One Great Idea After Another Coming Out Of The Trump Administration

    From Katie Tastrom writing for THINK:

In a letter to state Medicaid directors Thursday morning, the Trump administration announced that it would allow states to require Medicaid recipients to participate in a work program or other form of approved “community engagement” in order to retain their health benefits. While there will supposedly be exceptions for disabled people, allowing states to implement the work requirement is a terrible idea. As a disability lawyer and disabled person myself, I know this policy change will be disastrous for my community in a number of important ways.  

My first concern involves the eligibility process. According to the Washington Post, states will be able to decide for themselves who qualifies as “disabled” for the purpose of being exempt from the work requirement. No matter how broad they define the category, there will be disabled people who do not qualify for the exemption even though they should. ...  

While this appeals process [concerning whether the person is disabled for purposes of Medicaid] plays out, people are likely to get sicker and more disabled as they await a final decision. In the end, many people could become stuck in a grey area: too sick or disabled to work, but not sick or disabled enough to be exempt from the work requirement. ...  

The states that will end up implementing these work requirements are also the states that tend to be the poorest to begin with ...

COBRA Only Disability Claim?

     From a recent addition to Social Security's Program Operations Manual Series (POMS):

Claimants do not have to meet the non-disability requirements for Title II (e.g., insured status or an onset date more than 5 months before full retirement age (FRA)) or Title XVI (e.g., income or resources) to qualify for the additional 11 months of health care benefits under COBRA. ...

To extend health care coverage under COBRA based on disability, the individual must:

• File for disability benefits (Title II, Title XVI, or concurrent) with COBRA extension, or

• File for COBRA extension only. ...

     I've never seen any of these claims. I can't imagine many are filed.

The Time To Act Is Now

     The U.S. Senate will soon take up the Republican healthcare bill. Call it Trumpcare if you will. The current plan is that the text of the bill will only be announced next week and the Senate will vote on the bill a couple of days later. There will only be a limited debate. Senators will not have the ability to offer amendments. 

     The bill is expected to be similar to the bill passed earlier in the House of Representatives. That bill would have the effect of increasing the number of uninsured Americans by 24 million. Health care premiums would go up dramatically for those who are older or who have preexisting conditions.    







      Rumor has it that the Senate version of Trumpcare will include dramatic cuts in Medicaid. Do not think that you would be unaffected by Medicaid cuts. Medicaid pays for most long term care. Most Americans don't have the resources to pay for nursing home care for themselves or their parents. You or your elderly relatives are likely to depend upon Medicaid at some point in your life -- assuming Medicaid will still be able to pay for this coverage.

     It is not too early to start telling your Senators what you think about this bill and about the process that the Republican leadership is following. It will soon be too late.

     It is especially important to contact Republican Senators. The Republican majority in the Senate is slim. They can only afford to lose two Senators. 

     Below is contact information for all Senators, sorted by state. Call, write, fax, e-mail. Do it now while you can.

     If you are a government employee, you have every right to contact your Senator. Just don't do it from your office!

Murkowski, Lisa - (R - AK)

522 Hart Senate Office Building Washington DC 20510

(202) 224-6665

Contact: www.murkowski.senate.gov/public/index.cfm/contact

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Sullivan, Dan - (R - AK)

702 Hart Senate Office Building Washington DC 20510

(202) 224-3004

Contact: www.sullivan.senate.gov/contact/email

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Shelby, Richard C. - (R - AL)

304 Russell Senate Office Building Washington DC 20510

(202) 224-5744

Contact: www.shelby.senate.gov/public/index.cfm/emailsenatorshelby

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Strange, Luther - (R - AL)

326 Russell Senate Office Building Washington DC 20510

(202) 224-4124

Contact: www.strange.senate.gov/content/contact-senator

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Boozman, John - (R - AR)

141 Hart Senate Office Building Washington DC 20510

(202) 224-4843

Contact: www.boozman.senate.gov/public/index.cfm/contact

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Cotton, Tom - (R - AR)

124 Russell Senate Office Building Washington DC 20510

(202) 224-2353

Contact: www.cotton.senate.gov/?p=contact

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Flake, Jeff - (R - AZ)

413 Russell Senate Office Building Washington DC 20510

(202) 224-4521

Contact: www.flake.senate.gov/public/index.cfm/contact-jeff

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McCain, John - (R - AZ)

218 Russell Senate Office Building Washington DC 20510

(202) 224-2235

Contact: www.mccain.senate.gov/public/index.cfm/contact-form

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Feinstein, Dianne - (D - CA)

331 Hart Senate Office Building Washington DC 20510

(202) 224-3841

Contact: www.feinstein.senate.gov/public/index.cfm/e-mail-me

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Harris, Kamala D. - (D - CA)

112 Hart Senate Office Building Washington DC 20510

(202) 224-3553

Contact: www.harris.senate.gov/content/contact-senator

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Bennet, Michael F. - (D - CO)

