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Medicare: Disappointment and Insolvency, Part 3

The New York Analysis of Policy and Government concludes its review of the disappointment to users of Medicare, and its pending insolvency.

The 2018 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds was issued this month, and it outlines the challenges facing the system:

In 2017, Medicare covered 58.4 million people: 49.5 million aged 65 and older, and 8.9 million disabled. Over 34 percent of these beneficiaries have chosen to enroll in Part C private health plans that contract with Medicare to provide Part A and Part B health services. Total expenditures in 2017 were $710.2 billion, and total income was $705.1 billion, which consisted of $694.3 billion in non-interest income and $9.8 billion in interest earnings. Assets held in special issue U.S. Treasury securities decreased by $5.0 billion to $289.6 billion.

Short-Range Results

The estimated depletion date for the HI trust fund is 2026, 3 years earlier than in last year’s report. As in past years, the Trustees have determined that the fund is not adequately financed over the next 10 years. HI income is projected to be lower than last year’s estimates due to (i) lower payroll taxes attributable to lowered wages for 2017 and lower levels of projected GDP and (ii) lower income from the taxation of Social Security benefits as a result of legislation. HI expenditures are projected to be slightly higher than last year’s estimates, mostly due to higher-than-expected spending in 2017, legislation that increased hospital spending, and higher Medicare Advantage payments.

In 2017, HI income exceeded expenditures by $2.8 billion. The Trustees project deficits in all future years until the trust fund becomes depleted in 2026. The assets were $202.0 billion at the beginning of 2018, representing about 65 percent of expenditures during the year, which is below the Trustees’ minimum recommended level of 100 percent. The HI trust fund has not met the Trustees’ formal test of short-range financial adequacy since 2003. Growth in HI expenditures has averaged 2.1 percent annually over the last 5 years, compared with non-interest income growth of 4.9 percent. Over the next 5 years, projected annual growth rates for expenditures and non-interest income are 6.2 percent and 5.3 percent, respectively.

The SMI trust fund is expected to be adequately financed over the next 10 years and beyond because premium income and general revenue income for Parts B and D are reset each year to cover expected costs and ensure a reserve for Part B contingencies. The Part B premium for 2018 is $134.00, the same as for 2017. However, a hold-harmless provision limited the premium increase in 2016 and 2017 for about 70 percent of enrollees. These Part B enrollees saw an increase in their Part B premium from about $109 in 2017, on average, to about $130, on average, in 2018.

Part B and Part D costs have averaged annual growth of 5.5 percent and 8.5 percent, respectively, over the last 5 years, as compared to growth of 3.7 percent for GDP. Under current law, the Trustees project an average annual Part B growth rate of 8.2 percent over the next 5 years; for Part D, the estimated average annual increase in expenditures for these 5 years is 6.0 percent. The projected average annual rate of growth for the U.S. economy is 4.7 percent during this period, significantly slower than for Part B and Part D. The Trustees are issuing a determination of projected excess general revenue Medicare funding in this report because the difference between Medicare’s total outlays and its dedicated financing sources6 is projected to exceed 45 percent of outlays within 7 years. Since this is the second consecutive such finding, the law specifies that a Medicare funding warning is triggered and that the President must submit to Congress proposed legislation to respond to the warning within 15 days after the submission of the Fiscal Year 2020 Budget. Congress is then required to consider the legislation on an expedited basis.

Long-Range Results

For the 75-year projection period, the HI actuarial deficit has increased to 0.82 percent of taxable payroll from 0.64 percent in last year’s report. (Under the illustrative alternative projections, the HI actuarial deficit would be 1.71 percent of taxable payroll.) The 0.18 percent of payroll increase in the actuarial deficit was primarily due to lower projected payroll tax income, higher expenditures in 2017, higher payments to Medicare Advantage plans, and legislation that increased expenditures.

Part B outlays were 1.6 percent of GDP in 2017, and the Board projects that they will grow to about 2.8 percent by 2092 under current law.
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The long-range projections as a percent of GDP are slightly higher than those in last year’s report due to recent legislation and higher Medicare Advantage spending. (Part B costs in 2092 would be 4.3 percent under the illustrative alternative scenario.)

The Board estimates that Part D outlays will increase from 0.5 percent of GDP in 2017 to about 1.2 percent by 2092. These long-range outlay projections, as a percent of GDP, are about the same as those shown in last year’s report.

Transfers from the general fund finance about three-quarters of SMI costs and are central to the automatic financial balance of the fund’s two accounts. Such transfers represent a large and growing requirement for the Federal budget. SMI general revenues equal 1.5 percent of GDP in 2017 and are projected to increase to an estimated 2.8 percent in 2092.

Conclusion

Total Medicare expenditures were $710 billion in 2017. The Board projects that expenditures will increase in future years at a faster pace than either aggregate workers’ earnings or the economy overall and that, as a percentage of GDP, they will increase from 3.7 percent in 2017 to 6.2 percent by 2092 (based on the Trustees’ intermediate set of assumptions). If the relatively low price increases for physicians and other health services under Medicare are not sustained and do not take full effect in the long range as in the illustrative alternative projection, then Medicare spending would instead represent roughly 8.9 percent of GDP in 2092. Growth under any of these scenarios, if realized, would substantially increase the strain on the nation’s workers, the economy, Medicare beneficiaries, and the Federal budget.

