their candidate.

So let’s get out the Vote in our 50+ community.  Each state has different rules, different timelines, and different procedures.

Everything you need to know to vote safely is at aarp.org/election2020  and APIAvote.org.

Older voters are more likely to vote in person.  If there is a vulnerable senior citizen in your family, please take the proper precautions but help them make their vote count.

We can’t afford to let anyone’s vote go uncounted.

Anjana Nagarajan-Butaney is a Bay Area resident with experience in educational non-profits, community building, networking, and content development and was Community Director for an online platform. She is interested in how to strengthen communities by building connections to politics, science & technology, gender equality and public education.

image: BBH Singapore on Unsplash

The New Digital World Can Give Seniors A Hard Time

Family gatherings on Zoom and FaceTime. Online orders from grocery stores and pharmacies. Telehealth appointments with physicians.

These have been lifesavers for many older adults staying at home during the coronavirus pandemic. But an unprecedented shift to virtual interactions has a downside: Large numbers of seniors are unable to participate.

Among them are older adults with dementia (14% of those 71 and older), hearing loss (nearly two-thirds of those 70 and older) and impaired vision (13.5% of those 65 and older), who can have a hard time using digital devices and programs designed without their needs in mind. (Think small icons, difficult-to-read typefaces, inadequate captioning among the hurdles.)

Many older adults with limited financial resources also may not be able to afford devices or the associated internet service fees. (Half of seniors living alone and 23% of those in two-person households are unable to afford basic necessities.) Others are not adept at using technology and lack the assistance to learn.

During the pandemic, which has hit older adults especially hard, this divide between technology “haves” and “have-nots” has serious consequences.

Older adults in the “haves” group have more access to virtual social interactions and telehealth services, and more opportunities to secure essential supplies online. Meanwhile, the “have-nots” are at greater risk of social isolation, forgoing medical care and being without food or other necessary items.

Dr. Charlotte Yeh, chief medical officer for AARP Services, observed difficulties associated with technology this year when trying to remotely teach her 92-year-old father how to use an iPhone. She lives in Boston; her father lives in Pittsburgh.

Yeh’s mother had always handled communication for the couple, but she was in a nursing home after being hospitalized for pneumonia. Because of the pandemic, the home had closed to visitors. To talk to her and other family members, Yeh’s father had to resort to technology.

But various impairments got in the way: Yeh’s father is blind in one eye, with severe hearing loss and a cochlear implant, and he had trouble hearing conversations over the iPhone. And it was more difficult than Yeh expected to find an easy-to-use iPhone app that accurately translates speech into captions.

Often, family members would try to arrange Zoom meetings. For these, Yeh’s father used a computer but still had problems because he could not read the very small captions on Zoom. A tech-savvy granddaughter solved that problem by connecting a tablet with a separate transcription program.

When Yeh’s mother, who was 90, came home in early April, physicians treating her for metastatic lung cancer wanted to arrange telehealth visits. But this could not occur via cellphone (the screen was too small) or her computer (too hard to move it around). Physicians could examine lesions around the older woman’s mouth only when a tablet was held at just the right angle, with a phone’s flashlight aimed at it for extra light.

“It was like a three-ring circus,” Yeh said. Her family had the resources needed to solve these problems; many do not, she noted. Yeh’s mother passed away in July; her father is now living alone, making him more dependent on technology than ever.

When SCAN Health Plan, a Medicare Advantage plan with 215,000 members in California, surveyed its most vulnerable members after the pandemic hit, it discovered that about one-third did not have access to the technology needed for a telehealth appointment. The Centers for Medicare & Medicaid Services had expanded the use of telehealth in March.

Other barriers also stood in the way of serving SCAN’s members remotely. Many people needed translation services, which are difficult to arrange for telehealth visits. “We realized language barriers are a big thing,” said Eve Gelb, SCAN’s senior vice president of health care services.

Nearly 40% of the plan’s members have vision issues that interfere with their ability to use digital devices; 28% have a clinically significant hearing impairment.

“We need to target interventions to help these people,” Gelb said. SCAN is considering sending community health workers into the homes of vulnerable members to help them conduct telehealth visits. Also, it may give members easy-to-use devices, with essential functions already set up, to keep at home, Gelb said.

