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April 12, 2011; 1 note posted today



Fiscal Year 2011 Bill Would Cut Legal Aid by $15.8 Million

4/12:  The following is from an April 12th note from the Legal Services Corporation:  The Fiscal Year 2011 budget for the Legal Services Corporation (LSC) would be cut by $15.8 million, reducing funds for civil legal assistance to low-income Americans, according to legislation announced today. LSC received $420 million in funding for Fiscal Year 2010, and the funding bill for 2011 would provide $404.2 million, a reduction of 3.8 percent. The legislation, the result of a negotiated agreement between the Congress and the White House to avoid a government shutdown, is scheduled for votes in the House and Senate this week. "Every dollar provided for civil legal assistance helps low-income individuals gain access to our justice system. We are grateful that funding cuts will not be as deep as initially proposed, and we look forward to working with the Congress on Fiscal Year 2012 funding to provide even greater access to justice for the growing number of low-income Americans in need of civil legal assistance," LSC Board Chairman John G. Levi said. The funding reduction would affect the grants that LSC distributes to 136 independent nonprofit legal aid programs across the nation, the District of Columbia and U.S. territories. Last year, these programs closed nearly 1 million cases, which affected 2.3 million people. The cases involve domestic violence, foreclosures, landlord-tenant disputes, bankruptcy, consumer issues and other civil legal matters.  For more on this, click above.


Obama's new approach to deficit reduction to include spending on entitlements

4/11:  The following is from an April 11th Washington Post article: President Obama this week will lay out a new approach to reducing the nation's soaring debt, proposing reductions in spending on entitlements such as Medicare and Medicaid and renewing his call for tax increases on the rich. ... Contrasting the president's approach with what Republican leaders have put forward, Plouffe said Obama will use a "scalpel" and not a "machete" as he seeks to preserve funding for education and other areas he considers crucial to the country's long-term economic success. ... In a speech scheduled for Wednesday, Obama will present his most extensive response to date in the debate over controlling federal spending. ... On Sunday, Plouffe did not specify how much more the president wants to cut or whether his speech would propose a specific legislative agenda other than to say he will be looking for savings in both Medicare and Medicaid.   He said that though Obama does not think Social Security liabilities are a primary driver of the nation's deficit and debt, the president would be open to discussing that, too.  Click above for the full article.


CBO Report: Ryan Plan Specifies Spending Path That Would Nearly End Most of Government Other Than Social Security, Health Care, and Defense by 2050: Plan Also Contains Deeper Cuts to Medicare and Medicaid Than Ryan Revealed

4/8:  The following is from an April 7th Center on Budget & Policy Priorities analysis: House Budget Committee Chairman Paul Ryan's budget plan specifies a long-term spending path that means that, by 2050, most of the federal government aside from Social Security, health care, and defense would literally cease to exist, according to figures in a Congressional Budget Office report that was released on Tuesday [April 5th].  CBO's report, prepared at Chairman Ryan's request, also reveals that, as explained below, his plan envisions additional Medicare cuts that were not disclosed in the documents that the chairman released on Tuesday; and his Medicare "premium support" and Medicaid block grant proposals differ substantially from — and have much deeper cuts than — the "Ryan-Rivlin" plan of last fall, which itself was rejected as too severe by the Bowles-Simpson fiscal commission.  On the chairman's plan to dramatically shrink the size and scope of government, the documents that he released show that his plan would shrink federal spending to about 20 percent of Gross Domestic Product (GDP) by 2015 and to 14.75 percent of GDP by 2050 — the lowest level since 1951, a time when Medicare and Medicaid did not exist. ... Grover Norquist, president of Americans for Tax Reform and one of Washington's most influential anti-tax conservatives, told National Public Radio in 2001, "I don't want to abolish government.  I simply want to reduce it to the size where I can drag it into the bathroom and drown it in the bathtub."  The CBO report suggests that, other than for Social Security, health, and defense, Chairman Ryan has much the same vision.  To access the full analysis, click above.  See related article directly below.


Conservatives unveil alternative budget with $9.1 trillion in cuts; Substantially more cuts than Ryan proposal

4/8:  According to an April 7th The Hill article: The House Republican Study Committee on Thursday released an alternative to the 2012 budget resolution from Budget Committee Chairman Paul Ryan (R-Wis.) that would cut $9.1 trillion over the next decade. The RSC, a 176-member caucus, will offer the plan, entitled "Honest Solutions," as a floor amendment to the budget resolution next week. The GOP budget plan was passed by the House Budget Committee late Wednesday [April 6th].  Like a failed RSC effort to cut $40 billion more from 2011 spending in February, the amendment is expected to fail, but it sends a strong signal to GOP leadership and to Democrats that there's backing for going even further than Ryan's plan on spending cuts.  Whereas Ryan's plan would balance the federal budget by 2040, the RSC plan would do so by 2020.  It does so by cutting $3.3 trillion more over 10 years than Ryan's plan. The Ryan budget resolution cuts $5.8 trillion over the next decade, while the RSC plan would cut $9.1 trillion. ... The RSC budget shores up the solvency of Social Security by raising the retirement age to 70 by 2045. That timeline is faster than the one proposed by president's fiscal commission, which would raise the retirement age to 69 by 2075 while paring back benefit calculations. ...  The RSC's Medicare overhaul plan would accelerate Ryan's proposed conversion of Medicare to a type of voucher system. While the House GOP budget eliminates the traditional program in 10 years for those currently 55 and under and replaces it with a "premium support" system, in which Medicare pays private insurance plans for an option selected by seniors, the RSC budget speeds up the process.  Under the RSC plan, individuals 59 years old and younger would enter the premium support system, while seniors of any age could voluntarily opt-in to the voucher-type system in 2017.   The RSC budget also gradually raises the Medicare eligibility age to 67 by 2030, while the House GOP budget does the same three years later.  The RSC, as the House budget does, transforms Medicaid into a block-grant system that provides states with a fixed payment and flexibility to manage their programs. The RSC cuts Medicaid deeper by bringing program spending down to 2006 levels and limiting its growth just to inflation, while the House GOP budget also allows spending to grow with the population, Peuquet said.  For full article, click above.


House Cuts $70 Million in FY'11 LSC Funding

2/22:  According to a Feb. 19th e-mail from the legal Services Corporation: The U.S. House of Representatives today passed a $70 million cut in Legal Services Corporation (LSC) funding from the current level, reducing grants to 136 local legal aid nonprofit programs by an average of 18 percent. The proposed $70 million cut is from the Fiscal Year 2010 funding of $394.4 million provided to LSC programs. An effort to eliminate all funding for LSC programs was defeated on a bipartisan vote, 259 to 171, on February 16. Under the House proposal, about 160,000 fewer low-income people would receive civil legal assistance and 80,000 fewer cases would be handled by the LSC-funded programs. The proposed funding cut would force layoffs of about 370 staff attorneys and shut down some offices in rural areas. "The impact of the proposed reduction would be devastating to these LSC programs," LSC President James J. Sandman said. "These proposed cuts would come at a time when many LSC programs are overwhelmed with requests for civil legal assistance. The Constitution says in its very first line that a primary purpose of government is to 'establish justice.' Our country cannot sacrifice equal access to justice to any year's fiscal pressures." The civil legal assistance provided by the 136 nonprofit programs across the nation helps women escape domestic violence, keeps families in their homes by averting unlawful foreclosures and evictions, helps veterans and the disabled obtain benefits, protects the elderly from consumer fraud, and provides help with other civil legal problems. The programs provide legal services to persons at or below 125 percent of the federal poverty guidelines—$27,938 for a family of four. The House approved the funding reduction as part of its Continuing Resolution to fund federal agencies and programs through the remainder of Fiscal Year 2011. The proposal would represent an $85 million reduction from the White House's Fiscal Year 2011 budget request of $435 million. The bill will now go to the Senate for a vote. The government is currently funded at Fiscal Year 2010 levels until March 4.  For more info, go to the LSC web site by clicking above.


President Obama's Proposed FY12 Budget Shows Strong Support for Legal Aid, Funding LSC at $450M, While House Republicans Introduce Drastic Cuts for Remainder of FY11

2/18:  The following is from a Brennan Center for Justice e-mail note:  On February 14, the Obama Administration submitted a budget to Congress for fiscal year 2012 that recommends increasing funding for the Legal Services Corporation to $450 million. At $30 million more than current levels, this additional funding would provide a much needed boost for civil legal service providers at a time when they are turning away a record number of low income Americans due to shrinking state budgets and IOLTA accounts across the country. In keeping with his previous proposals, the President recommended that Congress also remove the restrictions on non-LSC funds and class actions. LSC also submitted its formal budget request to the Congress calling for $516.5 million in funding.  Republicans in the House Appropriations Committee on the other hand, moved in the opposite direction. Introducing a Continuing Resolution for the remainder of fiscal year 2011, they proposed a $70 million cut for LSC from current spending levels of $420 million, which will expire on March 4, 2011. Directed mainly at basic field grants, the proposal amounts to a nearly eighteen percent reduction in funding for local legal aid programs across the country, likely forcing programs to downsize their staff and client pool. The Senate Appropriations Committee has not released its version of the Continuing Resolution.  For more info on this, go to the LSC site by clicking above.


Proposed $75 Million Budget Cut by U.S. House Would Devastate Legal Aid to Poor

2/10:  The following is from a Feb. 9th Legal Services Corporation e-mail: A congressional proposal to cut $75 million from the Legal Services Corporation's (LSC) budget would decimate civil legal aid to low-income Americans at a time when it is most needed by the tens of millions suffering economic hardship. The proposed $75 million funding cut would represent a 17 percent reduction from the White House's Fiscal Year 2011 budget request of $435 million for LSC and a 14 percent decline from LSC's current funding level, $420 million. The proposed cutback was announced today by the House Appropriations Committee as part of its Continuing Resolution to fund federal agencies and programs through the remainder of Fiscal Year 2011. "The Constitution calls for establishing justice in its very first line, even before mentioning the common defense. Our Pledge of Allegiance proclaims our national commitment to 'justice for all.' Hard times test our values, and we cannot sacrifice equal access to justice to any year's fiscal pressures," LSC President James J. Sandman said. LSC Board Chairman John G. Levi said, "Justice is a hollow promise without LSC. The Corporation and its national legal services network turn the abstraction of equal access to justice into a living, everyday reality for millions of low-income Americans. They are the most vulnerable in our society, and it is our responsibility as a country to make sure that our justice system works for them irrespective of the state of the national economy."  The impact of the proposed reduction at the mid-point of a fiscal year would be devastating to the 136 nonprofit legal aid programs across the nation that receive funding from LSC. The proposed cut could result in the layoffs of at least 300 legal aid staff attorneys who help victims of domestic violence, keep families in their homes by averting unlawful foreclosures and evictions, help veterans and the disabled obtain benefits, protect the elderly and others from consumer fraud, and provide other services in civil cases. Programs would be forced to turn away cases except for those involving immediate issues of safety and security, and many programs serving rural areas would be forced to close offices.  To learn more, go to the LSC web site by clicking above.


House Continuing Resolution Spending Cuts to Go Deep in Current FY'11 Appropriations

2/10:  The following is from a Feb. 9th press release from the U.S. House Committee on Appropriations:  House Appropriations Chairman Hal Rogers today announced a partial list of 70 spending cuts that will be included in an upcoming Continuing Resolution (CR) bill. The CR legislation will fund the federal government for the seven months remaining in the fiscal year and prevent a government wide shut-down, while significantly reducing the massive increases in discretionary spending enacted in the last several years by a Democrat majority. A full list of program cuts will be released when the bill is formally introduced.  The total spending cuts in the CR will exceed $74 billion, including $58 billion in non-security discretionary spending reductions. To access the full press release, with a partial listing of the agencies to be cut, click above.  To access a Washington Post article, click here.


Medicare cutoff battle brewing: 'I feel they wrote me off'

2/4:  The following is from a February 4, 2011 Detroit Free Press article: The state's 1.5 million Medicare recipients, along with thousands of others insured by private plans, could get some relief under a lawsuit challenging the cutoff of physical and other therapies if patients cannot demonstrate improvement. The problem particularly affects people with multiple sclerosis, Parkinson's disease, spinal cord injuries, heart failure and Alzheimer's disease, among others. Advocates for patients say the cutoffs are not warranted by Medicare regulations.  The practice is often followed by private insurers, too, because they take their cue from Medicare. The lawsuit, which seeks to be a class action, was filed last month on behalf of five national organizations and four consumers.  It charges that the cutoffs deny patients care they need to maintain their health, even if they are not improving beyond a certain level. They represent an incorrect interpretation of the law by hospitals, nursing homes, outpatient centers and others, the lawsuit says.  ... Last month, the Center for Medicare Advocacy filed a class action on behalf of five national organizations and four consumers to stop what is known in the insurance industry as the improvement standard. The suit names the Department of Health and Human Services and its secretary, Kathleen Sebelius. ... Medicare law and regulations do not require improvement for therapy coverage to continue, Judith Stein, CEO of the Washington, D.C.-based center, said last month. In fact, many people benefit from services that keep them from deteriorating and may save money in the long run, if it helps people stay out of hospitals and nursing homes, she and others say.  A 2008 paper from the Multiple Sclerosis Society, one of the organizations in the lawsuit, concluded that rehabilitation services, such as physical therapy, help people achieve and maintain maximum physical, social and vocational potential.  Dr. Robert Lisak, chief of neurology at the Detroit Medical Center and a nationally recognized multiple sclerosis specialist, said he believes Medicare is shortsighted in denying therapy. He also said he sees the issue more with private insurers than Medicare.  Click above to access the full article.


Supreme Court Agrees to Hear Wal-Mart Bias Case Appeal; Major Class Action Issue Involved

12/6: The following is from a December 6th NY Times report:  The Supreme Court on Monday [December 6th] agreed to hear an appeal in the biggest employment discrimination case in the nation's history, one claiming that Wal-Mart discriminated against hundreds of thousands of women in pay and promotion. The lawsuit seeks back pay that could amount to billions of dollars.  The question before the court is not whether there was discrimination but rather whether the claims by the individual employees may be combined as a class action. The court's decision on that issue will almost certainly affect all sorts of class- action suits, including ones asserting antitrust, securities and, products liability and other claims.  If nothing else, many pending class actions will slow or stop while litigants and courts await the decision in the case. "We are pleased that the Supreme Court has granted review in this important case," Wal-Mart said in a statement. "The current confusion in class-action law is harmful for everyone — employers, employees, businesses of all types and sizes and the civil justice system. These are exceedingly important issues that reach far beyond this particular case."  Brad Seligman, the main lawyer for the plaintiffs, said in a telephone interview after the court decision: "Wal-Mart has thrown up an extraordinarily broad number of issues, many of which, if the court seriously entertained, could very severely undermine many civil rights class actions. We welcome the court's review of this limited issue, and we're confident that the core of our action will go forward."  In their brief urging the justices to deny review, the plaintiffs had said Wal-Mart's objection to class-action treatment boiled down to the enormous size of the class.  "Petitioner returns repeatedly to the refrain that the certified class is very large, a fact that is indisputably true but legally irrelevant," the brief said. "The class is large because Wal-Mart is the nation's largest employer and manages its operations and employment practices in a highly uniform and centralized manner."  Wal-Mart, which says its policies expressly bar discrimination and promote diversity, said the plaintiffs, who worked in 3,400 different stores in 170 job classifications, cannot possibly have enough in common to make class-action treatment appropriate.  In April, an 11-member panel of the United States Court of Appeals for the Ninth Circuit, in San Francisco, ruled by a 6-to-5 vote that the class action could go forward.   Click above for the full article.


Medicare Advantage provision going smoothly so far

12/1:  The following is from a Nov. 30th Washington Post report:  One of the most significant savings envisioned in the new health- care law - limiting payments to the private health plans that cover 11 million older Americans under Medicare - is, so far, bringing little of the turbulence that the insurance industry and many Republicans predicted.  The law, which sets in motion the broadest changes to the U.S. health-care system in decades, will hold down the amount of money the government gives to Medicare Advantage plans, which are available to patients who prefer a managed-care version of the program. The savings is forecast to amount to $145 billion by the end of the decade.  Whether the payment changes are warranted was a contentious subplot in the protracted debate over the legislation. Democrats argued successfully that the private plans were being overpaid and could withstand the changes. Republicans warned that such plans would raise prices, lower benefits or cause defections from the program, stranding the elderly people who rely on them.  Early clues to the actual effects have now materialized, as elderly Americans may sign up for a health plan for 2011 during an enrollment period through the end of the year, and the warnings of swift, serious damage to the program are not borne out. Fewer health plans are available for the coming year, but the decrease is largely for reasons unrelated to the new law. Premiums have not jumped substantially, and benefits have not tended to erode.   Click above for the full article.


Milestone: Niles Housing Commission becomes 50th in Michigan to adopt smoke-free policy

11/22:  On November 18th, the Board of the Niles Housing Commission voted unanimously to adopt a smoke-free policy for all its properties. This action is a milestone in Michigan, as Niles becomes the 50th local housing commission in the state to adopt a smoke-free policy.  The Board of the Niles Housing Commission voted to make all indoor and outdoor common areas smoke-free effective on January 1, 2011. The Board also voted to make all indoor and outdoor areas, including living units, totally smoke-free as of January 1, 2012.  Thus, all 179 units owned by the Niles Housing Commission will be completely smoke-free in about 13 months; this includes 129 units in a high rise and 50 scattered site homes.  The Cadillac Housing Commission was the first Michigan housing commission to adopt a smoke-free policy, doing so in July, 2005.  Since then, 48 other housing commissions had also adopted smoke-free policies for some or all their properties.  The housing commissions range in size from ones with 20 or fewer units to the largest in the state, including Detroit, Grand Rapids and Lansing.  With the action by the Niles Housing Commission, about 8,400 units of public housing will be covered by smoke-free policies in Michigan. Nationally, about 225 local housing authorities have now adopted smoke-free policies for some or all their residential units. Inasmuch as only about 18 housing authorities had adopted smoke-free policies as of December 31, 2004, there has been a very dramatic increase of about 1250%  in less than 6 years, as housing authorities have seen that smoke-free policies are not only good for the health of their residents, but are good for the financial bottom line because smoke-free policies reduce maintenance costs and prevent cigarette-caused fires.  Jim Bergman, director of TCSG's Smoke-Free Environments Law Project, praised the Board of the Niles Housing Commission and their Executive Director, Mary Ann Bush, for their leadership in promoting a healthy living environment for their residents.  The federal Department of Housing & Urban Development (HUD) in recent years has strongly encouraged housing authorities and other HUD-subsidized property owners to adopt smoke-free policies. Further, hundreds of thousands of apartment units of market-rate housing are now smoke-free in Michigan. "Clearly, smoke-free policies in multi-unit housing are rapidly becoming the norm in Michigan and across the nation," said Bergman.  To access a listing of all the housing authorities in the U.S. that have adopted smoke-free policies, click above.


