March 3, 2013

When You're Cutting Social Security, 'Wealthy' Begins at $25K

http://www.commondreams.org/view/2013/02/23-3

Here's a proposal for Social Security that was on the New York Times' op-ed page Wednesday (2/20/13):



Wealthy…or super-wealthy? This is part of Paul Ryan adviser Yuval Levin's attempt to find "common ground" on the entitlement issue: "Both sides should agree at least to spend less money on the wealthy." So who are these "wealthy" people who would be getting a benefit cut equal to the rate of inflation every year? According to the SSA, about 34 percent of people over 65 have family incomes of $50,000.

Now, you can argue about what "wealthy" is, but I think you would find pretty widespread agreement on what wealthy isn't: $50,000 a year. If you sent the New York Times an op-ed outlining your plan to balance the budget by raising taxes on "wealthy" people who make 50k a year or more, it would be put in the same pile that gets the submissions about Elvis's UFO diet. But when you're talking about cutting entitlements, if you want to call those people "wealthy," that's perfectly reasonable.

But wait! Those aren't the only people who are getting too much from the government and need to have their benefits cut–the middle third of the elderly are also "wealthy" and need their benefits cut–but by only half the rate of inflation per year. The ones making more than $50,000 must be the super-wealthy, the regular wealthy make…between $25,000 and $50,000, roughly.

For comparison purposes, the poverty line for a family of four is $23,350. Talk about a shrinking middle class!

February 22, 2013

Why Republican governors want Medicaid expansion but not exchanges

Medicaid is a government-run program, and the exchanges are market-based. They're just recognizing that government does better at funding health care than the market. On to single payer?

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/02/21/why-republican-governors-are-saying-yes-to-medicaid-no-to-obamacares-exchanges/

These same governors have, however, also eschewed another big Obamacare component: The exchanges. The three most recent Medicaid expansion converts—Florida’s Rick Scott, Michigan’s Rick Snyder and Ohio’s John Kasich—have all rejected the idea of setting up the marketplace, leaving it to the feds to do the work, instead (Michigan is splitting the difference and will run its market in partnership with the feds).

Why embrace one part of the health care law — a single-payer system that will stretch President Obama’s law to cover millions more Americans — while ditching the other more market-oriented aspect? It likely has to do with the big consequences for a governor who chooses not to expand Medicaid—versus the tiny reward with setting up a very complex insurance marketplace.

There’s not a lot riding on governors’ decision to build a health insurance exchange. The marketplaces certainly are important to the Affordable Care Act: They’re the online portals where millions of Americans will ultimately purchase health insurance, the key vehicle for delivering the health law’s insurance expansion.

Building a health exchange is a huge undertaking. Between connecting disparate government computer systems and creating a seamless shopping experience, industry analysts say that this process should take two or three years.

If governors cram it into 10 months, and the final product comes out subpar, they would likely take the blame. But if a governor doesn’t go through with building one, the federal government swoops in. It has promised that every state will have an insurance exchange by Oct. 1, the date that the new markets will open for enrollment.

February 13, 2013

Why Social Security Recipients Shouldn't Be Shackled With the Chained CPI

Institute for America’s Future http://www.ourfuture.org/

The Challenge
As conservatives relentlessly demand more and more spending cuts in their crusade to impose austerity on our economy, they have fixated on cuts to benefits offered by Medicare, Medicaid and Social Security – the core pillars of family security.

One particularly noxious idea is the "chained CPI.” Conservatives like it because it would cut Social Security benefits immediately for everyone in the system – if we let them replace the more scientific index we have used for years to make sure benefits keep up with the cost of living. And some Democrats like it because it’s a way to give deficit hawks real spending reduction – while pretending it is simply a "technical fix" – not really a benefit cut.

At this writing, President Obama’s staff pretends it’s a better index – and the president keeps offering it as part a “grand bargain.”