Landmark Health serves a highly vulnerable group of 42,000 people in 14 states, bringing services into patients’ homes. Its average patient is nearly 80 years old, with eight medical conditions. After the first few weeks of the pandemic, Landmark halted in-person visits to homes because personal protective equipment, or PPE, was in short supply.

Instead, Landmark tried to deliver care remotely. It soon discovered that fewer than 25% of patients had appropriate technology and knew how to use it, according to Nick Loporcaro, the chief executive officer. “Telehealth is not the panacea, especially for this population,” he said.

Landmark plans to experiment with what he calls “facilitated telehealth”: nonmedical staff members bringing devices to patients’ homes and managing telehealth visits. (It now has enough PPE to make this possible.) And it, too, is looking at technology that it can give to members.

One alternative gaining attention is GrandPad, a tablet loaded with senior-friendly apps designed for adults 75 and older. In July, the National PACE Association, whose members run programs providing comprehensive services to frail seniors who live at home, announced a partnership with GrandPad to encourage adoption of this technology.

“Everyone is scrambling to move to this new remote care model and looking for options,” said Scott Lien, co-founder and chief executive officer of the company, which is headquartered in Orange County, California.

PACE Southeast Michigan purchased 125 GrandPads for highly vulnerable members after closing five centers in March where seniors receive services. The devices have been “remarkably successful” in facilitating video-streamed social and telehealth interactions and allowing nurses and social workers to address emerging needs, said Roger Anderson, senior director of operational support and innovation.

Another alternative is technology from iN2L (an acronym for It’s Never Too Late), a company that specializes in serving people with dementia. In Florida, under a new program sponsored by the state’s Department of Elder Affairs, iN2L tablets loaded with dementia-specific content have been distributed to 300 nursing homes and assisted living centers.

The goal is to help seniors with cognitive impairment connect virtually with friends and family and engage in online activities that ease social isolation, said Sam Fazio, senior director of quality care and psychosocial research at the Alzheimer’s Association, a partner in the effort. But because of budget constraints, only two tablets are being sent to each long-term care community.

Families report it can be difficult to schedule adequate time with loved ones when only a few devices are available. This happened to Maitely Weismann’s 77-year-old mother after she moved into a short-staffed Los Angeles memory care facility in March. After seeing how hard it was to connect, Weismann, who lives in Los Angeles, gave her mother an iPad and hired an aide to ensure that mother and daughter were able to talk each night.

Without the aide’s assistance, Weismann’s mother would end up accidentally pausing the video or turning off the device. “She probably wanted to reach out and touch me, and when she touched the screen it would go blank and she’d panic,” Weismann said.

What’s needed going forward? Laurie Orlov, founder of the blog Aging in Place Technology Watch, said nursing homes, assisted living centers and senior communities need to install communitywide Wi-Fi services — something that many lack.

“We need to enable Zoom get-togethers. We need the ability to put voice technology in individual rooms, so people can access Amazon Alexa or Google products,” she said. “We need more group activities that enable multiple residents to communicate with each other virtually. And we need vendors to bundle connectivity, devices, training and service in packages designed for older adults.”

This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

Many Nursing Homes Are Failing the Coronavirus Stress Test

Long before the novel coronavirus made its surprise appearance, the nation’s nursing homes were struggling to obey basic infection prevention protocols designed to halt the spread of viruses and bacteria they battle daily.

Since the beginning of 2017, government health inspectors have cited more nursing homes for failing to ensure that all workers follow those prevention and control rules than for any other type of violation, according to a Kaiser Health News analysis of federal records.

In all, 9,372 nursing homes, or 61%, were cited for one or more infection-control deficiencies, the analysis showed. It also found violations were more common at homes with fewer nurses and aides than at facilities with higher staffing levels.

Even among nursing homes crowned with the maximum government rating of five stars for overall quality, 4 in 10 have been cited for an infection-control lapse. Those include the Life Care Center of Kirkland, Washington, a Seattle suburb, where  five people who had lived at the facility have died.

Inspection reports from around the country show many errors are rudimentary, such as workers not washing their hands as they moved to the next patient, or failing to don masks, gloves and gowns when in the rooms of contagious patients in isolation.

“It’s all these little things that are part of infection-control practices that when they are added up can create an environment for an infection outbreak,” said Patricia Hunter, the Washington State Long-Term Care Ombuds, who addresses complaints from residents and families and pushes for improvements in facilities.