At Least 215 Housing Authorities Have Smoke-Free Policies for Some or All of Their Residential Properties

11/4:  The Smoke-Free Environments Law Project maintains an up-dated listing of all the public housing authorities/commissions in the U.S. that we know of which have adopted smoke-free policies for one or more of their apartment buildings.  The listing is done largely in the order in which the policies have been adopted, and with data which is as accurate as we can make it, but we can't vouch for its total accuracy.  As of October, 2010, at least 215 local housing authorities had adopted smoke-free policies for some or all of their apartment buildings, with about 199 being adopted since the beginning of January, 2005; an average of about 2.8 per month. That constitutes an increase in the number of housing authorities with smoke-free policies of about  1,200% in 70 months.  The 27 states with such policies, with the number of individual local housing authorities with smoke-free policies in parentheses, include Michigan (49), Minnesota (34), Nebraska (24), Maine (20), Colorado (14), Washington (14), Oregon (14), New Hampshire (10), California (8), Alaska (4), Idaho (3), Utah (3), New Jersey (2), Wisconsin (2), Arkansas (2), Florida, Montana, Indiana, Kentucky, Pennsylvania, Texas, Massachusetts, Connecticut, Vermont, Illinois, New York and Kansas. To access the list, click above.


IMPORTANT RULINGS:  Medicare Standards Are Too Strict, 2 Courts Find

11/2:  The following is from a Nov. 2nd New York Times article:  Two federal courts have ruled that the Obama administration is using overly strict standards to determine whether older Americans are entitled to Medicare coverage of skilled nursing home care and home health care.  Medicare will pay for those services if they are needed to maintain a person's ability to perform routine activities of daily living or to prevent deterioration of the person's condition, the courts said. Medicare beneficiaries do not have to prove that their condition will improve, as the government sometimes contends, the courts said.  The rulings are potentially significant for many people with chronic conditions and disabilities like multiple sclerosis, Alzheimer's disease and broken hips. Skilled care may be reasonable and necessary and covered by Medicare even if the person's condition is stable and unlikely to improve, the courts said.  The government has not said whether it intends to appeal either decision.  Representative Joe Courtney, Democrat of Connecticut, welcomed the decisions. "People with chronic conditions are being denied care in the mistaken belief that Medicare requires improvement of a person's condition as a prerequisite for coverage," Mr. Courtney said Monday. "That's not in the law. It's urban legend."  In one case, the Federal District Court in Pittsburgh said Medicare officials had used the wrong legal standard in denying coverage of skilled nursing home care to an 81-year-old woman, Wanda Papciak.  After hip replacement surgery, Ms. Papciak received skilled nursing care, physical therapy  and occupational therapy in a nursing home. Medicare terminated coverage after five weeks, saying her condition had not improved and was unlikely to improve.  In reversing the decision of Medicare officials, the court said Ms. Papciak needed skilled nursing home care "to maintain her level of functioning" and to prevent her condition from deteriorating.  Medicare officials had argued that Ms. Papciak was receiving only "custodial care," for which the program does not pay. The court said Medicare officials had "failed to apply the correct legal standard," and it cited court rulings in support of the proposition that the Medicare law "is to be liberally construed in favor of beneficiaries."  To access the full article, click above.


Public Housing, Private Vice; Should smoking be banned in people's homes?

10/28:  The following is from an article of the above title in the Fall, 2010 issue of the Harvard Public Health Review:  Welcome to the next front in the battle against Big Tobacco: public housing. Following the passage in 23 states of laws that ban smoking in workplaces, restaurants, and bars, anti-smoking advocates are increasingly training their sights on private spaces in public buildings. Last June, in Boston's Roslindale neighborhood, the Washington-Beech housing development became the city's debut smoke-free public housing site—the first step toward the Boston's Housing Authority's ambitious goal of clearing the air by 2013 at all 64 public housing sites. And in 2009, an office within the federal Department of Housing and Urban Development issued a memorandum that "strongly encourages Public Housing Authorities ... to implement nonsmoking policies in some or all of their public housing units.  To be sure, the trend has sparked dissent. After all, smoking is legal for adults, and nicotine is known to be one of the hardest addictions to kick. Why should poor people be asked to give up smoking at home when rich people have the right to indulge this harmful vice? Is the intrusive government "nanny state," as libertarians dub it, discriminating against those who are least powerful?  A new wave of published papers from the Harvard School of Public Health (HSPH) and elsewhere sheds light on why smoking should be banned in public housing, and how the policy question should be considered. ... Experience in vanguard states like Maine, Michigan, and Massachusetts shows that when the public health community turns up the pressure—"helping, prodding, assisting"—the move towards smoke-free housing goes much faster, Bergman says.  To access the full article, click above.


Probe shows court-appointed guardians often not screened or monitored

10/27:  The following is from an Oct. 27th CNN news report: Some court-appointed guardians for incapacitated seniors are not screened before they're appointed, and many are not monitored by the courts after they've taken over the affairs of their charges, resulting in hundreds of allegations of abuse, a federal probe found.  An investigation by the Government Accountability Office found allegations of abuse by legal guardians in 45 states and the District of Columbia, according to an advance copy of the report obtained by CNN. The report is scheduled to be released Wednesday.  In 20 cases studied by the office in which criminal or civil penalties resulted, investigators found that guardians stole at least $5.4 million in assets from 158 victims, the report said. In some instances, these same guardians abused or physically neglected the people they were supposed to help and protect.  In six of the 20 cases examined, the courts failed to screen guardians before giving them control over the financial affairs and care of their wards, the federal agency found. In one case in Missouri, a former taxi driver and convicted bank robber was appointed the legal guardian of a wealthy customer who had no family. As the elderly man developed Alzheimer's disease, his guardian stole more than $640,000 from him, writing checks out of the victim's estate to pay for exotic dancers and a new Hummer, court records show.  To access the full story, click above. 


Social Security benefits will remain flat for 2nd straight year, government says

10/15:  The following is from an Oct. 15th Washington Post article: For the second year in a row, the nearly 54 million retirees and other Americans who receive Social Security benefits will not get any cost-of-living increase in 2011 in their monthly checks, government officials announced Friday morning.  The absence of any growth in Social Security checks for consecutive years is unprecedented in the 3 1/2 decades that payments have been automatically adjusted according to the nation's inflation rate. The Social Security Administration made the announcement moments after the Labor Department released the latest figures for the consumer price index. They show that prices for the third quarter of this year rose by 1.5 percent compared with a year earlier, but fell by 0.6 percent compared with the same time in 2008.  In a symptom of the weak economy, last year marked the first time since the automatic formula has existed that consumer prices fell, so Social Security recipients were given no increase in their checks.  This year, the picture is more complicated - and likely to produce louder complaints over the lack of a cost-of-living increase. Click above for the full story.


44 Charged in Huge Medicare Fraud Scheme

10/14:  The following is from an October 13th NY Times report:  An Armenian-American crime syndicate stole the identities of doctors and thousands of patients and used them and more than a hundred spurious clinics in 25 states to bill Medicare for more than $100 million for treatments no doctor ever performed and no patient ever received, the federal authorities announced on Wednesday.   Prosecutors said the case represented the largest Medicare fraud operation ever carried out by a single group that resulted in criminal charges. The group succeeded in stealing $35 million in Medicare reimbursements, officials said, before the charges were leveled and arrests were made on Wednesday.  The "highly organized massive scheme" is at the heart of a racketeering indictment and other charges unsealed in federal court against 44 people, including a number of members of the Armenian crime group, according to the F.B.I. and federal prosecutors in New York and Georgia.   "With 118 phantom clinics and over $100 million in bogus billings, this group of international gangsters allegedly ran a veritable fraud franchise," Preet Bharara, the United States attorney in Manhattan, said in a statement announcing the charges. "As charged, they stole taxpayer dollars earmarked for the elderly and infirm and got away with it, until now." As of early Wednesday afternoon, 41 of the people accused had been arrested, 21 of them in the New York City area, and a number of others in Los Angeles and elsewhere, the authorities said.   Click above for the full report.


Medicare Advantage Premiums to Fall in 2011

9/22:  The following is from a Sept. 22nd NY Times report:  The Obama administration announced Tuesday that average premiums paid by individuals for private Medicare Advantage  plans, which insure about one-fourth of all beneficiaries, would decline slightly next year, even as insurers provide additional benefits required by the new health care law.  By contrast, commercial insurance premiums for many people under 65 and many small businesses are increasing 10 percent to 25 percent or more. Insurers say that a significant share of the increases is attributable to requirements of the new law, a contention that infuriates Obama administration officials and Democrats in Congress.  Many of the law's requirements take effect this week. President Obama plans to highlight the potential benefits for consumers on Wednesday.  The announcement on Medicare came as something of a surprise. Some members of Congress and some health policy experts had predicted that insurers would increase average premiums for Medicare beneficiaries in private plans.  "Despite the claims of some, Medicare Advantage remains a strong, robust option for millions of seniors who choose to enroll or stay in a participating plan," said Dr. Donald M. Berwick, the administrator of the Centers for Medicare and Medicaid Services.  Insurers can begin marketing to beneficiaries on Oct. 1 for Medicare coverage that starts Jan. 1.  Medicare officials said they had held down premiums and co-payments by negotiating with insurers, which sponsor the Medicare Advantage plans. The law, signed by Mr. Obama in March, gave officials new power to negotiate and to reject bids, as they did in a few cases. "We negotiated more aggressively than in the past," said Jonathan D. Blum, deputy administrator of the Medicare agency. "As a result, some plans changed their bids to produce more value for beneficiaries."   "On average," Mr. Blum said, "Medicare Advantage premiums will be 1 percent lower in 2011 than today. Medicare Advantage plans project that enrollment will increase by 5 percent in 2011."  About 11.3 million of the 46 million Medicare beneficiaries are in private Medicare Advantage plans, which offer comprehensive care in return for monthly premiums. While premiums for a particular plan in a particular county may increase next year, beneficiaries may be able to find other plans offering a better deal.  In the yearlong fight over health care, Mr. Obama said the government was overpaying Medicare Advantage plans.  John K. Gorman, a former Medicare official who is now a consultant with clients in the insurance industry, said: "Today's announcement shows that there is a new sheriff in town. Medicare officials were very specific and very forceful. Insurers succumbed to the government's demands and stayed in the Medicare market because they have become much more dependent on Medicare business." Payment rates for Medicare Advantage plans will generally be frozen next year at 2010 levels, with rates subject to tighter constraints in subsequent years. The cuts are expected to save $136 billion over 10 years.  To access the full story, click above.


HUD Multi-Family Housing issues Notice encouraging owners and management agents to implement smoke-free policies

9/20:  On September 15th, the HUD Multi-Family Housing section issued a Notice in which they encouraged owners and management agents of HUD Multi-Family Housing rental assistance programs, such as Section 8, to adopt and implement smoke-free policies for some or all their properties.  The Notice provides guidance to owners and managers on how to implement such policies.  The Notice tells owners and managers to implement smoke-free policies by updating their House Rules.  This Notice is similar to one HUD issued on July 17, 2009 to public and Indian housing authorities and demonstrates HUD's commitment to protecting the health of residents.  To access a copy of the HUD Notice, click above.


Poll shows Michigan voters against raising Social Security age

9/17:  The following is from a Sept. 16th Detroit Free Press article: Michigan's got some ideas about how to fix the nation's fiscal solvency, but when it comes to raising the age for getting Social Security or Medicare, forget about it.  Nearly three-quarters of those likely to vote in the November election who were surveyed last weekend in a Free Press/WXYZ-TV poll oppose raising the age for full Social Security benefits to 70, and nearly as many — 69% — oppose raising the age to receive Medicare benefits from age 65 to 67. Both ideas have been offered to keep the programs solvent.  But Michigan voters like some other solutions for the government's fiscal crisis: ... More than half would lift the cap on the payroll tax for Social Security, meaning people making more than $107,000 a year would pay more.  By a 49%-42% margin, the likely voters want tax cuts approved while George W. Bush was president to expire for people who earn more than $250,000 a year.  To access the full article, click above.


Smoke-Free Multi-Unit Housing:  Changing the Landscape of Michigan & America

9/17:  At the 2010 Fall Conference of NAHRO-Michigan, TCSG's Jim Bergman gave a presentation titled Smoke-Free Multi-Unit Housing:  Changing the Landscape of Michigan & America.  The presentation and the accompanying PowerPoint provided information about the dramatic changes that have occurred in the past decade in smoke-free housing nationally and in Michigan, particularly related to public housing and other affordable housing.  It also presented information on how and why to go smoke-free and included many slides of public housing and other affordable housing entities that have smoke-free policies.  There is also one slide that includes info from the CDC research released on Sept. 7, 2010 on the % of nonsmokers exposed to secondhand smoke.  You can view and download the PowerPoint presentation titled Smoke-Free Multi-Unit Housing:  Changing the Landscape of Michigan & America and you can also view and download a pdf version by clicking above. You can also access the ppt and pdf version directly here (ppt) and here (pdf).


Cook Inlet Housing's Centennial Village Grows to Meet Alaskan Seniors' Housing Needs, Eklutna Estates Grand Opening as a Smoke-Free Building is August 3rd; Starting September 1, 2010 All CIHA Buildings Will Begin Becoming Totally Smoke-Free

9/8:  The following is from a press release from Cook Inlet Housing Authority in Alaska: Cook Inlet Housing Authority (CIHA) will celebrate the grand opening of Eklutna Estates, located at 8850 Centennial Circle on Tuesday, August 3rd at 1:30 p.m. Eklutna Estates is a fifty-nine unit facility located within CIHA's existing senior community, Centennial Village, in east Anchorage.   Eklutna Estates consists of 46 one-bedroom/one-bath units and 13 two-bedroom/two-bath units and is open to Alaskans aged 55 and older. Eklutna Estates is a mixed-income property with most rental units available based on income eligibility guidelines and a limited number of units available at market rate without income restrictions. ... CIHA is proud to announce that Eklutna Estates is a smokefree building. "More and more Alaskans want to live in a smokefree environment," says Carol Gore, President and CEO of CIHA. "It is our goal to provide quality, affordable and healthy homes."  The Alaska Tobacco Control Alliance will present CIHA with a Letter of Commendation for their efforts in providing healthy housing options. This is CIHA's first smokefree property. As of September 1 CIHA will implement a smokefree housing policy in all of our properties – all new leases will be smokefree and expired leases will become smokefree as they come up for renewal.  To access the full press release, click above.


How to fix Social Security in one graph

9/2:  The following is from an August 29th column by Ezra Stein in the Washington Post: "The revenue loss over the next 75 years just from extending the tax cuts for people making over $250,000 -- the top 2 percent of Americans -- would be about as large as the entire Social Security shortfall over this period," writes Kathy Ruffing and Paul N. Van de Water at the Center on Budget and Policy Priorities. "Members of Congress cannot simultaneously claim that the tax cuts for people at the top are affordable while the Social Security shortfall constitutes a dire fiscal threat." We do have fiscal problems in this country: health care, for instance. We have to get growth in that sector down or we'll bankrupt the country. But that's not the case with Social Security. Social Security is just a question of priorities. And the legislators who are saying that we can extend the Bush tax cuts without offsets but that we need massive benefit cuts in Social Security are showing where their priorities lie, not stating a sad economic reality.  Click above to access the column.  To access the analysis to which this column refers, see the news note here.


What the 2010 Trustees' Report Shows about Social Security

9/2:  The following is from an August 13th analysis from the Center on Budget & Policy Priorities: On August 5, the Social Security Board of Trustees issued the 70th annual report on the program's financial and actuarial status.  The trustees' report shows some mild deterioration in the program's short-term outlook -- a finding that was widely expected -- and a mild improvement in its long-run finances, thanks largely to the recent enactment of health reform. 

       The trustees continue to estimate that the trust funds will be exhausted in 2037 -- the same date that they forecast in last year's report.

       Even after 2037, Social Security could pay more than three-fourths of scheduled benefits using its annual tax income. Those who fear that Social Security won't be around when today's young workers retire misunderstand the trustees' projections.

       The program's shortfall is relatively modest, amounting to 0.7 percent of Gross Domestic Product (GDP) over the next 75 years (and 1.4 percent of GDP in 2084). A mix of tax increases and benefit modifications -- carefully crafted to shield recipients of limited means, potentially make benefits more adequate for the neediest beneficiaries, and give ample notice to all participants -- could put the program on a sound footing indefinitely.

       The 75-year Social Security shortfall is about the same size as the cost, over that period, of extending the 2001 and 2003 tax cuts for the richest 2 percent of Americans (those with incomes above $250,000 a year). Members of Congress cannot simultaneously claim that the tax cuts for people at the top are affordable while the Social Security shortfall constitutes a dire fiscal threat.

       Preserving and building upon the cost-control measures enacted in the health reform law will be important not only to Medicare, but -- to a lesser degree -- to Social Security as well.

To access the full report, click above.


Seniors opt to stay put; More are adapting homes as needs change

8/17:  The following is from an August 15th Detroit Free Press article: The new catch phrase among homeowners is "aging in place."  Instead of selling their homes and moving into retirement villages or assisted-living quarters, a growing number of older Americans are modifying their homes to make them more user-friendly as they age.  The concept has caught on so successfully that  it even has its own National Aging in Place Week, which falls on Oct. 11-16 this year.  "Aging in place is a near and dear subject," said Karen Kassik, president of Home Accessibilities, a residential design firm that focuses on building barrier-free homes. Click above to access the full story.


Detroit Housing Commission adopts smoke-free policy for all properties, effective January 1, 2011

8/17:  We're very pleased to report that the Detroit Housing Commission — Michigan's largest public housing authority — adopted a smoke-free policy for all its multi-family properties.  The smoke-free policy goes into effect for all residents — no grandfathering — on January 1, 2011 in all its 15 properties with a total of 2,118 units.  The policy covers 10 elderly buildings with 1,440 units and 5 family buildings with 678 units.  Smoking will only be allowed in outdoor designated smoking areas, if any.  The Detroit Housing Commission will provide assistance to residents to quit smoking.  It has been our pleasure to assist the Detroit Housing Commission in adopting this policy.  Michigan now has 42 housing commissions with smoke-free policies for some or all their properties. The policies cover about 85 apartment buildings/developments and over 384 townhouses/scattered site units, with about 7,744  total apartment units.  Three of the largest housing commissions in Michigan now have adopted smoke-free policies — Grand Rapids with about 900 units, Detroit with 2,118 units, and Lansing with 834 units. Nationally, there are now at least 179 local housing authorities that have adopted smoke-free policies for some or all their properties.  Among the largest housing authorities to have adopted smoke-free policies for almost all their properties are the 3 three Michigan ones named above; Portland, Oregon with 1,993 units covered and may be adding 3,760 units soon; and Everett, Washington with 1,047 units to be smoke-free in June, 2011.  Other large housing authorities that have adopted smoke-free policies, but only for a few of their properties or are phasing in the smoke-free policies over the next few years include:  Minneapolis, Boston, Denver, and Seattle.  To access an updated listing of all the housing authorities we know of with smoke-free policies, click above.


