Senate Majority Leader Mitch McConnell in Washington, D.C., on June 6. Photo by Aaron P. Bernstein/Reuters

Reform movement decries Senate Republicans’ health care bill


The Reform movement sharply criticized a Republican bill in the Senate that would repeal and replace major parts of the Affordable Care Act and make severe cuts to Medicaid.

On Thursday, Senate Republicans revealed a draft of a measure that would get rid of the legal requirement that most Americans have health coverage and offer federal tax credits to aid Americans in paying for health insurance.

The Reform movement called the proposed measure “deeply harmful.”

“The Senate bill revealed this morning is a major undermining of American health care that will hurt Americans most in need: the elderly, the poor, children and people with disabilities,” Barbara Weinstein, director of the Commission on Social Action of Reform Judaism, said in a statement on behalf of the Reform movement. “Jewish tradition’s emphasis on caring for the sick and lifting up those in need inspires us to call on Senators to reject the Better Care Reconciliation Act of 2017.”

Weinstein alluded to the Jewish prayer for healing in her statement.

“In the Jewish ‘Mi Sheberach’ prayer for the ill, we ask for the Holy One to be filled with compassion for the sick and to swiftly provide a complete renewal of body and spirit. As we pray for all those in need of healing, let us also act with compassion and wisdom,” she said. “We call on Senators to reject this deeply harmful legislation and work instead to expand access to affordable health care for all.”

Bend the Arc: Jewish Action also decried the measure.

“We must call the Senate’s ACA repeal bill exactly what it is: a moral travesty — a tax cut for the rich financed on the backs of the most vulnerable members of our society,”  the group’s CEO, Stosh Cotler, said in a statement. “This legislation will result in millions of Americans losing their health care.”

In May, the House of Representatives passed a similar bill backed by Republicans and President Donald Trump. Jewish groups, including the Reform movement, the Jewish Federations of North America, B’nai B’rith International, the National Jewish Democratic Council, the National Council of Jewish Women and Jewish Women International denounced that measure, while the Republican Jewish Coalition praised it.

President Donald Trump, middle, gathers with Vice President Mike Pence, right, and Congressional Republicans at the White House on May 4. Photo by Carlos Barria/Reuters

The stigma of the unworthy unhealthy


There was something sublimely degrading about the beer bash President Donald Trump threw May 4 for House Republicans who passed his health care bill by the narrowest of partisan margins.

Start with the host, who will say or do anything. By now it’s apparent that the president is untethered to reality. If he were to be impeached, a compassionate chief justice might declare him incompetent to stand trial because he lacks the mental capacity to be responsible for his words or acts. But the Republicans who sniffed his musk last week aren’t blissed by the clueless stupor his narcissism affords him. They’re fearful of their constituents. No wonder that, of the 217 congress members who voted his way, only two — one in Idaho, one in upstate New York — held district town halls this past weekend. They did not go at all well. When the rest of the cowering Republican conference is forced to face their voters, it will be similarly ugly.

They must be baffled by how devoid of mojo their old battle cries have become. “Jobs-killing Obamacare” packs no punch in an economy that’s added more than 10 million jobs since the Affordable Care Act passed. “Disaster” and “death spiral” sound demented to someone who’s gone from no insurance to comprehensive coverage. “Higher premiums, higher deductibles, higher co-pays” may in some cases be accurate, but for Americans long suffering from rising prices, the real news is the slowing of the rate of increase.

Republican capitulation to the Freedom Caucus’ demand to torpedo Obamacare’s coverage of pre-existing conditions has prompted hundreds of heartbreaking — and televised — stories of congenital defects, deadly tumors, chronic ailments, addictions and mental illnesses, whose long-term treatment was until recently made affordable by irrevocable insurance, but which now is slated for sacrifice in exchange for a trillion-dollar cut to Medicaid and a humongous tax cut for the wealthiest. Not only will those stories, juxtaposed with Rose Garden revelry, make for mercilessly effective ads in the coming midterm campaign; they also sound the death knell for the most toxic trope in the Republican rhetorical armory: the stigma of the unworthy unhealthy.

The label descends from the widespread distinction, as recent as a century ago, between the worthy and the unworthy poor. The worthy poor — widows, orphans, the blind — were indigent through no fault of their own, victims of random misfortune, life’s vicissitudes, circumstances beyond their control. But the unworthy poor were the cause of their own impoverishment. Lazy, morally weak, addled by drink, gamblers: They had only themselves to blame. The worthy poor deserved charity; the unworthy, a kick in the pants.

The Depression altered the presumption that bootstrapping is the royal road to success. If there aren’t any jobs, it doesn’t matter how much moxie you have. From our common catastrophe came a new compact. Every person is worthy of basic human decency, a safety net to catch us, a freedom from want we pledge to one another. To secure it? Not the market, not inheritance, not the luck of our genes — the government. And so from Social Security to Medicare, unemployment insurance to food stamps, we committed public resources to promote the public good.

Universal health care was always the outlier in America — not just the notion that government should provide it, but the idea that it’s an inalienable right. You could see that wariness, stoked by decades of propaganda, in a Wall Street Journal-Harris poll two years before Obama was elected. Asked whether unhealthy people should pay more for insurance, a majority of Americans – 53 percent – said yes. You can hear that same animus today in Alabama Republican Rep. Mo Brooks’ defense of Trumpcare: “It will allow insurance companies to require people who have higher health costs to contribute more to the insurance pool that helps offset all these costs, thereby reducing the cost to those people who lead good lives. They’re healthy, they’ve done the things to keep their bodies healthy, and right now, those are the people who have done the things the right way that are seeing their costs skyrocketing.”