In recent years, the federal government has been ramping up the standards for nursing homes, but inspectors remain frustrated by the prevalence of sloppy or nonexistent handwashing. “We have got to do better on handwashing,” Evan Shulman, the director for the nursing home division of the Centers for Medicare & Medicaid Services, told an association of nursing home directors in 2018.

While citations are rampant across the industry, health inspectors have classified all but 1% of violations as minor and not warranting fines, the KHN analysis found. A single low-level citation usually has limited impact on the overall star rating, the only metric most consumers examine.

The coronavirus has demonstrated its potential lethality among the old and frail in Kirkland, but the infections that nursing homes already battle with mixed success — influenza and antibiotic-resistant bacteria like methicillin-resistant Staphylococcus aureus (MRSA) — can be equally fatal. As many as 3.8 million infections occur in nursing homes each year, killing nearly 388,000 residents.

Dr. David Gifford, the chief medical officer for the American Health Care Association, the primary nursing home trade group, told reporters Monday that these facilities were ready to deal with coronavirus infections through the prevention plans they have in place. “We prepare for seasonal influenza every year — it’s very similar to that,” he said.

“We are reinforcing the information for basic procedures for how to prevent the spread,” he added, such as keeping infected residents away from others and having sick employees stay home.

Yet the same industry deficits that have hampered past infection-control efforts are in play with the coronavirus. Nursing homes experience frequent staff turnover, and new or temporary workers are less likely to be familiar with a facility’s protocols. Also, inspectors have found that these homes have had difficulty making sure that potentially infected workers stay home, a problem compounded by the low pay and limited time-off benefits many receive.

During a norovirus outbreak in 2017 at another Washington state nursing home, for instance, at least six infected employees returned to work earlier than they were supposed to. Inspectors discovered the virus ultimately spread to 32 employees and 43 residents — more than 40% of those living in the home, according to an inspection report.

Even if nursing homes are successful in getting infected workers to take days off, they may run into trouble finding replacements. Dr. David Nace, director of long-term care and flu programs at the University of Pittsburgh Department of Medicine, said staffing issues are compounded by a national shortage of healthcare workers. “Facilities may be faced with the issue of closure if they don’t have the staffing,” he said.

KHN’s analysis found that 53% of homes with the most nurses and aides — which CMS awards five stars for staffing on its Nursing Home Compare website — had been cited for infection-control violations in the past three years, while 65% of homes with the fewest staff — garnering only one star — were cited for the same type of failing. The staffing stars make up one component of the overall rating.

“So many times, when there aren’t enough staff, the aides and nurses are literally trying to do 50 things at once, running from person to person,” said Lori Smetanka, executive director of the National Consumer Voice for Quality Long-Term Care, a nonprofit based in Washington, D.C. “That’s when things fall through the cracks, like handwashing, which is the most useful thing to do to prevent infections.”

More sparsely staffed nursing homes were also cited more often: one-star facilities averaged 1.5 deficiencies while five-star facilities averaged 1.3 deficiencies. But out of more than 13,000 citations for infection-control lapses, regulators classified only 109 as serious harms or threats to patients. That finding echoed the results of a similar investigation KHN conducted in 2017. “It shows how ineffectual the enforcement situation is,” said Toby Edelman, a senior policy attorney at the Center for Medicare Advocacy.

One such violation was cited last April at the Kirkland nursing home after inspectors there observed a registered nurse treating a patient whose feet were touching the floor, even though one heel had a pressure sore that the resident’s daughter said she feared was infected. “It was unhygienic,” the daughter told inspectors.

Inspectors also watched another nursing home employee work in the room of a patient with pneumonia without wearing a mask, gown and gloves as required by a sign outside the room. They noted in their report that the facility had experienced two outbreaks of influenza that year, affecting at least 17 residents and seven staff members all told. Inspectors labeled the violations they observed as low level because they caused “minimal harm or potential for actual harm.” The nursing home pledged to reeducate staff on procedures and investigators found no problems when they revisited two months later.

Life Care Center, in an upscale, wooded neighborhood less than a mile from Lake Washington’s popular Juanita Beach Park, said in a statement released Monday that it is screening workers before they start work and after and has suspended visits and new admissions.

