Safety Net

Medicare at 50: Then and Now

Fifty years ago, on July 30, 1965, Medicare was signed into law by President Lyndon Johnson.  The program has been keeping our oldest citizens – and those with disabilities – out of poverty ever since. Before Medicare, less than 50 percent of people ages 65 and over had health insurance, 35 percent lived in poverty, and life expectancy was much lower than now. But despite its tremendous success, Medicare faces significant threats.  We need to redouble our efforts not only to protect the program, but to strengthen it.

Throughout its history, Medicare has been effective at reducing poverty for older people and people with disabilities, and at increasing access to health care. In the program’s very first year, more than 19 million people over age 65 enrolled; access to care increased by one-third; poverty among older and disabled Americans decreased by nearly two-thirds; and personal economic security increased for older people and their families.

As Congresswoman Rosa DeLauro said, “Medicare is a bedrock part of the American social insurance system.” It has provided peace of mind for millions of Americans, who know they will have reliable health care coverage in retirement. The program covers people most in need of care—people who often wouldn’t be covered by private insurers or couldn’t afford such insurance. It also strengthens families by limiting the financial burden of health care costs for their older and disabled relatives.

Many people are unaware that Medicare has also helped change our society. For example, its creation was a huge boost for civil rights. Any hospital wishing to collect Medicare funds had to desegregate to qualify for payments. As a result, thousands of hospitals fully desegregated in only four months.

Medicare has seen many positive changes.  It added hospice coverage in 1982 and now almost half of beneficiaries who die use this important benefit. In 2008, Medicare coverage of mental health services changed, so that these services were reimbursed at the same rates as other Medicare-covered services delivered in the same care settings. As a result, hospital care for mental health services no longer costs more than hospital care for a physical health problem.

In 2010, the Affordable Care Act added a decade of economic security to the Medicare Trust Fund, increased free preventive services, and increased parity between traditional Medicare and private Medicare plans.

A recent “improvement” came about as a result of work by the Center for Medicare Advocacy – where I serve as the Executive Director – and by our partners at Vermont Legal Aid. When Medicare beneficiaries have a chronic condition, such as Alzheimer’s or Multiple Sclerosis, they often need skilled care in order to maintain their condition or slow deterioration. Medicare regularly denied such coverage because the beneficiaries weren’t “improving.” This harmful practice impeded access to necessary care and placed an unfair burden on families who were forced to pay for these services. As a result of a 2012 settlement with the Centers for Medicare & Medicaid Services, coverage for skilled care can no longer be denied simply because an individual isn’t improving. Coverage is available for skilled care to maintain an individual’s condition.

Despite Medicare’s success, it faces threats like never before. From privatization to coverage denials, to political pressure that would limit coverage and increase costs for beneficiaries in the future. However the Center for Medicare Advocacy is advocating for a number of common sense solutions that would better protect beneficiaries and help improve Medicare’s financial security, without cutting benefits or coverage. These include:

  • Paying Medicare Advantage at the same rates as traditional Medicare. Private plans should not be paid more than traditional Medicare. This would save more than $132 billion dollars over 10 years;
  • Adding a prescription drug benefit to traditional Medicare;
  • Requiring Medicare to obtain the best prices for prescription drugs — — which would save more than $141 billion over 10 years;
  • Fixing the broken Medicare appeals system by eliminating one of the first levels of review. The vast majority of reviews at the initial and second levels are “rubber stamp” denials which simply add bureaucracy and waste money. This would save around $100 million per year in operating costs.

Medicare works well for the American people and it has for 50 years. Let’s ensure that it stays strong and continues to open doors to health insurance and health care for our nation’s most vulnerable people and their families.

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Labor

Fast Food CEO Blames Low-Wage Workers for Poverty

To be “poor” in America isn’t an identifying characteristic or a defining trait, like being forgetful or creative or tall.

Being a low-income American comes from being paid a low income.

It seems like a basic point, but it’s one Andy Puzder needs to review. Puzder is CEO of CKE Restaurants, Inc., which employs more than 20,000 people and worldwide owns, operates and franchises more than 3,300 fast food restaurants, including Hardee’s and Carl’s Jr.

In a recent op-ed, Puzder made the specious claim that the social safety net “can lock [people] into poverty.”

He argues that “these programs have the unintended consequence of discouraging work rather than encouraging independence, self-reliance and pride,” and that, because of government assistance, his low-wage employees across the U.S. are refusing promotions and additional hours “for fear of losing public assistance.”