The Trustees project that HI tax income and other dedicated revenues will fall short of HI expenditures in all future years. The HI trust fund does not meet either the Trustees’ test of short-range financial adequacy or their test of long-range close actuarial balance.

The Part B and Part D accounts in the SMI trust fund are expected to be adequately financed because premium income and general revenue income are reset each year to cover expected costs. Such financing, however, would have to increase faster than the economy to cover expected expenditure growth.

The financial projections in this report indicate a need for substantial steps to address Medicare’s remaining financial challenges.

Consideration of further reforms should occur in the near future. The sooner solutions are enacted, the more flexible and gradual they can be. Moreover, the early introduction of reforms increases the time available for affected individuals and organizations—including health care providers, beneficiaries, and taxpayers—to adjust their expectations and behavior. The Trustees recommend that Congress and the executive branch work closely together with a sense of urgency to address the depletion of the HI trust fund and the projected growth in HI (Part A) and SMI (Parts B and D) expenditures.

illustration: Pixabay

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Medicare: Disappointment and Insolvency, Part 2

The New York Analysis of Policy and Government continues its review of the disappointment to users of Medicare, and its pending insolvency.

 Despite what many believe to be less than ideal coverage, the system itself will soon face bankruptcy. The Urban Institute  suggests inefficiency as a key reason:

“Fee for service Medicare, which enrolls some 85 percent of all participants, lacks strong incentives either for beneficiaries to seek or providers to supply only cost-effective care or, for that matter, only care that has a reasonable chance of improving health outcomes. Of course, many private sector health plans also suffer from this deficiency. Medicare, however, faces another challenge —setting its payments at the right level—that does not bedevil private plans to the same degree. The program pays for thousands of medical services delivered by hundreds of thousands of providers and suppliers operating in hundreds of separate market areas. Because it must operate throughout this very diverse nation, it is impossible to set uniform payment rates that will be efficient everywhere. Some providers are overpaid, others are undercompensated. Because the consequences of underpayment are so serious—denial of access to needed services for a vulnerable population—and because political pressures can affect payment policies, overpayments (rather than under payments) tend to be the norm. Of course, all complex systems tolerate some inefficiency because the costs of wringing out the excess exceeds the gain. But the level of inefficiency accepted in Medicare is higher than that in private sector plans because Medicare, being a government program, has objectives other than efficiency, such as ensuring that certain types of providers survive in rural areas. As reform options that promise improved efficiency are debated, it will be important to consider whether and how these other goals of the Medicare program will be met under a restructured system.”

In a 2011 National Affairs examination, Avik Roy wrote “Medicare’s woes are partly demographic. In 2030, when the last of the Baby Boomers retires, there will be 77 million people on Medicare, up from 47 million today. But there will be fewer working people funding the benefits of this much larger retiree population: In 2030, there will be 2.3 workers per retiree, compared to 3.4 today and about 4 when the program was created. But a bigger part of Medicare’s troubles is the rapid inflation of health-care costs. In 2010, the per capita cost of providing health-care services in America increased by 6.1%, according to Standard & Poor’s, while overall inflation increased by only 1.5%. Over the past decade, health-care inflation has risen 48%, while inflation in the broader economy has increased by only 26%, according to the Department of Labor…

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First, other government agencies help administer the Medicare program. The Internal Revenue Service collects the taxes that fund the program; the Social Security Administration helps collect some of the premiums paid by beneficiaries (which are deducted from Social Security checks); the Department of Health and Human Services helps to manage accounting, auditing, and fraud issues and pays for marketing costs, building costs, and more. Private insurers obviously don’t have this kind of outside or off-budget help. Medicare’s administration is also tax-exempt, whereas insurers must pay state excise taxes on the premiums they charge; the tax is counted as an administrative cost. In addition, Medicare’s massive size leads to economies of scale that private insurers could also achieve, if not exceed, were they equally large.

But most important, because Medicare patients are older, they are substantially sicker than the average insured patient — driving up the denominator of such calculations significantly. For example: If two patients cost $30 each to manage, but the first requires $100 of health expenditures and the second, much sicker patient requires $1,000, the first patient’s insurance will have an administrative-cost ratio of 30%, but the second’s will have a ratio of only 3%. This hardly means the second patient’s insurance is more efficient — administratively, the patients are identical. Instead, the more favorable figure is produced by the second patient’s more severe illness.

The Report Concludes Tomorrow

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Medicare: Disappointment and Insolvency

10,000 boomers turn 65 each and every day, meaning that they will be eligible for Medicare.  Almost all of them will be disappointed, distressed and confused about the program they have paid into throughout their entire working lives.

Making matters worse, despite what many believe to be inadequate benefits and significant costs, the Medicare system itself is going broke more rapidly than expected, according to the recently released Medicare Trustees report.

The current total Medicare tax is 2.9%, .half of which is paid for by employees, and half by employers. Spread over an average working life, this adds up to a considerable sum of money. A Forbes analysis reports that a male earning an average wage over his lifetime will have paid about $61,000 into Medicare.

It’s not inappropriate, then, that many believe that when (and if) they reach their 65th year, their medical insurance needs will be fully and simply accommodated. Unfortunately, they will face a bitter shock. There’s no free ride after turning 65. Medicare Part B monthly premiums can range from $134 to $428.60, based on income, for coverage that does not even cover many needs.  To make up the difference, seniors need to purchase private plans to fill in the gaps to cover to cover what a CNBC study estimates will be the $280,000 the average retired couple will spend on health care for the remainder of their lives.