“We are also following infection control recommendations, including proper hand-washing techniques and wearing masks, gowns and gloves when caring for any symptomatic patients,” the statement said. The facility declined to discuss its previous citation.

Seema Verma, the CMS administrator, said during a press briefing at the White House Tuesday night that her agency is sending inspectors to the nursing home, as well as a hospital and dialysis center that treated coronavirus patients, to see if federal health and safety regulations were followed.

Hunter, the Washington state ombud, said that during her recent visits to 14 nursing homes in three Northwestern states, she observed that aides were generally good about using hand sanitizer but rarely washed residents’ hands. Not every resident room had a sink, she said. “I haven’t seen one resident have their hands washed during lunchtime or dinnertime,” she said.

While some nursing homes are making concerted efforts, “there are nursing homes that are really dirty and there are concerns that they’re not getting the job done,” Hunter added.” The trouble is when you don’t have enough workers, or you don’t have a stable workforce that’s trained to follow your protocol, that’s a weakness in the system.”

In 2016, CMS updated and expanded its infection-control rules, requiring among other things that each facility appoint one person to be in charge of infection control. CMS required the employee in that position, known as an infection preventionist, to complete specialized training and work at the facility either part time or full time. The Trump administration has proposed eliminating the on-site requirement.

Instead, CMS proposed the preventionist be someone who has spent “sufficient time” at the facility to oversee its infection-control efforts. It has asked the public for advice on how to define sufficient.

“We believe this is an appropriate standard,” the agency wrote in its proposed rule, issued last July. “However, we are also concerned that there could be a substantial variance in how LTC [long-term care] facilities interpret this requirement.”

KHN senior correspondent JoNel Aleccia contributed to this report.

This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

Behind The Troubling Rise Of Uninsured American Kids

More than a million fewer children receive public health insurance now than in December 2017. In some cases, their parents acquired coverage at work. But researchers also see a troubling rise in uninsured children — and say the Trump administration’s policies are partially to blame.

Kaiser Health News senior correspondent Sarah Varney and PBS NewsHour producer Jason Kane report from Tennessee, where the rate of uninsured kids has soared. This story aired on PBS NewsHour on Dec. 2

This article was originally posted by Kaiser Health News.

One-On-One With Trump’s Medicare And Medicaid Chief: Seema Verma

Seema Verma, administrator for the Centers for Medicare & Medicaid Services, sat down for a rare one-on-one interview with Kaiser Health News senior correspondent Sarah Varney.

They discussed her views on President Donald Trump’s plan for sustaining public health insurance programs, how the administration would respond if Obamacare is struck down by the courts in the future and her thoughts on how the latest “Medicare for All” proposals would affect innovation and access to care.

A portion of their conversation aired on PBS NewsHour on Dec. 23. A transcript follows, edited for length and clarity.

Congressman Khanna Informs Local Media on What Keeps Congress Awake at Night

Congressman Ro Khanna spoke with the journalists from ethnic media on 12th November 2019. The teleconference, organized by Vandana Kumar, Publisher India Currents, came at a timely juncture when the nation and community is gearing up for the 2020 Presidential elections and it is time to take stock of what the nation has gained and lost in the last few years. Cyber security and Healthcare emerged as two issues that impact the community and are close to the heart of the Congress.

Cyber security, with routine data mining in the face of the fast changing social media landscape, was raised as a special concern. As Internet becomes a large part of our daily lives what is Congress doing in terms of legislation to address the issue of cyber crime? The Congressman addressed the press’ concerns and spoke of his request for the Internet Bill of Rights.

Congressman Ro Khanna (California’s 17th district) has introduced the Internet Bill of Rights, a proposal that includes the right to know about “all collection and uses of personal data by companies,” and to be notified “in a timely manner when a security breach or unauthorized access of personal data is discovered.” He aims to strengthen people’s ability to correct or delete personal data in a company’s control, and require companies to obtain consumer consent before collecting or sharing data with third parties. In the Congressman’s words the bill would require people to give their consent making it harder for the companies to collect data, a situation better than the one in China where people have very little protection.

The Congressman also felt blatant falsity should not be allowed. There is an obligation on the part of companies like Google and Facebook to check for an obvious disregard of the truth. If copyright violation can be checked then surely they can remove false information by following the same procedure. Perhaps, he said, we need an independent depoliticized government agency that can define the rules and draw the boundary of truth.