“Moral hazard” is how economists describe the ability to evade the bad consequences of risky decisions. The Wall Street bailout, which prevented a global meltdown, absolved the banks of having hell to pay. I get why House Republicans almost sank it; it maddened me, too. To them, the ACA’s passage two years later reprised that escape from accountability. It didn’t penalize people enough for being addicted to nicotine, for consuming the sugar and fat marketed to them, for escaping a stressful day with a sedentary night.

The ACA has helped millions of Americans with illnesses unrelated to personal decisions get access to health care. At the same time, it established a no-fault policy for having made choices that are bad for you. Under current law, your right to treatment doesn’t depend on how or why you became dependent on opioids or alcohol, or whether your high blood pressure or cholesterol might have been prevented by behavior change. All that counts is that you’re seeking a path to health. We don’t punish the sick for being unhealthy; life has done that enough. There are not the worthy unhealthy and the unworthy unhealthy. All there is is us.


Marty Kaplan is the Norman Lear professor at the USC Annenberg School for Communication and Journalism. Reach him at martyk@jewishjournal.com.

U.S. House Majority Leader Kevin McCarthy, House Speaker Paul Ryan, and Representative Greg Walden hold a news conference on the American Health Care Act. March 7. Photo by Eric Thayer/REUTERS.

Jewish elderly advocates take aim at GOP’s proposed changes to health care


Two Jewish agencies charged with elderly care sharply criticized the new Republican health care bill.

B’nai B’rith International, which sponsors low-income housing for the elderly, and the Jewish Federations of North America, which advocates for funds for the poor and the elderly, took aim changes contained in the American Health Care Act, the bill Republican leaders hope to pass as a replacement for the Affordable Care Act, known as Obamacare.

“Congress and the Trump Administration appear to be moving quickly to pass potentially devastating cuts to Medicaid,” JFNA said in an action alert sent this week to its constituent groups, urging them to lobby Congress against the cuts.

The organization said the cuts “would greatly impact Jewish federation partner agencies that provide health, long-term care and home and community-based care,” noting that federation partner agencies get about $6 billion from Medicaid each year.

Medicaid is the government program that supports health care for the poor. The bill proposes to cap Medicaid funding to each state according to the number of eligible participants at the beginning of the fiscal year. B’nai B’rith and JFNA said such caps would not take into account changes in enrollment numbers and other unexpected health care cost increases.

“Changing any portion of the Medicaid funding to a per capita cap proposal would have a significant negative impact on seniors, because capping federal funding for Medicaid would add an additional layer of pressure to state budgets, and put the health care and financial security of millions of older adults at risk,” B’nai B’rith said in its March 8 statement.

B’nai B’rith also took aim at a component of the bill that would reduce premiums for younger, healthier Americans, citing studies predicting “low-income adults in their 60s could see dramatic increases in premiums.”

U.S. House Majority Leader Kevin McCarthy, House Speaker Paul Ryan, and Rep. Greg Walden hold a news conference on the American Health Care Act on Capitol Hill. March 7. Photo by Eric Thayer/REUTERS.

The cruelest cuts of all


Many Americans were no doubt pleased to hear that the Donald Trump administration’s first budget proposal spared Social Security and Medicare, but the health and well-being of 74 million vulnerable, lower-income Americans who receive Medicaid are still very much in jeopardy. In fact, the means-tested Medicaid program now is directly in the bull’s-eye of cuts and drastic changes the Trump administration and Republican leaders are considering as part of their vow to replace the Affordable Care Act (ACA), also known as Obamacare.

Created in 1965 as part of President Lyndon Johnson’s “War on Poverty,” Medicaid is our country’s largest health care insurance program, with 74 million enrollees, or about 1 in 4 Americans, surpassing the better-known health insurance Medicare program with its 55 million-plus enrollees. Medicaid provides health care services for low-income individuals, including families with children, seniors, people with disabilities, those in foster care, pregnant women and low-income people with specific diseases, such as tuberculosis or HIV/AIDS. Chances are, you probably know many people on Medicaid, such as a 54-year-old woman who is without private insurance, too young for Medicare, who then developed breast cancer; or a young adult who developed a traumatic brain injury after an automobile accident.

Some 60 percent of Medicaid’s spending is for the elderly and the disabled. For many people with disabilities, Medicaid services are the only way they are able to live and work in the community with friends and families. Medicaid helps children and adults with a significant disability — such as autism, cerebral palsy or intellectual disabilities — to remain at home and avoid placement in costlier and harmful segregated nursing homes or institutions. Medicaid also provides services, such as personal care aides who help people in their own homes with everyday needs like bathing, dressing, eating and managing medications. And because adults with disabilities have such a low employment rate (30 percent), they don’t have any other health insurance options for their ongoing and acute medical needs except Medicaid. Under the ACA, there has been a large expansion of Medicaid, although some Republican governors declined that Medicaid expansion.