What Puzder forgets to point out is that it is poverty wages—poverty wages paid by institutions like Hardee’s and Carl’s Jr. to many of their 20,000-plus employees—that force families to turn to nutrition and housing assistance, and other government-supplemented work supports, just to get by.

Media Matters reports that a 2013 study by the National Employment Law Project (NELP) found that “the overwhelming majority of fast food employees (89.1 percent) make less than $9 per hour and face significant ‘barriers to upward mobility’ in the profession.”

In a recent interview with Fox News, Puzder doubled down on his flawed thesis.

Video provided  by Media Matters for America

“We need a different system,” he concluded.

On that point he’s right.

We need a system where people like Savino, a father of two in Brooklyn and a member of the New York Communities for Change, don’t have to work 72 hours a week at a local supermarket for wages that are so low they still struggle to get by.

“Sometimes things are so bad that I have to decide–should I pay rent this month, or should I eat?” said Savino.

We need a system where mothers like Ashely, a Washington, D.C. resident and a member of Working Families, don’t have to sleep with a young child on the floor because jobs don’t pay enough to cover rent.

“If I were paid a living wage, I could get my own place,” Ashley said. “As it is, I feel stuck, and don’t see a way out.”

We need employers to pay enough money so that people like Darrell, who works in the auto parts industry in Ohio, can bring home more than $272 a week. Darrell hopes to move out of the two-bedroom trailer he shares with his daughter, son-in-law and 17-month-old granddaughter.

“I just want enough to survive,” Darrell said, “and I think that is a reasonable expectation for someone who goes to work and works hard every day.”

We need a system where parents aren’t forced to choose between working more hours for low wages and paying exorbitant child care fees, or staying home with their kids and barely scraping by on government assistance.

We need a system where people are paid enough during their working years to put money away in order to retire peacefully in old age.

We need to change the current system, where people like Puzder make more in one day ($17,192) than one of his minimum wage employees would earn after working full-time for an entire year ($15,130).

This system was created by people like Puzder and political leaders who, like him, blame the very people who are just trying to make ends meet. But we have the power to change how the system works.

Not surprisingly, the road to change doesn’t involve taking away supports from the people who need them most. It involves creating good jobs for the people who need them most; jobs that provide a fair wage and benefits—that give people options rather than forcing them to choose between bad and worse.

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Safety Net

Struggling to Get By on SSI

Editor’s note: Supplemental Security Income (SSI) is a safety net program that provides a very basic income to older adults and people with disabilities who have either no or very limited other income and resources. The maximum possible federal monthly benefit for an individual is currently $733. The SSI program’s financial eligibility requirements have changed little since the program was signed into law in 1972, and increasing numbers of recipients are living in poverty, going hungry, or becoming homeless. The SSI Restoration Act of 2015 would update the program’s out-of-date income and asset limits to better reflect the cost of living in today’s dollars.

You work your whole life. You pay your taxes – boy, do you pay your taxes. Unlike upper-middle and upper-class folks who have tax preparers and accountants to help them with their taxes and find deductions and loopholes and so forth, you get slammed every year and you can barely keep afloat…then, the worst happens.

You get old and disabled and you can’t work any more and your disability/social security isn’t really enough to live on and you never were able to get much retirement money together so the government gives you something called SSI. Between that and Social Security you still don’t have enough to live on but what can you do?

To add indignity to insult, the government tells you how much money you can have in the bank and it ain’t much: just $2,000.

If someone lends you money to get by you can’t repay the debt out of your Social Security or SSI because the government watches everything you do and they don’t want you to borrow money or pay it back because the bottom line is the government is afraid to be cheated. Sadly enough, they are mostly afraid of being cheated by poor people. Rich people seem to be able to get away with murder.

The government is mostly afraid of being cheated by poor people. Rich people seem to be able to get away with murder.

Now a bunch of politicians and well-wishers are trying to change the laws a little bit…not majorly, just minorly, to make it a little easier for us to survive. And yet they will run into obstacles.

I wish everyone who opposes making life a little better for poor old disabled people (or even poor old people) would put $10.00 in an envelope and send it anonymously to a poor old person.