Though there is a desire to regulate social media before the 2020 election, what really keeps the Congress awake at night is the question of healthcare. Khanna is hoping the social media corporations will hopefully voluntarily self regulate if no legislation can be passed in time for the 2020 elections. However, Congress must and has been working hard on providing affordable healthcare.

It is the Congressman’s view that “more than almost anything else, our health has a tremendous impact on our day-to-day activities, state of mind, and overall well-being. Good health is foundational to everything else we do – our ability to take care of our families, be productive at work, and pursue our passions and hobbies”.

“We need basic care and low premiums,” said the Congressman.

Congressman Khanna would like the creation of a single-payer health care system, or Medicare for All and supports legislation to allow Medicare to negotiate for more reasonable drug prices. This type of legislation will allow Americans below the age of 65 to buy into Medicare. A result of this would be that community members could save money through reduced fees and premiums.

Congressman Khanna also supports legislation to allow for the importation of drugs from nations that we trust. He was an original co-sponsor of legislation to allow for the importation of Canadian drugs.

“We must increase coverage, support small businesses, expand primary care, and provide lower premiums. Medicare for All is the next step toward addressing the high costs and inequalities in the current health care system,” said Congressman Ro Khanna. The congressman feels the states should be empowered to create their own solution if the federal government is unable to establish a single-payer system. We must guarantee health care as a right, not a privilege.

The telebriefing on “The Role of Silicon Valley in the 2020 Elections”, moderated by Vandana Kumar (Publisher, India Currents), gave Congressman Ro Khanna (California’s 17th district) an opportunity to share his perspectives as a key lawmaker representing the Silicon Valley. Sponsored by India Currents in partnership with Ethnic Media Services, it is part of the ‘Conversations with Candidates’ series initiated by India Currents to expand ethnic media news access to elected officials and presidential candidates.

Ritu Marwah is a citizen who would like to pay closer attention to the political issues that are bound to impact her life. She understands that an informed citizen is a safer citizen.

Verma Attacks Critics Of Medicaid Work Requirement, Pushes For Tighter Eligibility

Seema Verma, the Trump administration’s top Medicaid official, Tuesday sharply attacked critics of her plan to force some Medicaid enrollees to work, a policy that led to thousands of people losing coverage in Arkansas.

“We cannot allow those who prefer the status quo to weaponize the legal system against state innovation,” the administrator of the Centers for Medicare & Medicaid Services said in a fiery speech to the nation’s 56 state and territorial Medicaid directors in Washington, D.C.

A federal judge shut down the short-lived work requirement initiative in Arkansas and stopped it from launching in Kentucky last spring. Several states including Indiana, Arizona and New Hampshire that had won federal approval have put their implementation plans on hold pending an appellate court ruling.

Advocates for the poor argue work requirement policies are illegal and unfairly add hurdles to people who qualify for coverage in the federal-state health program.

But those opponents are seeking “to manipulate Medicaid into the prototype of a single-minded, single-payer nirvana – a utopia of open-ended government run health care,” Verma said. “Part of my mission is to fight such under-handed tactics and preserve the right of states to shape your programs in ways that are consistent with the needs of your residents, your cultures and your values. Anything less stifles innovation.”

That would be “a disservice to the millions of people on Medicaid today and those who will need it in the years and decades to come,” she added.

The federal government has approved work requirement plans in 10 states and requests are pending from 10 others. Most of those initiatives are directed at the low-income adults who gained coverage through the Medicaid expansion initiated by the Affordable Care Act.

Verma first announced plans to open the door to work requirements in a speech to Medicaid directors in 2017.

Medicaid – like Medicare – is an open-ended entitlement program, which means federal funding increases as costs and enrollment rise.

In addition to doubling down on the controversial work requirements, Verma renewed her interest in letting states get Medicaid funding through a block grant system. Block grants would give states more flexibility to limit enrollment and enforce eligibility rules, she added.

Critics have said such a change would cut Medicaid funding, limit coverage, hurt beneficiaries and lead to lawsuits.

But Verma said CMS would soon publish guidance to states to allow them to get block grant funding for “certain optional adult populations.”

“Many states have expressed a willingness to be held accountable for improving outcomes in exchange for greater flexibility and budget certainty,” Verma said. “Block grants and per capita cap proposals are two such alternative financing approaches.”