But the chained CPI is a political trick, not a technical fix. It is a hidden benefit cut that would shackle seniors with lower benefits and thus less security over time. With seniors in the bottom 40 percent of the income scale dependent on Social Security for almost 90 percent of their income, it would dramatically raise poverty levels among the retired, the disabled and the widowed.

Tremendous pressure to enact this change is being exerted by private groups funded by Wall Street advocates of Social Security retrenchment or even privatization. They seek to use the current deficits – the result of the economic collapse caused by Wall Street's excesses – to force unpopular cuts in the security programs American families rely on. They do so by claiming that "entitlements" cause our long-term debt problems, lumping Social Security in with health care programs like Medicare and Medicaid. They claim Social Security is going bankrupt without changes. And then they call for "reform," with the supposedly technical fix of a lower cost of living adjustment masking a deep cut in benefits. A powerful bipartisan array of Washington insiders has echoed this argument, from deficit jeremiads like Erskine Bowles and Alan Simpson, the Bipartisan Policy Center's Deficit Reduction Task Force and the Heritage Foundation to established liberal groups like the Center for American Progress and Center for Budget and Policy Priorities.

Without a massive mobilization by an informed public, there is a clear and present danger that within the next few months the economic security of the elderly, disabled and surviving children will be needlessly compromised for decades to come by our country's political elites.

Make the Case
A "chained CPI" differs from the standard consumer price index we're familiar with because it claims to take into account “substitutions” — the degree to which consumers will change what they buy in response to price increases. For example, if the price of going to the movies dramatically increases, consumers might instead rent more DVDs to save money. Now we all make substitutions – but many of the things seniors buy are things you just can’t substitute, like medicines, or doctors visits, or basic foods. But the chained CPI wasn’t designed with seniors’ buying habits in mind. Applying it to Social Security assumes seniors make the same substitutions as the average consumer, which they often can’t afford.

Here are seven reasons shackling seniors and the disabled with a chained CPI is just plain wrong.

1. It's a huge benefit cut that seniors, veterans and the disabled cannot afford. It would cut benefits by $135 billion over 10 years and much more in ensuing decades as its impact is compounded. It would also cut another $24 billion from veterans' and federal retirement benefits. The Social Security recipient who retired at age 65 in 2012 would be receiving $658 a year less in benefits under the chained CPI calculation by the time he or she is 75, an almost 4 percent cut; by 85, that person would be getting $1,147 less a year, a 6.5 percent benefit cut. This is a feature, not a bug; the budget savings from the benefit cuts are the key selling point of the chained CPI. These cuts would hit the oldest seniors the hardest, exactly when they are the most economically vulnerable, right when they are likely to have exhausted their retirement savings and are facing their highest out-of-pocket health care costs.

2. The chained CPI is patently inaccurate at measuring the cost of living of the elderly and disabled. This is a political trick, not a technical fix. Since 1975, Social Security benefits are adjusted annually based on what is now called the consumer price index for urban wage earners and clerical workers (CPI-W). Ironically, its cost calculations exclude people outside the workforce, and thus most Social Security beneficiaries. Recently, the government's Bureau of Labor Statistics has developedan experimental CPI-E that more directly measures the cost of living of people age 62 and over. If the chained CPI were a technical fix, its advocates would be pushing to perfect the CPI-E and adopt it as the basis for Social Security's cost of living adjustments. But the CPI-E indicates that the cost of living of the elderly is rising faster than that of the overall population.So adopting a true measure of seniors' costs would increase benefits and cost more money. Advocates of switching to the chained CPI don't want more accuracy. They invented the chained CPI to shackle seniors with lower benefits in order to cut spending.

3. The chained CPI violates Social Security's promise: that Social Security's cost-of-living adjustments should maintain the purchasing power of benefit levels over time. This is no minor detail. The value of pensions or 401(k) balances that are not inflation-protected typically decline by half over 20 years. Virtually no retirement savings vehicles available in private markets offer inflation protection for life. Social Security does. It is one of the program's most important defining features. Given that the average benefit today is only $1,153 per month, that 36 percent of beneficiaries get 90 percent or more of their income from Social Security, and that 65 percent of Americans get 50 percent or more of their income from the program, this inflation protection is critical to recipients' economic security. It's just obscene to shackle seniors and the disabled to benefits that won't keep up with rising costs. Faced with the soaring costs of drugs, seniors already are sometimes forced to cut back on food or on medicine to make ends meet. We should be raising benefits to alleviate those pressures, not cutting them because to reflect the savings they exact.