New Health Official Faces Hostility in Senate

7/28:  The following is from a July 27th NY Times article: Unlike many other health policy experts, Dr. Donald M. Berwick, the new chief of Medicare and Medicaid, has extensive real world experience.  As co-founder of the Institute for Healthcare Improvement in Cambridge, Mass., he worked with doctors and nurses to upgrade care at hundreds of hospitals from Contra Costa County, Calif., to Green Bay, Wis., to Florence, S.C. -- and from Britain to Sweden to South Africa.  He led efforts to reduce medical errors, eliminate hospital-acquired infections, standardize treatments and cut waste. One of his students, Dr. John S. Toussaint, former president of ThedaCare in Appleton, Wis., said his hospital had reduced the cost of inpatient care by about 25 percent, "using principles of continuous improvement espoused by Dr. Berwick."  But two weeks after taking office, Dr. Berwick is still struggling to tamp down a furor over past statements in which he discussed the rationing of health care and expressed affection for the British health care system. And he is finding his ability to do his job clouded by the circumstances of his appointment, with many Republicans in open revolt over President Obama's decision to place him in the post without a Senate confirmation vote.  Dr. Berwick never had a confirmation hearing and has not responded publicly to critics. The White House declined to make him available for an interview. But friends and allies said he was preparing a point-by-point rebuttal, most likely to be delivered when he first testifies before Congress. He wants to focus on the work of his agency, which finances health care for one in three Americans and has a budget bigger than the Pentagon's.  As a recess appointee, Dr. Berwick has the same legal authority as a Senate-confirmed appointee. But his supporters worry that he will be a lame duck because agency employees and health care interest groups know he may be gone in 18 months. Unless he is confirmed, his appointment will expire at the end of the Senate's next session.  Click above to access the full article. 


Boston Housing Authority pushes for smoke-free housing; Ban in Hub could be nation's largest

7/28:  The following is from a July 27th Boston Globe report: Meena Carr figured out years ago why her young grandson, Malik, was chronically coughing and wheezing: Her home made him sick. Carr, 69, didn't smoke cigarettes, but some of her neighbors in the Washington-Beech housing development did, often in the hallway. The smell permeated Carr's apartment.  Last month, Washington-Beech in Roslindale became the city's first smoke-free public housing development. Today, Carr plans to join other community leaders, public officials, and housing advocates to discuss the Boston Housing Authority's more ambitious long-term objective --  clearing the air by 2013 at all 64 public housing developments.  That positions Boston to become the first city in Massachusetts, and perhaps the largest housing authority nationwide, to impose such a ban. Under the proposal, still in its initial stages, about 27,000 residents in 12,000 units would be prohibited from smoking in common areas and their own apartments. "This new initiative will go a long way to encourage more healthy living styles for our residents," said Mayor Thomas M. Menino, who earlier this year unveiled the plan to make housing developments smoke free. "You don't live in a single-family home, you are in multiunit housing," Menino said. "What you do there has an effect on all other folks living in that building."  Today's meeting at Suffolk University is being billed by officials as a "summit" to launch the campaign. Details, including how a ban would be phased in and how violators would be punished, are still unclear. Housing officials say the process will include community debate and a public comment period. By January, they hope to submit a proposal to the Department of Housing and Urban Development.  Nationwide, about 170 public housing authorities -- roughly 5 percent -- have instituted some kind of no-smoking policy in the past few years, according to the Smoke-Free Environments Law Project in Michigan, a nonprofit that tracks the issue. But so far none as large as Boston's has implemented the ban, making the city a leader if it moves more quickly than other authorities of similar size.  Click above for the full story.


Senate Appropriations Committee Approves $430 Million in Funding for LSC and Repeals Restriction on Non-Federal Funds

7/26:  The following is from a July 23rd Brennan Center for Justice alert:  On July 22, 2010, the Senate Appropriations Committee approved (by a vote of 17-12) $430 million in total funding for the Legal Services Corporation (LSC) as part of the Commerce-Justice-Science (CJS) Fiscal Year 2011 appropriations bill. This funding level represents an increase of $10 million from the current year's appropriation for LSC. However, the $10 increase is contingent upon LSC's implementation of all 17 of the recommendations made by the Government Accountability Office in its 2007 audit. It is reported that the Senate bill would also almost wholly repeal the LSC restriction on non-federal funds (the bill would leave in place the restriction on representing prisoners with any funds). The bill would leave in place all restrictions on federal funds. Since 1996, a rider to the federal appropriation for LSC has prohibited LSC-funded lawyers from using certain tools when advocating on behalf of their clients and has barred certain categories of people from qualifying for LSC-funded representation. The restriction on non-federal funds, which the Senate bill would repeal, is a provision of the rider that currently extends the set of LSC restrictions to all of the funding that an LSC grantee receives, including money from state, local, and private sources. This aspect of the LSC funding restrictions has created waste and inefficiency in the delivery of legal services and the Brennan Center and its allies have long advocated for its repeal.  The House version of the CJS appropriations bill, which passed out of subcommittee on June 29, would allocate $440 million for LSC and includes language that would repeal the LSC restriction currently barring LSC programs' clients from participating in class action lawsuits. The language in the House bill leaves the restriction on non-federal funds in place. Read more about the LSC funding restrictions and about the Brennan Center's campaign to fix them by clicking above.


LSC Board Launches Fiscal Oversight Task Force

7/26:  The following is from a July 21st LSC press release:  The Board of Directors of the Legal Services Corporation (LSC) today approved creation of an independent task force to review and make recommendations to the Board regarding LSC's fiscal oversight responsibilities and how LSC conducts fiscal oversight of its grantees.  LSC Board Chairman John G. Levi, who proposed the task force, said it grew out of his review of Government Accountability Office reports and other issues concerning LSC following his nomination last year to the Board.  "Given the number of issues that have confronted LSC in the recent past, I thought as a matter of some urgency that I wanted to get a blue-ribbon task force in place to help us take a hard look at how we conduct fiscal oversight -- how we have in the past, how we do it currently, and to give us advice on how we might best do it in the future," Chairman Levi said.  The task force's "findings and expertise will be critically important as the Board works to expand legal assistance to low-income Americans across the nation," Chairman Levi said.  The task force will seek information and advice from other grant-making organizations, accounting firms, technology experts, and other business and academic advisers familiar with institutions similar to LSC, Chairman Levi said. Current and former LSC employees will not serve on the task force, he said, "so that we get a completely independent look at our operations and we can all stand by and feel good about the process that we went through."  Board members Robert J. Grey Jr. and Victor Maddox will lead the task force, which is scheduled to issue findings and any recommendations by March 31.  "The magnitude of our challenge cannot be overstated," Chairman Levi said. "Fifty-four million Americans qualify for legal assistance from LSC programs, and these programs are vital to building stronger communities across the nation. Legal aid programs help low-income Americans when they are trying to maintain livelihoods, keep a roof over their heads or escape domestic violence. The work of legal aid programs helps bring life to our nation's promise of equal access to justice."  Click above to access the LSC web site for additional information.


Cuts in Home Care Put Elderly and Disabled at Risk

7/21:  The following is from a July 21st NY Times article:  As states face severe budget shortfalls, many have cut home-care services for the elderly or the disabled, programs that have been shown to save states money in the long run because they keep people out of nursing homes. Since the start of the recession, at least 25 states and the District of Columbia have curtailed programs that include meal deliveries, housekeeping aid and assistance for family caregivers, according to the Center on Budget and Policy Priorities, a research organization. That threatens to reverse a long-term trend of enabling people to stay in their homes longer.  For Afton England, who lives in a trailer home here, the news came in a letter last week: Oregon, facing a $577 million deficit, was cutting home aides to more than 4,500 low-income residents, including her. Ms. England, 65, has diabetes, spinal stenosis, degenerative disc disease, arthritis and other health problems that prevent her from walking or standing for more than a few minutes at a time.  Through a state program, she has received 45 hours of assistance a month to help her bathe, prepare meals, clean her house and shop. The program had helped make Oregon a model for helping older and disabled people remain in their homes.  But state legislators say home care is a service the state can no longer afford. Cuts affecting an additional 10,500 people are scheduled for Oct. 1.  ... Nursing homes here [Oregon] cost the state an average of $5,900 a month; home and community-based services cost $1,500 a month.  Other states have made similar cuts:  For the full article, click above.


Sault Tribe Housing Authority offers smoke-free housing

7/20:  The following is from a July 20th news story:  The Sault Ste. Marie Tribe of Chippewa Indians has become the first tribe in Michigan - and fifth in the nation - to establish smoke-free housing units for tribal members.  The Sault Tribe Housing Authority today celebrated the opening of smoke-free homes for eight tribal families (four duplex units) in Kincheloe, Michigan. Additional smoke-free housing units will be established in future years, under a new policy adopted earlier this year by the Sault Tribe Housing Authority Commission.  "Providing a healthy living environment for tribal members is our main goal," said Sault Tribe Housing Director Joni Talentino. "We want to give our members the opportunity to join the nationwide movement toward becoming smoke-free."  All of the smoke-free units are full.  Starting in November 2008, as an initiative of the Sault Tribe Strategic Alliance for Health Project, the Sault Tribe Tobacco Task Force, the Sault Tribe Housing Authority, the Sault Tribal Youth Council, the Chippewa County Tobacco-Free Living Coalition, the Smoke-free Environments Law Project and the Michigan Department of Community Health worked together to adopt the policy and establish the smoke-free housing units.  Other supporters of the policy included the Tribal Youth Council and smoke-free environments.  "Many tribal and non-tribal entities worked hard on obtaining this status," said Donna Norkoli, project coordinator of the Sault Tribe Strategic Alliance for Health Project. "It truly could not have been done without these partnerships."  The Sault Tribe Housing Authority joins nine other local housing commissions in the U.P. who have adopted smoke-free policies.  "Of 11 tribal housing authorities in Michigan, the Sault Tribe has taken the lead in adopting a smoke-free policy," said Jim Bergman of the Smoke-Free Environments Law Project. "Hopefully, other tribes will soon follow the Sault Tribe's leadership role." ... The Sault Tribe Housing Authority manages more than 500 housing units across the Upper Peninsula.  To access the news story, click above.


Obama bypassing Senate for new Medicare chief

7/7:  According to the July 7th Washington Post: Bypassing Republicans eager to grill an administration official over the new health care law, President Barack Obama is planning to appoint the head of Medicare and Medicaid without Senate hearings.  Obama intends to use a so-called recess appointment to put Dr. Donald Berwick in charge of the Centers for Medicare and Medicaid Services, a White House official said Tuesday night. The appointment was expected Wednesday. The decision means Berwick, an expert on patient care, can assume the post without being confirmed by the Senate, which is in recess for the July Fourth holiday. He could serve through next year without Senate confirmation.  Republicans had indicated they were prepared to oppose him over comments he had made on rationing of medical care and other matters. Democrats wanted to avoid a nasty confirmation fight that could reopen the health care debate. Berwick was nominated in April but no confirmation hearing had been scheduled.  Click above for full article.


'Father of modern gerontology' Robert N. Butler dies at 83

7/7:  The following is from the July 7th Washington Post: Robert N. Butler, 83, a Pulitzer Prize-winning author, psychiatrist and expert on aging who helped illuminate the "quiet despair, deprivation, desolation and muted rage" that he said characterized the act of growing old in America, and who co-wrote a best-selling sex manual for senior citizens, died July 4 at Mount Sinai Medical Center in New York. He had leukemia. For more than half a century, Dr. Butler was a leading advocate in academic and policy circles for the dignified treatment and care of the elderly. He coined the term "ageism" to describe systematic discrimination against older people and challenged lawmakers, scientists and medical students to consider how to create a health-care system in which Americans could grow old gracefully.  "Bob was certainly the person, more than any other single individual, who helped create the modern notion that aging is a time of choice, of opportunity, of growth," said Dan Perry, who leads the Washington-based Alliance for Aging Research. "He was really the father of modern gerontology."  Dr. Butler was appointed the first director of the National Institute on Aging, part of the National Institutes of Health, in the 1970s. Later, he established a geriatrics department at Mount Sinai, one of the first such comprehensive departments at an American medical school. At the time of his death, he was president and chief executive of the International Longevity Center-USA, a New York-based nonprofit research organization he founded in 1990.  ... Through his work as a clinician and researcher, Dr. Butler saw firsthand how difficult it was for the elderly to find adequate health care and live with dignity. They were treated by society as useless, warehoused in nursing homes staffed by woefully undertrained caregivers and seen by doctors who knew little about the unique needs of people in the latter stages of life.  Dr. Butler compiled those observations in his 1975 book "Why Survive? Being Old in America," which won the Pulitzer for general nonfiction in 1976. "We have shaped a society which is extremely harsh to live in when one is old," he wrote. "The tragedy of old age is not the fact that each of us must grow old and die but that the process of doing so has been made unnecessarily and at times excruciatingly painful, humiliating, debilitating, and isolating through insensitivity, ignorance, and poverty."  Click above for full obituary.


House Subcommittee Approves $20 Million Increase for LSC

7/1:  The following is from a June 30th note from the Legal Services Corporation: The House Appropriations Subcommittee on Commerce, Justice, Science and Related Agencies approved a $440 million Fiscal Year 2011 budget for the Legal Services Corporation (LSC) on June 29.  The funding increase was announced by Rep. Alan B. Mollohan (D-W.Va.), chairman of the House Appropriations Subcommittee, and represents a nearly 5 percent increase in the LSC budget. Rep. Frank R. Wolf (R-Va.) is the Subcommittee's ranking member.  "LSC is enormously grateful for the strong support of Chairman Mollohan, Ranking Member Wolf and all Subcommittee members. The ranks of low-income Americans are growing and LSC-funded programs report that requests for legal assistance are increasing. This new funding approved by the Subcommittee will help legal aid programs to better serve the nation's poor," LSC President Victor M. Fortuno said.  In February, President Fortuno testified before the Subcommittee, noting that requests by low-income Americans for help with foreclosure and unemployment problems were increasing. Fifty-four million Americans, including 18.5 million children, are eligible for civil legal assistance. The weak economy has placed a great strain on the resources that support legal aid programs, with some non-federal funding for legal aid in decline, raising concerns about the ability of legal aid programs to provide increased services this year and next year.  The Subcommittee bill continues existing restrictions on the use of funds, but lifts the restriction on the ability of LSC-funded programs to consolidate related client cases into class-action suits. Chairman Mollohan and Reps. Patrick J. Kennedy (D-R.I.) and Adam B. Schiff (D-Calif.) urged the Subcommittee to permit class actions. "Lifting this restriction will allow grantees to more efficiently address systemic issues such as predatory lending or wrongful eviction," Chairman Mollohan said in a statement.  LSC is the single largest funder of civil legal aid in the nation, and currently funds 136 independent nonprofit legal aid programs across the country. Established in 1974, LSC operates as a 501(c)(3) nonprofit corporation to promote equal access to justice and to provide for high-quality civil legal assistance to low-income Americans.  The annual LSC budget includes basic field grants that provide for the delivery of civil legal assistance, technology grants, an education loan repayment program for the recruitment and retention of lawyers, and grants oversight to ensure compliance and accountability by legal aid programs. For more info, go to the LSC web site by clicking above.


Investing in Prevention: The New National Prevention, Health Promotion and Public Health Council

7/1:  The following is from a June 30th Fact Sheet from the U.S. Surgeon General's office: Chronic diseases -- such as heart disease, cancer, stroke, and diabetes -- are responsible for 7 of 10 deaths among Americans each year and account for 75% of the nation's health spending. Often due to economic, social, and physical factors, too many Americans engage in behaviors -- such as tobacco use, poor diet, physical inactivity, and alcohol abuse -- that lead to poor health.  A focus on prevention will offer our nation the opportunity to not only improve the health of Americans but also help reduce health care costs and improve quality of care.  By concentrating on the underlying drivers of chronic disease, the Affordable Care Act helps us move from today's sick-care system to a true "health care" system that encourages health and well-being.  The Affordable Care Act signed into law by President Obama creates a National Prevention, Health Promotion, and Public Health Council. The Council, composed of senior government officials, will elevate and coordinate prevention activities and design a focused National Prevention and Health Promotion Strategy in conjunction with communities across the country to promote the nation's health. The Strategy will take a community health approach to prevention and well-being -- identifying and prioritizing actions across government and between sectors.  On June 10, the President signed an Executive Order creating the National Prevention Council.  Established within the Department of Health and Human Services, the Council is chaired by the U.S. Surgeon General.  Click above to access the full Fact Sheet.  To access the Council's report in pdf format, click here.


Health Agency Nominee Faces Confirmation Battle

6/22:  The following is from a June 21st NY Times article:  President Obama's nominee to run Medicare and Medicaid, Dr. Donald M. Berwick, is a man with a mission, a preacher and teacher who has been showing hospitals how they can save lives and money by zealously adhering to clinical protocols for the treatment of patients.  Hospital executives who have worked with Dr. Berwick describe him as a visionary, inspiring leader.  But a battle has erupted over his nomination, suggesting that Dr. Berwick faces a long uphill struggle to win Senate confirmation.  Republicans are using the nomination to revive their arguments against the new health care law, which they see as a potent issue in this fall's elections, and Dr. Berwick has given them plenty of ammunition. In two decades as a professor of health policy and as a prolific writer, he has spoken of the need to ration health care and cap spending and has confessed to a love affair with the British health care system. He has made numerous public appearances to talk about health care and has published a book of his speeches on the topic.  Mr. Obama nominated Dr. Berwick on April 19 to be administrator of the Centers for Medicare and Medicaid Services, the largest purchaser of health care in the United States. The post has been vacant since October 2006, and the need to fill it has become more pressing with passage of the new law. The agency must write and enforce dozens of regulations to expand Medicaid, trim Medicare and test new ways to deliver care. Click above for full article.


Should public housing projects go smoke-free?

6/17:  The following is from a June 16th CNN report: Between puffs of his cigarette, Aristo Lizica explains why he's all for a smoking ban in public housing -- including his own housing project on the Upper West Side of Manhattan. "When you smoke indoors, it hurts everybody," the 59-year-old says, leaning against an iron fence outside his building. "It's better for me to just make myself sick."  Lizica would prefer to avoid making himself sick too, of course. "I want to quit," he adds. "I know cigarettes are bad for my health." Yet he remains unable to kick the habit. Federal housing officials are trying to help people like Lizica -- and his neighbors -- by making public housing smoke-free. Full or partial smoking bans would reduce secondhand smoke drifting between apartments, prevent cigarette-related fires, and even help smokers quit, they argue.  "We see it as a win-win for both residents and housing authorities," says Donna White, a spokesperson for the U.S. Department of Housing and Urban Development, the federal agency that oversees public housing.  In a 2009 memo, the department highlighted the dangers that indoor smoking poses to the nation's 2.1 million public housing residents, and "strongly encouraged" local housing authorities to implement smoking restrictions. But doing so remains voluntary, and so far only about 4 percent of local authorities have taken the step. "Change is hard," White says.  Public health experts are hoping to light a fire under the cause. In a paper published today in the New England Journal of Medicine, a team of researchers and attorneys from Harvard University argue that the health and safety gains of a smoking ban in housing projects would far outweigh the losses, which some say would include the privacy rights of smokers.  Yet smokers like Lizica could prove to be the biggest winners, the authors suggest. "If federal officials and public housing authorities take this cue, we can expect to have large numbers of people quit smoking," says the lead author of the article, Jonathan Winickoff, M.D., a pediatrician and assistant professor at Harvard Medical School, in Boston. "That could be the single greatest health benefit." Click above for the full CNN article.  To access the full NEJM article, click here.