Also Tuesday, CMS issued a proposed rule that would overhaul so-called supplemental payments that many states receive to help their hospitals, nursing homes and doctors get extra funding beyond those received when caring for Medicaid enrollees.

The federal government spent about $48.5 billion on such supplemental payments in 2016 for states.

The payments – as a share of total Medicaid fee-for-service expenditures for health providers – ranged from 1% in North Dakota to 65% in Tennessee, according to a Congressional Research Service report.

CMS and congressional investigators have said the payments allow states to game the system to help bring in additional revenue for these providers without showing how they spend the money.

“I recognize that these schemes often have their roots in self-interested providers, egged on by opportunistic consultants seeking to leverage regulatory loopholes or hide behind a lack of transparency,” Verma said. “I know that most state leaders want to make sure every dollar is supporting value and improving care for Medicaid beneficiaries, and those of you that are doing the right thing have nothing to worry about. We have your back.”

The supplemental Medicaid payment system has come under criticism for many years because of the lack of transparency at the state level. However, efforts to curtail the spending has faced pushback from both states and providers fearful of losing dollars.

Matt Salo, executive director of the National Association of Medicaid Directors, said state officials are open to efforts to bring more transparency but they will be cautious about anything that severely reduces their funding.

“The challenge is how do you do this in a thoughtful, real world way?” Salo said. “We have to do it in a way that is achievable, but that does not jeopardize patient care in the process.”

Verma acknowledged that the uninsured rate among children has grown in the past two years despite the strong economy. She said the solution is to lower health costs to make it easier for their parents to afford private coverage.

Patient advocates have blamed states’ efforts to tighten Medicaid eligibility as a leading factor in the drop in coverage.

Nonetheless, Verma said she would push states to further limit eligibility to make sure only those eligible are getting benefits.

“Lax eligibility practices jeopardize the sustainability of the program,” she said.

CMS will “ensure that states conduct timely redeterminations and make use of appropriate data sources to verify ongoing income eligibility.”

Salo said state Medicaid directors agree with the need for appropriate safeguards to make sure people are not getting assistance who are not eligible. But, he added, forcing enrollees to go through more steps to get and retain coverage will come at a cost of losing people who truly deserve to get help.

“You want government to work for people and want to create a system that if you are eligible it should be easy to get on,” he said. “And if you set barriers and hurdles you will lose a lot of people who are eligible but could not deal with the paperwork.”

This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

Trump in a Landslide? Absolutely Not!

Trump in a Landslide? Absolutely Not!

By Mani Subramani

Moody’s model predicted the wrong outcome in the 2016 elections. “In response to the miss, Moody’s expanded the range of potential voter turnout and made several other changes to how it assesses voter reaction to economic conditions. If applied now, Moody’s says the altered models would have called 2016 for Trump,” says this article. That’s the nature of statistical models – they are sometimes wrong!   

Americans are tired of Trump style over substance approach. They are sick of him labeling critical media outlets as fake news, overruling US institutions (CIA) in favor of foreign entities (Putin), disrespecting decorated veterans (Senator McCain), making crude remarks about women, denying climate change, peddling fake conspiracy theories about the deep state and now, potential impeachable offenses!  

In order to justify Trump’s behavior one needs to disbelieve all media outlets, ignore the obvious effects of climate change, accept incompetent foreign policy, believe the fake theory that coal jobs are coming back and that globalization can be reversed. 

Trump has always been a conman with a solid base of supporters. Proving the adage that you can fool some people all the time, and all the people some of the time.  Let’s hope, for the sake of this great democracy, that he cannot fool all the people all the time!!

A lot has been made of US economic strength under Trump. However, these analyses ignore several factors. With the exception of a three quarters of 3+% growth, it has been around ~2% to below 2% in the most recent quarter –  a rate which Trump characterized as “weak” while campaigning in 2016.  

Similarly unemployment rate decline, which began in 2010, has just continued to decline and now stabilized around 3.6%. On the other hand budget deficits have exploded. Three consecutive years of rapidly rising deficits threatens to break the trillion dollar mark this year. Having this occur during an economic expansion shows dangerous underlying economic weakness. In sharp contrast, after a high in 2009 the deficits steadily reduced under Obama. Proving once again that whatever Trump does, he does horribly. Exactly what you would expect from a man who specialized in serial bankruptcies! 