4. The chained CPI flagrantly flies in the face of public opinion. By a two-to-one margin in one recent poll, respondents said using the chained CPI was "totally unacceptable" as a way to adjust Social Security benefits. Other polls have found that overwhelming majorities of Americans are opposed to undertaking Social Security reform in the context of deficit reduction talks. The most recent polling by the National Academy of Social Insurance shows that a majority of Americans across the political spectrum think Social Security benefits should be raised, not lowered – and are willing to pay more in taxes to protect those benefits. By far the most popular reform is to raise the cap on the payroll tax, so that the wealthier Americans pay at the same rate as low-wage workers.

5. The chained CPI will hurt more than just the elderly. The groups of Americans that would also see their benefits cut if the chained CPI were implemented government-wide include people with disabilities; widows and children who receive survivor's benefits; disabled veterans, particularly those who are totally disabled and therefore eligible for both veterans benefits and Social Security Disability; lifelong public servants who retire from the federal government, and anyone who retires from the military after serving our country for decades.

6. Social Security benefits are modest and should be increased, not cut. Social Security retirement benefits average just $14,900 a year, and nearly 5 million retirees live below 125 percent of the federal poverty level. Already their current cost-of-living adjustments do not compensate for the fact that they spend roughly twice as much on health care as the average worker or urban consumer and a larger percentage of their income on basic necessities. A chained CPI only makes that problem worse. The Center for Retirement Research at Boston College has estimated that more than half of the nation's households would be unable to maintain their standards of living during their retirement years, given the damage the 2008 financial crash did to housing values, stock portfolios and worker earnings. Given our national retirement income security crisis, policymakers should be increasing Social Security benefits, not cutting them.

7. The advocates of the chained CPI implicitly admit that it is not an accurate measure of inflation faced by seniors. They are now scrambling to propose modifications that will "protect" the oldest and poorest seniors from the effects of a change they claim is technical. But if the chained CPI were an accurate measure of the cost of living, why would 80-year-olds need protection? In fact, the measures proposed to blunt the effect of the chained CPI on vulnerable populations are shamelessly inadequate. For example, even with the most commonly proposed compensatory measure – a bump-up in benefits after 20 years, starting at age 82 – an 85-year-old would still lose more than $12,000 in benefits over a 20-year period.

Counterpoint
When they say: The chained CPI is more accurate.

You can say: The chained CPI is a political trick, not a technical fix. It is not more accurate for seniors and people with severe disabilities. As 250 top economists and more than 50 social insurance experts with Ph.D.s in related fields recently pointed out in an Economic Policy Institute statement : "Since elderly and disabled people spend a greater share of their incomes on necessities such as health care, rent, and utilities, and since this population is also less mobile, a chained COLA based on the spending patterns of workers or the general population may overestimate the ability of Social Security beneficiaries to take advantage of cheaper substitutes." To obtain a more accurate cost-of-living adjustment, we should give the experts the resources needed to perfect the CPI-E (a consumer price index for elderly consumers) and then consider adopting it for determining Social Security COLAs. It would surely end up increasing rather than decreasing the adjustment for inflation.

When they say: If we reduced the COLA, wouldn't that just slow the rate of growth of benefits rather than cut benefits?

You can say: Cost of living adjustments don't increase benefits, they simply allow them to keep pace with inflation. A lower adjustment will result in benefit checks that have less purchasing power. This is a benefit cut masked as a technical fix.

When they say: Isn't the chained CPI a relatively small cut?