Medical Marijuana and Smoke-Free Multi-Unit Housing:  An Analysis

6/11: We at TCSG's Smoke-Free Environments Law Project (SFELP) are pleased to release a new document by SFELP Consulting Attorney  Cliff Douglas, J.D., titled Restricting the Use of Medical Marijuana in Multi-Unit Residential Settings:  Legal and Practical Considerations.  This may be one of the first such analyses done anywhere in the U.S., and, while it focuses on Michigan's Medical Marihuana Act, it has great relevance for other states (at least 13 to 15 states have such laws).  We have now added a section to the Landlord Rights page of the MISmokeFreeApartment web site where you can access the analysis.  At that site, you can also access a copy of the Michigan Medical Marihuana Act and a copy of a 1999 HUD legal memorandum on this topic.  The analysis is 12 pages, but the introduction is just one page, and it summarizes the question addressed -- Do multi-unit residential property owners have the authority to prohibit the smoking of marijuana in their properties when the individual marijuana user is authorized by the state of Michigan to user it? -- and provides answers to that question for both market-rate properties and for affordable housing, including public housing.  Our conclusion is that owners may prohibit the smoking of marijuana, including medical marijuana, in their properties. We addressed this issue because many multi-unit residential property owners, including housing authorities, who had adopted overall smoke-free policies, wanted to know how they would deal with individuals who are licensed by the state to use marijuana for medicinal purposes.  We encourage you to go to the site and download copies of the analysis and the HUD memorandum.  Also, feel free to do a link to the page from your own web sites.  To access the analysis and 1999 HUD memorandum, click above.


Social Security's defenders wary of deficit reduction commission

6/9:  The following is from a June 9th Washington Post article:  One of the oddest Web posts making the rounds in Washington is a series of blurry videos from Capitol Hill showing people coming and going from a closed-door meeting of President Obama's new deficit commission.  The mundane scenes have a sinister cast for activists who say the commission is at work on a secret plan to gut Social Security. Nancy Altman, whose group, Social Security Works, shot the footage, says the threat to the nation's primary social safety net is greater now than at any time in the program's 75-year history.  "This is going to affect every single American if they reach agreement," she said. "People need to know what's going on."  The heated rhetoric is an ominous sign for Obama's deficit-fighting task force, which is charged with developing a bipartisan plan to stabilize the soaring national debt. Adjusting Social Security benefits is a likely point of consensus, commission members say. Now, some of the same activists who helped derail a 2005 GOP plan to restructure the program are threatening to rally the public against any proposal to cut benefits.  Their campaign to take Social Security off the commission's agenda has so far been limited to op-eds, online postings and thousands of postcards to lawmakers. But AARP, which lobbies on behalf of people over 50, recently fired a warning shot, urging the commission not to "unfairly target hard-earned benefits of millions of Americans." And several groups, including and the Campaign for America's Future, are threatening to make Social Security an issue in the midterm elections. "It's likely to be a pretty full court press," said MoveOn campaign director Daniel Mintz, whose group plans to ask candidates to sign a pledge opposing Social Security cuts. "We're going to demand solutions to the deficit that make corporations and the rich pay their fair share of taxes, rather than cutting benefits and squeezing the middle class." ... Over the past month, deficit commission members have begun meeting in small working groups, including one subpanel, chaired by former Clinton budget director Alice Rivlin and Sen. Judd Gregg (R-N.H.), dedicated to Social Security. Other panels are focusing on other entitlement programs, such as Medicare, an even bigger budget problem, as well as discretionary spending and the tax system. If 14 of the commission's 18 members reach agreement on a deficit-reduction plan, congressional leaders have pledged to put it to a vote after the fall elections.  Commission members have declined to say what options they are considering, repeating the Obama mantra that everything is "on the table." But options for Social Security are no secret: In addition to boosting taxes, the lengthy list includes raising the retirement age for people now in middle age and trimming benefits for the wealthy. Social Security has been self-supporting since 1935, with taxes paid by current workers financing benefits for current retirees. But people today retire earlier, live longer and have fewer children. As result, the number of workers for each retiree is expected to fall from about three to one now to two to one by 2050. Sometime in the next few years, taxes will no longer cover benefits. The program's defenders argue that there is no crisis: If Treasury would repay billions of dollars in surplus Social Security taxes borrowed over the years, the program could pay full benefits through 2037. But many budget experts question whether supporting the existing benefit structure should be a cash-strapped nation's first priority.  To access the full article, click above.


Counting on Medicaid Money, States Face Shortfalls

6/8:  The following is from a June 7th NY Times article: Having counted on Washington for money that may not be delivered, at least 30 states will have to close larger-than-anticipated shortfalls in the coming fiscal year unless Congress passes a six-month extension of increased federal spending on Medicaid.  Governors and state lawmakers, already facing some of the toughest budgets since the Great Depression, said the repercussions would extend far beyond health care, forcing them to make bone-deep cuts to education, social services and public safety. ... The Medicaid provision, which would extend assistance first granted in last year's stimulus package, was considered such a sure bet by many governors and legislative leaders that they prematurely included the money in their budgeting. But under pressure from conservative Democrats to rein in deficit spending, House leaders in late May eliminated $24 billion in aid to states from a tax and jobs bill that was approved and forwarded to the Senate.  The Senate plans to take up the measure this week, and the majority leader, Harry Reid of Nevada, favors restoring the money, said his spokesman, Jim Manley. The House speaker, Nancy Pelosi, signaled last week that her chamber was open to reconsidering the appropriation.  But state and Congressional officials said the evolving politics of an election-year Congress meant the federal aid could no longer be taken for granted. And if it does not arrive, it will leave gaping shortages for states that are already slashing services and raising taxes to balance their recession-wracked budgets.  According to the National Conference of State Legislatures, states are relying on the money to close more than a fourth of the $89 billion in cumulative budget shortfalls projected for fiscal 2011, which starts on July 1 in 46 states. Click above to access the full article.


Secretary of HHS announces tobacco-free initiative

5/12:  On May 11th, HHS Secretary Sebelius announced a major new initiative to prevent and reduce tobacco use and its effects.  Her web site states: Smoking harms nearly every organ of the body, causing many diseases and affecting the health of smokers in general. Quitting smoking has both immediate and long-term benefits for you and your loved ones. Despite progress in reducing tobacco use, more than 20% of Americans still smoke and smoking rates that have been falling for decades have now stalled. The good news is that we know what it will take to get those numbers dropping again – comprehensive, sustained, and accountable tobacco control efforts based on evidence-based interventions.  We have identified the following set of actions to accelerate our efforts to prevent and reduce tobacco use.  To go to the web site, click above.


Feds put up $5B for retiree plans; Employer subsidy to cover gap until health care safety net kicks in

5/6:  The following is from a May 5th Detroit News Article: Trying to entice employers to keep early retirees on their medical plans, the Obama administration announced Tuesday it's making $5 billion available until the safety net of the new health care law is in place.  Effective next month, federal subsidies will allow employers to recoup a big chunk of the cost of medical claims for retirees ages 55 to 64 not yet eligible for Medicare.  Older baby boomers working for large companies -- and looking to downshift to less-demanding employment-- could be immediate beneficiaries.  However, in the long run, experts predict that President Barack Obama's health overhaul will accelerate the decline of employer-sponsored retiree coverage, by making it easier for people to find and keep affordable coverage on their own, as well as improving Medicare benefits.  Starting in 2014, the health care law forbids insurers from denying coverage to people with medical problems, limits what the companies can charge older individuals, and sets up competitive health insurance markets where consumers can buy a policy, in many cases with direct government assistance. Early retirees will have options they don't currently enjoy. Click above to access the full article.


Secretary Sebelius on Important New Benefits for Companies and Early Retirees in the Affordable Care Act

5/5:  According to a May 4th press release from HHS:  The U.S. Department of Health and Human Services today issued regulations establishing the Early Retiree Reinsurance Program in the Affordable Care Act.  This temporary program will make it easier for employers to provide coverage to early retirees.  "Rising costs have made it hard for employers to provide quality, affordable health insurance for workers and retirees," said Secretary Sebelius.  "As a result, many Americans who retire before they are eligible for Medicare are worried about losing health insurance coverage through their former employers, putting them at risk of losing their life savings due to medical costs. This new program will provide much-needed relief so that employers can provide more retirees with quality, affordable insurance, starting this year."  The percentage of large firms providing workers with retiree coverage has dropped from 66 percent in 1988 to 31 percent in 2008.  The Affordable Care Act includes $5 billion in financial assistance to employers to help them maintain coverage for early retirees age 55 and older who are not yet eligible for Medicare.  The program will end in 2014, when Americans will be able to choose from additional coverage options through the health insurance exchanges.  Eligible employers can apply for the program through the Department of Health and Human Services. Applications will be available by the end of June.  Both self-funded and insured plans can apply, including plans sponsored by private entities, state and local governments, nonprofits, religious entities, unions, and other employers. You can find more information about this important new program by clicking above.


Liberals battle for benefits

4/28:  The following is from an April 26th The Hill story: A liberal lawmaker on the White House fiscal commission warned its Republican co-chairman against relying on cuts to seniors' entitlement benefits to craft a plan to rein in the deficit.  Rep. Jan Schakowsky (D-Ill.) said former Sen. Alan Simpson (R-Wyo.) and other fiscal hawks have focused too much on possible changes to entitlement programs, especially Social Security, ahead of the White House fiscal commission's first meeting on Tuesday.  "If Alan Simpson is so committed to putting entitlements on the table... then we better put all entitlements, including tax entitlements, on the table as well," Schakowsky told The Hill on Monday.  The "tax entitlements" Schakowsky referring to were exemptions aimed at helping people save for retirement, such as tax breaks on money invested in 401k and individual retirement accounts (IRAs), according to her office.  The commission's recommendations need the votes of 14 of the 18 members to make it to Congress, so any defector could be a cause for concern. And if Schakowsky's against the possible changes to entitlement programs than other Democrats would worry about voting for them because it could be seen as a vote against seniors.  Schakowsky joined liberal groups in pushing back Monday against Simpson and the fiscal commission's Democratic co-chairman, former Clinton White House Chief of Staff Erskine Bowles, who have said that all options for reducing deficits must be considered.  "I feel that part of my job on the commission is to make sure that we have a consensus that the goal of fiscal policy and budget policy is to make sure that we serve the needs of the people in our country, in our democratic society, and not just put out a green eyeshade and start slashing programs," Schakowsky said. Simpson and Bowles, picked to lead the commission by President Barack Obama, have made clear that the commission will consider new taxes that could irk Republicans and cuts in spending and entitlement benefit levels that would be unpopular with Democrats.  Click above for the full article.


Justices Put Curbs on Payment for Lawyers

4/23:  The following is from an April 22nd NY Times article:  The Supreme Court on Wednesday made it a little harder for civil rights lawyers to be paid extra for exceptional results.  In most American lawsuits, each side pays for its own lawyers whether they win or lose. But Congress occasionally allows the winning side to claim its legal fees from its adversaries, notably in cases involving claims of civil rights violations.  The question in the case decided Wednesday, Perdue v. Kenny A., No. 08-970, was how judges should determine how much the losing side has to pay.  The case arose from a successful class-action suit on behalf of 3,000 children in Georgia that helped reform the foster-care system there.  The trial judge awarded the lawyers $6 million using a conventional way of calculating legal fees -- hours worked times the local hourly market rate for lawyers of comparable experience and skill. The judge then added $4.5 million for what he said was work of exceptionally high quality.  Justice Samuel A. Alito, writing for five justices, said that some additional payments may be proper in rare cases but that the judge here had not given good enough reasons for increasing the basic payment by 75 percent. For the most part, Justice Alito said, it is not possible to know what role a lawyer played in obtaining a favorable result. ... Justice Alito, joined by Chief Justice Roberts and Justices Antonin Scalia, Anthony M. Kennedy and Clarence Thomas, said that the trial judge's "essentially arbitrary" award in the Georgia case would have caused the lawyers there to "earn as much as the attorneys at some of the richest law firms in the country."  The legal-fees provision, he wrote, "was enacted to ensure that civil rights plaintiffs are adequately represented, not to provide such a windfall."  Justice Stephen G. Breyer, joined by Justices John Paul Stevens, Ruth Bader Gisburg and Sonia Sotomayor, said the Georgia lawyers had indeed vindicated important civil rights and helped reform an abusive foster-care system through an exceptionally long, complex and hard-fought litigation. Justice Breyer added that the trial judge was in the best position to assess their performance.  "If this is not an exceptional case," Justice Breyer asked, "what is?"  Click above for full article.


Federal Government Will Pick Up Nearly All Costs of Health Reform's Medicaid Expansion

4/22:  The following is from an April 20th Center on Budget and Policy Priorities analysis: Health reform's critics argue that states will bear a significant share of the costs of the new law's Medicaid expansion, placing an unaffordable financial burden on states. The argument does not withstand scrutiny. In its first five years, the Medicaid expansion will add just 1.25 percent to what states were projected to spend on Medicaid over that period in the absence of health reform, while providing health coverage to 16 million more low-income adults and children.  The health reform law requires all states to expand Medicaid to all non-elderly individuals with incomes up to 133 percent of the poverty line, or about $29,000 for a family of four. The Medicaid expansion and new premium credits for people with incomes too high to qualify for Medicaid will, together, reduce the number of uninsured people by 32 million by 2019, according to the Congressional Budget Office (CBO).  The Medicaid expansion in health reform is a good deal for states. 1) The additional cost to the states represents only a 1.25 percent increase in what states would have spent on Medicaid from 2014 to 2019 in the absence of health reform.  2) The federal government will assume 96 percent of the costs of the Medicaid expansion over the next ten years, according to an analysis of CBO estimates.  3) And having more people covered as a result of the Medicaid expansion and other provisions in the health reform law will reduce state and local governments' current spending on other services for the uninsured, such as mental health services.  In sum, the Medicaid expansion will significantly increase coverage at a modest cost to the states and will help reduce states' costs for providing care to the uninsured through a variety of state programs outside of Medicaid.  Click above for the full analysis.


Sault Tribe Housing Authority adopts smoke-free policy; Fifth tribal housing authority in nation to do so

4/22:  We are delighted to report that the Sault Tribe Housing Authority in the Upper Peninsula of Michigan on April 19th adopted a smoke-free policy for some of their Tribal Housing homes.  The policy states that "The Housing Authority Board of Commission has declared that certain Tribal Housing homes, located in the Seven-County service area of the Sault Ste. Marie Tribe of Chippewa Indians, shall be designated as smoke-free.  Smoking is not permitted in any inside area of the designated homes."  The Housing Authority Board of Commission will, at the May meeting and at subsequent meetings as needed, approve a resolution for each individual property that will be designated as smoke-free.  We expect that initially a number of duplexes will be designated as smoke-free, as well as some triplexes that will be constructed in 2011 for elderly housing.  This is a great achievement by the Sault Tribe Housing Authority and is something that has been worked on for well over a year.  Our congratulations to their Board, their Executive Director Joni Talentino and her staff, including Mariea Mongene, who worked tirelessly on this.  Congratulations also to Donna Norkoli of the Sault Tribe Health Center, as well as Lauren Eveleigh of the Health Center, and Julie Trotter of the Chippewa County Health Department and to all the other folks who contributed so much to this effort.  It has been our pleasure at TCSG's Smoke-Free Environments Law Project to be a part of this endeavor.  The Sault Tribe Housing Authority is the first tribal housing authority in Michigan to adopt a smoke-free policy and, as far as we know, only the fifth in the nation.  There are three tribal housing authorities in Alaska and one in Maine that also have adopted smoke-free policies.  The Sault Tribe Housing Authority has about 500 units of housing in the 7-county area.  To access the Sault Tribe web site, click above.


Obama picks Donald Berwick of Harvard to run Medicare and Medicaid

4/21:  The following is from an April 20th Washington Post report: President Obama formally announced Monday his nominee for administrator of the Centers for Medicare and Medicaid Services, fulfilling widespread expectations that he would tap Donald Berwick, a Harvard University professor and leading advocate for improving health-care quality and efficiency.  If confirmed by the Senate, Berwick will play a pivotal -- and challenging -- role in implementing the recently enacted health-care overhaul legislation. The agency, which is part of the Department of Health and Human Services, must oversee a massive expansion of Medicaid, the federal-state insurance program for the poor, with an estimated 16 million people expected to join its rolls by 2020. At the same time, Medicare, the insurance program for the elderly, will need to reduce payments to health-care providers by about $400 billion over 10 years without impacting the quality of coverage.  Berwick, who specializes in health-care policy and pediatrics, has never led such a large organization. As head of the Boston-based Institute for Healthcare Improvement, however, he is known for persuading doctors and hospitals to adopt innovative methods for reducing medical errors.  Click above to access the story.