An Urban Institute study found that “The Medicare benefit package is inadequate by the health insurance standards that prevail for the under age 65 population. It lacks coverage for most out-patient prescription drugs and imposes relatively high cost sharing requirements. It has no catastrophic cap on out-of-pocket expenditures and has very limited coverage for long-term care. The gaps in the benefit package have led the vast majority of beneficiaries—some 88 percent—to seek supplemental insurance coverage through individually purchased Medigap policies, employer-sponsored retiree policies, Medicaid, or M+C plans. This practice of dual coverage is complex, confusing, and costly. Furthermore, it is a system that is unraveling. Many employers are scaling back or dropping their retiree coverage, Medigap premiums are rising rapidly, and M+C plans are withdrawing from many markets and reducing their supplemental benefits. Any serious reform must begin by establishing a standard benefit package that the vast majority of beneficiaries consider sufficient without supplementation. Expanding the benefit package to include only prescription drug coverage will reduce, but not solve, this problem.”

The official Medicare website itself warns the approximately 48 million Americans enrolled in Medicare that “Even if Medicare covers a service or item, you generally have to pay your deductible, coinsurance, and copayments.” Some items are not covered at all, including: long-term care (also called custodial care); most dental care; eye exams related to prescribing glasses; dentures; cosmetic surgery; acupuncture; hearing aids and exams for fitting them; and routine foot care.

There can be some nasty shocks, as well, depending on how a physician describes, for example, a hospital visit.  If an inpatient stay is for “observation” as opposed to “treatment,” costs may not be covered.

To cover some of the expenses not covered by Medicare, seniors often seek private additional coverage, in the form of “supplemental” or “advantage” plans. Healthmarkets.com notes that costs for these plans can range into the high $300’s per month, although the average is considerably less.

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Part A helps pay the costs of a stay in a hospital or skilled nursing facility, home health care, hospice care, and medicines administered to inpatients.

Part B helps pay bills for physicians and outpatient services such as rehab therapy, lab tests and medical equipment. It also covers doctors’ services in the hospital and most medicines administered in a doctor’s office.

Part C is a different way you can choose to receive your Medicare benefits. It consists of a variety of private health plans, known as Medicare Advantage plans (mainly HMOs and PPOs) that cover Part A, Part B and (often) Part D services in one package.

Part D helps pay the cost of prescription drugs that you use at home, plus insulin supplies and some vaccines. To get this coverage, you must enroll in a private Part D drug plan or in a Medicare Advantage plan that includes Part D drugs.

Notice the use of the word “helps,” as opposed to “fully covers.”

The Report Continues Tomorrow.

Illustration: Pixabay

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Ignoring the Issues That Matter, Part 2

What are the most important challenges and issues facing America—and why do politicians and pundits ignore them? We  concludes our review this vital topic.

Consistently, the most important challenges facing the American people are covered inadequately  by most media sources. Yesterday, we examined inaccurate coverage of national defense. Today’s report looks at Social Security, Medicare, health care, education, and the problems facing the middle class. 

SOCIAL SECURITY AND MEDICARE. Social Security and Medicare are frequently and mistakenly called “entitlements,” lumping them in with a variety of assistance programs.  That is incorrect.  Working Americans pay for these benefits throughout their working lives, and depend on them when they reach their senior years. But all those dollars taken from paychecks are not put into an account with the workers name on them.  They are simply mingled with all other government income. And, both programs are going broke.

A Time Money report reports: “How worried should you be over Social Security’s future? According to the most recent Annual Report of the Board of the Social Security Trustees…After 2019, Treasury will start spending down the fund; its reserves are estimated to be depleted by 2035.”

Much the same can be said about Medicare. Modern Health Care reports that  “The Medicare trust fund will be insolvent by 2028, according to the 2016 Medicare trustees’ report released [in 2016].”

The fiscal health of both of those programs are vital, but far too many politicians are frightened of doing anything to remedy the problem.

MIDDLE CLASS DESPERATION. As the New York Analysis of Policy and Government recently reported, middle income Americans are losing ground. In December, 2015, Pew Social Trends reported “…middle-income Americans have fallen further behind financially in the new century. In 2014, the median income of these households was 4% less than in 2000. Moreover, because of the housing market crisis and the Great Recession of 2007-09, their median wealth (assets minus debts) fell by 28% from 2001 to 2013.” Pew Social Trends also reported that “From 2000 to 2014 the share of adults living in middle-income households fell in 203 of the 229 U.S. metropolitan areas examined in a new Pew Research Center analysis of government data. The decrease in the middle-class share was often substantial, measuring 6 percentage points or more in 53 metropolitan areas, compared with a 4-point drop nationally.”