In California, the program is called Medi-Cal, and as is the case in every state, the feds pay close to 60 percent of the program’s overall expenses. Under the current structure, the federal government has a commitment to help states cover costs, and in turn, states must provide specific benefits to certain groups of people, including people with disabilities. Although Medi-Cal has issues, including a very low reimbursement rate, which prompts many specialists and other providers to limit or simply stop taking on Medi-Cal patients, it is nevertheless a crucial and lifesaving program.

Currently, Medicaid is an open-ended entitlement for states — if residents meet strict income and asset criteria and other health/disability-related criteria, then they can enroll. During economic recessions, more people enroll; other factors, such as expensive new lifesaving prescriptions drugs, also can increase the costs of administering the program. The “block grants” being touted by the Trump administration as a way of giving states more control over their state Medicaid program will translate into a whole new definition of pain, as each state would receive a fixed amount of money based on a predetermined formula, most likely at a per-capita rate. A recent editorial by The ARC (formerly known as the Association for Retarded Citizens, started by parents who had children with disabilities in the 1950s) analyzed the problem: “Unlike the current funding system, the amount provided under a per capita cap will not automatically increase when the cost of providing covered services to eligible individuals goes up. The intent of the per capita cap is to reduce federal spending by restructuring the program and significantly cutting the cost to the federal government. Using this technique, the federal government limits spending, regardless of the needs of the people receiving Medicaid services.”

State governments will be forced to make decisions from an array of bad choices, such as increasing state taxes, limiting services to existing Medicaid patients, reducing eligibility or cutting already low reimbursement rates even further. Health outcome disparities between states will grow as wealthier states can help backfill some of these cuts but poorer states will not be able to do the same. Without early intervention, many infants and toddlers with disabilities will be denied therapies that can change their lives’ trajectories. Without community services and support, too many adults with disabilities will be stuck at home, dependent on aging parents and even forced into unnecessary institutionalization, a huge step backward in the civil rights of people with disabilities. Many Medicaid patients will suffer from delayed or denied medical treatment, and some people may even die.

Kellyanne Conway, counselor to President Trump, has said publicly that moving to Medicaid block grants will ensure “that those who are closest to the people in need will be administering the program,” but what kind of freedom is choosing between bad, worse and terrible? 

Michelle K. Wolf is a special needs parent activist and nonprofit professional. She is the founding executive director of the Jewish Los Angeles Special Needs Trust. Visit her Jews and Special Needs blog at jewishjournal.com/jews_and_special_needs.

Why isn’t this night different?


Predictably, the 2015 House Republican budget released by House Budget Committee chairman Paul Ryan (R-Wis.) on April 1 proposes devastating and monumental cuts to programs designed to help those among us who need it most. It would slash Medicaid; it would change the funding, eligibility standards and structure of SNAP (Supplemental Nutrition Assistance Program); it would repeal the Affordable Care Act. The same harsh proposals couched in the same tired rhetoric. 

And just as predictably, progressives are wringing their hands and describing the cuts as immoral. They invoke images of the seniors, children and disabled people who have done nothing to deserve their terrible lot but will feel these cuts most deeply. They cite independently verified statistics intended to dispel persistent myths about who actually needs these programs, because, the progressives proclaim, the political tides would change if they could just get everyone to actually understand the truth. The same hitherto ineffective counterpunches couched in the same tired rhetoric.

This is the time of year when we ask a very pointed question: “Why is this night different from all others?” The Passover seder is actually replete with questions — most of them ages old. But these questions, by their very nature, challenge us to stop and think, and to consider the range of possible answers to pinpoint why this night is different from all others — those during this year, or any other year. So I’m struggling to understand how this Republican budget and this progressive response are different from all others.

The facts about the astounding prevalence of hunger have remained essentially the same since the recession began in 2008: 

• 14.5 percent of American households were food insecure in 2012. That means 45 million Americans — nearly 1 out of every 6 of us — struggled to put adequate nutritious food on the table. 

• The rate of food insecurity in California — our great state where nearly half of the nation’s fresh produce is grown — is higher than the national average (15.6 percent).

• 1.7 million Angelenos are food insecure. That means the number of people struggling to feed themselves in our county is greater than the population of twelve individual states, and larger than that of the District of Columbia.

Despite the supposed recovery of our economy, the struggle of these vulnerable Americans continues to be the same. But the sameness of their struggle does not merit the same polarizing responses.

I have always embraced the rich Jewish tradition of asking questions, a custom that seems amplified during Passover. So especially now, when I consider the recent actions of our policymakers and lobbyists in Washington, I feel compelled to demand answers to questions that too often go unasked. 

Why, today, do the rhetoric and the overblown caricatures of “left” and “right” continue to remain so predictably the same? 

Why has it become more important for one or another side to be “right” than it is to do the right thing?

Why can we not be more courageous and willing to compromise?

What would it take for us to try a new and creative approach or framework that may yield a better result? 

How can we make today different from yesterday and all the days that came before it?

Albert Einstein defined insanity as doing the same thing over and over again and expecting a different result. Today, we must stop the insanity. We cannot travel the same path and expect to reach a different destination. 

It is not in our Jewish DNA to blindly accept the status quo. We are a people that takes action to create change when we encounter injustice. And there is no greater reversible injustice than the oppressive persistence of hunger in our county, our state and our nation. That so many struggle to survive means that our policymakers are failing us. Our job is to continue to ask questions. It is their job to provide different answers.