In the meantime, I’m looking for a part-time or freelance job. I’m 72 and I’m broke and can’t afford to live on Social Security and SSI and I don’t really know what to do. Also, I’m in dialysis, so that chews up around four days a week. So I’ll keep looking for a job, albeit futilely, and if I can figure out a way to rob a bank I might do that…I have an electric wheelchair and could do a slow-speed chase down the street if I had to.…

So, whilst I’m thinking of it, if anyone out there wants to offer me a job I would be extremely happy, and also, I could use a nice little house with a yard for my dog and a couple of tomato plants and maybe a lemon tree or an avocado tree. Just thought I’d put that out there.

Cheers to all, and remember, wait for the supermarket sales! And never give up – fight to the bitter end.

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Safety Net

Reducing Future Homelessness by Keeping Families Together

Though the child welfare system has an important role to play in protecting families and children, taking a child away from his or her family is too often the main tool in its toolkit. Poverty, homelessness, mental illness and substance abuse can lead to child neglect and abuse, but if those factors are addressed, a safe home environment with family members can be achieved.

Foster care itself is an incomplete solution. As many as half of young adults who age out of foster care spend time homeless. More than half a million unaccompanied youth experience homelessness every year, and only 10 percent of them are served by targeted programs funded under the Runaway and Homeless Youth Act, such as basic care centers, emergency shelters, transitional living programs and street outreach.

The Corporation for Supportive Housing (CSH) calls on Congress to change child welfare policy based on what works: “Keeping Families Together” (KFT).  KFT is a pilot effort that uses federal Family Unification Program (FUP) vouchers to provide affordable housing to families at risk of losing their children and also to youth aging out of foster care at risk of becoming homeless. Rather than targeting the most “stable” families, KFT is unusual because it seeks out families with the most complex cases. Case managers build trust with the families, help them navigate multiple government systems, connect them with parenting classes and resources, and mediate between the family and the child welfare system to resolve new and ongoing cases based on direct knowledge of the family’s circumstances.

Michelle and her three young sons offer a clear example of how KFT helps sustain families. Michelle spent years struggling with poverty and drug abuse and shuttling her children between homeless shelters. With the help of KFT, the family moved into a two-bedroom apartment. But suddenly, crisis struck. Michelle’s 13-year-old son, Donovan, has serious behavioral and emotional problems and can be physically aggressive. One night, he attacked Michelle with a broom.  The only way she could defend herself was to strike back. Donovan reported his mother for hitting him and the city opened a child welfare case against her. Michelle’s KFT case manager interceded with child welfare on Michelle’s behalf. Now Donovan is getting proper treatment and medication, and Michelle’s family has stayed intact. “I don’t know what I would do without the services here,” Michelle said. “Sometimes when you need support, you need it right then—not tomorrow or next week.”

If we value families, we should do everything we can to help them stay together and succeed.

Thanks to KFT, families once on the brink of crisis now have a place to call home and the support they need to stay together. Most families had no new abuse or neglect cases after moving to supportive housing. Six children were reunited with their families from foster care. Nearly all of the families with substance abuse problems reported that they were clean and sober at the end of the evaluation period. School attendance improved steadily. Moreover, so much money was saved by reducing the use of foster care and the shelter system that the program cost the public only three dollars per family per day. The pilot was therefore expanded to 665 families in five states, through a private-public partnership with the Department of Health and Human Services.

We now have important evidence about how to use FUP vouchers effectively. First, youth leaving foster care currently only receive 18 months of assistance. This isn’t nearly enough time to adjust to their new housing and services and successfully transition to independence. We urge Congress to extend assistance to 60 months. Second, family FUP vouchers are not being used as an early intervention strategy to stabilize families, which is essential to avoid the trauma of separation. Finally, there are almost no ongoing services for families or youth receiving the FUP voucher.

Congress should follow the lead of the KFT program—enact legislation that encourages family preservation and reunification, community-based services, and developmentally appropriate services for youth leaving foster care.  If we value families, we should do everything we can to help them stay together and succeed.

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Culture

Orange is the New Black is Dead Wrong About Disability

SPOILER ALERT: This article discusses events within the first episode of Season 3.

Et tu, Orange is the New Black?

The Netflix drama is back with a third season, and if you’re like me, it monopolized the better part of the last two weekends. The show deserves credit for sparking dialogue and increasing awareness about mass incarceration in the U.S., particularly among people who hadn’t previously considered criminal justice reform to be their thing.

The show’s typically smart writing and masterful treatment of a serious and complex topic made the first episode all the more disappointing.