After Health Care Passage, Obama Pushes to Get It Rolling

4/20:  The following is from an April 18th NY Times article:  Mindful that the new health care law's ability to slow rising medical costs will depend to a great extent on how it is put in effect, President Obama is assembling a high-level team to carry out key elements of the overhaul and is considering moving faster than the law requires to put them into action.  The president has tapped Pete Rouse, one of his closest White House advisers, to oversee what one insider described as an "elaborate implementation plan."  And he personally pressed Nancy-Ann DeParle, who directed the legislative effort and has long experience in the health sector, to shelve her plans to leave; she will instead manage construction of the machinery for extending coverage to about 30 million uninsured Americans while also moving toward the law's long-run goal: cost containment.  Kathleen Sebelius, the secretary of health and human services and, before that, insurance commissioner and then governor of Kansas, has assumed a higher-profile role both within the administration and publicly.  Ms. Sebelius has begun work on the first of what will be numerous regulations for Medicare, Medicaid and private health care providers. Within her department, she has reorganized the Centers for Medicare and Medicaid Services to make room for an innovation center intended to test ways of reimbursing providers that could reduce spending while improving patient care.  The secretary can expand successful ideas nationwide without Congress's permission. ... The law's main provisions, including those creating state insurance exchanges where uninsured Americans can shop for competitively priced policies, will not take effect until 2014 -- two years after the next presidential election.  But Mr. Obama has urged advisers to consider moving sooner to set up an Independent Payment Advisory Board for controlling Medicare spending. Some administration officials, however, fear that creating the board much before 2014 could prematurely make it a target for attacks of the "death panel" sort, leaving it politically vulnerable before its powers to impose changes take effect.  The board was a top priority for Mr. Obama during the long legislative battle. He faced down Democratic leaders, who opposed delegating powers to an unelected board for the government's popular health insurance programs.  Even some skeptics of the health insurance law say that the board, and the law more generally, could prove more effective at restraining spending than estimated by the nonpartisan Congressional Budget Office -- if only because of the nation's bleak fiscal future. ... The president will nominate the 15 members of the Independent Payment Advisory Board; Senate confirmation is required for the six-year terms at what are to be full-time jobs, for better bureaucratic clout. Each year that Medicare spending exceeds annual targets, as most analysts expect it will, the board must propose ways to reduce payments to care providers.  Unlike an existing Medicare commission whose recommendations Congress routinely disregards, the board could put its proposals into effect unless Congress modified or rejected them within 30 days. Even then, the president could veto a disapproval resolution; it would take a two-thirds vote of both houses of Congress to override the veto. "It's a very promising structure," said Peter R. Orszag, Mr. Obama's budget director.  "But like anything else in life, it's what you make of it. So whether it realizes its potential depends on how it's implemented."  Click above for the full article.


Smoke-Free Affordable Housing:  Picking on Poor People or a Case for Social Justice?

4/15:  The Non-Smokers' Rights Association in Canada has just released a new resource for tobacco control and smoke-free housing advocates entitled "Smoke-Free Affordable Housing: Picking on Poor People or a Case for Social Justice?"  To access this informative analysis, click above.


California protest seeks Social Security benefits for gays

4/13:  The following is from an April 12th Washington Post article: Protesters chanting slogans and carrying signs marched in Hollywood Sunday to demand equal Social Security benefits for same-sex couples.  About 700 peaceful demonstrators walked more than a mile to rally outside the Hollywood Social Security Administration office, said Lorri L. Jean, CEO of the Los Angeles Gay & Lesbian Center.  "This was the kickoff for a national campaign to end discrimination when it comes to Social Security," Jean said. "We not only have to educate the straight community, but we have to educate our own. Many don't know how it works until they're older and faced with having been denied benefits."  Before the march, U.S. Rep. Linda Sanchez told the cheering crowd she would author legislation that would extend survivor benefits to older gay and lesbian couples.  "We now have quality, affordable health care coming to all," Sanchez said. "What good is the quality of our health care in America if Americans are not treated equally under all of our laws?"  U.S. Rep. Judy Chu offered to co-author the bill. U.S. Sen. Barbara Boxer also spoke.  Senior citizen Alice Herman spoke about being denied benefits after the death of her partner, Sylvia, even though they were legally married. Had Sylvia been a man, Herman said, she would have been entitled to receive her spouse's larger Social Security payments.  Click above for full article.


Bernanke: Paying for Medicare, Social Security weighs on economy

4/8:  The following is from an April 7th Washington Post article: The United States needs to take new steps to improve the financial condition of Medicare and Social Security, Federal Reserve Chairman Ben S. Bernanke said Wednesday, describing the challenges of paying for those programs as one of the greatest long-term challenges for the economy.  Bernanke, in an unusual discussion of an area outside his immediate responsibility, seemed to be using his bully pulpit to try to focus attention what he views as the top long-run challenge for U.S. economic policy. "To avoid large and ultimately unsustainable budget deficits, the nation will ultimately have to choose among higher taxes, modifications to entitlement programs such as Social Security and Medicare, less spending on everything else from education to defense, or some combination of the above," Bernanke said in a speech to the Dallas Regional Chamber.  "These choices are difficult, and it always seems easier to put them off -- until the day they cannot be put off any more. But unless we as a nation demonstrate a strong commitment to fiscal responsibility, in the longer run we will have neither financial stability nor healthy economic growth."  Bernanke did make clear that he does not view immediate steps to reduce the budget deficit as desirable, given the continued high joblessness.  Click above to access the full article.


Public housing resident challenges smoking ban; Burlington Housing Authority high-rises to become smoke-free

4/8:  The following is from an April 7th Buyrlington Free Press report:  Burlington Housing Authority's three high-rise buildings will become smoke-free Nov. 1, but at least one resident of Decker Towers on St. Paul Street vows a legal challenge to the new policy.  "If I can't find someone to help me, I'll do it myself," said Chris Hersey, who has lived in the high-rise for six years. "I'll walk into federal court by myself if I have to. I won't let some city bureaucracy tell me what I can and can't do. I'm not letting them get away with this."  The new policy will affect the 159 units in Decker Towers, the 65 units in South Square Apartments on College Street, and the 50 units in Champlain Apartments on North Champlain Street. The apartments provide housing for income-eligible people over age 62 and for the disabled.  BHA Executive Director Paul Dettman said the new policy, announced in late February in a letter to residents, is part of a national trend encouraged by the U.S. Department of Housing and Urban Development, which provides funding for the housing. The shift is motivated by concerns about the effects of second-hand smoke on residents and by safety concerns.  He said BHA has not tested the flow of second-hand smoke in the three Burlington high-rises but has received "infrequent" complaints about smoke from some tenants. The letter to residents said, "BHA takes the health, safety and welfare of our tenants very seriously" and noted that Decker Towers had an apartment fire Feb. 17 "caused by careless smoking." Water from the building's sprinkler system caused $100,000 damage, Dettman said.  He said the BHA decision wa s not arbitrary but part of a national movement.  The Smoke-Free Environments Law Project of the Center for Social Gerontology in Ann Arbor, Mich., is an advocate for smoke-free housing units. Jim Bergman, the project director and co-director of the gerontology center, said the increase nationally in smoke-free, market-rate and affordable housing has been dramatic. ... The BHA policy will require resident smokers to leave the property. "Violating this policy," BHA's letter said, "will result in terminating your tenancy."  Bergman and Dettman said they are unaware of any legal challenge to smoke-free housing policies such as those being implemented in Burlington. "I'm totally confident a legal challenge would not prevail," Bergman said.  Click above to access the full article.


School Law Clinics Face a Backlash

4/7:  The following is from an April 4th NY Times article:  Law school students nationwide are facing growing attacks in the courts and legislatures as legal clinics at the schools increasingly take on powerful interests that few other nonprofit groups have the resources to challenge.  On Friday, lawmakers here [Annapolis, Maryland] debated a measure to cut money for the University of Maryland's law clinic if it does not provide details to the legislature about its clients, finances and cases.  The measure, which is likely to be sent to the governor this week, comes in response to a suit filed in March by students accusing one of the state's largest employers, Perdue, of environmental violations -- the first effort in the state to hold a poultry company accountable for the environmental impact of its chicken suppliers.  Law clinics at other universities -- from New Jersey to Michigan to Louisiana -- are facing similar challenges. And legal experts say the attacks jeopardize the work of the clinics, which not only train students with hands-on courtroom experience at more than 200 law schools but also have taken on more cases against companies and government agencies in recent years. "We're seeing a very strong pushback from deep-pocket interests, and that pushback is creating a chilling effect on many clinics," said Robert R. Kuehn, a law professor at Washington University in St. Louis, citing a recent survey he conducted that found that more than a third of faculty members at legal clinics expressed fears about university or state reaction to their casework and that a sixth said they had turned down unpopular clients because of these concerns.  But critics say law clinics are costly, unaccountable and often counterproductive to states' interests, especially as they have broadened the scope of their work. The debate has raised larger questions about academic freedom at state-financed law schools and the role lawmakers should have over decisions at those schools.  Click above for full article.


Report on Social Security Delayed Until June 30th

4/6:  The following is from an April 5th Associated Press report:  The Obama administration is delaying release of the annual report on the financial health of Social Security and Medicare so that the new report can reflect the impact of the recently passed health care overhaul.  An administration official told The Associated Press that this year's trustees report will be delayed until June 30, three months later than it usually comes out.  The official, who spoke on condition of anonymity before the formal announcement, said that the delay will allow the government to determine the impact of the massive overhaul of health care that President Barack Obama just signed into law. In January, Richard Fisher, the chief actuary for Medicare, estimated that the Senate bill which passed on Christmas eve would extend the life of the Medicare hospital trust fund by 10 years. The legislation that finally passed Congress was the Senate bill but with revisions approved to win House support.  The administration official said that passage last month of the health care overhaul legislation had made the trustees report, which usually comes out around April 1, obsolete. This official said the decision was made to incorporate all of the changes made by the legislation to better reflect reality now that Congress has passed health care overhaul.  The new health care law seeks to guarantee health insurance coverage for nearly all Americans while cracking down on insurance industry abuses. It also promises to reduce federal deficits by an estimated $143 billion over a decade.  Click above for the full article.


Seniors wary of health overhaul impact on Medicare

4/1:  The following is from an April 1st Washington Post article: Seniors aren't celebrating President Barack Obama's health care overhaul.  While Democrats hail the sweeping legislation as the greatest expansion of the social safety net since Medicare, they also fear that seniors won't see it that way for this fall's elections. Indeed, Republicans have portrayed the overhaul as a raid on Medicare - a bedrock of retirement security - to provide money to pay for covering younger, uninsured workers and their families. An Associated Press-GfK survey in March found that 54 percent of seniors opposed the legislation that was then taking final shape in Congress, compared with 36 percent of people age 18-50. And last week a USA Today/Gallup Poll found that a majority of seniors said passing the bill was a bad thing - while younger people were positive about it. There's no doubt that broad cuts in projected Medicare payments to insurance plans, hospitals, nursing homes and other service providers will sting. What hasn't sunk in yet is that the new law also improves the lot of many Medicare beneficiaries. Obama is hoping that most will eventually conclude the plusses outweigh the minuses.  Keenly aware that this is a congressional election year, Democrats structured the law so virtually all the cuts start next year and take effect only gradually. For this year, the law provides a sweetener. More than 3 million seniors who have been falling into a Medicare prescription coverage gap will get a $250 rebate, a down payment on closing the "doughnut hole."  Nonetheless, seniors are anxious.  Click above for full article.


Obama Chooses Health Policy Scholar as the Director for Medicare and Medicaid

3/31:  The following is from a March 27th New York Times report:  President Obama will soon name Dr. Donald M. Berwick, an iconoclastic scholar of health policy, to run Medicare and Medicaid, the programs that serve nearly one-third of all Americans, administration officials said Saturday. Dr. Berwick, a pediatrician, is president of the Institute for Healthcare Improvement in Cambridge, Mass. He has repeatedly challenged doctors and hospitals to provide better care at a lower cost. He says the government and insurers can increase the quality and efficiency of care by basing payments on the value of services, not the volume. Mr. Obama plans to nominate Dr. Berwick to be administrator of the Centers for Medicare and Medicaid Services, a unit of the Department of Health and Human Services that has been without a permanent chief since October 2006, when Dr. Mark B. McClellan stepped down.  If confirmed by the Senate, Dr. Berwick would have a huge plate of responsibilities under the new health care law.  The law, signed Tuesday by Mr. Obama, will expand Medicaid to cover 16 million more people, squeeze nearly a half-trillion dollars out of Medicare in the next 10 years and establish many demonstration projects to test innovative ways of delivering health care.  Dr. Berwick's nomination would be subject to Senate confirmation. Senators would almost surely use a confirmation hearing as a forum to debate the merits of the new health care law and to investigate how the administration plans to carry it out.  Steven D. Findlay, a health policy analyst at Consumers Union, said: "This would be a spectacular appointment. Don has been an intellectual force in health care for decades. He helped forge many ideas incorporated in the new health care law."  Click above for full article.


Health Reform Law Has Options for Affordable Long Term Care Insurance

3/31:  The following is from a March 30th New York Times article:  So Ms. Priaulx has been paying close attention to a little-remarked but potentially transformational provision of the health care bill President Obama signed last week.  The Class Act, a legacy of Senator Edward M. Kennedy (whose widow and son were on hand for the signing), sets up the first national government-run long-term care insurance program, which will be offered primarily through employers.  Long-term care means help with the so-called activities of daily living -- like bathing, dressing, getting in and out of bed and using a toilet -- for those, old or young, who become disabled. More than 10 million Americans need long-term care, nearly 60 percent of them 65 or older, Georgetown University researchers reported in 2007. But few are prepared for the expense. ... The Class Act does not require screening of applicants for health problems, so people who might not qualify for private long-term care insurance can enroll. Participants will pay monthly premiums; after a five-year vesting period, they receive benefits if they need care, whether they are 28-year-olds hurt in snowboard accidents or 88-year-olds with Parkinson's disease.  The program is not designed to pay the entire cost of long-term care, which can be staggering, but it could nevertheless provide substantial help with the burden. And because beneficiaries will receive cash -- the projected minimum average is $50 a day, depending on how disabled they are -- they can choose the kind of assistance that best suits their needs: several hours' daily help from a home care aide (including a family member or a neighbor), participation in an adult day program, adaptations to their own homes, or a move to assisted living or a nursing home, though advocates argue that the program will help the disabled stay in their homes.  Ms. Priaulx plans to sign up. Actually, she won't have to: the new program is a benefit that employees will have to opt out of if they don't want it. ... The law --  "Class" stands for Community Living Assistance Services and Supports -- authorizes the secretary of Health and Human Services to establish such all-important details as the new program's eligibility requirements and premiums, and to devise mechanisms to include the self-employed and those whose employers decline to participate. Even the timing appears unclear.  Click above to access the full article.


N.C., S.C., Ohio, Oregon and Rhode Island to receive mortgage relief; States join CA, NV, AZ, MI and FL in special program

3/30:  The following is from a March 29th Washington Post article:  The Obama administration announced Monday that it is expanding by $600 million a fund aimed at helping states tackle the foreclosure crisis with locally tailored approaches.  State housing finance agencies from North Carolina, South Carolina, Ohio, Oregon and Rhode Island will share $600 million to test new approaches to helping borrowers save their homes from foreclosure. That is in addition to $1.5 billion set aside for California, Nevada, Arizona, Michigan and Florida when the program was initially announced in February. Both initiatives will be financed through the government's Troubled Assets Relief Program.  While the first round of funding targeted states that had seen home values decline more than 20 percent, the second round of states were picked because they had high concentrations of people living in economically distressed areas, including counties where the unemployment rate exceeded 12 percent in 2009.  Click above for full article.


Phoenix Senior Apartment Complex Goes Smokefree

3/30:  According to a March 25th press release from the Maricopa County Tobacco Use Prevention Program:  Manistee Manor Senior Apartments will go completely smokefree on April 1, 2010, according to Debi Widahl, property manager. This 75 multi housing unit is following the July 2009 HUD document that "strongly recommended all HUD funded properties go smokefree or partially smokefree."  A celebration will be held at Manistee Manor located at 7987 N. 53rd Ave. Glendale, AZ at 1 pm on Thursday, April 1. An award will be presented by the Maricopa County Tobacco Use Prevention Program.  Sue Bergquist, Community Development Specialist in Multi Housing says, "Manistee Manor has gone above and beyond in setting the standard for multihousing. Smoke-free multi-housing is a critical frontier that needs to be promoted to protect the health of non smoking residents. Residents often experience exposure to secondhand smoke that migrates into their apartments through common air ducts and walls under which they have no recourse under most state clean indoor air acts." While considering the decision to become smokefree, Manistee Manor had a smoking related fire that could have been disastrous. It occurred on a balcony at 3:00 in the morning. The heat was so intense it melted the metal railing. Someone adjacent to the building saw the fire and called the fire department. Luckily it was contained. Smoking is the number one cause of residential fires.  Residents were notified in April 2009 that the property would go smokefree in April 2010. A few residents chose to move, some quit and some agreed to smoke off the property.  Interviewed residents say they are thrilled and have thanked management for their decision. Management now has a waiting list for tenants who want a smokefree environment. ... Maricopa County Tobacco Use Prevention Program was instrumental in helping Manistee go smokefree. It provided a Tobacco 101 presentation to residents, information regarding the state-funded ASHLine that provides free online or phone cessation counseling for those that want to quit, and sample document language for the property owners.  Click above for the full press release.


Review heightens concerns over Medicare billing at nursing homes

3/29:  The following is from a March 29th Washington Post report:  More than a decade ago, Congress set out to squeeze the fraud out of Medicare billing at nursing homes, requiring more precise justifications for costs. It created new "ultra-high" billing categories intended to be used for only 5 percent of the patients needing highly specialized care and rehabilitation.  But within a few years, nursing homes flooded the ultra-high categories with patients, contributing to $542 million a year in potential overpayments, federal analysts found.  Since then, the numbers in the ultra-high categories have quadrupled, and the amount of waste and abuse could reach billions of dollars a year, according to nursing home experts and a Washington Post examination of the program. The billing program is specifically targeted in President Obama's health-care legislation passed last week by Congress, changing two rules that experts said have been exploited by nursing homes to inflate bills. "Facilities have been able to bill the way they want, and they are billing for more services than they are providing to people," said Toby S. Edelman, a senior attorney for the Center for Medicare Advocacy, a watchdog group in Washington. "There's been a lot of abuse." Federal analysts assigned to the inspector general's office for the Department of Health and Human Services are examining the billing program.  "There is a lot of vulnerability in the system, and we are concerned by what we've seen," said Jodi Nudelman, regional inspector general for the HHS New York field office, which is conducting the examination.  A separate division of the HHS inspector general's office is investigating North American Health Care, which operates 35 facilities, most of them in California.  Across the chain, 64 percent of NAHC patients are billed in the highest category; the national average is 9 percent. The category covers the most extensive medical care combined with the most intensive rehabilitation.  The pattern was discovered last year by the Service Employees International Union, which has been feuding with NAHC over efforts to organize the homes' employees. The Post independently analyzed an updated version of the data and confirmed the pattern. The Post also found that NAHC operated 21 of the top 30 facilities nationally with the highest percentage of residents billed in the most expensive category.  Click above for the full article.


Social Security to See Payout Exceed Pay-In This Year

3/26:  The following is from a March 25th New York Times article: The bursting of the real estate bubble and the ensuing recession have hurt jobs, home prices and now Social Security. This year, the system will pay out more in benefits than it receives in payroll taxes, an important threshold it was not expected to cross until at least 2016, according to the Congressional Budget Office. Stephen C. Goss, chief actuary of the Social Security Administration, said that while the Congressional projection would probably be borne out, the change would have no effect on benefits in 2010 and retirees would keep receiving their checks as usual.  The problem, he said, is that payments have risen more than expected during the downturn, because jobs disappeared and people applied for benefits sooner than they had planned. At the same time, the program's revenue has fallen sharply, because there are fewer paychecks to tax.  Analysts have long tried to predict the year when Social Security would pay out more than it took in because they view it as a tipping point -- the first step of a long, slow march to insolvency, unless Congress strengthens the program's finances.  "When the level of the trust fund gets to zero, you have to cut benefits," Alan Greenspan, architect of the plan to rescue the Social Security program the last time it got into trouble, in the early 1980s, said on Wednesday.  That episode was more dire because the fund could have fallen to zero in a matter of months. But partly because of steps taken in those years, and partly because of many years of robust economic growth, the latest projections show the program will not exhaust its funds until about 2037.  Click above for full article.