Abby J. Leibman is president and CEO of MAZON: A Jewish Response to Hunger.

Sasha Abramsky: Still fighting the war on poverty


In his new book, “The American Way of Poverty: How the Other Half Still Lives” (Nation Books, $26.99), journalist Sasha Abramsky interviews a couple unable to qualify for Medicaid because of the monetary value of the burial plots they bought to avoid being buried in a pauper’s cemetery one day. Stories like this one, collected during road trips across the United States, highlight the deep economic inequality that still pervades the country 50 years after President Lyndon Johnson’s War on Poverty. In his book, released in September, Abramsky, who grew up in London and now lives in Sacramento, introduces readers to the people he calls the “invisible” poor and offers solutions for a second, modern-day War on Poverty.

 

Jewish Journal: Could you summarize the thesis of your book?

Sasha Abramsky: The idea of the book is that there is a huge number of Americans — tens of millions of Americans — who are living in fairly profound poverty, and that poverty is largely invisible to the broader community. It’s a poverty that is caused not by a lack of resources but by a lack of political will to tackle the crisis. It’s a poverty related to the rise of a peculiarly unequal society in the last 30 years. The poorer you are in that society, the less visible you are, the less political voice you have, the less economic security you have, the more vulnerable you are to any shift … in the labor market, in the housing market, in how health care is delivered. The underlying idea is that these lives, these stories, are worth telling, and that we weaken ourselves as a society if we ignore tens of millions of people just because they’re poor.

 

JJ: Has your Jewish background inspired the moral message in your book?

SA: I’m not religious. I come from a secular family. … But I think if you look at Jewish ethics over the centuries, you see a tremendous emphasis on poverty. You see a tremendous emphasis not just on charity, which is a starting point, but on social justice and on exploring some of the consequences of unfair systems. 

 

JJ: Did the interviews you conducted change your thinking about poverty and solutions to the issue?

SA: Yes … what struck me was really the complexity of the story. There are 50 million people, by government measure, who are in poverty in this country. You neither can nor should reduce them to a set of stereotypes. You can’t say this group of people is important for this particular reason and they did this and therefore they’re poor.

 

JJ: How did you decide whom to interview or which interviews to include in the book?

SA: I wanted people who reflected all these broad entry points into poverty. There are tremendous numbers of working poor who either have been bankrupted or their lives have been made incredibly precarious by medical bills. I wanted to talk to people in food-bank lines. I wanted to talk to elderly Americans who’d lost their retirement savings. … I wanted to go all over the country, or as much of the country as I could, given the time limit of the project.

 

JJ: Why is it that we have such a serious issue of poverty 50 years after President Lyndon Johnson’s War on Poverty?

SA: Because, I think, for most of the last 40 years it hasn’t been a priority. It became a priority in the early ’60s and remained something of a national priority until the mid-’70s. The language that emerged in the Victorian period re-emerged in the 1980s — this very, very harsh language that blamed poor people for their own poverty. And when you individualize it like that, you lose the momentum acquired for a national strategy. And I think that’s the way that, for a generation now, we’ve been taught to understand poverty.

 

JJ: Of the solutions you’ve proposed, which ones would you prioritize if you were a political activist?

SA: I propose two things. … One of them is a public works fund that would be very specifically designed to protect employment during economic downturns. … The second thing is a social insurance system for higher education, and it would involve a very small line-item income tax paid by employees and employers, but it would render higher education massively more affordable for most Americans. … Then you can sort of go back in, and there are a whole bunch of smaller things we could do. … We could tax stock trades and bond trades and all the other financial trades that occur. You could use that for financial programs, for job-training programs. You could use it for gas stamp subsidies so rural Americans don’t get into fiscal trouble when gas goes up a dollar a gallon.

 

JJ: If you were a community activist in a poor community, what would you be doing right now?

SA: There are many things. If I were in a community where there were numerous fast-food restaurants, I’d probably be supporting the fast-food strikers who have been going out on strike in recent weeks campaigning for a living wage. If I were in an area of urban blight, I’d probably be pushing for affordable housing. I’d be campaigning against payday lenders, which have some of the most extraordinary interest rates that they charge to poor people because those poor people don’t have access to credit. I’d be working with community credit unions to try to keep foreclosed people in their homes —  and that’s been done in places like Boston and several other cities. As a consumer, I’d be thinking carefully about where I park my dollars.

 

JJ: In your book, you talk about the failure of poverty today in terms of the “weakening of collective institutions” and say that this has to do with democracy. What do you mean by that?

SA: If you completely corrode the notion of shared experience, then you corrode the notions of shared economic obligations. You no longer have an understanding that we pay into a tax base in order to get things like quality education or quality transport or quality housing. And if that happens, it becomes easier to delegitimize any defense in the government. Then you say … taxes are just robbery, public services are unnecessary, the social safety net is dysfunctional. You essentially skew more political access to the top, and a democracy involves everyone having political access.

 

JJ: How do you try to foster a moral response to poverty among the middle class, the upper class and the poor if each group has its own priorities?

SA: I think a lot of it is linguistic. In the 1960s, Lyndon Johnson reached into this history of using empathic language, which in some ways is an ethical religious language that had been marshaled in earlier years against slavery, against women’s suffrage, against child labor. If you can work out ways to create overlap in the experience between wealthy and poor Americans, and if you can work out ways to share common stories and aspirations, you open up a lot of doors. 