261 Russell Senate Office Building Washington DC 20510

(202) 224-5852

Contact: www.bennet.senate.gov/?p=contact

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Gardner, Cory - (R - CO)

354 Russell Senate Office Building Washington DC 20510

(202) 224-5941

Contact: www.gardner.senate.gov/contact-cory/email-cory

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Blumenthal, Richard - (D - CT)

706 Hart Senate Office Building Washington DC 20510

(202) 224-2823

Contact: www.blumenthal.senate.gov/contact/

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Murphy, Christopher - (D - CT)

136 Hart Senate Office Building Washington DC 20510

(202) 224-4041

Contact: www.murphy.senate.gov/contact

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Carper, Thomas R. - (D - DE)

513 Hart Senate Office Building Washington DC 20510

(202) 224-2441

Contact: www.carper.senate.gov/public/index.cfm/email-senator-carper

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Coons, Christopher A. - (D - DE)

127A Russell Senate Office Building Washington DC 20510

(202) 224-5042

Contact: www.coons.senate.gov/contact

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Nelson, Bill - (D - FL)

716 Hart Senate Office Building Washington DC 20510

(202) 224-5274

Contact: www.billnelson.senate.gov/contact-bill

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Rubio, Marco - (R - FL)

284 Russell Senate Office Building Washington DC 20510

(202) 224-3041

Contact: www.rubio.senate.gov/public/index.cfm/contact

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Isakson, Johnny - (R - GA)

131 Russell Senate Office Building Washington DC 20510

(202) 224-3643

Contact: www.isakson.senate.gov/public/index.cfm/email-me

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Perdue, David - (R - GA)

455 Russell Senate Office Building Washington DC 20510

(202) 224-3521

Contact: www.perdue.senate.gov/connect/email

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Hirono, Mazie K. - (D - HI)

730 Hart Senate Office Building Washington DC 20510

(202) 224-6361

Contact: www.hirono.senate.gov/contact

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Schatz, Brian - (D - HI)

722 Hart Senate Office Building Washington DC 20510

(202) 224-3934

Contact: www.schatz.senate.gov/contact

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Ernst, Joni - (R - IA)

111 Russell Senate Office Building Washington DC 20510

(202) 224-3254

Contact: www.ernst.senate.gov/public/index.cfm/contact

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Grassley, Chuck - (R - IA)

135 Hart Senate Office Building Washington DC 20510

(202) 224-3744

Contact: www.grassley.senate.gov/contact

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Crapo, Mike - (R - ID)

239 Dirksen Senate Office Building Washington DC 20510

(202) 224-6142

Contact: www.crapo.senate.gov/contact

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Risch, James E. - (R - ID)

483 Russell Senate Office Building Washington DC 20510

(202) 224-2752

Contact: www.risch.senate.gov/public/index.cfm?p=Email

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Duckworth, Tammy - (D - IL)

524 Hart Senate Office Building Washington DC 20510

(202) 224-2854

Contact: www.duckworth.senate.gov/content/contact-senator

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Durbin, Richard J. - (D - IL)

711 Hart Senate Office Building Washington DC 20510

(202) 224-2152

Contact: www.durbin.senate.gov/contact/

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Donnelly, Joe - (D - IN)

720 Hart Senate Office Building Washington DC 20510

(202) 224-4814

Contact: www.donnelly.senate.gov/contact/email-joe

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Young, Todd - (R - IN)

400 Russell Senate Office Building Washington DC 20510

(202) 224-5623

Contact: www.young.senate.gov/content/contact-senator

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Moran, Jerry - (R - KS)

521 Dirksen Senate Office Building Washington DC 20510

(202) 224-6521

Contact: www.moran.senate.gov/public/index.cfm/e-mail-jerry

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Roberts, Pat - (R - KS)

109 Hart Senate Office Building Washington DC 20510

(202) 224-4774

Contact: www.roberts.senate.gov/public/?p=EmailPat

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McConnell, Mitch - (R - KY)

317 Russell Senate Office Building Washington DC 20510

(202) 224-2541

Contact: www.mcconnell.senate.gov/public/index.cfm?p=contact

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Paul, Rand - (R - KY)

167 Russell Senate Office Building Washington DC 20510

(202) 224-4343

Contact: www.paul.senate.gov/connect/email-rand

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Cassidy, Bill - (R - LA)

520 Hart Senate Office Building Washington DC 20510

(202) 224-5824

Contact: www.cassidy.senate.gov/contact

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Kennedy, John - (R - LA)

383 Russell Senate Office Building Washington DC 20510

(202) 224-4623

Contact: www.kennedy.senate.gov/content/contact-senator

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Markey, Edward J. - (D - MA)