In Health Care Bill, Obama Attacks Wealth Inequality

3/25:  The following is from a March 24th New York Times article:  For all the political and economic uncertainties about health reform, at least one thing seems clear: The bill that President Obama signed on Tuesday is the federal government's biggest attack on economic inequality since inequality began rising more than three decades ago.  Over most of that period, government policy and market forces have been moving in the same direction, both increasing inequality. The pretax incomes of the wealthy have soared since the late 1970s, while their tax rates have fallen more than rates for the middle class and poor.  Nearly every major aspect of the health bill pushes in the other direction. This fact helps explain why Mr. Obama was willing to spend so much political capital on the issue, even though it did not appear to be his top priority as a presidential candidate. Beyond the health reform's effect on the medical system, it is the centerpiece of his deliberate effort to end what historians have called the age of Reagan. Speaking to an ebullient audience of Democratic legislators and White House aides at the bill-signing ceremony on Tuesday, Mr. Obama claimed that health reform would "mark a new season in America." He added, "We have now just enshrined, as soon as I sign this bill, the core principle that everybody should have some basic security when it comes to their health care."  The bill is the most sweeping piece of federal legislation since Medicare was passed in 1965. It aims to smooth out one of the roughest edges in American society -- the inability of many people to afford medical care after they lose a job or get sick. And it would do so in large measure by taxing the rich.  A big chunk of the money to pay for the bill comes from lifting payroll taxes on households making more than $250,000. On average, the annual tax bill for households making more than $1 million a year will rise by $46,000 in 2013, according to the Tax Policy Center, a Washington research group. Another major piece of financing would cut Medicare subsidies for private insurers, ultimately affecting their executives and shareholders. The benefits, meanwhile, flow mostly to households making less than four times the poverty level -- $88,200 for a family of four people. Those without insurance in this group will become eligible to receive subsidies or to join Medicaid. (Many of the poor are already covered by Medicaid.) Insurance costs are also likely to drop for higher-income workers at small companies.  Finally, the bill will also reduce a different kind of inequality. In the broadest sense, insurance is meant to spread the costs of an individual's misfortune -- illness, death, fire, flood -- across society. Since the late 1970s, though, the share of Americans with health insurance has shrunk. As a result, the gap between the economic well-being of the sick and the healthy has been growing, at virtually every level of the income distribution. The health reform bill will reverse that trend. By 2019, 95 percent of people are projected to be covered, up from 85 percent today (and about 90 percent in the late 1970s). Even affluent families ineligible for subsidies will benefit if they lose their insurance, by being able to buy a plan that can no longer charge more for pre-existing conditions. In effect, healthy families will be picking up most of the bill -- and their insurance will be somewhat more expensive than it otherwise would have been.  Click above to access the full article.


Smoking to be banned in public housing in Milford, Connecticut; Now at least 153 public housing authorities in the nation with smoke-free policies

3/25:  The following is from a March 24th New Haven Register article:  Residents in the city's 465 public housing units soon no longer will be able to light up in their homes.  Spurred in part by a "strong recommendation" from the U.S. Department of Housing and Urban Development, the Milford Redevelopment & Housing Partnership banned smoking in all parts of its buildings in a recent split vote. "It is a smoke-free facilities policy," Milford Housing Authority Executive Director Anthony Vasiliou said Tuesday. "It covers 100 percent of all of the property we own and operate."  The last day current residents can light up inside their MRHP-owned house or apartment is Nov. 1. The ban takes effect immediately for anyone signing a new lease, and smoking in common areas already has been banned for more than a decade.  Smoking still will be allowed outside the buildings, but designated areas will be established if people don't "exhibit common sense" and stay away from the entrances when they go out for a cigarette, Vasiliou said.  Vasiliou said public housing smoking bans are becoming more prevalent across the country, but particularly have taken root in the Northeast.  In supporting the ban, MRHP Chairwoman Hilary H. Holowink cited health concerns over secondhand smoke, safety surrounding accidental fires and economic reasons concerning smoke damage. "We voted for the health benefits and the fire safety benefits and to be a good steward of state and federal money," Holowink said Tuesday. "It takes at least twice as much money to refurbish a unit after a smoker has been living there."  Click above to access the full article. This brings the total nationally to at least 153 housing authorities.  To access a list of all 153, click here.


House-Passed and Senate Health Bills Reduce Deficit, Slow Health Care Costs, and Include Realistic Medicare Savings; Congress Has Good Record of Implementing Medicare Savings; Medicare Savings in These Bills Are Similar to Those Implemented in the Past

3/24:  The Center on Budget & Policy Priorities has re-posted its Dec. 4, 2009 analysis of the above title.  The following is from that analysis:  Health reform legislation that has passed the House in one form and is before the Senate in another is facing a series of attacks that, taken together, suggest the legislation would do little to control health care costs and would increase budget deficits. Many of these charges are exaggerated or simply incorrect, based on the Center's careful analysis of the legislation. In particular, a number of criticisms rest on a mistaken belief that, in recent years, Congress has repeatedly enacted provisions to achieve savings in Medicare and then generally blocked these provisions before they could take effect. Thus, critics say, no one should take seriously the provisions of the current bills that would produce Medicare savings. In fact, the Center's analysis of major legislation affecting Medicare that Congress has enacted over the last two decades shows that Congress has permitted the vast majority of Medicare savings to take effect. A number of commentators have leveled at least four distinct, though related, lines of attack either on the House-passed bill or on both the House bill and the pending Senate bill. As summarized below and explained in more detail in subsequent sections of this paper, these attacks do not hold up well under scrutiny.  To access the full analysis, click above.


Obama to sign health-care bill into law Tuesday; Has Medicare improvements as well as much more

3/23:  The following is from a March 22nd Washington Post article: President Obama will sign landmark health-care legislation into law Tuesday without waiting for the Senate to deal with a package of revisions that was also approved by the House late Sunday, administration officials said. ... The Senate will begin work on the House-passed revisions as soon as Obama signs the broader legislation, said Jim Manley, spokesman for Senate Majority Leader Harry M. Reid (D-Nev.). The debate will be limited to 20 hours and likely will end early Thursday, Manley said. Then begins a series of votes on amendments, a process with no time limit but that allows for just one minute between votes.  At the moment, Democratic Senate leaders are uncertain how long the voting process will last, although most senators still expect to leave more or less on schedule for a two-week recess scheduled to begin Saturday. ... The bill will affect virtually every man, woman and child in the United States in some way, from the 20-somethings who constitute one of the largest uninsured groups to poor, childless adults who don't qualify for Medicaid in most states to well-paid professionals who could see their benefits shrink. ... Medicare, the federal health program for people over 65, will undergo significant changes intended to deliver care more efficiently and at a lower price, with the aim of using the nation's largest insurance plan to force doctors, hospitals and other private-sector players to follow suit. Medicare Advantage, a form of Medicare provided by private insurance companies to about 11 million seniors, will lose nearly $120 billion over the next decade, probably forcing providers to drop popular add-on benefits such as gym memberships. ... For seniors, the bill will immediately expand the Medicare drug benefit and, effective July 1, provide a 50 percent discount on brand-name drugs for the low-income elderly.  To access the full article, click above.


Obama FY'11 Budget Includes Major Plan to Preserve Needed Affordable Housing; Proposal Would Provide More Adequate and Sustainable Funding, Expand Housing Choices for Low-Income Families

3/18:  The following is from a March 16th Center on Budget & Policy Priorities analysis:  The President's $350 million Transforming Rental Assistance (TRA) initiative, outlined in his fiscal 2011 budget, would enable local housing agencies and private owners to more easily preserve affordable housing, in part by giving them more adequate and sustainable funding to operate it. As a result, TRA would help preserve an estimated 300,000 affordable apartments (both publicly and privately owned) in its first year and more in later years. Most of these apartments house low-income elderly people and people with disabilities, and without TRA many of these units would eventually become uninhabitable or be lost as affordable housing in other ways.  In addition, TRA would make other improvements to rental assistance programs (including public housing) that would give families with housing subsidies the choice to rent housing in a wider range of neighborhoods, which would allow them better access to employment or educational opportunities. TRA also would streamline administration of these programs.  Public housing preservation: Of the 300,000 apartments that the Department of Housing and Urban Development (HUD) estimates TRA would reach during its first year, as many as 280,000 would be in public housing, which now assists 1.2 million units. The federal government has consistently provided less funding for public housing than agencies need to operate and occasionally renovate it. As a result, more than 165,000 public housing units have been demolished or otherwise removed from the available stock in the last 15 years, and the remaining units have a backlog of unmet renovation needs of at least $20 billion (and possibly considerably more).  To address this problem, TRA would give agencies the option to convert public housing units to a new type of long-term housing subsidy. That would help preserve the units for the long term in two main ways:  1) Sustainable funding levels. Of the $350 million that the President has requested for TRA, $290 million would boost subsidies for underfunded public housing developments to a level that is adequate to sustain them in good condition over time.  2) Greater ability to leverage private investment. The rules governing the new subsidies would allow housing agencies to more easily borrow private funds to perform needed renovations. HUD estimates that TRA would enable agencies to obtain $7.5 billion in private financing.  Preservation of private affordable housing: TRA would allow the private owners of units that are supported through three small rental assistance programs to convert about 20,000 such units to new long-term subsidies that would preserve the units as affordable housing. Under current law, subsidies for many of these units will end in the coming years because there currently is no adequate mechanism to extend their subsidy contracts.  Click above for the full analysis.


With Medicaid Cuts, Doctors and Patients Drop Out

3/16:  The following is from a March 16th NY Times article:  It has not taken long for communities like Flint to feel the downstream effects of a nationwide torrent of state cuts to Medicaid, the government insurance program for the poor and disabled. With states squeezing payments to providers even as the economy fuels explosive growth in enrollment, patients are finding it increasingly difficult to locate doctors and dentists who will accept their coverage. Inevitably, many defer care or wind up in hospital emergency rooms, which are required to take anyone in an urgent condition. ... The inadequacy of Medicaid payments is severe enough that it has become a rare point of agreement in the health care debate between President Obama and Congressional Republicans. In a letter to Congress after their February health care meeting, Mr. Obama wrote that rates might need to rise if Democrats achieved their goal of extending Medicaid eligibility to 15 million uninsured Americans.  In 2008, Medicaid reimbursements averaged only 72 percent of the rates paid by Medicare, which are themselves typically well below those of commercial insurers, according to the Urban Institute, a research group. At 63 percent, Michigan had the sixth-lowest rate in the country, even before the recent cuts.  In Flint, Dr. Nita M. Kulkarni, an obstetrician, receives $29.42 from Medicaid for a visit that would bill $69.63 from Blue Cross Blue Shield of Michigan. She receives $842.16 from Medicaid for a Caesarean delivery, compared with $1,393.31 from Blue Cross.  If she takes too many Medicaid patients, she said, she cannot afford overhead expenses like staff salaries, the office mortgage and malpractice insurance that will run $42,800 this year. She also said she feared being sued by Medicaid patients because they might be at higher risk for problem pregnancies, because of underlying health problems.  As a result, she takes new Medicaid patients only if they are relatives or friends of existing patients. But her guilt is assuaged somewhat, she said, because her husband, who is also her office mate, Dr. Bobby B. Mukkamala, an ear, nose and throat specialist, is able to take Medicaid. She said he is able to do so because only a modest share of his patients have it. The states and the federal government share the cost of Medicaid, which saw a record enrollment increase of 3.3 million people last year. The program now benefits 47 million people, primarily children, pregnant women, disabled adults and nursing home residents. It falls to the states to control spending by setting limits on eligibility, benefits and provider payments within broad federal guidelines.  Michigan, like many other states, did just that last year, packaging the 8 percent reimbursement cut with the elimination of dental, vision, podiatry, hearing and chiropractic services for adults.  Click above to access the full article.


Changes in Medicare Tax on High-Income People Represent Sound Additions to Health Reform

3/11:  The following is from an analysis of the above title from a March 4th paper released by the Center on Budget & Policy Priorities: The President's health reform plan would raise the Medicare tax rate for single filers with incomes over $200,000 and married filers with incomes over $250,000 -- a provision that was included in the Senate-passed health bill -- and also would extend this tax to the unearned income these affluent households receive such as income from capital gains, dividends, and royalties. These proposals, which would help finance the expansion of health coverage to more than 30 million Americans, would affect only U.S. households at the very top of the income scale while improving tax equity and economic efficiency.  These provisions would affect only the 2.6 percent of U.S. households with the highest incomes, according to the Urban Institute-Brookings Institution Tax Policy Center. The Medicare taxes that the other 97.4 percent of Americans pay would remain unchanged. Among elderly households, only the top 2.2 percent would be touched, with the other 97.8 percent remaining unaffected.  These proposals would mainly affect people with incomes exceeding $1 million a year. The Tax Policy Center reports that 74 percent of the increase in Medicare tax contributions would come from people making over $1 million a year, and 91 percent would come from people with incomes over $500,000. Among elderly households, 78 percent of the new tax contributions would come from those with incomes exceeding $1 million, while 93 percent would come from seniors with incomes over $500,000.  The proposals also would improve both tax equity and economic efficiency. Under current law, people with very high incomes generally pay a smaller share of their income in Medicare taxes than middle-class and low-income working families do because they derive much of their income from capital gains and dividends, which are now exempt from the Medicare tax. The proposal would address this disparity.  Click above for the full analysis.


Senate Panel to Investigate Deaths at Long-Term Care Facilities

3/10:  The following is from a March 8th New York Times report:  The Senate Finance Committee has opened an investigation into patient deaths and allegations of substandard treatment at long-term care hospitals, small specialty medical centers that treat chronically ill patients.  The investigation focuses on the Select Medical Corporation, a for-profit corporation that runs 89 long-term care hospitals, more than any other company. In a letter sent on Monday to Select's chief executive, Robert Ortenzio, the committee's top two senators demanded that Select provide records about staffing levels and quality at its hospitals.  The committee has substantial power over long-term care hospitals because it oversees Medicare. The federal program spends almost $5 billion annually on the hospitals, providing about 60 percent of their total revenue.  An article in The New York Times last month detailed poor treatment and patient deaths at long-term care hospitals, which treat 200,000 seriously ill patients a year nationwide, but rarely have full-time physicians on staff. In one incident at a Select hospital in Kansas, a dying patient's heart alarm sounded for 77 minutes before nurses responded. Select has said that it conducted an appropriate clinical review in the case and terminated a clinician involved in the patient's care.  The article prompted the investigation, according to the letter, which was sent by Senator Max Baucus, Democrat of Montana, the committee's chairman, and Senator Charles E. Grassley of Iowa, the panel's senior Republican. The letter is not a subpoena, but companies usually respond voluntarily to such requests for information.  Select Medical said that it would cooperate fully with the inquiry. Through a spokeswoman, Carolyn Curnane, the company referred to the Times article as misleading and inaccurate and said it looked forward to providing the committee with accurate facts about the quality of care in its long-term care hospitals. Mr. Baucus and Mr. Grassley asked Select to disclose its policies for patient monitoring, emergency situations and staffing, including physician involvement at its hospitals and staff turnover. Former employees of Select have said that the company's hospitals are understaffed and rely heavily on temporary nurses.  The letter also requests that Select disclose information about its discharge policies. Former employees have also said that the company presses to keep patients for 25 days and then discharge them almost immediately, because patients are most profitable if they stay exactly 25 days under government reimbursement rules. At some Select hospitals, the 25th day is called the "magic day," ex-employees say.  Click above for full article.


Obama to target Medicare and Medicaid fraud

3/10:  According to a report in the March 10th Washington Post:  Today President Obama will embrace tougher new efforts to fight fraud in Medicare and Medicaid as part of his drive to pass comprehensive changes to the nation's health care system, the White House announced last night.  Officials said the president will sign a presidential memorandum today that directs all federal departments and agencies to expand their use of audits that recapture improper or erroneous payments. They said that could save the government as much as $2 billion over the next three years.  In a health-care speech in St. Louis, Obama will also offer his explicit support for bipartisan legislation aimed at expanding the use of so-called "recapture audits" in government agencies, officials said.  Together, the announcements are intended to show the president's seriousness on two fronts: the willingness to incorporate Republican ideas into his overall plans for health reform, and his desire to confront fraud and waste in government. Click above to access the full news report.


In a Polarized Court, Getting the Last Word

3/8:  The following is from a March 8th New York Times column:  A few times a year, Supreme Court justices go out of their way to emphasize their unhappiness by reading a dissent from the bench out loud, supplementing the dry reason on the page with vivid tones of sarcasm, regret, anger and disdain. The practice is on the rise, and it is suggestive of an increasingly polarized court.  "Dissenting from the bench," a new study to be published in Justice System Journal contends, is a sort of nuclear option that "may indicate that bargaining and accommodation have broken down irreparably."  Yes, a new study. Academic scrutiny of almost every aspect of the Supreme Court is oppressively comprehensive, and now three sets of researchers have identified the empirical analysis of oral dissents as a new frontier.  Over the 36 years Warren E. Burger and William H. Rehnquist served as chief justices, there were on average three dissents read from the bench each term. In the first four years of the court under Chief Justice John G. Roberts Jr., the number rose by a quarter, to 3.75. So far this term, there has been only one oral dissent, but it was a doozy.  For the full column, click above.


Senate rejects bonus Social Security payments

3/4:  The following is from a March 4th Washington Post report: The Senate has rejected President Barack Obama's proposal to give a $250 bonus payment to people on Social Security.  The proposal failed by a 50-47 vote in which Republicans and Democratic budget hawks opposed the idea for adding $14 billion to the budget deficit. Independent Vermont Sen. Bernie Sanders said the $250 payment was needed to make up for the lack of a cost-of-living adjustment this year for beneficiaries. Disabled people and veterans also would have been eligible for the payments.  Seniors received an identical $250 bonus last year as part of the economic stimulus bill.  But economists say the payments don't do much to boost the economy since many seniors simply save the money rather than spend it.  Click above to access the news story.