The Obamacare Apocalypse


Last week, a professor of physics and astronomy ” target=”_blank”>Koch brothers’ plan to stop them.  It’s possible that some of the Republican governors who refused Medicaid money for 8 million of their constituents will find themselves so wildly unpopular that they’ll do a 180.  It’s possible that people in the individual market stranded by the law and their insurance companies will find solutions.  Hell, it’s even possible that healthcare.gov will work.

So it’s not nuts to think that by the time Obama leaves office, the American health care system will be better in lots of ways, Obamacare will be the new normal and solid majorities will like it.  There may be no “Keep Your Hands Off My Obamacare” signs during the 2016 campaign, but it’s possible that the painful rollout of the exchanges will be forgotten.

That would ruin things for the drama queens in the media.  Their master narrative is Countdown to Armageddon.  Demagogues need end times to raise money.  News needs to shout apocalypse to get attention.

It’s not just Obamacare.  Imagine that CBS News had no reason to retract the Benghazi piece on “60 Minutes.”  If accounts of Dylan Davies’s F.B.I. interviews hadn’t made their way to the ” target=”_blank”>The Last Hours: Warming the World to Extinction,” a 10-minute movie written by Thom Hartmann and directed by Leila Conners makes terrifyingly clear, climate change is on track to cause the sixth mass extinction in geologic history. The fifth, the K-T extinction 65 million years ago, was caused by an asteroid hitting the earth off the coast of the Yucatan peninsula – and it killed the dinosaurs.  The third mass extinction – the Permean, the worst – was caused by volcanic eruptions in the Siberian Traps that warmed the oceans six degrees Celsius and melted trillions of tons of methane that had been frozen beneath the sea floor and ice sheets.  The methane this released into the atmosphere doubled the warming the volcanoes caused and killed 95 percent of all life on earth.  Today, fossil fuel burning and industrial agriculture are increasing greenhouse gases at rates never before recorded by humans, physicist Michael Mann says in the film, “far greater than any of the most rapid events that happened in the deep geological past,” including the Permean extinction. 

Talk about doomsday scenarios.  If this keeps happening, Obamacare, along with everything else we love, hate or talk about, will be irrelevant, because our species won’t be around to love, hate or talk about anything. But you would not know that things are as dire as they are from watching the news, which is just how Exxon-Mobil, Monsanto and the Koch brothers like it.

The day before the Times reported a tenfold increase in the odds of an asteroid strike, Erik Petiguara, a graduate student at the University of California, Berkeley martyk@jewishjournal.com.

Senior service providers wary as New Year approaches


They’ve weathered five years of economic crisis, relentless state budget cuts and growing demand for their services. Now, social service providers for seniors in the Los Angeles area are bracing for a new slew of challenges in 2013.

From federal budget negotiations and the looming “fiscal cliff” to state-level pilot reforms of Medicaid — known in California as Medi-Cal — these are uncertain times for seniors, their caregivers and the agencies that help them. 

“We’re not really sure how it’s going to play out,” said Paul Castro, CEO of Jewish Family Service of Los Angeles (JFS). “We try as best we can to anticipate and plan, but it’s a very uncertain environment and there’s so many parts to it.” 

At the top of most agencies’ watch list is the “fiscal cliff,” the dramatic concoction of federal spending cuts and tax hikes slated to take effect Jan. 2, unless Congress agrees on an alternative. Programs in line for automatic cutbacks include nutrition services for the elderly, funding for in-home care providers, low-income heating assistance, and social and legal support for the vulnerable. The sum of these reductions — $55 billion for all nondefense spending — could have devastating consequences for millions of older Americans, providers fear.

In Los Angeles, JFS says federal cutbacks, if they go ahead, would hamper the agency’s ability to help seniors, particularly those living in poverty. The organization receives federal dollars for numerous programs, including in-home nursing care for the sick and frail; community dining and home-delivered meals; and free transportation services for seniors who need help going to medical appointments, meal sites and elsewhere.

Of those, nutrition services are the most critical for low-income seniors, many of whom rely on the agency for their meals, JFS public policy director Nancy Volpert said. If automatic cuts go into effect, the agency will be unable to feed 83 seniors out of the 1,040 it serves daily. 

“If someone loses food, that is an existential problem,” Volpert said. 

Barbra McLendon, public policy director for the California Southland chapter of the Alzheimer’s Association, said state budget cuts over the past few years have already caused programs to shrink and sometimes even shut down, including adult day care facilities for people with dementia. 

“There’s no more fat to be cut,” she said. “They would be cutting into direct services that people depend on.”

Still, McLendon and JFS officials said they remain optimistic Congress will strike a deal before Jan. 2. They also pointed to positive news at the state level. Voters’ approval in November of Proposition 30, which cleared the way for temporary tax increases, should prevent more funding cuts for senior services in the state budget, they said.

Assemblyman Bob Blumenfield (D-Van Nuys) agreed the budgetary outlook for the state has improved with the passage of Proposition 30. Nevertheless, ongoing shakeups of health-related programs affecting seniors, including a new effort aimed at keeping ailing elderly people in their homes, will need to be monitored closely, he said. 

And if big cuts kick in on the federal level, the system could come tumbling down.