THE HEALTH CARE CRISIS. America’s health care system was demonstrably superior to those of other nations, but it did have flaws. Obamacare, advertised as a means to address those flaws, actually made matters worse. Examples:

  1. Lost plans. Sen. Ben Sasse released a report about Obamacare’s effects on competition among insurers, concluding that outcomes have worsened for most Americans, in terms of choice of insurers and plans. Over the past year, the number of insurers offering plans in exchanges has dropped by nearly 6%.Many states have lost more than 80% of their insurers: Alabama went from 23 to 3, Arkansas went from 24 to 4, and Wyoming from 21 to 1, just to name a few. Only New York did not lose over half of its insurers, going from 28 to 15 insurers, a 46% decline.
  2. Higher premiums. A report by the Kaiser Family Foundation and the Health Research & Educational Trust found that, since 2008, average employer family premiums have climbed a total of $4,865. From 2015 to 2016 the most popular exchange family plan, Family Silver, saw a 10% average increase in its premiums. In some states, premiums rose by nearly 40%.In 2015 the average annual family premium was $17,545 per year, and the average premium for a single policy was $6,251. Young men were particularly hard-hit. Average premiums rose by 49% from 2013 to 2014, the year Obamacare was supposed to go into effect.
  3. Higher deductibles. The New York Times, long a cheerleader for Obamacare, reported that many people can’t afford to use the health insurance that they have purchased because of the deductibles .New York Times reporter Robert Pear wrote that the median deductible in Miami was $5,000 in 2015. It was $5,500 in Jackson, Miss., and $4,000 in Phoenix. One Chicago family of four paid $1,200 monthly for coverage yet had an annual deductible of $12,700.
  4. High costs. The Office of the Actuary of the Center for Medicare and Medicaid Services has projected that Obamacare will result in an additional $274 billion in administrative costs alone over the period of 2014 through 2022.

Obamacare is collapsing in a whirlpool of skyrocketing premium costs, vanishing choices, and deductibles so high as to make the coverage more an illusion than a reality.

EDUCATION. Despite spending more pupil than just about every other nation, America’s students have fallen behind their international peers. U.S. employers find that far too many are ill-prepared for the job market. Their lack of knowledge in the basics of science, math, American history and civics bode ill for the future.  The nation stands to lose much if not all of its leadership in technology, economy, and the very essence of its being within just a few short years.  Yet there is little movement to address this fundamental threat to the nations’ future.

There are solutions

None of these issues are insolvable.  In fact, some are readily correctable.

  • The nation’s electrical grid can be protected for less than $10 billion.
  • President Reagan faced a similar defense challenge when he took office. His increased spending on national defense actually discouraged America’s main adversary at the time, the Soviet Union, and commenced several decades of relative peace and prosperity between superpowers. The same can be done again.
  • The policies that have slashed middle class jobs, including favorable treatment for China, tax policies that encouraged corporations to take jobs overseas, and Obamacare policies that actually reward companies for replacing full time jobs with part-time positions are solvable through legislation.
  • Federal spending on anti-poverty programs that have failed to reduce poverty could be redirected to Social Security and Medicare.
  • The authority to determine school curriculum can be removed from the self-interested government bureaucrats, teachers’ unions, and the educational hierarchy and put back to where it belongs—in the hands of parents, organized into appropriate formats.

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Ignoring the Issues That Matter

What are the most important challenges and issues facing America—and why do politicians and pundits ignore them? The New York Analysis of Policy & Government reviews this vital topic in this two-part review.

The nation needs to distinguish between issues that count, and those of far lesser importance. Inevitably, this will produce rage in advocates of those causes deemed comparatively inconsequential.

The United States faces numerous challenges. Many of the fundamental underpinnings of America’s economy, national security, health, preparation for future generations, and even the very existence of the country’s cultural and ideological underpinnings are threatened as never before.

During recent years, The U.S. endured an armed force weakened by years of disinvestment, wishful thinking replaced blunt realism in foreign affairs, an attempt to improve the nation’s health insurance system failed, the middle class was deeply wounded, public education deteriorated, and the population became more divided than at any time since the Civil War.

Serious attempts to address any of these crises are substantially hampered by the national debt of about $20 trillion, (half of which was accumulated in just the past eight years) the influence of special interests which ignore the harm they have wrought, and a determined effort by many educational, media and political figures to, as Barack Obama promised, “fundamentally change” America.

The former president was never seriously questioned as to what he sought to change America into.  Those agreeing with his political views fail to explain how the government-dominated economic system he sought to bring about, and in the case of health care, actually did establish, would succeed in the U.S. after failing in almost every other nation in which it has been tried.  Countries as diverse as the former Soviet Union and modern-day Venezuela have tried and failed.  Some point to Europe, but the nations of that continent essentially established their government-heavy economic systems by relying on Washington to take over most of their defense spending. Even China, ostensibly a Communist regime, employs a form of capitalism, and, not incidentally, relies heavily on the American consumer to keep its economy moving.

As profound and existential threats to America remain unaddressed, much of our national conversation pretends they don’t exist and focuses instead on issues of, at best, secondary importance—or no importance at all. Much of the blame for the failure to successfully confront, or even acknowledge, the nation’s real challenges falls on the traditional media. In its fevered attempt to assist progressive candidates, America’s premiere news sources have chosen to gloss over the extraordinary problems that plague the nation.

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NATIONAL SECURITY AND FOREIGN AFFAIRS. The national discussion about foreign affairs and defense planning has borne little relation to reality, probably because the actual facts are sufficiently distressing to make pundits and politicians alike worry that an honest narrative, and an accurate description of the costs that need to be afforded to ensure America’s safety, are sufficiently unpleasant that audiences and constituents alike would turn away.

Bluntly: Russia, China, and Iran constitute a singular and unified threat against the west.  Their geographical size and population make them the largest foe the United States has ever encountered. Russia, for the first time in history, has a greater nuclear arsenal than the U.S. China will soon have a larger navy. As a unit, they are America’s equal in technology, conventional and strategic military strength, and industrial capacity.

Their belligerent goals are manifestly clear through their actions in Ukraine, the South China Sea, the Middle East, and their dramatic armaments buildup. As America slashed its defense budget, these nations hiked theirs.  Washington, over the past eight years, gave peace a chance; it didn’t work.