255 Dirksen Senate Office Building Washington DC 20510

(202) 224-2742

Contact: www.markey.senate.gov/contact

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Warren, Elizabeth - (D - MA)

317 Hart Senate Office Building Washington DC 20510

(202) 224-4543

Contact: www.warren.senate.gov/?p=email_senator

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Cardin, Benjamin L. - (D - MD)

509 Hart Senate Office Building Washington DC 20510

(202) 224-4524

Contact: www.cardin.senate.gov/contact/

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Van Hollen, Chris - (D - MD)

110 Hart Senate Office Building Washington DC 20510

(202) 224-4654

Contact: www.vanhollen.senate.gov/content/contact-senator

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Collins, Susan M. - (R - ME)

413 Dirksen Senate Office Building Washington DC 20510

(202) 224-2523

Contact: www.collins.senate.gov/contact

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King, Angus S., Jr. - (I - ME)

133 Hart Senate Office Building Washington DC 20510

(202) 224-5344

Contact: www.king.senate.gov/contact

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Peters, Gary C. - (D - MI)

724 Hart Senate Office Building Washington DC 20510

(202) 224-6221

Contact: www.peters.senate.gov/contact/email-gary

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Stabenow, Debbie - (D - MI)

731 Hart Senate Office Building Washington DC 20510

(202) 224-4822

Contact: www.stabenow.senate.gov/contact

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Franken, Al - (D - MN)

309 Hart Senate Office Building Washington DC 20510

(202) 224-5641

Contact: www.franken.senate.gov/?p=contact

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Klobuchar, Amy - (D - MN)

302 Hart Senate Office Building Washington DC 20510

(202) 224-3244

Contact: www.klobuchar.senate.gov/public/index.cfm/contact

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Blunt, Roy - (R - MO)

260 Russell Senate Office Building Washington DC 20510

(202) 224-5721

Contact: www.blunt.senate.gov/public/index.cfm/contact-roy

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McCaskill, Claire - (D - MO)

503 Hart Senate Office Building Washington DC 20510

(202) 224-6154

Contact: www.mccaskill.senate.gov/contact

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Cochran, Thad - (R - MS)

113 Dirksen Senate Office Building Washington DC 20510

(202) 224-5054

Contact: www.cochran.senate.gov/public/index.cfm/email-me

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Wicker, Roger F. - (R - MS)

555 Dirksen Senate Office Building Washington DC 20510

(202) 224-6253

Contact: www.wicker.senate.gov/public/index.cfm/contact

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Daines, Steve - (R - MT)

320 Hart Senate Office Building Washington DC 20510

(202) 224-2651

Contact: www.daines.senate.gov/connect/email-steve

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Tester, Jon - (D - MT)

311 Hart Senate Office Building Washington DC 20510

(202) 224-2644

Contact: www.tester.senate.gov/?p=email_senator

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Burr, Richard - (R - NC)

217 Russell Senate Office Building Washington DC 20510

(202) 224-3154

Contact: www.burr.senate.gov/contact/email

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Tillis, Thom - (R - NC)

185 Dirksen Senate Office Building Washington DC 20510

(202) 224-6342

Contact: www.tillis.senate.gov/public/index.cfm/email-me

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Heitkamp, Heidi - (D - ND)

516 Hart Senate Office Building Washington DC 20510

(202) 224-2043

Contact: www.heitkamp.senate.gov/public/index.cfm/contact

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Hoeven, John - (R - ND)

338 Russell Senate Office Building Washington DC 20510

(202) 224-2551

Contact: www.hoeven.senate.gov/public/index.cfm/email-the-senator

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Fischer, Deb - (R - NE)

454 Russell Senate Office Building Washington DC 20510

(202) 224-6551

Contact: www.fischer.senate.gov/public/index.cfm/contact

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Sasse, Ben - (R - NE)

136 Russell Senate Office Building Washington DC 20510

(202) 224-4224

Contact: www.sasse.senate.gov/public/index.cfm/email-ben

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Hassan, Margaret Wood - (D - NH)

330 Hart Senate Office Building Washington DC 20510

(202) 224-3324

Contact: www.hassan.senate.gov/content/contact-senator

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Shaheen, Jeanne - (D - NH)

506 Hart Senate Office Building Washington DC 20510

(202) 224-2841

Contact: www.shaheen.senate.gov/contact/contact-jeanne

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Booker, Cory A. - (D - NJ)

359 Dirksen Senate Office Building Washington DC 20510

(202) 224-3224

Contact: www.booker.senate.gov/?p=contact

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Menendez, Robert - (D - NJ)

528 Hart Senate Office Building Washington DC 20510

(202) 224-4744

Contact: www.menendez.senate.gov/contact

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Heinrich, Martin - (D - NM)

303 Hart Senate Office Building Washington DC 20510

(202) 224-5521

Contact: www.heinrich.senate.gov/contact

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Udall, Tom - (D - NM)