You can say: The chained CPI snowballs year after year, so the cut is the largest for the oldest seniors who need it the most. For the average worker retiring at age 65 in 2012, the chained CPI would cut benefits by more than $1,000 a month by the time that worker is 85. The cumulative effect of the cut gets worse over time.

When they say: Can't we make accommodations in the chained CPI to protect the most vulnerable people?

You can say: No. None of the proposed "sweeteners" to cushion the impact of the chained CPI on vulnerable groups holds them harmless – far from it. The proposed modest increase in benefits after 20 years (sometimes called the "birthday bump&quot still leaves the average senior with a net cumulative loss of $12,000 by age 85 and over $16,000 by age 95.

When they say: The chained CPI is a necessary part of getting our deficits under control

You can say: Social Security has not and cannot by law contribute to the federal debt. And the program is too important to be used as a bargaining chip in negotiations about deficits that Social Security has not contributed to.

When they say: Isn't the chained CPI necessary to help balance Social Security's finances?

You can say: Social Security's finances should be addressed on their own, not in the midst of the hysteria surrounding deficits that have nothing to do with Social Security. In fact, Social Security is in good shape, with current assets covering benefits for the next 22 years. To strengthen the long-term solvency in Social Security, there are far better policy options than cutting benefits. For example, lifting the Social Security tax cap would eliminate at least 70 percent of Social Security's modest 75-year shortfall.

Public Pulse
•62% of individuals called the Simpson-Bowles recommendation to adopt the chained CPI "totally unacceptable," while 31% said it was "acceptable." (Democracy Corps)
•60% of Americans thought that it was "unacceptable" to change Social Security to increase at a slower rate in order to strike a deal to avoid the January 1 "fiscal cliff." ( Washington Post )
•Only 8% of individuals support cutting "scheduled benefit increases for future retirees" when asked to choose one preferred Social Security reform (New York Times/CBS).
•56% of individuals consider preserving current Social Security and Medicare benefits a higher priority than reducing the budget deficit" (Pew).
•77% of Americans consider cutting Social Security "mostly or totally unacceptable" in order to reduce the deficit ( Wall Street Journal/NBC ).
•Two-thirds of people support raising payroll taxes on the upper-income earners, compared with 38% who support raising Social Security's "eligibility age." (Pew Research) .
•66% of Americans, including 45% of Republicans and 64% of Independents, favor increasing income taxes for upper-income Americans, compared with 42% who favor making "significant changes" to Social Security and Medicare" (Gallup/USA Today).
•57% of respondents think that reducing retirement benefits for people who are currently under age 55 is a bad idea (Gallup).
•62% of individuals agreed that the government needs to keep its promises to older people by maintaining their benefits, even for those who are well-off (Pew Research).

Hot Facts
•$55 a month: That's how much less a 65-year-old retiree today would end up getting 10 years from now than they would under the current cost-of-living adjustment.
•Health expenses take up almost twice as much a share of a senior's monthly expenses as it does of average workers, and health care costs rose at twice the rate of inflation in 2012.
•Even with Social Security, almost one in seven seniors fall below the poverty line when all of their expenses are taken into account, according to the Census Bureau's supplemental poverty measure.

Tweet This
#ChainedCPI is a #SocialSecurity cut that gets deeper every year, hitting the oldest hardest. http://bit.ly/WIbHsO #SmartTalk @ourfuture

Average Social Security check under $1,200/month. Don't chain seniors to poverty with #ChainedCPI http://bit.ly/WIbHsO #SmartTalk @ourfuture

#ChainedCPI is NOT more accurate for Social Security beneficiaries. It just cuts benefits http://bit.ly/WIbHsO #SmartTalk @ourfuture

Instead of #ChainedCPI, make millionaires pay same rate into Social Security as the rest of us. http://bit.ly/WIbHsO #SmartTalk @ourfuture

2 years of no Social Security COLA—and now they want to cut it?! Stop the #ChainedCPI. http://bit.ly/WIbHsO #SmartTalk @ourfuture

February 11, 2013

Tax hikes you may have forgotten about

Comment by Don McCanne of PNHP: When we are talking about financing our health care system - 17 percent of our GDP - we have to get tax policy right. One tax being imposed by the Affordable Care Act - a tax on health insurers - will surely be passed on to purchasers of health plans in the form of higher premiums. When health health insurance premiums are already unbearable for many, it doesn't seem wise to adopt a tax policy that pushes premiums even higher.