One of the very first scenes of the third season is a flashback to the character Pennsatucky’s childhood. We watch as her mother forces her to chug an entire two-liter bottle of Mountain Dew. Pan right to the sign showing us that they’re at the Social Security Administration office. Then we hear Mom say, with a young Pennsatucky now bouncing off the walls behind her, “So I understand, Supplemental Security Income benefits for kids like mine are $314 a month, is that right?”

The implication is clear: Mom is attempting to simulate the symptoms of ADHD in her child in order to fraudulently obtain SSI benefits.

This scene caused me to have several flashbacks of my own. First, to the mid-1990s, when a flurry of media reports accused parents of “coaching” their children to “act disabled” in order to feign eligibility for SSI benefits. The “crazy checks” media frenzy, as it came to be known, spurred Congress to narrow the program’s eligibility rules, causing more than 100,000 children with disabilities to lose critically needed benefits. The media claims were later shown to be baseless, but the damage had already been done, and Congress had already legislated by anecdote.

I also flashed back to 2010, when media allegations accused parents of seeking psychotropic medications for their children in hopes of SSI eligibility. These claims were similarly debunked after multiple investigations. But again, the media allegations rang loudly in the halls of Congress, leading to hearings and yet more proposals to cut SSI.

My head swirling, I was next transported to 2012, when New York Times columnist Nick Kristof sparked yet another kids’ SSI media hubbub by accusing parents of pulling their kids out of literacy programs in order to obtain SSI benefits. Mr. Kristof’s claims that the program incents parents to keep their kids from learning to read were similarly unsupported by the facts—but that didn’t stop NPR from doubling down on his claims with their own (widely discredited) “reporting” just a few months later. Legislation that would kick young people with disabilities off of SSI if they miss school is now pending in Congress.

Each set of media allegations—as well as the disappointing OITNB scene—reflects a continued lack of understanding of mental impairments. They perpetuate the stereotype that if you have a visible physical impairment, you’re ‘truly disabled,’ but if you have an invisible mental disorder, your impairment is somehow less real, or less legitimate.

What’s more, each set of media attacks—as well as the OITNB scene—reflects vast ignorance about the SSI program, perpetuating the myth that it’s easy to get benefits. Getting hyped up on a caffeinated drink before you walk into the Social Security office may make for entertaining TV, but it won’t get you anything in real life.

SSI serves as a vital lifeline for families caring for children with disabilities. It makes it possible for families to care for their children with disabilities at home and in their communities, instead of in costly and isolating institutions. Only children with the most severe impairments and illnesses qualify for SSI. The majority of children who apply are denied, and fewer than 1 in 4 U.S. children with disabilities receive benefits.

The silver screen’s treatment of important public policy issues has a very real, and potentially destructive, impact.

Raising a child with a disability is extraordinarily expensive. Families caring for children with disabilities are more than twice as likely as other families with children to face material hardships such as homelessness, food insecurity, and utility shutoff. The financial support that SSI provides helps to offset some of the commonly incurred costs, including special therapies, diapers for older children, adaptive equipment, and transportation to doctors and specialists, many of which are not covered by insurance or have high copays. SSI benefits also replace a portion of lost income when a parent must stay home or reduce her hours to care for a child.ADHD is a neurobiological disorder that affects 5 to 8 percent of school-age children.

But only the most severely impaired children are eligible for SSI. More than 75 percent of children with ADHD who apply for benefits are denied, and just 4 percent of U.S. children with ADHD receive SSI.

Moreover, qualifying for SSI on the basis of ADHD—or any other mental or physical impairment—requires extensive medical evidence from approved medical sources (including physicians and specialists) documenting the severe impairment as well as its resulting symptoms. A child’s impairment must result in marked and severe functional limitations and must be expected to last at least 12 months or to result in death.

In fairness to Orange is the New Black, the show is fiction. Unlike the media frenzies over the years, it didn’t claim to be reporting the facts. But, as with the latest season of House of Cards, which was infused with “real-world lies” about Social Security—it’s “sucking us dry”… “entitlements are bankrupting us”—the silver screen’s treatment of important public policy issues has a very real, and potentially destructive, impact. (Coincidentally or not, House of Cards is also produced by Netflix.)

Media portrayals that reinforce myths about mental disorders do us a significant disservice and contribute to the harmful denial of mental illness that persists even in the 21st century. Media portrayals that reinforce negative stereotypes about vital programs and the individuals helped by them are similarly dangerous, sowing the seeds for cuts that will make vulnerable people’s lives all the more difficult.

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