531 Hart Senate Office Building Washington DC 20510

(202) 224-6621

Contact: www.tomudall.senate.gov/?p=contact

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Cortez Masto, Catherine - (D - NV)

204 Russell Senate Office Building Washington DC 20510

(202) 224-3542

Contact: www.cortezmasto.senate.gov/content/contact-senator

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Heller, Dean - (R - NV)

324 Hart Senate Office Building Washington DC 20510

(202) 224-6244

Contact: www.heller.senate.gov/public/index.cfm/contact-form

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Gillibrand, Kirsten E. - (D - NY)

478 Russell Senate Office Building Washington DC 20510

(202) 224-4451

Contact: www.gillibrand.senate.gov/contact/

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Schumer, Charles E. - (D - NY)

322 Hart Senate Office Building Washington DC 20510

(202) 224-6542

Contact: www.schumer.senate.gov/contact/email-chuck

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Brown, Sherrod - (D - OH)

713 Hart Senate Office Building Washington DC 20510

(202) 224-2315

Contact: www.brown.senate.gov/contact/

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Portman, Rob - (R - OH)

448 Russell Senate Office Building Washington DC 20510

(202) 224-3353

Contact: www.portman.senate.gov/public/index.cfm/contact?p=contact...

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Inhofe, James M. - (R - OK)

205 Russell Senate Office Building Washington DC 20510

(202) 224-4721

Contact: www.inhofe.senate.gov/contact

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Lankford, James - (R - OK)

316 Hart Senate Office Building Washington DC 20510

(202) 224-5754

Contact: www.lankford.senate.gov/contact/email

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Merkley, Jeff - (D - OR)

313 Hart Senate Office Building Washington DC 20510

(202) 224-3753

Contact: www.merkley.senate.gov/contact/

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Wyden, Ron - (D - OR)

221 Dirksen Senate Office Building Washington DC 20510

(202) 224-5244

Contact: www.wyden.senate.gov/contact/

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Casey, Robert P., Jr. - (D - PA)

393 Russell Senate Office Building Washington DC 20510

(202) 224-6324

Contact: www.casey.senate.gov/contact/

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Toomey, Patrick J. - (R - PA)

248 Russell Senate Office Building Washington DC 20510

(202) 224-4254

Contact: www.toomey.senate.gov/?p=contact

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Reed, Jack - (D - RI)

728 Hart Senate Office Building Washington DC 20510

(202) 224-4642

Contact: www.reed.senate.gov/contact/

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Whitehouse, Sheldon - (D - RI)

530 Hart Senate Office Building Washington DC 20510

(202) 224-2921

Contact: www.whitehouse.senate.gov/contact/email-sheldon

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Graham, Lindsey - (R - SC)

290 Russell Senate Office Building Washington DC 20510

(202) 224-5972

Contact: www.lgraham.senate.gov/public/index.cfm/e-mail-senator-gr...

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Scott, Tim - (R - SC)

717 Hart Senate Office Building Washington DC 20510

(202) 224-6121

Contact: www.scott.senate.gov/contact/email-me

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Rounds, Mike - (R - SD)

502 Hart Senate Office Building Washington DC 20510

(202) 224-5842

Contact: www.rounds.senate.gov/contact/email-mike

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Thune, John - (R - SD)

511 Dirksen Senate Office Building Washington DC 20510

(202) 224-2321

Contact: www.thune.senate.gov/public/index.cfm/contact

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Alexander, Lamar - (R - TN)

455 Dirksen Senate Office Building Washington DC 20510

(202) 224-4944

Contact: www.alexander.senate.gov/public/index.cfm?p=Email

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Corker, Bob - (R - TN)

425 Dirksen Senate Office Building Washington DC 20510

(202) 224-3344

Contact: www.corker.senate.gov/public/index.cfm/emailme

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Cornyn, John - (R - TX)

517 Hart Senate Office Building Washington DC 20510

(202) 224-2934

Contact: www.cornyn.senate.gov/contact

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Cruz, Ted - (R - TX)

404 Russell Senate Office Building Washington DC 20510

(202) 224-5922

Contact: www.cruz.senate.gov/?p=email_senator

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Hatch, Orrin G. - (R - UT)

104 Hart Senate Office Building Washington DC 20510

(202) 224-5251

Contact: www.hatch.senate.gov/public/index.cfm/contact?p=Email-Orrin

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Lee, Mike - (R - UT)

361A Russell Senate Office Building Washington DC 20510

(202) 224-5444

Contact: www.lee.senate.gov/public/index.cfm/contact

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Kaine, Tim - (D - VA)

231 Russell Senate Office Building Washington DC 20510

(202) 224-4024

Contact: www.kaine.senate.gov/contact

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Warner, Mark R. - (D - VA)