“If the feds take us over the cliff, that could cost us $5 [billion] or $6 billion, and we’re back to the drawing board,” Blumenfield said.

Even if federal lawmakers stave off an immediate fiscal catastrophe, the long-term outlook for programs critical to seniors — including Medicare, Medicaid and Social Security — remains shaky. With the nation facing an unwieldy $1 trillion deficit, large social programs are a conspicuous target. 

Republicans, who control the House of Representatives, have already proposed smaller annual increases in Social Security payments, capping Medicaid spending and raising the Medicare eligibility age from 65 to 67, or turning it into a voucher program.

Jim Specht, spokesman for U.S. Rep. Jerry Lewis (R-Redlands), said the congressman believes reforms to Medicare and Social Security are necessary to avoid the programs’ financial collapse in the future.

“Both the entitlement programs, particularly Medicare, are on a course now to run out of money over the next 10 years or so,” Specht said. “Mr. Lewis believes you cannot just allow that kind of a fiscal problem … to continue.”

The fiscal cliff, and the automatic cuts it would imply, pose a greater threat to current seniors than proposed entitlement reforms, Specht said. Changes to Medicare and Social Security supported by Lewis would not affect people now over 55. For younger people nearing retirement age, reforms would be phased in, he said.

Lewis “is not interested in reducing any benefits for current seniors,” Specht said.

Still, U.S. Rep. Henry A. Waxman (D-Beverly Hills) said,“Seniors ought to be worried and aware of proposals that have been put on the table. I’m hoping that President Obama will be able to push back hard enough not to get them into law.”

Meanwhile, Los Angeles senior service providers said they are uneasy over another critical issue dependent on action by Congress: reauthorization of the Older Americans Act. The almost 50-year-old legislation authorizes federal funding for a wide range of senior services, including Meals on Wheels and home-based care programs, which is funneled through the Administration on Aging to state and local entities. It was due for renewal in 2011 but remains in limbo.

“It should have been done months ago. It has been introduced, but it’s just not going anywhere, which is a problem,” Volpert said. 

Failure to renew the act means agencies that receive federal funds to help seniors are not sure how to plan for their future, McLendon said. 

In California, another development is adding to the cloud of uncertainty, although there is hope it could bring about positive change. The state is one of 15 across the country participating in a federal pilot project that aims to shift so-called “dual eligibles” — people who qualify for both Medicare and Medicaid — into managed care. Officials say the change will reduce costs while providing beneficiaries with better-quality care.

Los Angeles is among five counties setting up the plan, which affects some of the poorest and sickest Californians, most of them elderly. About a third of the state’s 1.1 million dual eligibles live in L.A. County. Under the project, expected to start some time next year, local health plans L.A. Care and Health Net would be in charge of financing and delivering both medical and social services to dual-eligible patients. Currently, individual providers, such as JFS, are compensated directly by the government based on the number of services they provide.

Castro said JFS and other organizations in Los Angeles that run programs for seniors are anxious to ensure the transition doesn’t wipe away the current infrastructure and leave the elderly without access to services they’ve depended on for years.

It’s “a dramatic change in the service landscape,” he said. “The question is how much money will the state fund the health plans to do this kind of work, and how much will the plans be willing to spend on these clients, particularly those who are most fragile and imply the most cost?” 

Blumenfield echoed those concerns.

“We’ve really got to watch the implementation and make sure it helps seniors and doesn’t harm them,” he said. “The devil is in the details.” 

HEALTH CARE DECISION — Jews react: Los Angeles Jewish Home CEO & President


Molly Forrest, CEO and president of the Los Angeles Jewish Home, had surgery to alleviate arthritis in her neck in December 2010.

Stuck in bed for 35 days, she read the entire Affordable Care Act – all 2,080 pages of it. She has since read it again so she knows it well, and she takes it personally.

“If I were unemployed now, I would not be able to get insurance, and I’m not old enough for Medicare,” Forrest remembers thinking after her surgery.

The Supreme Court’s decision today to uphold the law “settles a 100 year debate about whether access to health care is a right that each American has,” Forrest said.

The 1,000 elderly clients who live at the Jewish Home in Reseda, as well as the 1,500 non-residents it serves and the employees the organization insures all will benefit from the law as implementation goes forward, she said.

“Seventy-five percent of our clients rely on welfare programs to support whatever care they receive, and so anything that threatens or affects Medicaid or Medi-Cal dollars is of enormous concern and importance to us,” Forrest said.

Forrest said she supports the one adjustment to the law the court made—prohibiting the Federal government from withholding Medicaid funds from states that do not comply with the Affordable Care Act.

“We already face such enormous challenges with funding programs for the needy in this state, that for us the decisions of the Supreme Court at least removes the threat that the Federal government could penalize the state in any way for not fully complying with the Affordable Care Act,” Forrest said.

Forrest sees many benefits in the law.

Not only will those with preexisting conditions not be denied coverage now, she said, but the law prohibits insurers from charging highly elevated premiums to those with complicated conditions. This will help many disabled adults get private insurance, she said, since previously their pre-existing conditions either shut them out of insurance or made it entirely unaffordable.

She also sees much benefit in removing insurers’ lifetime cap and the annual cap, and in allowing children to stay on parents’ plans through age 26.