Rather than confront the facts and take the necessary steps to protect the nation, politicians see more benefit on spending for more popular domestic programs. Reporters and analysts allow that irresponsibility to continue, citing irrelevant statistics such as comparisons of how much larger Washington’s budget is than Moscow, China, and Tehran.  But that comparison is inaccurate. Those axis powers don’t have to worry about paying a profit to private companies to the extent the U.S. does, nor do they disclose all their spending, or include many personnel costs. Since they constitute a contiguous land mass, they also don’t have to worry about extensive lines of supply, as the Pentagon does.

A related issue:  America’s electrical grid is very vulnerable to attack by an electromagnetic pulse (EMP) that could be triggered by a single well-placed nuclear blast, (North Korea has implied its ability and willingness to do this) or even a naturally occurring solar event, such as that which occurred in the 1850’s.

The Report concludes tomorrow with a look at Social Security, Medicare, Public Education, and Healthcare.

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Obamacare’s Demise, and its Replacement

In a 51-48 vote, The Senate yesterday took an important step to replace Obamacare. The measure was a nonbinding budget bill that establishes the path for a repeal of the failing Affordable Care Act within the next few months.

U.S. Senate Majority Leader Mitch McConnell (R-KY)  stated “Too many have been personally hurt by this law. Too many feel they’re worse off than they were before Obamacare…Too many Americans say their Obamacare plans are too expensive to actually use. Too many say their Obamacare premiums have gone up and up though their options have diminished.”

While, as the 51-48 vote indicates, repeal is largely the work of the Republican majority, the reality is that Obamacare was collapsing under its own weight in what some pundits have termed a “death spiral.” Skyrocketing premiums, diminished choices, physicians opting to not take Obamacare-covered patients, a sharp decline in enrollments, and vanishing co-ops have been key indicators that its demise was inevitable.  Public support for the 2010 Affordable Care Act legislation, which was passed without the public being informed of the details (former House speaker Nancy Pelosi (D-California) famously told the public that they would have to pass the bill to see what was in it) had dropped precipitously. Subsequent to its enactment, the laws’ architect, Jonathon Gruber attributed its passage to the “stupidity” of the American people.

Young people have been forced to buy policies which included costs for services they didn’t need. Seniors have been denied necessary treatments because of expense factors. Those with irregular incomes face constant changes in coverage. Physicians are drowning in inadequate reimbursement and bureaucracy. Obamacare in general charges excessive rates and imposes deductibles that make the concept of coverage more illusion than reality.

Many of the legislation’s own advocates had seen it as only an interim step towards the implementation of completely nationalized health care under a single payer plan. But that could not be sold to an American public that was well aware that the concept has failed wherever it has been tried.  Indeed, many in the United Kingdom, whose National Health Service was, quietly, the admired model of Obamacare advocates, have sought methods to extricate themselves from their failing system.

Those advocates who have claimed that Obamacare has had some success are fudging facts. As the National Center for Policy Analysis, quoting a Heritage study  noted in 2014: “while health insurance coverage — whether in the private market or in Medicaid — grew by 8.5 million individuals in 2014, the vast majority (71 percent) of that gain was due to increases in Medicaid. According to the authors, “[T]he inescapable conclusion is that, at least when it comes to covering the uninsured, Obamacare so far is mainly a simple expansion of Medicaid.”

The need to address Obamacare has been summarized by the Heritage Foundation,  which outlined how the legislation detrimentally affects Americans:
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“Seniors: The law cuts an estimated $716 billion from Medicare over ten years. However, these “savings” are not set aside to preserve Medicare’s future, instead they are used to fund new spending created by the law. Nearly one-third of all seniors rely on Medicare Advantage, the private health care option in Medicare. Despite the program’s growing enrollment and beneficiary satisfaction, Obamacare makes deep cuts to the program that jeopardize its viability in coming years. In addition to payment cuts, Obamacare imposes new taxes on drug companies and medical device makers, and new regulations that will make health care more costly for seniors.

“Doctors: The United States is facing a severe physician shortage. By 2020, the nation will need an additional 91,500 doctors to meet medical demand. Obamacare exacerbates this problem by further increasing physicians’ workload and worsening their attitudes regarding the health care system. A 2012 survey found that Obamacare is motivating doctors to change their retirement timeline, with 43 percent of respondents stating that they are considering retiring within the next five years as a result of the law.

“Business & The Economy: The Congressional Budget Office estimates that the Obamacare subsidies will discourage Americans from working, and cause 2.5 million employees to drop out of the labor force.Obamacare’s employer mandate will raise the minimum cost of hiring a full-time worker to $10.30/hour in 2015. Congress has already raised the minimum wage from an employer’s point of view, but the money goes to the government instead of the employees.

“States: Obamacare’s Medicaid expansion worsens the already heavy burdens facing states. By 2021, approximately 78 million people are projected to be enrolled in Medicaid—requiring billions of dollars from state budgets and taxpayers. In the individual market, Obamacare’s exchanges have on average decreased insurer competition by an estimated 29 percent nationwide. Furthermore, over half of the counties in the U.S. have only one or two insurers to choose from in their Obamacare exchange.

“Families: Obamacare adds nearly $2 trillion in new health care spending according to the Congressional Budget Office. Over the next 10 years, Obamacare will levy about$771 billion in new taxes and fees. Obamacare imposes significant financial penalties on the decision to get or remain married – over $10,000 per year for certain couples.