703 Hart Senate Office Building Washington DC 20510

(202) 224-2023

Contact: www.warner.senate.gov/public/index.cfm?p=Contact

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Leahy, Patrick J. - (D - VT)

437 Russell Senate Office Building Washington DC 20510

(202) 224-4242

Contact: www.leahy.senate.gov/contact/

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Sanders, Bernard - (I - VT)

332 Dirksen Senate Office Building Washington DC 20510

(202) 224-5141

Contact: www.sanders.senate.gov/contact/

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Cantwell, Maria - (D - WA)

511 Hart Senate Office Building Washington DC 20510

(202) 224-3441

Contact: www.cantwell.senate.gov/public/index.cfm/email-maria

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Murray, Patty - (D - WA)

154 Russell Senate Office Building Washington DC 20510

(202) 224-2621

Contact: www.murray.senate.gov/public/index.cfm/contactme

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Baldwin, Tammy - (D - WI)

709 Hart Senate Office Building Washington DC 20510

(202) 224-5653

Contact: www.baldwin.senate.gov/feedback

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Johnson, Ron - (R - WI)

328 Hart Senate Office Building Washington DC 20510

(202) 224-5323

Contact: www.ronjohnson.senate.gov/public/index.cfm/email-the-sena...

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Capito, Shelley Moore - (R - WV)

172 Russell Senate Office Building Washington DC 20510

(202) 224-6472

Contact: www.capito.senate.gov/contact/contact-shelley

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Manchin, Joe, III - (D - WV)

306 Hart Senate Office Building Washington DC 20510

(202) 224-3954

Contact: www.manchin.senate.gov/public/index.cfm/contact-form

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Barrasso, John - (R - WY)

307 Dirksen Senate Office Building Washington DC 20510

(202) 224-6441

Contact: www.barrasso.senate.gov/public/index.cfm/contact-form

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Enzi, Michael B. - (R - WY)

379A Russell Senate Office Building Washington DC 20510

(202) 224-3424

Contact: www.enzi.senate.gov/public/index.cfm/contact?p=e-mail-sen...

I Knew There Was Something Good About Trumpcare!

     Matt Fuller noticed something interesting hidden in the Congressional Budget Office (CBO) projection of the effects of the Republican plan for replacing the Affordable Care Act. The CBO is projecting that Social Security expenditures over the time period 2017-2026 would decrease by $3 billion under the GOP plan. The explanation is that more people will die under the Republican plan, about 17,000 in 2018 rising to 29,000 in 2026 alone. People can't draw Social Security benefits if they're dead.

Astrue Not A Fan Of Obamacare

     I was wondering what Michael Astrue, the most recent Commissioner of Social Security, was up to. I found an opinion piece that he had done in May for The Weekly Standard, a right wing publication, on the implementation of the Affordable Care Act, which he and many others call Obamacare. I won't bore you with the details of Astrue's piece. I'll just list a few of the words he used and you can infer the rest:

• Self-preservation
• Waste
• Fraud
• Abuse
• Criminal
• Wreckage
• Massive
• Failure
• Mislead
• Stonewall
• Failures
• Reckless

     Astrue was a Massachusetts resident at the time that state implemented a health care plan devised by its Republican governor, Mitt Romney. Astrue was active in Massachusetts politics at the time. I can't find any record of him publicly criticizing Romney's plan. The Affordable Care Act was modeled after Romney's plan. It's no exaggeration to say that Obamacare is Romneycare writ large. If you hate the Affordable Care Act, you should have hated Romney's healthcare plan too.

Obamacare May Be Reducing Number Of Disability Claims In Arkansas

     From Modern Healthcare:

The number of Arkansas residents signing up for federal disability benefits has dropped 19% since October 2013, which some state officials are attributing to expanded Medicaid eligibility....

Arkansas is providing subsidies to individuals with incomes up to 138% of the federal poverty threshold to purchase private health plans through the exchange, a model of expansion that several other Republican-controlled states are following. More than 190,000 Arkansas residents qualified for the expanded coverage through the end of July.  

State Sen. Jonathan Dismang, a Republican who was one of the architects of the “private option” plan, said that he and his colleagues had hoped that expanding Medicaid would reduce the disability rolls. “It's too early to say with any certainty that that's the case,” Dismang said. “I think that there's an indication that there has been an impact.”

A Poll

Free Web poll for your Web site - freepolls.com

Health Care Exchange Widget Added To Blog

     I have added a Health Exchange widget on the right side of the page. This allows readers to get information from the Department of Health and Human Services on the Health Care Exchanges set to begin operation on October 1, 2013. There is massive confusion across the country about the Health Care Exchanges. Most of this is due to the fact that it's all new. Some of it is due to deliberate lies told by those who oppose the Health Care Exchanges. On the whole, apart from the deliberate lies, I'd compare this to the implementation of the Medicare Prescription Drug benefit. The Prescription Drug benefit, although less important, was at least as complex to implement as the Health Care Exchanges. Things settled down fairly quickly on the Medicare Prescription Drug benefit. I've seen new government programs implemented over the decades. There will be the inevitable glitches but I expect things will settle down fairly quickly with the Health Care Exchanges. Despite what you've heard, it's not all that complicated and the Obama Administration has been working hard to achieve a smooth implementation.