“I think there are a lot of good things here,” she said. “I know there is a lot of controversy around this, but this is America, and I think in the end this will work out and American will be better for it. I know the health of American will be better for it.”

Opinion: Medicaid reforms need not undermine services


During February, Jewish communities across North America observe Jewish Disability Awareness Month. It is an opportunity for us to raise awareness of the needs, strengths, opportunities and challenges of individuals with disabilities in our communities, and to ensure we are building more inclusive communities that celebrate all of our neighbors.

The Jewish community, through its institutions and social service agencies, has been increasingly effective in serving the critical needs of individuals with disabilities and their families. At the same time, we recognize the indispensible impact that Medicaid has on the ability to provide for these needs.

For many members of our communities with disabilities seeking healthy, independent lives, Medicaid is an essential resource. Earlier this month, Jewish leaders from across America came to Washington to express to Congress how vitally important Medicaid is to the disability community, as well as the agencies and communities that serve them.

More than 8 million individuals with disabilities in America rely on Medicaid as their sole source of comprehensive health and long-term care coverage. Medicaid ensures that people with disabilities have access to essential services, including transportation, medical care and personal care assistance. This, in turn, ensures that they are able to contribute economically, socially, politically and spiritually to their communities.

Unfortunately, under several prominent congressional proposals being considered as part of deficit reduction efforts, Medicaid would be restructured by capping funds flowing to states and/or creating a block grant formula. Block granting or capping Medicaid funds would result in the denial of health and long-term care to millions of Americans, including those with disabilities. These kinds of spending cuts and harmful changes to Medicaid would undermine human dignity by limiting the choices and opportunities for people with disabilities.

Terry Burke and Andy Berman of St. Louis Park, Minn., say that Medicaid has truly been “the saving grace in their family.” Their 23-year old daughter, Rachel, who has cerebral palsy, epilepsy, autism and moderate cognitive disability, is the joy of their lives, but things have not always been easy.

When Andy was diagnosed with chronic lymphocytic leukemia, he and Terry quickly learned that juggling the demands of health care for Andy and care for Rachel was extremely challenging. Through Medicaid, Rachel is able to have personal care assistants, or PCAs, help her with basic needs, ranging from showers and meals to helping with her visits to the doctor. She also has the opportunity to participate in programs that truly contribute to her happiness and “allow her to really have a life,” such as recreational social nights, exercise programs and making dinner with her PCAs.

As Terry and Andy grow older, as they balance managing the health needs of Andy and Rachel, and their ability to manage Rachel’s care declines, they cannot imagine a future without the services provided through Medicaid.

Leading Jewish organizations have made it a priority to fight to protect the services and benefits that individuals with disabilities and their families receive under the Medicaid program. We as a community believe that while there is still a need to reform the program to ensure it remains sustainable through a time of austerity, the program provides services to individuals with disabilities and their families that must remain intact.

Collectively, the Jewish community sees a number of effective ways that Medicaid can be reformed while realizing cost savings. These proposed recommendations range from allowing funding for home- and community-based services (services that cost less than comparable institutionalized care) to be accessed without the current burdensome waiver process, to promoting preventative measures such as chronic disease management.

Other recommendations include enrolling beneficiaries in drug and care management programs, which ultimately would improve the delivery of services and generate savings.

Any reforms to Medicaid to make it financially sustainable for future generations must be made with the mind-set that Medicaid remains available as a source of health and long-term services for individuals with disabilities and other low-income populations.

Jewish organizations and social service agencies across America stand ready to work with our federal and state governments to ensure that individuals with disabilities are able to live healthy, independent lives. We all have a role to play in ensuring this end, and Medicaid is an essential tool in that effort.

Rabbi David Saperstein is director and counsel of the Religious Action Center of Reform Judaism. William Daroff is vice president for public policy and director of the Washington office of The Jewish Federations of North America.

U.S. House extends Medicaid funding


The U.S. House of Representatives approved the extension of vital Medicaid funding, which was a top priority of the Jewish community.

The House voted Tuesday to extend the Federal Medical Assistance Percentage, a formula used to determine how much Medicaid funding each state receives. It also helps fund education jobs. President Obama signed the bill into law that afternoon.

The six-month extension of FMAP had been a priority of the Jewish Federations of North America, as 60 cents on every dollar of public revenue brought in by the federations or their partner agencies comes from Medicaid.

“Without these funds, states would have certainly cut back on their Medicaid programs, which would have had an adverse impact on how Jewish communal providers deliver needed care to their respective communities,” said William Daroff, vice president for public policy and director of the Jewish Federations of North America’s Washington office, in a statement.

Daroff added that he was concerned that the new funding was made possible by reductions to the Supplemental Nutrition Assistance Program, which also has been a priority of the federations. However, as the reductions are not set to go into effect until 2014, Daroff said JFNA will work with Congress to find an alternative.

The FMAP money will prevent cuts that could have cost the Jewish community $150 million to $200 million in social services funding.

The Association of Jewish Aging Services, whose members often depend on Medicaid funding, applauded the bill’s passage.

“Special thanks go to Speaker Nancy Pelosi and the House of Representatives for interrupting their annual August district workk period to come back to Washington and pass the long-awaited FMAP extension,” AJAS President Marla Gilson said in a statement.