U.S. Plans New Measure for Poverty

3/3:  According to a NY Times report:  The federal government announced on Tuesday [March 2nd] that it would begin producing an experimental measurement of poverty next year, a step toward the first overhaul of the formula since it was developed nearly a half-century ago by an obscure civil servant in the Social Security Administration.  While the original definition -- the cash income collected by a family or individual -- will remain the official statistical measure for eligibility and distribution of federal assistance for the time being, "the new supplemental poverty measure will provide an alternative lens to understand poverty and measure the effects of antipoverty policies," said Rebecca Blank, the under secretary of commerce for economic affairs.  Advocates for the poor and technical experts have argued for years that the original standard, developed in conjunction with the Johnson administration's War on Poverty, was anachronistic. The civil servant who created it, Mollie Orshansky, based it on the Agriculture Department's cheapest meal plan, on the assumption that the average family spent a third of its income on food at the time. Her formula has largely remained the same except for inflation adjustments. ... The new supplemental measure will be released for the first time in the fall of next year. It adapts National Academy of Sciences recommendations issued in 1995 and later embraced by, among others, the administration of Mayor Michael R. Bloomberg of New York to formulate antipoverty policies.  Federal officials describe the supplemental measure as experimental and a work in progress. It establishes a poverty threshold that depends on the cost of food, shelter, clothing and utilities "plus a little more" for "a population that is not poor but is somewhat below the median."  Click above to access the article.


LSC Publishes Interim Final Rule on Attorneys' Fees Regulation

3/2:  The Legal Services Corporation published an interim final rule and request for comments in the Federal Register on February 11 to repeal the Corporation's regulation that prohibits LSC grantees from claiming, collecting and retaining attorneys fees.  The rule, which becomes effective on March 15, permits LSC grantees to make claims for attorneys' fees in any case in which the award of fees is permitted by law. LSC grant recipients also will be permitted to collect and retain attorneys' fees whenever such fees are awarded to them.  The rule notes that LSC has adopted a policy under which it will exercise its enforcement discretion and not take enforcement action against any recipient that filed a claim for or collected and retained attorneys' fees between the period of December 16, 2009, and March 15, 2010. LSC's action is in keeping with the intent of Congress, which repealed the statutory prohibition on attorneys' fees in the bill containing LSC's fiscal year 2010 appropriations bill.  President Obama signed the bill into law on December 16, 2009.  To access the interim final rule, click above.  LSC has issued a program letter to LSC grantees containing additional guidance on the matter; it can be accessed here.


We Keep Hearing About "Reconciliation" in Congress, But What Is It?

2/26:  In the Feb. 25th New York Times, there is a very good article which describes the so-called "reconciliation" process that Congress can use to pass legislation in such manner that the legislation can avoid being held captive by a filibuster in the U.S. Senate in which 60 votes are required to gain passage, not just a 51 vote majority.  The article gives some history of the "reconciliation" process, and it also describes how it is done.  As you'll see, it isn't a simple process, and it gives credence to the old saying that "if you like sausage and the law, don't watch either being made".  To access the article, click above.


Stimulus Funds Support Smoke-Free Multi-Unit Housing Project in Michigan

2/19:  We're thrilled to announce that the Michigan Department of Community Health's (MDCH) Tobacco Section has just been awarded a $1.5 million grant for a 2 year project to greatly expand the smoke-free multi-unit dwellings (SF MUDS) efforts we have been involved in since 2003.  The funding is from the funds the Centers for Disease Control & Prevention received under the American Recovery & Reinvestment Act of 2009 (ARRA) aka "stimulus funding".  15 grants were awarded nationwide (to 13 states), and it appears that only 2 dealt with tobacco or secondhand smoke issues, and Michigan's appears to be the only one that dealt with SF MUDS. The other awards dealt with reducing obesity, increasing physical activity, improving nutrition, and decreasing smoking.  This project has as its goal to increase smoke-free public and other affordable housing in Michigan by making 80% to 90% of all public and other affordable housing smoke-free by the end of 2011, including tribal public and other affordable housing.  This ambitious project is a partnership of the MDCH Tobacco Section, TCSG's Smoke-Free Environments Law Project, two tribal organizations (the South Eastern Michigan Indians, Inc., and the Sault Tribe), and about 10 local health departments.  The project will involve working closely with local public housing commissions, tribal housing authorities, other private affordable housing owners/operators, sovereign tribal entities, and others.  The project starts almost immediately and will go on until February, 2012. You can access the HHS press release on this by clicking above.


At Least 145 Housing Authorities in 22 States Now Have Smoke-Free Policies, Many for Elderly Housing; An Increase of Over 866% in 5 Years

2/19:  TCSG's Smoke-Free Environments Law Project maintains an up-dated listing of all the public housing authorities/commissions in the U.S. that we know of which have adopted smoke-free policies for one or more of their apartment buildings.  The listing is done largely in the order in which the policies have been adopted.  As of January, 2010, at least 145 local housing authorities had adopted smoke-free policies for some or all of their apartment buildings, with about 130 being adopted since the beginning of January, 2005; an average of over 2 per month. That constitutes an increase in the number of housing authorities with smoke-free policies of over 866% in 60 months.  The 22 states with such policies include Michigan (33), Minnesota (29), Maine (19), Colorado (13), California (7), Nebraska (6), Washington (6), Oregon (5), New Hampshire (4), Alaska (4), Idaho (3), Utah (3), New Jersey (2), Wisconsin (2), Arkansas (2), Florida, Montana, Indiana, Kentucky, Pennsylvania, Texas and Massachusetts.  To access the listing, in pdf format, click above.


County Health Rankings Include Smoking and Obesity Rates, Social & Economic Factors

2/18:  On Feb. 17th, the County Health Rankings -- the first set of reports to rank the overall health of every county in all 50 states -- were released by the University of Wisconsin's Population Health Institute and the Robert Wood Johnson Foundation at a briefing in Washington, D.C.  The health rankings include the smoking rates, obesity rates, economic data, and more in each county.  To access the rankings web site, click above.


AoA Statement on the release of FY 2011 budget request

2/17:  The Administration on Aging budget request for FY 2011 was sent to Capital Hill on February 1st with the overall HHS budget request.  AoA has released a brief statement describing the AoA budget request, which calls for an increase of $108.4 million above the FY 2010 enacted level.  To access the statement, click above.


President's FY 2011 Budget Proposes $435 Million for LSC and Urges Repeal of Restrictions on Non-LSC Funds and Class Actions

2/10:  The following is from a news note from the Brennan Center for Justice:  On February 1, 2010 President Obama released his federal budget for Fiscal Year 2011, which includes a proposed total funding level of $435 million for the Legal Services Corporation, $15 million more than LSC's current funding level, but the same amount the Administration included in its FY 2010 budget for LSC.  This flat funding recommendation follows the Administration's announcement that it plans to freeze non-security related, discretionary spending for the next three fiscal years.  LSC submitted its own budget request to Congress on January 29th, requesting $516.5 million in total funding, 95% of which, or $484.9 million, would be granted to local programs for the provision of civil legal assistance.  In its request for increased funding, LSC cites the severe drop in IOLTA and other non-federal funding for legal services and the growing number of requests for representation by low-income Americans. The President's FY 2011 budget also calls on Congress to repeal two of the onerous legal services funding restrictions that have been attached to the Corporation's funding in every appropriations cycle since 1996:  the restriction that extends federal control to LSC grantees' state, local, private, and other funds, and the restriction prohibiting LSC grantees from participating in class action lawsuits.    The Administration urged Congress to repeal these two restrictions in last year's budget as well, but Congress failed to go that far.  Instead, Congress lifted a third restriction whose repeal the President also urged: the restriction that had barred LSC grantees from seeking court awarded attorneys' fees from those who have violated the law.  Under no legal obligation to enact the President's budget as recommended, the House and Senate will now draft their own appropriations bills for FY 2011.  For more info, go to the LSC web site by clicking above.


LSC Sends FY 2011 Budget Request to Congress

2/3: The following is from a Jan. 29th announcement from the Legal Services Corporation: The Legal Services Corporation (LSC) today asked Congress to provide $516.5 million in Fiscal Year 2011 funding, with more than 95 percent of the budget request going to fund 136 nonprofit legal aid programs across the nation that provide civil legal assistance to the nation's poor.  The 2008 recession and the rise in unemployment during 2009 created new stresses for legal aid programs, which are able to serve only half of those seeking help with pressing civil legal problems. The Corporation's 2009 Justice Gap Report showed that in one category – foreclosures -- LSC programs are turning away two people for every client served.  Many legal aid programs are confronting a downturn in non-federal funding at a time when they report increasing requests for help by low-income Americans. In particular, Interest on Lawyers' Trust Accounts (IOLTA) -- a major source of funding for legal aid programs -- has declined significantly because of the drop in short-term interest rates.  In addition to providing $484.9 million for the provision of civil legal assistance, the Corporation's Fiscal Year 2011 Budget Request proposes $6.8 million for technology grants that improve access to legal assistance and self-help guides for the poor, $1 million for student loan repayment assistance to legal aid lawyers, $19.5 million for management and grants oversight and $4.35 million for the LSC Office of Inspector General.  The 2009 Justice Gap Report found that for every client served by LSC programs, another person who seeks help is turned away due to a lack of program resources. The conclusion reaffirmed the findings of the original report on the justice gap published by LSC in 2005.  LSC is the single-largest funder of civil legal assistance for the poor in the nation. Established by Congress in 1974, LSC operates as a private, nonprofit organization to promote equal access to justice and to ensure the provision of high-quality legal assistance to low-income Americans.  Download the full budget request by clicking above. Download a summary of the document in pdf format by clicking here.


Boston Mayor Thomas Menino lights up battle of the butt; Launches crusade to ban smoking in public housing; All BHA housing to be smoke-free in3-4 years

2/1:  The following is from a January 31st Boston Herald article: Mayor Thomas M. Menino is opening a new front in his war against tobacco: the city's cigarette-riden housing projects, which he vows to make smoke-free in the next four years.  "What we are trying to do is make a healthier environment for people who work and live in our city," Menino told the Herald.  By this summer, smoking could be banned in more than 100 new units in Boston Housing Authority public housing, which currently sees rates of smoking 50 percent higher than the general population. According to a 2006 city survey, 15.5 percent of nonpublic housing residents smoke, compared to 23 percent of BHA renters. ... The newly built smoke-free units include: 14 at Franklin Hill in Dorchester that opened in October; up to 100 at Roslindale's Washington-Beech that will open in August; and 100 at Old Colony by 2012.  While those units represent less than 2 percent of the BHA's 12,000 units, it's a start, said Menino.  "I would think in the next three to four years every public housing unit will be a smoke-free unit," he said.  The ban comes amid a perfect storm of factors, according to BHA officials: Demand by parents. Children in public housing are more likely to have asthma and to live with or around cigarette smoke, which triggers asthma attacks.  "People are trying to escape second-hand smoke and so we're trying to create this option for folks," said BHA director of planning Kate Bennett.  Pressure from the feds. In July, the U.S. Department of Housing and Urban Development "strongly encouraged" public housing authorities go smoke-free.  Click above for the full article and two related articles.



1/29:  The following is from the National Senior Citizens Law Center:  State Medicaid programs increasingly are able to pay for assisted living services, but most consumers and advocates know little about how these programs work.  In this case, what you don't know can hurt you, as policies differ widely from state to state, and many state Medicaid programs follow rules that disadvantage assisted living residents and their families.  NSCLC has prepared an issue brief that examines many of the most important issues in Medicaid payment for assisted living, and makes recommendations for policy changes at the federal and state levels.  Among other things, the issue brief recommends that Medicaid-certified facilities be required to accept Medicaid from Medicaid-eligible residents, and not be allowed to demand or solicit "supplemental payments" from residents' family members or friends.  The federal government at a minimum should require that Medicaid-certified facilities not discriminate against Medicaid-eligible residents.  To access the NSCLC issue brief in pdf format, please click above. 


Foreclosure Resources Available on Legal Services Corporation site

1/29:  For those working with elders facing foreclosure, there are a wealth of resources on the Legal Services Corporation web site to assist you in working with clients.  To access the site, click above.


States Can Opt Out of the Costly and Ineffective "Domestic Production Deduction" Corporate Tax Break

1/20:  The following is from a Center on Budget & Policy Priorities analysis: Over the past year, state revenue collections have dropped dramatically, creating large budget gaps for many states. A contributor to this fiscal crisis in many states is a relatively new and rapidly growing corporate tax break -- one that in most states never even received a vote in the state legislature but nonetheless is costing states hundreds of millions of dollars each year.  The federal government created this tax break, known as the "domestic production deduction," in 2004. Since most states base their own tax codes on the federal tax code, the tax break was carried over into many states without specific legislative scrutiny or a vote. Now it is costing not only the federal government but also 25 states a large, and growing, amount of money. By 2011, it will cost these states over $500 million per year.  The deduction -- enacted as Section 199 of the federal Internal Revenue Code -- allows companies to claim a tax deduction based on profits from "qualified production activities," a sweeping category that goes well beyond manufacturing to include such diverse activities as food production, filmmaking, and utilities -- a substantial share of states' corporate income tax base.  The revenue loss to states that still allow the deduction will increase steeply this year because of how the federal credit is designed. Initially, the cost was relatively modest because the deduction was limited to 3 percent of qualifying income. As of January 1, 2007, the percentage rate rose to 6 percent. The final increase to 9 percent takes effect in the 2010 tax year. Federal estimates suggest that allowing this deduction will reduce the revenue yield of corporate taxes by roughly 3.1 percent in 2011 and also reduce individual income taxes somewhat.  States are not required to allow this deduction. Since 2008, Connecticut, New York, Wisconsin, and the District of Columbia have joined 18 other states in disallowing the deduction and thereby reducing their current budget shortfalls and benefitting their states' economies. But another 25 states continue to permit it.  Click above for full analysis.


Utah Tobacco Prevention & Control Program Statewide Conference Features Smoke-Free Multi-Unit Housing Sessions

1/12:  The Utah Tobacco Prevention and Control Program is holding its annual statewide conference in Salt Lake City on January 12th.  The keynote will be given by Greg Connelly of Massachusetts who will discuss Federal, State & Local Tobacco Control in the 21st Century.  Jim Bergman of TCSG will do two presentations on Smoke-Free Multi-Unit Housing: Blazing Trails – Rapidly.  One session will be for housing authority directors and staff, and the second will be for health and tobacco control professionals.  To access the 57-slide PowerPoint that Bergman will use, click above.  To access a pdf copy of the ppt presentation, click here.


AoA Launches New Web site for the National Legal Resource Center; Web site provides streamlined access to resource support critical to preserving the independence and financial security of seniors

1/11:  The following is from a Jan. 8th Administration on Aging press release:  Recognizing the challenges many older Americans are facing in today's economic climate, HHS Assistant Secretary for Aging Kathy Greenlee has launched a new Web site for the National Legal Resource Center (NLRC).  The NLRC was created in 2008 by the Administration on Aging (AoA) to empower legal and aging services advocates with the resources necessary to provide high quality legal help to seniors who are facing direct threats to their ability to live independently in their homes and communities.  "It is important that legal and aging service providers have easy access to the wide range of support resources the NLRC has to offer," said Assistant Secretary Kathy Greenlee. "The new NLRC Web site creates a much needed resource portal to critical support tools designed to help providers serve older consumers facing difficult legal issues impacting their independence and financial security."  The NLRC is a collaborative project involving five national non-profit organizations known for their work in legal and aging services support who have teamed up to better help people in need. The new NLRC Web site provides professionals and advocates in aging and law with streamlined access to important resource support including case consultation and training on the most difficult legal issues facing older persons.  State offices on aging and local community-based aging organizations can also gain Web site access to technical assistance for efficient, cost-effective and targeted provision of legal services to older persons in the most social or economic need.  AoA funds over 1,000 legal services providers nationwide, which provide nearly one million hours of legal assistance per year. Legal challenges faced by seniors may include the loss of their homes through foreclosure, consumer scams that destroy nest eggs and steal identities, and difficulties in accessing public benefits essential to remaining financially secure, independent, and healthy.  The five national non-profit organizations of the NLRC are: National Senior Citizens Law Center; National Consumer Law Center; The Center for Social Gerontology; The Center for Elder Rights Advocacy; and the American Bar Association-Commission on Law and Aging.  The new Web site can be accessed by clicking above.


National Lawyers Guild Calls On President Obama to Withdraw Nomination of Sharon Browne to the Legal Services Corporation

1/11:  The following is from a Dec. 22nd National Lawyers Guild press release:  The National Lawyers Guild (NLG) calls on President Obama to withdraw the nomination of Sharon Browne to the board of directors of the Legal Services Corporation (LSC). On December 17, Obama announced his intention to nominate Ms. Brown, a principal attorney and member of the senior management at the conservative Pacific Legal Foundation and a member of the Civil Rights Practice Group of the Federalist Society.  The Legal Services Corporation is the nation's principal funder of civil legal aid for the poor. Established by Congress in 1974, it operates by providing grants to -- and overseeing -- independent nonprofit legal aid programs throughout the US. The LSC operates as a private, nonprofit corporation, with a board of directors composed of 11 members appointed by the president and confirmed by the Senate. By law, the board is bipartisan: no more than six members may be of the same political party.  The Pacific Legal Foundation, in contrast, describes itself as a "public interest legal organization that fights for limited government, property rights, individual rights and a balanced approach to environmental protection." At the PLF, Browne has authored briefs arguing against race-based school district assignment policies. She and the PLF have also been ardent supporters of Prop. 209, the 1996 ballot initiative that ended most affirmative action programs in California.  Not only does the PLF oppose much of what Legal Services stands for, but it has also directly opposed funding for Legal Services agencies. The PLF filed an amicus brief seven years ago in support of litigation challenging the legality of IOLTAs, or Interest on Lawyers Trust Accounts, which are an essential supplementary funding resource for Legal Services agencies around the country. While this slot on the LSC Board cannot legally go to a Democrat and while the minority members are traditionally selected by the minority party's congressional leadership, there is no legal bar and ample precedent for naming an independent rather than a member of the opposition party. At the very least, the president is obligated to nominate someone who believes in the importance of ensuring that the poor be afforded the legal services they need. We note, for example, that the recently-deceased former head of the Legal Services Corporation, William McAlpin, was a Republican who fought vigorously to strengthen it.  [Note:  Ms. Browne had been recommended by U.S. Senate Republican Leader Mitch McConnell.] Click above to access the full press release.