     By the way, if you get your health care insurance through your employer or a family member's employer, just ignore the Health Care Exchanges. You don't need to sign up. In fact, you can't sign up if you have employer based health care insurance. I expect that nearly 100% of the people who are scared about "Obamacare" won't notice anything different once "Obamacare" is fully implemented.

Error In Blast E-Mail From SSA

     I received this e-mail from Social Security today, probably because I have set up a MySSA account:

Affordable Health Care

Need health insurance or know someone who does?  Thanks to the Affordable Care Act, more Americans now qualify to get coverage that fits their needs and budgets.  Visit the Health Insurance Marketplace at www.HealthCare.gov or call 1-800-318-2596 to get more information.  If you are deaf or hard of hearing, you may call 1-855-889-4325.

 

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Questions for SSA? Contact Us

     What you see if you try to go to the HealthCare.gov link is not HealthCare.gov but a Social Security website asking that you enter the "Word of the Day." I think somebody made a mistake. I wonder how many people got this e-mail with a bad link.

     Update: They're resent the e-mail with the correct link.

Obamacare Constitutional

     Those who predicted that the Supreme Court would hold the Affordable Care Act (AKA Obamacare) constitutional have been proved correct. This dramatic expansion of health care coverage -- most of it coming in about two years -- will be of dramatic benefit to Social Security disability claimants.

     Update: Because of Chief Justice Roberts' opinion, it may be possible for states to opt out of providing the additional Medicaid coverage to millions of people provided for in the Affordable Care Act. Would they? My guess is that after sober reflection Republican governors and legislators will decide not to opt out since opting out would cause states to lose billions of dollars of health care funding. I think that doctors and hospitals will lobby hard for states to accept the additional Medicaid coverage. We'll see.
     Better medical care cuts both ways for the Social Security disability programs. People who receive adequate medical care are less likely to become disabled. Those who are disabled despite adequate medical care will have better proof of their disability.

Lack Of Health Care Access A Big Problem For Disability Claimants

     From Improving Access: Expanding Acceptable Medical Sources for the Social Security Administration Disability Determination Process, a report by the National Law Center on Homelessness and Poverty:

Currently, the process for obtaining SSI [Supplemental Security Income] and SSDI [Social Security Disability Insurance] can be cumbersome and, too often, there are unnecessary delays. Allowing nurse practitioners, physician assistants, and licensed clinical social workers to provide diagnostic evidence of certain medical conditions would streamline the process for obtaining benefits, ensuring that eligible individuals gain access to these critical benefits in a timely manner.

For individuals who are homeless, such expansion would have an especially meaningful impact. Currently, many people who are homeless and who are generally uninsured have great difficulty accessing assessment, treatment, and care from physicians and, for mental health problems, psychologists and psychiatrists. Programs and services dedicated to serving homeless people are increasingly overwhelmed by the tremendous need for treatment and services, and many programs cannot meet this rising demand.

     This will only get poor people so far. There's no way you can get around it. Decision-makers aren't going to give as much weight to CNAs, PAs and LCSWs as to MDs.
     I represent a fair number of homeless people. Lack of access to medical care is a huge problem for this population. So many of these people would get on disability benefits quickly if they just had medical insurance. I expect that a lot of people who work at Social Security would agree. Obamacare should do that before long if the Supreme Court doesn't get in the way.

Health Care Coverage Goes Down; Psychiatric Disability Goes Up

     From a press release issued by the Johns Hopkins School of Public Health:

The prevalence of self-reported mental health disabilities increased in the U.S. among non-elderly adults during the last decade, according to a study by Ramin Mojtabai, MD, PhD, of the Johns Hopkins Bloomberg School of Public Health. At the same time, the study found the prevalence of disability attributed to other chronic conditions decreased, while the prevalence of significant mental distress remained unchanged. The findings will appear in the November edition of the American Journal of Public Health.

For the study, Mojtabai reviewed data from the U.S. National Health Interview Survey covering 312,364 adults ages 18 to 64 years. He found that the prevalence of self-reported mental health disability increased from 2.0 percent of the non-elderly adult population from 1997 to 1999 to 2.7 percent from 2007 to 2009. According to Mojtabai, the increase equates to nearly 2 million disabled adults. He also noted the increase in the prevalence of mental health disability was mainly among individuals with significant psychological distress who did not use mental health services in the past year. Findings showed that 3.2 percent of participants reported not receiving mental health care for financial reasons between 2007 and 2009, compared to 2.0 percent from 1997 to 1999.