“Uninsured: The Congressional Budget Office estimates that “between 6 and 7 million fewer people will have employment-based coverage each year from 2016 through 2024 than would be the case in the absence of [the new health law].”In 2024, after ten years of full implementation, 31 million people are projected to remain uninsured.”

The Report Concludes on Monday

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What Washington Must Do Now, Part 2

 Can the American people pull together after the bruising 2016 presidential election? There is a clear, even urgent, need to do so. The U.S. faces a number of extraordinarily troubling challenges. In Part One of our review, we discussed the nation’s faltering economy, its dramatically weakened national security, and the federal deficit.  Today, we review immigration, the plight of senior citizens, and the use of federal agencies for partisan purposes.

Immigration: The current wave of immigration is unlike any in America’s past. Far too large a percent of those arriving are doing so illegally, and soon seek public assistance, particularly straining state and local budgets.

Since so many have entered without any government oversight, the danger of re-introducing diseases long since eradicated within U.S. borders is significant.  According to the Southern Medical Association “Illegal immigration may expose Americans to diseases that have been virtually eradicated, but are highly contagious, as in the case of TB.”

The Washington Times reports: “Viruses we had finally eliminated from our lives are returning, and others we should never have to face are now crawling through our nation, targeting our children and families. In addition to the word “jihad” we now must re-introduce into our lexicon the words measles, polio, diphtheria, tuberculosis, malaria, scabies, dengue, and now ‘Zika.’ The Zika virus is emerging as a new threat, is spread by mosquito bites, but the CDC is now warning of a transmission through a blood transfusion and sexual contact. Symptoms include fever, rash, joint and muscle pain, and headache. The horror show part of this scourge is it can also apparently cause brain damage in the fetuses of pregnant women.

In 2000, the Centers for Disease Control (CDC) declared measles eradicated in the United States. But then there was suddenly a 20-year high of 600 cases in 2014, more than all reported cases between 2009 and 2013, reports Breitbart News.

“The government and media blamed a lack of vaccinations for the spread, while admitting that it was an unidentified “foreign visitor” who likely brought the virus into the country. At about the same time, in the summer of 2014, a mysterious polio-like illness began to strike children in 34 states. Over 100 children were impacted, many left permanently paralyzed. The CDC has guessed at a possible cause, but there has been no official finding as to what caused so many young people to be condemned with a virus similar to what was eradicated in the United States in 1979.

The pill has to generic professional viagra be taken only once a day. Moreover, the lack of libido condition is more common viagra shop online in men under 35, it generally tends to occur in men who are open to the idea of discussing their impotence as most men get erection many times during the intimacy. Usually, being a diabetic, one is sure to have two weeks of ready-made foods Place your mostly used items at your arm cialis online from india level at home to prevent bend down or reach up Hire a walker or a pair of crutches to walk Modifying your bathroom including raised toilet, shower chair or gripping bar Get involved in a recovery center to spend most of your. This blood moves buy cialis on line in large quantity through blood vessel to get filled all over the empty regions of penile. What was happening just prior to the spread of previously thought annihilated viruses? The massive surge of illegal immigrants, including “unaccompanied minors,” at the southern border and their transportation to the interior of the country by the federal government.

“According to a report by the House Committee on Home land security, illegal immigration is also responsible for the rise in gang activity throughout the nation.”

Senior Citizens:  The past eight years have been devastating for America’s senior citizens.  First, their medical care has been imperiled. Obamacare implements $716 billion in Medicare payments in the time span from 2013 to 2022 in reimbursement formulas for Medicare providers. Breitbart quotes Obama economic advisor Robert Reich, who explained in September 2007: “if you’re very old, we’re not going to give you all that technology and all those drugs for the last couple of years of your life to keep you maybe going for another couple of months. It’s too expensive…so we’re going to let you die… Or we could just listen to Dr. Howard Dean, the former head of the Democratic National Committee, who said in July 2013 in the pages of the Wall Street Journal that the so-called Independent Payment Advisory Board ‘is essentially a health-care rationing body. By setting doctor reimbursement rates for Medicare and determining which procedures and drugs will be covered and at what price, the IPAB will be able to stop certain treatments its members do not favor by simply setting rates to levels where no doctor or hospital will perform them.”

The travails of seniors don’t end with health issues. Over the past eight years, seniors have received less in social security cost of living increases than at any time in memory.  This was based on formulas that make little sense.  The reduction in gas prices accounted for the alleged drop in the cost of living, but food, medical care and other expenses rose, in some cases sharply.

Add to those woes actions by the Federal Reserve to mask a faltering economy by keeping interest rates low, which affected seniors trying to live off their savings.

Agency Accountability: During the past eight years, the Internal Revenue Service has been used to target political opponents of the White House; the Department of Justice has refused to prosecute clear-cut cases of election violations by pro-White House interests; and the Environmental Protection Agency has been heavily influenced by non-governmental, politically motivated sources. The list could go on, but the principle is clear: federal agencies have been abused for partisan political purposes. Safeguards are badly needed.

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Seniors Adversely Affected as Federal Funds are Diverted

America’s seniors are suffering as federal funds are diverted to questionable uses.

As America’s national debt rapidly soars to the $20 trillion mark (it currently stands at over $19 trillion) key needs are facing a lack of funds, and Americans relying on Social Security and Medicare are the most directly affected.  The problems are not just the future insolvency of those programs. The impact has already been felt.