Another peculiarity about this tax is that self-insured employers are exempt. We have already written about the serious problems with the current trend of small businesses self-insuring - less regulatory oversight, exemption from some of the provisions of the Affordable Care Act, and the vagaries of stop-loss insurance for the self-insured. Yet the insurance tax will increase this unfortunate trend.

Since the global amount of the tax is set in law and it is assessed proportionately amongst the insurers, as many employers convert to self-insurance, the tax payment required of those continuing to be insured through private plans will rise disproportionately. Although this might not reach the level of a death spiral, the distribution would certainly be inequitable.

One of the most important features of a single payer national health program is that it would be funded through equitable tax policies. Everyone pays their fair share, based on ability. Not only could we fix our health care system through single payer reform, but we would have the additional advantage of moving us much closer to an equitable system of taxation.

February 8, 2013

Strengthening Social Security--what do Americans want?

Strengthening Social Security--what do Americans want?

http://www.nasi.org/sites/default/files/research/What_Do_Americans_Want.pdf?

Americans value Social Security, want to improve benefits, and are willing to pay for the program.
■ Americans don’t mind paying for Social Security because they value it for themselves (80%), for their families (78%), and for the security and stability it provides to millions of retired Americans, disabled individuals, and children and widowed spouses of deceased workers (84%).

■ 84% believe current Social Security benefits do not provide enough income for retirees, and 75% believe we should consider raising future Social Security benefits in order to provide a more secure retirement for working Americans.

■ 82% agree it is critical to preserve Social Security for future generations even if it means increasing Social Security taxes paid by working Americans, and 87% want to preserve Social Security for future generations even if it means increasing taxes paid by wealthier Americans.

Americans support a package of changes that eliminates Social Security’s financing gap while improving benefits.

The trade-off analysis conducted for this study shows that, rather than maintain the status quo, 71% of Americans would prefer a package of changes that increases Social Security revenues, pays for benefit improvements, and eliminates more than 100% of the projected financing gap.

The preferred package would:

■ Gradually, over 10 years, eliminate the cap on earnings that are taxed for Social Security. This would mean that the 5% of workers who earn more than the cap ($110,100 in 2012; $113,700 in
2013) would pay into Social Security throughout the year, as other workers do.

■ Gradually, over 20 years, raise the Social Security tax rate that workers and employers each pay from 6.2% of earnings to 7.2%. A worker earning $50,000 a year would pay about 50 cents a week more each year.

■ Raise Social Security’s basic minimum benefit so that someone who paid into Social Security for 30 years can retire at 62 or later and not be poor.

■ Increase Social Security’s cost-of-living adjustment (COLA) to more accurately reflect the level of inflation experienced by seniors.

This package would entirely eliminate Social Security’s projected financing gap and provide additional funding. The package is preferred over the status quo by large majorities of seniors in the so-called Silent Generation, born before 1946 (76%); Baby Boomers, born from 1946 to 1964 (71%); and younger Americans in Generation X, born from 1965 to 1979 (73%) and Generation Y, born in 1980 and after (67%). See Figure 1.

February 6, 2013

Signing up an estimated 30 million uninsured Americans for coverage under the health-care law--

--is shaping up to be, if not a bureaucratic nightmare, at the very least a daunting task.

It certainly wouldn't be a problem if there was only a single comprehensive plan to which people could add bells and whistles on their own if they chose. Or even a decent-sized pool of people in a public option. Dems are going to be destroyed by this politically if we don't move to single payer in 2017.

http://www.washingtonpost.com/national/health-science/for-insurance-exchanges-states-need-navigators--and-hiring-them-is-a-huge-task/2013/02/04/bb5e577c-6960-11e2-ada3-d86a4806d5ee_print.html

While some people will find registering for health insurance as easy as booking a flight online, vast numbers who are confused by the myriad choices will need to sit down with someone who can walk them through the process.