     Beginning in 2014 when the Affordable Care Act fully kicks in, if the Supreme Court does not strike it down and if Republicans cannot find a way to kill it, almost all Americans will have health care coverage and this rate of psychiatric disability should decrease. If you are concerned about the number of people going on Social Security disability, you ought to be concerned about the state of health care in this country because they are directly related.

Health Care Reform Helping Social Security Trust Funds?

Bruce Webb at the Angry Bear blog makes an interesting observation about the annual report of Social Security's trustees issued yesterday:

The 2009 Social Security Report projected a 75 year actuarial gap for combined OASDI [Old Age Survivors and Disability Insurance trust funds] of 2.00%. ... I fully expected this gap to edge up. Instead it was revised down to 1.92% putting it back to where it was in 2001. Why the change? ...

The OACT [Office of Chief Actuary, Social Security] calculates that HCR [Health Care Reform] will result in dollars being shifted from employer paid health insurance to wages after the Exchanges et al are fully in operation. This seems to rest on an argument from economic theory that has employers setting total compensation at some rate established by the underlying fundamentals and then backing out health care costs from that, with the idea that savings in the latter simply means more of the total flowing to wages.

Left Out Of Health Care Reform

From The Oregonian:

Sue Sherman of Southwest Portland lived a peaceful, healthy life until she was dealt an ugly card last year: a diagnosis of pancreatic cancer. ...

She joined nearly 2 million disabled Americans -- at least 15,000 in Oregon -- who fall into a twilight with the first monthly Social Security disability payment, for they then must wait two years to become eligible for Medicare. ...

This year, nearly 8 million Americans are receiving Social Security disability income. About a quarter, 1.8 million, are in the 24-month waiting period. ...

[T]he Congressional Budget Office, which estimates the cost of legislation to the taxpayer, calculated that eliminating the wait would cost an average of $10 billion a year over 10 years. ...

A private 2003 study found that nearly 25 percent of the disabled in the waiting period go the two years without any insurance.

It Figures

From the Washington Post (emphasis added):

The call to arms was issued at 5:55 a.m. last Friday.

"To all modern Sons of Liberty: THIS is your time. Break their windows. Break them NOW."

These were the words of Mike Vanderboegh, a 57-year-old former militiaman from Alabama, who took to his blog urging people who opposed the historic health-care reform legislation -- he calls it "Nancy Pelosi's Intolerable Act" -- to throw bricks through the windows of Democratic offices nationwide.

"So, if you wish to send a message that Pelosi and her party [that they] cannot fail to hear, break their windows," Vanderboegh wrote on the blog, Sipsey Street Irregulars. "Break them NOW. Break them and run to break again. Break them under cover of night. Break them in broad daylight. Break them and await arrest in willful, principled civil disobedience. Break them with rocks. Break them with slingshots. Break them with baseball bats. But BREAK THEM." ...

Vanderboegh was unapologetic in a 45-minute telephone interview with The Washington Post early Thursday. He said he believes throwing bricks through windows sends a warning to Democratic lawmakers that the health-care reform legislation they passed Sunday has caused so much unrest that it could result in a civil war.

"The federal government should not have the ability to command us to buy something that it decides we should buy," Vanderboegh said. The government, he added, has "absolutely no idea the number of alienated who feel that their backs are to the wall are out here . . . who are not only willing to resist this law to the very end of their lives, but are armed and are capable of making such resistance possible and perhaps even initiating a civil war."...

Vanderboegh said he once worked as a warehouse manager but now lives on government disability checks. He said he receives $1,300 a month because of his congestive heart failure, diabetes and hypertension.

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Health Care Reform Matters Now

A couple of items from House Speaker Nancy Pelosi's blog on the immediate effects of the health care bill that was just signed into law:

IF YOU ARE A SMALL BUSINESSES OWNER:

SMALL BUSINESS TAX CREDITS—Offers tax credits to small businesses to make employee coverage more affordable. Tax credits of up to 35 percent of premiums will be immediately available. Effective beginning for calendar year 2010. (Beginning in 2014, small business tax credits will cover 50 percent of premiums.)
...

COMMUNITY HEALTH CENTERS—Increases funding for Community Health Centers to allow for nearly doubling the number of patients served over the next 5 years. Effective beginning in fiscal year 2010.

The first one matters a lot to those of us who represent claimants. The second is important to everyone. Inadequate medical care is a huge problem for Social Security disability claimants. Often, Social Security disability claimants' health suffer as a result of inadequate medical care. The lack of decent medical records also makes it more difficult for claimants to win their Social Security disability cases.

The 24 Month Medicare Gap

From the Associated Press:

Disabled by chronic back pain and unable to afford medical insurance, Lea Walker hoped President Barack Obama's health care overhaul would close a coverage gap that has trapped her and millions of other workers.