The Social Security Administration (SSA) projects that “Social Security’s Disability Insurance (DI) Trust Fund now faces an urgent threat of reserve depletion, requiring prompt corrective action by lawmakers if sudden reductions or interruptions in benefit payments are to be avoided. Beyond DI, Social Security as a whole as well as Medicare cannot sustain projected long-run program costs under currently scheduled financing.”

Social Security will face virtual bankruptcy by 2034. Medicare will endure the same fate by 2030.

But those future dates are not the extent of the problem. During the Obama Administration, seniors have been subjected to an unprecedented lack of cost of living increases.

Since the regular program of Cost of Living increases began in 1975, (prior to that increases were provided by legislation) there has never been a period when such adjustments were lower than they have been under President Obama’s term. Not once had there been a year in which there was no increase at all. Since 2009, two consecutive years, 2009 and 2010, provided no adjustments, and there was also no adjustment in 2015.  Before 2009, the average annual increase was 4.4%; during the Obama presidency, it was 1.7%.

Social Security Cost-Of-Living Adjustments

(Chart provided by the Social Security Administration) 
Year COLA
1975 8.0
1976 6.4
1977 5.9
1978 6.5
1979 9.9
1980 14.3
1981 11.2
1982 7.4
1983 3.5
1984 3.5
1985 3.1
1986 1.3
1987 4.2
1988 4.0
1989 4.7

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Year COLA
1990 5.4
1991 3.7
1992 3.0
1993 2.6
1994 2.8
1995 2.6
1996 2.9
1997 2.1
1998 1.3
1999  a 2.5
2000 3.5
2001 2.6
2002 1.4
2003 2.1
2004 2.7
Year COLA
2005 4.1
2006 3.3
2007 2.3
2008 5.8
2009 0.0
2010 0.0
2011 3.6
2012 1.7
2013 1.5
2014 1.7
2015 0.0

It’s not just Social Security problems that are affecting America’s seniors. Medicare has taken a hit, and the problem has been accelerated and worsened due to Obamacare.  Three examples of how Obamacare hurts seniors are provided by The Daily Signal:

 1) Huge payment reductions that reduce access to care. According to the Congressional Budget Office (CBO), Obamacare will reduce Medicare reimbursements by $716 billion over 10 years. These cuts will hit Part A providers such as hospitals, nursing homes, skilled nursing facilities, and hospices, along with Medicare Advantage plans. The trustees predict that if Congress allows these cuts to go into effect, 15 percent of Medicare providers would go in the red by 2019, 25 percent by 2030, and 40 percent by 2050…

2) Medicare “savings” are spent on other parts of Obamacare. As CBO plainly states, “CBO has been asked whether the reductions in projected Part A outlays and increases in projected [hospital insurance] revenues under the legislation can provide additional resources to pay future Medicare benefits while simultaneously providing resources to pay for new programs outside of Medicare. Our answer is basically no.”

3) The ominous and looming power of IPAB.  When Medicare spending surpasses the target, IPAB will have to make recommendations to lower Medicare spending.

While America’s seniors, who have earned their Social Security and Medicare benefits through a lifetime of work, face cuts, questions arise about the diversion of federal funds to pay for benefits for illegal immigrants.

The Federation for Immigration Reform has estimated the cost of illegal immigration to U.S. taxpayers:

  • Illegal immigration costs U.S. taxpayers about $113 billion a year at the federal, state and local level. The bulk of the costs — some $84 billion — are absorbed by state and local governments.
  • The annual outlay that illegal aliens cost U.S. taxpayers is an average amount per native-headed household of $1,117. The fiscal impact per household varies considerably because the greatest share of the burden falls on state and local taxpayers whose burden depends on the size of the illegal alien population in that locality
  • Education for the children of illegal aliens constitutes the single largest cost to taxpayers, at an annual price tag of nearly $52 billion. Nearly all of those costs are absorbed by state and local governments.
  • At the federal level, about one-third of outlays are matched by tax collections from illegal aliens. At the state and local level, an average of less than 5 percent of the public costs associated with illegal immigration is recouped through taxes collected from illegal aliens.
  • Most illegal aliens do not pay income taxes. Among those who do, much of the revenues collected are refunded to the illegal aliens when they file tax returns. Many are also claiming tax credits resulting in payments from the U.S. Treasury.

The lack of priority the Obama Administration has given to the needs of seniors, while turning a blind eye towards the growing financial impact of illegal aliens, is a cause of deep concern.

(Note: We originally published this article on March 18. However, we were informed that many subscribers were not able to view it due to technical issues arising from a website update.) 

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Obamacare impact on seniors

At several campaign events, Democrat candidates have disapprovingly noted that the U.S. lags behind European and other nations in not having full government health care.

A closer examination reveals that may be a good thing. It has become a fairly common pattern for foreign leaders seeking the most advanced care to travel—sometimes secretly—to America for treatment. Forbes reports that “An estimated 40% of all medical travelers are looking for the world’s most advanced technologies…Commonly seeking cutting-edge cardiovascular, neurological or oncology treatments, the bulk of medical travelers head to U.S. medical facilities … there’s the United States’ reputation when it comes to health care…”

A study from the Batelle Technology Partnership Practice  notes that the U.S. is the world’s leader in medical innovation, although increasing taxes and regulations may affect that going forward. There are viable and very relevant questions as to whether the adoption of European style medical care would change that.