Enter the “navigators,” an enormous new workforce of helpers required under the law. In large measure, the success of the law and its overriding aim of making sure that virtually all Americans have health insurance depends on these people. But the challenge of hiring and paying for a new class of workers is immense and is one of the most pressing issues as the Obama administration and state governments implement the law.

Tens of thousands of workers will be needed — California alone plans to certify 21,000 helpers — with the tab likely to run in the hundreds of millions of dollars.

<snip>Over the short term, some workers may be funded by federal grants, state budgets or private money. But over the longer term, most of the costs are to be covered by the new health-care marketplaces, called “exchanges,” being set up in every state. The money will come from fees that insurers will pay to sell their plans on the exchanges.

Added to the logistical challenge is a political one: Insurance brokers in many states are lobbying to prohibit the navigators from giving advice on which plans to choose and to make them liable for their guidance if it results in financial harm.

February 2, 2013

Sen. Mark Kirk's message to stroke victims: "Don't give up"

(And try to get insurance as good as what I get as a member of Congress)

Comment by Don McCanne of PNHP: It was quite moving watching the live C-SPAN broadcast of Sen. Mark Kirk today, climbing the Capitol steps to the resounding ovation given to him by his colleagues in the Senate. After his severely debilitating stroke, his message to other stroke victims is, "Don't give up," and he didn't.

He has had a year to think about stroke victims on Medicaid in Illinois and what the limit of a total of eleven rehabilitation visits must mean to them. This is clearly an inhumane public policy that must be changed.

But what about all of the other patients with major medical problems who do not get the care that they need because they are uninsured, or Medicaid doesn't provide adequate access, or private insurance...

What about private insurance? Sen. Kirk has coverage through the Federal Employees Health Benefits Program (FEHBP) - a menu of private health plans. That is about as good coverage as you can get today, yet with the major out-of-pocket expenses, it has not protected his savings and retirement.

We have a much bigger problem in health care other than simply trying to figure out how we can get Medicaid patients adequate rehabilitative services after a stroke.

If only Sen. Kirk's colleagues in the Senate and House could learn from his travails. They might begin to consider that we really do need a comprehensive health care system that takes care of all of us - an Improved Medicare for All.

In the battle for reform, remember Sen. Kirk's words, "Don't give up."

February 2, 2013

Federal Rule Limits Aid to Families Who Can’t Afford Employers’ Health Coverage

http://www.nytimes.com/2013/01/31/us/politics/irs-to-base-insurance-affordability-on-single-coverage.html?ref=us&_r=1&

The Obama administration adopted a strict definition of affordable health insurance on Wednesday that will deny federal financial assistance to millions of Americans with modest incomes who cannot afford family coverage offered by employers.

In deciding whether an employer’s health plan is affordable, the Internal Revenue Service said it would look at the cost of coverage only for an individual employee, not for a family. Family coverage might be prohibitively expensive, but federal subsidies would not be available to help buy insurance for children in the family.

<snip>

In 2012, according to an annual survey by the Kaiser Family Foundation, total premiums for employer-sponsored health insurance averaged $5,615 a year for single coverage and $15,745 for family coverage. The employee’s share of the premium averaged $951 for individual coverage and more than four times as much, $4,316, for family coverage.

Under the I.R.S. rule, such costs would be considered affordable for a family making $35,000 a year, even though the family would have to spend 12 percent of its income for full coverage under the employer’s plan.

The tax agency proposed this approach in August 2011 and made no change in the definition of “affordable coverage” despite protests from advocates for children and low-income people and many employers. Employers did not want to be required to pay for coverage of employees’ dependents. But they said that family members should have access to subsidies so they could buy insurance on their own.