It won't.

Although disabled workers can expect improvements, the legislation moving toward final passage in Congress doesn't deliver the clean fix that advocates for people with serious medical conditions hoped for. Some of the neediest could find themselves still in limbo. ...

She started receiving monthly disability checks from Social Security, but found she would face a 24-month wait for Medicare. Insurance available through her husband's job was out of reach at $800 a month.

At any given time, an estimated 1.8 million disabled workers languish in the Medicare coverage gap, a cost saver instituted nearly 40 years ago. Many, like Walker, are uninsured. Lawmakers had hoped to eliminate the gap as part of health care overhaul, but concluded it would be too expensive. ...

"I think everyone needs to realize this is going to be a first, very major step toward health care reform and then there will be a need to come back in the next several years and make midcourse adjustments," said Sen. Jeff Bingaman, D-N.M., who pushed unsuccessfully to phase out the waiting period.

While I wish that Congress would deal fully with the problem now, this article makes the problem out to be worse than it is. Many, perhaps most, of the people in the 24 month waiting period will be eligible for Medicaid under the health care reform bills pending in Congress. Because Medicare lacks an adequate prescription drug benefit, Medicaid may be better for low income families anyway. These bills would also give Medicaid coverage to many of those who are stuck in the lengthy process of appealing Social Security disability denials.

By the way, I will make a prediction now. If some combination of the plans pending in Congress come into effect, a higher percentage of Social Security disability claims will be approved because of better documentation of illness. I think we can also hope that eventually the rate of disability in this country will decrease because of better access to medical care.

Health Care Reform And Medicare

The Coalition to End the Two-Year Wait for Medicare has sent a letter to the Speaker of the House of Representatives and the Senate Majority Leader giving their views on the pending health care reform legislation. The two year wait that the Coalition's name refers to is the waiting period for Medicare after a person becomes eligible for disability benefits under Title II of the Social Security Act. The waiting period is actually two and a half years since it is on top of a five month waiting period before cash benefits begin that is usually six months because it is five full calendar months.

The letter is a good summary of the possible effects of the bills going into conference between the House and the Senate. Eliminating the two year waiting period is out of the question at the moment. The main issue is how many of these people will qualify for Medicaid. Here is an excerpt from the letter:

While both bills have a Medicaid expansion as an essential element in providing coverage to the uninsured, the House bill extends eligibility to people not eligible for Medicare with incomes up to 150 percent of the federal poverty level. The Senate bill’s ceiling on eligibility is set at 133 percent of the federal poverty level. Expanding eligibility for Medicaid will provide people with disabilities living near the poverty level access to comprehensive health coverage with limited cost sharing. Compared to providing coverage through an exchange, expanding Medicaid is both cost-effective and provides a level of benefits that helps eliminate cost as a barrier to care. We urge you to adopt the House bill’s directive to set eligibility for Medicaid at 150 percent of the federal poverty level.

The House and Senate bills also differ considerably in the help they provide with premiums and cost-sharing for individuals with limited incomes but above the Medicaid eligibility threshold. For example, under the Senate bill, individuals at 200 percent of the federal poverty level pay a higher share of income in premiums for plans that pay a smaller percentage of health care costs (lower actuarial value) than under the House bill. As a result, people with disabilities and limited incomes could face a combination of high premiums and large deductibles that make cost, even under the new coverage options available through the exchange, a continuing barrier to care. The Senate bill does provide valuable protections worth maintaining in the final bill, including overall caps on out-of-pocket spending and more generous premium subsidies for individuals between 250 percent and 400 percent of the federal poverty level. However, it is essential that the final bill provide affordable coverage to people with disabilities on limited incomes. We urge you to adopt the actuarial values for exchange plans and the premium subsidies for people with limited incomes from the House bill.

Social Security Owes $160 Million To Massachusetts?

From the Boston Herald:

Massachusetts is owed $160 million from the federal government for a little-known Social Security policy that’s been erroneously overlooked for 35 years, according to Gov. Deval Patrick’s top health and human services adviser.

At issue is the way the Social Security Administration handles disability claims. Health and Human Services Secretary Bigby said the federal agency often declines applications for disability payouts on an applicant’s first attempt. However, if an applicant appeals the rejection, the state then covers health care costs for that person until the matter is resolved. If the applicant is ultimately approved, the SSA is supposed to reimburse the state for that interim coverage.

“We’re one of the first states that brought it to their attention,” Bigby said in a phone interview. “We are pushing for a mechanism to get that money back to the state.”

Noting the SSA has acknowledged the error, Bigby said U.S. Sen. Jay Rockefeller, Democrat of West Virginia, attempted to get a provision into the Senate’s national health reform bill that would reimburse Massachusetts and 30 other states.

“That measure was not accepted,” she said. “We just need the SSA to develop a methodology to pay us.”