This does not mean the voters are going to hand the election to the Democratic nominee. The nominee needs to articulate the message that an irresponsible and crooked leader has wastefully spent the public treasure on wealthy individuals and corporations who spent it on stock buybacks. 

This money would have been better spent on addressing inequality, health security, infrastructure, job training and securing the world for future generations for all Americans. Such investment would lead to sustained economic growth, jobs of the future and improved quality of life.  

In July 2019 the support for impeachment was around ~40%. Recent polls show a majority supporting impeachment. The Democratic nominee must inspire a robust voter turnout. There are a few candidates in the pool who are articulating populist ideas well and practicing good retail politics.  They are quite capable of unseating Trump. 

Mani Subramani is a veteran of the semiconductor equipment industry.  He enjoys following politics and economics.

Trump in a Landslide? Yes!

By Rameysh Ramdas

Recently, the highly predictive Moody’s election model projected President Trump would easily win re-election by a wider margin and could even win a Reagensque landslide.

Despite my Democratic Party affiliation, I must regrettably agree with Moody’s model. With unemployment at a historic low of 3.5%, the S&P has risen 28% since the day he was elected, and we are on the cusp of ending the trade war with China with a deal, and possibly a denuclearization accord with North Korea.   

Whether it is due to Trump’s policies is arguable, but Trump has certainly boosted consumer and business confidence to new highs. Many areas in the nation face acute labor shortages in this expansion. It was a streak of political genius that he ran and won with a catchy slogan- “Make America Great Again.” Those four words were more powerful than the lengthy policy prescriptions that Hillary patiently presented.

With this economic tailwind behind our nation, the Democrats seem determined to lose in 2020. A motley crew of far left wing zealots like Senator Warren, Reps Ocasio-Cortez and Rep. Tlaib are driving the direction of the party and forcing candidates to fall in line.  Warren wants to almost criminalize wealth creation and corporations in this country. This is the only nation on earth where a graduate student like me could land with a meager $520 and today, 30 years later, live in a million plus dollar home and achieve a successful career while still enjoying all the rights and privileges of native-born fellow Americans. 

The Democrats promise a “Medicare for All” that essentially strips people of their choice of employer provided health care and impose fines if they do not enroll in Medicare. The Democrats would cripple life and commerce in the U.S with their  maniacal focus on climate change, forgetting that China, India and Mexico are the major polluters of this planet. The Democrats want to also make college tuition free, even for millionaire’s kids or those underperforming 

The average American, while certainly willing to make reasonable accommodations, is more focused on providing for their family, educating their kids, retaining their jobs in this rapidly changing workplace, having a secure retirement and on being able to pass on their life’s savings to their loved ones without the Government raiding them. The Democrats and their agendas are completely divorced from this reality. 

At the end of the day, as the old adage goes, Americans vote with their pocket books. Till Trump keeps our pocketbooks filled, the majority will gladly re-elect him in a heartbeat.  The Democrats have given me, this moderate, middle of the road Democrat nothing to say “Yes” to! 

Mark my words, with the Democrats not relating to mainstream  and rural America, and if the economy continues to boom and associated optimism continue to hold up, President Trump will be reelected, and yes, possibly in a landslide. 

Rameysh Ramdas, a resident of the SF Bay Area, has a keen interest in Politics and Current Events. 

Trump in a Landslide? Yes!

Trump in a Landslide? Yes!

By Rameysh Ramdas

Recently, the highly predictive Moody’s election model projected President Trump would easily win re-election by a wider margin and could even win a Reagensque landslide.

Despite my Democratic Party affiliation, I must regrettably agree with Moody’s model. With unemployment at a historic low of 3.5%, the S&P has risen 28% since the day he was elected, and we are on the cusp of ending the trade war with China with a deal, and possibly a denuclearization accord with North Korea.   

Whether it is due to Trump’s policies is arguable, but Trump has certainly boosted consumer and business confidence to new highs. Many areas in the nation face acute labor shortages in this expansion. It was a streak of political genius that he ran and won with a catchy slogan- “Make America Great Again.” Those four words were more powerful than the lengthy policy prescriptions that Hillary patiently presented.