Drug Plan Proving Bitter Pill for Seniors


After sorting through piles of brochures, Millie Topper thought she had finally found the right Medicare Prescription Drug Benefit plan to pay for the high blood pressure medications she wanted.

But once the 77-year-old resident of Silver Spring, Md., crunched the numbers, she realized she couldn’t afford the plan’s heavy deductibles and monthly premiums. Grudgingly, she signed up instead for a plan that forces her to take a generic drug in lieu of the brand name she prefers.

“I don’t know which way to turn,” Topper said.

Her friends, she said, complain that “you’d have to be a rocket scientist to figure out the Medicare drug benefit.”

It’s a familiar story for Jewish officials who staff the community’s elderly help lines, where phones have been ringing off the hook in advance of the May 15 deadline to enroll in a prescription benefit plan. The benefit, which took effect Jan. 1, has been financially detrimental to some Jewish seniors and helpful to others — but bewildering to almost all.

“I haven’t heard anybody say, ‘Boy that’s terrific,'” said Beth Hess, director of aging and disability services for the Jewish Social Services Agency. “Nobody’s dancing on the ceiling with enthusiasm for this.”

Its consequences are important for a Jewish community with disproportionately large numbers of seniors. A recent survey recorded 19 percent of U.S. Jews as seniors, as opposed to 12 percent in the general population.

The benefit is the fruit of the Medicare Prescription Drug Improvement and Modernization Act of 2003, which for the first time covers all Medicare beneficiaries. The government turned to private enterprise to handle the massive new entitlement, against the backdrop of escalating drug costs. Incentives were offered to private companies to administer the benefit at the lowest possible cost. The idea was to encourage profit-driven companies to compete against one another to enlist seniors, causing prices to drop.

Under the rules of Medicare’s new prescription drug plan, known as Part D, beneficiaries must choose a plan offered by a private insurer. Each Part D plan — and there are dozens in each state — has its own “formulary,” a restrictive list of drugs, pharmacies, monthly premiums, co-payments and yearly deductibles.

Finding the best and most affordable plan has Jewish seniors grousing about the maze of options. The jargon has added to the confusion.

“I didn’t even know what ‘formulary’ meant,” Topper said.

For those enrollees who stand to benefit from the new system, the immense confusion triggered by the transition has overshadowed the more affordable costs. With many seniors on multiple prescription drugs at once — along with the ever-present prospect of needing new medications, finding the right formulary has become a tall order.

One way of searching for plans is by accessing the “plan finder” on the Medicare.gov Web site, a process many experts say can be confusing for anyone, let alone seniors who may not be computer savvy.

Some seniors pore over each individual formulary brochure they receive in the mail. But most chafe at sifting through the formularies or using the Internet to find the best plan. Many Jewish seniors have turned to their children and grandchildren for help

“What’s most impressive is how active children are in trying to help their parents, regardless of how much money they have,” Hess said. “Active adult children are making it a lot easier on Jewish seniors.”

William Peirez, president of B’nai B’rith International’s MetroNorth region, enrolled his 87-year-old mother in an AARP plan. Peirez is angry about the new system, which he says is far too complicated.

“An 80-year-old can not figure this out,” he said. “It doesn’t make sense. It’s too difficult for me, and I’m 62 and a lawyer.”

Jewish leaders and policy analysts agree that some of the biggest losers from the benefit are the indigent on Medicaid, including a number of Jews.

“There is this stereotype that all Jews have money,” said Rachel Goldberg, director of senior advocacy at B’nai B’rith International. “We forget that while the average income for Jews is slightly higher, we still do have older Jews living in poverty.”

At the beginning of the year, all 6 million Americans who qualify for both Medicaid and Medicare were automatically enrolled in random private plans under the new benefit.

Prior to the switch, Medicaid recipients, who are in the lowest income bracket, had received their drugs without cost. Now they are saddled with more restricted options and face co-payment costs of a few dollars each time they request a prescription.

“Many are paying more than they used to, and simply cannot afford it,” Goldberg said. “What sounds like coffee money to middle-class people, if you’re living hand-to-mouth, can [determine] whether or not you make your electric bill.”

Goldberg and other Jewish leaders are also highlighting lower-middle and low-income seniors who come close but do not qualify for Medicaid. This group has the most to gain from the benefit but also the most to lose, they said. Many seniors lack assistance in paying for their drugs, though there are subsidies for people who pass an assets test. But poorer seniors are less likely to have access to advisers and the best information to find the right plan. Without help, many feel powerless and are avoiding the benefit altogether, experts said.

Another lightning rod for confusion and concern is gaps in the benefit structure, called “doughnut holes.” If drug costs — including out-of-pocket costs and Medicare’s portion — exceed $2,250, Medicare pays nothing, while the beneficiary must cover 100 percent, until costs reach $5,100. Then Medicare defrays 95 percent of costs.

Many Jewish seniors don’t know whether it’s worth spending the extra money in monthly premiums to receive a plan that will fill in all or part of the gap.

Jews who are better off financially and already receiving their drugs through separate plans are unsure whether they would fare better or worse under Part D. Opting into the benefit may result in worse or more costly coverage and lead to the termination of former plans — but seniors also want to avoid late fees incurred if they enroll after the May 15 deadline.

Seniors “are resigned to struggling with a very complicated situation, where what’s right for them can change over time,” said David Gamse, executive director of Jewish Council for the Aging.