One group of Americans has a particular vulnerability to the flaws in government-administered health care: senior citizens. The United Kingdom’s National Health Service (NHS), often set up as an example for those advocating government-administered health care in the U.S., has been frequently criticized for its failure to meet the needs of older patients.

The BBC has disclosed that English and Welsh health experts are concerned that older people in need of urgent help are being failed by the NHS, and the NHS’s own studies concur.  “Too many over-65s end up in accident and emergency unnecessarily” according to the NHS Confederation’s Commission on Improving Urgent Care for Older People. The group said this was because of a “lack of help when they fell ill…The commission’s report said older people were “poorly served.”

America’s most significant step towards greater federal involvement in health care has presented significant challenges to quality health care for seniors.

In 2014, John Goodman, writing for Forbes, stressed that “One of the best kept secrets of the Affordable Care Act (ACA) is that it imposes a global budget on Medicare spending – for the first time in the program’s history. Heretofore, Medicare was a pure entitlement program. The government had to pay for whatever care the elderly and the disabled obtained. But going forward, the health reform law imposes a cap on spending.

“For most of its history, per capita Medicare spending in real terms grew at about twice the rate of growth of real per capita GDP – just like the rest of the health care system. But going forward, the law requires Medicare to grow at a rate that is not much more than the growth of GDP – regardless of what happens to other health care spending. If the historical trend continues, that means spending on health care for the elderly and the disabled will grow about half as fast as spending on everyone else’s care.”

A New York Post review of Obamacare’s effect on healthcare for seniors: “It’s skimping on it, socking seniors with unexpected bills for “observation care” and likely shortening their lives…”

Senior Living.com   notes: “The cuts to Medicare—about $700 billion between 2013 and 2022—are actually decreases in the spending rate for this program. According to the Congressional Budget Office, the cuts will be felt in hospital services, Medicare Advantage plans, skilled nursing services, home health services and others. “

Dan Weber, writing for the Washington Times, describes another attack on senior care under Obamacare:

“Medicare’s home health care services, formerly serving 3.5 million elderly beneficiaries across the country, were cut under Obamacare. The cut deleted exactly 14 percent, or an estimated $22 billion, from these lowest-income Americans over four years. …This cut does irreparable damage to recipients of Medicare’s home health care services, those who are aged, homebound and sicker than the average Medicare population. Indeed, nearly two-thirds of Medicare home health care users live at or below the federal poverty level, meaning they are the most economically compromised of America’s precious senior citizens.”

The Galen Organization summarizes the impact on Medicare:

“ObamaCare doesn’t modernize the program or improve it for seniors. ObamaCare’s solutions are detrimental to today’s seniors:

  • The law takes $716 billion out of Medicare over 10 years to help fund a huge expansion of taxpayer subsidies for health coverage.
  • It creates an unelected, unaccountable board — the Independent Payment Advisory Board — with powers to limit payment and access to health care for seniors and which will become Medicare’s rationing board. ObamaCare drives your doctors and hospitals out of Medicare
  • The law makes deep cuts in payments to physicians treating Medicare patients.
  • Cuts to Medicare providers mean it will be harder for seniors to find doctors and hospitals to treat them.
  • Doctors are already threatening to drop out of the program in large numbers if the payment cuts go into effect.
  • Medicare actuaries predict that more than 40% of Medicare providers eventually will either go out of business or stop seeing Medicare patients altogether if the law’s cuts take effect.”

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The Ryan Budget

When Ronald Reagan succeeded jimmy Carter, the phrase “paradigm shift” became ubiquitous due to the radical alteration in the federal government’s focus.

Another such paradigm shift has been proposed by Rep. Paul Ryan, to the great consternation of both Democrats and some Republicans.  Progressives dislikes the concept because it would literally be a complete change of course in almost everything the President has done during his tenure in office. Republicans fear that his blunt assessments and rigorous policies would frighten voters.

Our review of the Ryan proposal, entitled the “Path to Prosperity,”  notes that it begins where both Democrats and Republicans have lately feared to tread: the issue of national defense.  President Obama and Senate Democrats have taken the US rapidly down the road towards significant arms reduction even while China, Russia, North Korea and Iran substantially expand their military.  While Republicans have objected to the White House’s actions, they have not acted as vigorously as expected, in substantial part due to the influence of “budget hawks” who point to the overwhelming national deficit and the isolationist influence of the increasingly popular Senator Rand Paul (R-Kentucky).

In a complete reversal of that trend, the Ryan budget begins with an emphasis on “Protecting the nation…The first job of the federal government is to protect the nation from threats at home and abroad…” The proposal would halt any cuts that would impede the effectiveness of U.S. armed forces.

In direct contrast to the massive increase in entitlement spending during the Obama Administration, Ryan proposes an emphasis on job creation and a reversal of the dramatic upswing in regulations that affect both individuals and businesses.
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But neither the defense provisions nor the change in course from government growth vs. business growth may be considered the most controversial for both Democrat and Republican observers.

The proposal would, in essence, transform Medicare from an entitlement to a voucher-type system in 2024, allowing those retiring at that point an option to retain the current system or transfer to competing plans.  Even more controversial, it would gradually increase the retirement age.

It would cut $23 billion in agriculture subsidies, and transform the SNAP program (food stamps) into a block grant program.

While Ryan’s proposal can’t be faulted for its fiscal logic or its emphasis on reversing the extremely dangerous Obama defense policies, the potential “fear factor” it could generate among many voters renders it a gutsy but politically risky move.