With this economic tailwind behind our nation, the Democrats seem determined to lose in 2020. A motley crew of far left wing zealots like Senator Warren, Reps Ocasio-Cortez and Rep. Tlaib are driving the direction of the party and forcing candidates to fall in line.  Warren wants to almost criminalize wealth creation and corporations in this country. This is the only nation on earth where a graduate student like me could land with a meager $520 and today, 30 years later, live in a million plus dollar home and achieve a successful career while still enjoying all the rights and privileges of native-born fellow Americans. 

The Democrats promise a “Medicare for All” that essentially strips people of their choice of employer provided health care and impose fines if they do not enroll in Medicare. The Democrats would cripple life and commerce in the U.S with their  maniacal focus on climate change, forgetting that China, India and Mexico are the major polluters of this planet. The Democrats want to also make college tuition free, even for millionaire’s kids or those underperforming 

The average American, while certainly willing to make reasonable accommodations, is more focused on providing for their family, educating their kids, retaining their jobs in this rapidly changing workplace, having a secure retirement and on being able to pass on their life’s savings to their loved ones without the Government raiding them. The Democrats and their agendas are completely divorced from this reality. 

At the end of the day, as the old adage goes, Americans vote with their pocket books. Till Trump keeps our pocketbooks filled, the majority will gladly re-elect him in a heartbeat.  The Democrats have given me, this moderate, middle of the road Democrat nothing to say “Yes” to! 

Mark my words, with the Democrats not relating to mainstream  and rural America, and if the economy continues to boom and associated optimism continue to hold up, President Trump will be reelected, and yes, possibly in a landslide. 

Rameysh Ramdas, a resident of the SF Bay Area, has a keen interest in Politics and Current Events. 

Trump in a Landslide? Absolutely Not!

By Mani Subramani

Moody’s model predicted the wrong outcome in the 2016 elections. “In response to the miss, Moody’s expanded the range of potential voter turnout and made several other changes to how it assesses voter reaction to economic conditions. If applied now, Moody’s says the altered models would have called 2016 for Trump,” says this article. That’s the nature of statistical models – they are sometimes wrong!   

Americans are tired of Trump style over substance approach. They are sick of him labeling critical media outlets as fake news, overruling US institutions (CIA) in favor of foreign entities (Putin), disrespecting decorated veterans (Senator McCain), making crude remarks about women, denying climate change, peddling fake conspiracy theories about the deep state and now, potential impeachable offenses!  

In order to justify Trump’s behaviour one needs to disbelieve all media outlets, ignore the obvious effects of climate change, accept incompetent foriegn policy, believe the fake theory that coal jobs are coming back and that globalization can be reversed. 

Trump has always been a conman with a solid base of supporters. Proving the adage that you can fool some people all the time, and all the people some of the time.  Let’s hope, for the sake of this great democracy, that he cannot fool all the people all the time!!

A lot has been made of US economic strength under Trump. However, these analyses ignore several factors. With the exception of a three quarters of 3+% growth, it has been around ~2% to below 2% in the most recent quarter –  a rate which Trump characterized as “weak” while campaigning in 2016.  

Similarly unemployment rate decline, which began in 2010, has just continued to decline and now stabilized around 3.6%. On the other hand budget deficits have exploded. Three consecutive years of rapidly rising deficits threatens to break the trillion dollar mark this year. Having this occur during an economic expansion shows dangerous underlying economic weakness. In sharp contrast, after a high in 2009 the deficits steadily reduced under Obama. Proving once again that whatever Trump does, he does horribly. Exactly what you would expect from a man who specialized in serial bankruptcies! 

This does not mean the voters are going to hand the election to the Democratic nominee. The nominee needs to articulate the message that an irresponsible and crooked leader has wastefully spent the public treasure on wealthy individuals and corporations who spent it on stock buybacks. 

This money would have been better spent on addressing inequality, health security, infrastructure, job training and securing the world for future generations for all Americans. Such investment would lead to sustained economic growth, jobs of the future and improved quality of life.  

In July 2019 the support for impeachment was around ~40%. Recent polls show a majority supporting impeachment. The Democratic nominee must inspire a robust voter turnout. There are a few candidates in the pool who are articulating populist ideas well and practicing good retail politics.  They are quite capable of unseating Trump. 

Mani Subramani is a veteran of the semiconductor equipment industry.  He enjoys following politics and economics.