Angry Seniors Take on AARP;  150,000 Leave AARP Due to Endorsement of Health Reform Legislation, But 2 Million New or Renwed Members Offset Loss

1/7:  The following is from a Jan. 6th CNN report:  November 5, 2009. That's the day the AARP endorsed the House health care bill. With nearly 40 million members, it's not surprising that the president quickly came before cameras in the White House to thank the AARP for its endorsement.  That AARP endorsement wasn't universally applauded by all of the organization's millions of members. The organization admits it has lost 150,000 members since the endorsement but says that's been offset by more than 2-million new or renewed memberships. Some, like Robert Tice, feel the AARP is out of touch with its members by focusing so much on selling insurance. He says he will let his AARP membership lapse without renewal because he doesn't like what they're up to.  "The letters don't mean American Association of Retired Persons," he told CNN's Carol Costello. "It just means AARP. It's just a name. ... The AARP is about insurance. People need to know that. AARP is not out there to help you."  In fact, the AARP brands several types of insurance, including health policies with United Healthcare. By endorsing so many insurance policies the organization brought in around $650 million dollars last year in premiums. That's almost three times what it took in from membership dues.  Republicans say the AARP's endorsement of the House health bill is more about supporting its insurance business than anything else. They point to the organization's acquiescence to billions of dollars in cuts to the Medicare Advantage Plans, which AARP and other insurers offer as private alternatives to Medicare that often includes extra medical coverage like dental and vision care.  According to the Congressional Budget Office, some suggested cuts in the program might make it so unattractive that millions of Americans could be forced out because the plan's benefits would shrink. It is also possible that some insurance companies would stop offering Medicare Advantage policies altogether because it would be far less profitable.  So, why would the AARP support cuts to Medicare Advantage? Rep. Phil Gingrey (R-GA) thinks he knows what the AARP is up to. Gingrey says the organization hopes that millions of seniors will move from Medicare Advantage to AARP's branded Medigap plan, which has far higher profit margins. ... Carol Costello asked the AARP if any of this is true. The AARP's director of legislative policy, David Certner, says "it's not an issue we have lobbied on at all."  Certner says his organization supported cuts to Medicare Advantage to "trim the fat" so Medicare itself survives. "We understand there are financial issues with Medicare, and we need to save money for the Medicare program." Click above for the full report, plus a video.


Additional Federal Fiscal Relief Needed to Help States Address Recession's Impact; Without It, States' Steps to Balance Their Budgets Could Cost Economy 900,000 Jobs in 2010

1/6:  The following is from a Dec. 18th Center on Budget & Policy Priorities analysis: States face a serious fiscal problem that could force them to institute additional deep budget cuts and tax increases in 2010, weakening the fragile economic recovery and harming vulnerable children, seniors, and people with disabilities, among others. The federal assistance that states received for their Medicaid programs under this year's economic recovery legislation is scheduled to end with a "cliff" on December 31, 2010, and the assistance states received for education and other services also will be largely exhausted by then. Although that date is more than a year away, the problem is coming to a head now.  That's because states -- which continue to face huge budget shortfalls that they must close -- are taking steps now to plan their budgets for state fiscal year 2011, which starts on July 1, 2010 in most states. Governors will send their budget proposals to their legislatures between next month and February 2010 in almost all states. The legislatures will have to pass budgets as early as March or April in some states and by the end of June in almost all states. If states do not know they will receive additional federal fiscal relief, they will begin implementing new budget cuts and tax increases by this summer, at the latest. Presuming they will get no more fiscal relief, states will have to take steps to eliminate deficits for state fiscal year 2011 that will likely take nearly a full percentage point off the Gross Domestic Product. That, in turn, could cost the economy 900,000 jobs next year.  Mark Zandi, Chief Economist of Moody's, recently warned that these state budgetary actions "will be a serious drag on the economy at just the wrong time." Click above for the full analysis.


State budget pictures bleak as lawmakers head back; Aging programs likely to be hard hit also

1/4/10:  According to a January 4th Washington Post report:  If you thought state budgets were in bad shape last year, just wait: 2010 promises to be brutal for lawmakers - many facing re-election - as they scramble to find enough money to keep their states running without raising taxes.  Tax collections continue to sputter. Federal stimulus dollars are about to dry up. Rainy day funds have been tapped. And demand for services - like Medicaid, food stamps and unemployment benefits - is soaring.  As lawmakers head back to state capitols this month, budget woes range "from bad to ridiculously bad," said David Wyss, chief economist at Standard & Poors in New York. "There are some states, those hit particularly hard by the recession, that I don't think can cut spending enough. They're running out of things to cut."  Typically, the worst budget years for states are the two years after a recession ends. Across the nation, budgets are already lean after several rounds on the chopping block. And unless lawmakers increase taxes or fees - unpopular moves in an election year - most will need to cut even more as they grapple with the steepest decline of tax receipts on record. Services ranging from higher education to programs for the elderly could be in jeopardy.  The crunch could also mean new tolls to fund road projects, more prisoners being released early to trim corrections budgets, and the end of welfare programs that don't bring federal matching dollars.  The Center on Budget and Policy Priorities offers a bleak forecast: State budget shortfalls are likely to reach a whopping $180 billion for the coming fiscal year, double the size of Texas' annual budget.  "It's going to be the toughest year yet," said Raymond Scheppach, director of the National Governors Association, who predicts funding could evaporate for higher education, the arts and economic development. "The states haven't hit bottom."  Mary Ann Neureiter, who runs an adult day care center in suburban Atlanta, saw her state aid cut in half in 2009. The Cambridge House Enrichment Center once offered state-subsidized care to 10 low-income clients with disabilities such as Alzheimer's. It's now down to three, and Neureiter fears the funding could dry up altogether this year.  "It's heartbreaking because I foresee, in the coming year, it's going to get even worse for services for the elderly," she said. Eckl predicted that after several years of across-the-board cuts and short-term fixes designed to ride out the sour economy, states this year will look to make deeper, more, sustained cuts that could fundamentally change what services government provides. Whole programs could be eliminated. Layoffs will take the place of furloughs. Click above for full article.


Aging adults in suburbs lose appetite for driving

12/30/09:  The following is from a Dec. 29th Washington Post article:  For 60 years, Mary Schaaf has had a driver's license, and now, at the age of 86, she finds she's driving more than ever.  That's because her friends are not. One by one they have surrendered their car keys, their independence overtaken by fading eye sight, slowing reflexes and physical infirmities that make navigating the fast-paced roads of Montgomery County on their own too risky.  They turn to Schaaf, who drives on undaunted by the years or the "erratic" younger drivers who share her roads. ... The generation that gave birth to suburbia and the two-car garage is reaching the age where for many driving no longer seems like such a swell option. As Americans grow older -- one in five will be over the age of 65 by 2030 -- many are finding that the world that lured them away from city life is losing some of its appeal.  "The concern is that when they no longer can drive they will find themselves trapped in their homes in suburban neighborhoods where there are no sidewalks or, if there are sidewalks, there's no place to walk to," said Stewart Schwartz, executive director of the Coalition for Smarter Growth. ... Suburbia is where the population is aging fastest. At the dawn of the 21st century, 69 percent of people 65 and older lived in the suburbs. ... And the aging baby boomers want to remain in the suburbs where they were raised. Eighty-five percent of people over the age of 50 told the American Association of Retired Persons (AARP) that they plan to live in their current communities for as long as they can.  But for many older people, the AARP said, driving has lost its attraction. More than half of drivers over the age of 75 say they avoid driving at night or in bad weather, and almost 40 percent of them stay home when traffic is at its worst, according to recent research.  The AARP also found that older adults prefer to travel by car, either as drivers or passengers, rather than take public transportation.  Click above to access the full article.


Health-Care Reform 2009: The not-so-sweet side of closing 'doughnut hole'

12/29:  The following is from a Dec. 28th Washington Post article:  Six years after Congress added a prescription drug benefit to Medicare, Democrats in the House and Senate are poised to make a central change that they and most older Americans have wanted all along: getting rid of a quirk that forces millions of elderly patients with especially high expenses for medicine to pay for much of it on their own. The closing of an unusual gap in Medicare drug coverage -- a gap that Republicans had, when they controlled Capitol Hill and the White House, insisted was needed for the government to be able to afford the program -- would "forever end this indefensible injustice for American's seniors," Senate Majority Leader Harry M. Reid (D-Nev.) said in announcing that the Senate would join the House in supporting the change.  But details of the change underscore that, for patients and the federal budget alike, the implications of the sprawling health-care bills pushed through by congressional Democrats are more nuanced than lawmakers' talking points.  The Democrats and President Obama have been clear that the "doughnut hole," as the gap is known, would disappear gradually over the next 10 years. They have not mentioned that Medicare patients would, according to House figures, face a slightly larger hole in coverage during two of the next three years than they do today. Proponents say the government can afford to eliminate the gap because the pharmaceutical industry would pay for the phaseout. But less than half of the $80 billion that drugmakers agreed to provide, under a health-care reform agreement over the summer with Senate Democrats and the White House, would be used to help fill the gap, according to Senate Democratic aides. Moreover, there are no budget forecasts far enough into the future to show how much the expanded drug benefit would cost the government once the gap is fully closed.  Despite such uncertainties, the prospect of filling the hole in drug coverage responds to a strong desire among older Americans -- a significant constituency that tends to be wary of changes to the health-care system. The 2003 law that added the drug benefit to Medicare was the largest expansion since the creation of the federal health insurance system for the elderly four decades ago. The new coverage became available in 2006. As of last year, about 32 million people, nearly three-fourths of everyone on Medicare, had it.  Click above for full article.


Smoke-Free Multi-Unit Housing in Michigan & the Nation: A Decade of Enormous Growth

12/29:  The following is from an end-of-the-year TCSG/SFELP press release: "As the first decade of the 21st century ends, we find that the growth in Michigan and nationally in smoke-free multi-unit housing has been enormous -- going from virtually no smoke-free housing in 2000 to many hundreds of thousands of units today," according to Jim Bergman, Co-Director of The Center for Social Gerontology, Inc. in Ann Arbor, Michigan, which operates the Smoke-Free Environments Law Project (SFELP).  "In 2000, it was virtually impossible to find apartment or condominium buildings that were smoke-free in all the living units, as well as the common areas.  This was true in Michigan and in almost every state in the nation.  By 2005, a number of states, including Michigan, Maine, Minnesota, and California had begun to develop a growing supply of smoke-free apartments.  By the end of the decade, virtually every state has smoke-free multi-unit housing available, and many states have thousands, if not hundreds of thousands, of smoke-free units," said Bergman. ... In public housing, funded by the federal Department of Housing & Urban Development (HUD) and other federal and state entities, the growth in smoke-free housing has been equally as great, if not greater.  In 2000, there were only two public housing authorities in the nation that had smoke-free policies for some or all their buildings (Kearney, NE and Fort Pierce, FL).  By the end of 2003, just eleven housing authorities had smoke-free policies.  By January, 2005, that number had only risen to fifteen.  But, then the growth sky-rocketed.  As of December, 2009, at least 136 public housing authorities in 19 states had adopted smoke-free policies for some or all their buildings.  The growth in the entire decade was 6700%; since December, 2003, the growth was 1136%; and the growth in the past 5 years has been over 800%.  In Michigan, the Cadillac Housing Commission was the first public housing authority to adopt a smoke-free policy, doing so in July, 2005.  Today, thirty-two local Michigan housing commissions have adopted smoke-free policies, covering about 56 apartment buildings/developments and over 60 townhouses/scattered site units, with about 4,158 apartment units.  That is a 3100% increase in the 48 months since January, 2006.  To access the full press release, click above.


Months to Live; Hard Choice for a Comfortable Death: Sedation

12/29:  The following is from a Dec. 27th New York Times article:  In almost every room people were sleeping, but not like babies. This was not the carefree sleep that would restore them to rise and shine for another day. It was the sleep before -- and sometimes until -- death.  In some of the rooms in the hospice unit at Franklin Hospital, in Valley Stream on Long Island, the patients were sleeping because their organs were shutting down, the natural process of death by disease. But at least one patient had been rendered unconscious by strong drugs.  The patient, Leo Oltzik, an 88-year-old man with dementia, congestive heart failure and kidney problems, was brought from home by his wife and son, who were distressed to see him agitated, jumping out of bed and ripping off his clothes. Now he was sleeping soundly with his mouth wide open. ... Mr. Oltzik received what some doctors call palliative sedation and others less euphemistically call terminal sedation. While the national health coverage debate has been roiled by questions of whether the government should be paying for end-of-life counseling, physicians like Dr. Halbridge, in consultations with patients or their families, are routinely making tough decisions about the best way to die.  Among those choices is terminal sedation, a treatment that is already widely used, even as it vexes families and a profession whose paramount rule is to do no harm. Doctors who perform it say it is based on carefully thought-out ethical principles in which the goal is never to end someone's life, but only to make the patient more comfortable.  But the possibility that the process might speed death has some experts contending that the practice is, in the words of one much-debated paper, a form of "slow euthanasia," and that doctors who say otherwise are fooling themselves and their patients.  There is little information about how many patients are terminally sedated, and under what circumstances -- estimates have ranged from 2 percent of terminal patients to more than 50 percent. (Doctors are often reluctant to discuss particular cases out of fear that their intentions will be misunderstood.)  While there are universally accepted protocols for treating conditions like flu and diabetes, this is not as true for the management of people's last weeks, days and hours. Indeed, a review of a decade of medical literature on terminal sedation and interviews with palliative care doctors suggest that there is less than unanimity on which drugs are appropriate to use or even on the precise definition of terminal sedation.  To access the full article, click above.


Senior-home hell; Brooklyn facility hit for $19M in neglect suit

12/28:  The following is from a Dec. 28th New York Post article: A Brooklyn nursing home will have to fork over nearly $19 million in damages to the family of a 76-year-old patient neglected so badly that he left with more than 20 bedsores.  The massive award, handed down by a Brooklyn jury earlier this month, is the first in the state against a nursing home that includes punitive damages, lawyers said. "It was horrible," said Margaret Whitehurst, 55, who pulled her father, John Danzy, from the Brooklyn Queens Nursing Home after just nine months. "He walked in on two legs and a cane. He was 237 pounds. When we got him back, he was 148 pounds and he had holes all over his body."  She and her siblings moved Danzy, a retired truck driver and butcher, to another nursing home. Six months later, in November 2003, he succumbed to an infection caused by the bedsores, according to testimony.  A Brooklyn jury deliberated two full days following the four-week trial before finding the Cypress Hills facility delivered substandard care.  The panel awarded $3.75 million for Danzy's pain and suffering, but tacked on $15 million in punitive damages, based in part on the allegation that the home had doctored records to try to cover up the neglect. Lawyer Dennis Kelly said the first-ever imposition of punitive damages against a nursing home in New York state was due in part to evidence that the home tried to cover up the lack of care Danzy was getting.  An FBI expert testified that about 100 different skin-check notes showing "G" for "good" had been penned over to show "B" for "broken" -- an effort by the home to claim it hadn't missed the horrific sores, Kelly said.  "Someone went back and wrote B's over the G's to cover their tracks, so they falsified the records, he said. "We believe that once they found out they were being sued, they went back and said, 'How could we have G's here when they guy has 20 sores?' "  Click above for full article.


Woman, 62, dies in Quincy fire; Blaze sparked by cigarette; oxygen devices fuel flames

12/28:  The following is from a Dec. 27th Boston Globe report: A woman died yesterday morning in a two-alarm fire sparked by a cigarette, according to fire officials.  Residents of the city-owned high-rise at 95 Martensen St., which houses elderly, low-income, and disabled residents, said they had warned 62-year-old Donna Marani not to smoke in her apartment - especially because she regularly used home oxygen devices.  "She was a smoker," said Jenn Fell, 31, who lives in the building with her two young sons. "Several people in the building have warned her about smoking while on oxygen. Smoking can be very dangerous, and unfortunately everybody lost a really good friend out of this tragedy."  State, local, and Norfolk County officials determined yesterday afternoon that a cigarette ignited the fire.  "The investigation revealed the cause to be consistent with a smoking-related fire," State Fire Marshal Stephen D. Coan told the Globe yesterday. "And there was home oxygen in the apartment." ... While firefighters managed to contain the fire to Marani's apartment, significant water and smoke damage could be seen throughout the building yesterday. Cleanup crews were on hand all afternoon. Most residents were allowed to return home, but more than a dozen from units near Marani's apartment were being sheltered at a Salvation Army facility, fire officials said. ... Since 1997, 18 people have died and more than 30 others have been severely burned or suffered serious smoke inhalation in fires across the state involving people who smoked while using a home oxygen system, Coan said.  Air is about 21 percent oxygen, but medical tanks are filled with 100 percent oxygen, which can fuel intense flames.  "Fires related to smoking and use of home oxygen have been a great concern of mine for a long time," Coan said. "We have a group made up of fire service personnel, members of the medical community, oxygen manufacturers, the Red Cross, and others focused on a public education campaign to highlight the dangers."  [It should be noted that a no-smoking policy could have prevented this tragedy.]  Click above to access the full report.


Leadership Change at Legal Services Corporation

12/22:  The following is from a Dec. 18th news note from the Brennan Center for Justice: The new Administration is bringing with it new leadership for LSC.  On December 17th, LSC president, Helaine M. Barnett, announced that she will be stepping down as president at year's end.  She has served as LSC chief executive for six years.  Barnett's successor will be chosen by the new sitting LSC Board of Directors once it is in place.  Until then, an interim president will likely lead the Corporation.   The LSC Board of Directors is comprised of 11 individuals who are nominated by the president and confirmed by the Senate.  By law, no more than six board members can be of the same political party.  President Obama has nominated nine members to the board:  Lauri I. Mikva was nominated in April and confirmed by the Senate on June 19th. On August 9th, President Obama nominated five members to the board:  Robert J. Grey, John G. Levi, Martha L. Minow, Julie A. Reiskin and Gloria Valencia-Weber.  December 17th, President Obama expressed his intent to nominate three more members to the Board: Sharon L. Browne, Charles Norman Wiltse Keckler, and Victor B. Maddox.  Mikva is the only nominee to have been confirmed by the Senate thus far.  Of the nine nominees, six are Democrats, including Mikva, and 3 are Republicans.  The President has the authority to nominate two additional members.  He is free to choose among Republicans and Independents, since six Democrats have already been nominated.  For more news from the Brennan Center, click above.


HHS Announces $27 Million from Recovery Act to Help Older Americans Fight Chronic Disease

12/18:  The following is from a Dec. 16th HHS press release:  HHS Secretary Kathleen Sebelius has announced the availability of $27 million to help older individuals with chronic conditions to improve their health and reduce their use of costly medical care. These funds are made possible through the American Recovery and Reinvestment Act, which has provided up to $650 million to HHS for the Communities Putting Prevention to Work initiative launched earlier this fall to promote evidence-based prevention strategies in communities and states across the country.  "This program is about getting money to communities to help seniors manage chronic conditions that threaten their ability to remain in their own homes. Through HHS' national aging-services network which reaches into nearly every community in America, we are helping people living with chronic conditions and others better manage their own health," Secretary Sebelius said.  Research has shown that prevention programs can improve the quality of life for older individuals, including frail seniors with multiple chronic conditions, and also reduce health care costs. The Recovery Act funds will put the results of HHS' research investments into practice at more than 1,200 community-based sites across the country -- reaching tens of thousands of older Americans and their families. "The American Recovery and Reinvestment Act has been about helping families in need during challenging economic times," said Assistant Secretary for Aging Kathy Greenlee. "This innovative program will give at-risk older people and their caregivers the tools they need to make their own decisions so they can live longer, healthier and more independent lives."  This competitive initiative gives every state Aging and Health Department and U.S. territory the opportunity to implement rigorously tested Chronic Disease Self-Management Programs (CDSMP), one of the most prominent being the Stanford University model. The CDSMP is a six-week peer-led training program that covers topics such as healthy eating, exercise, managing fatigue and depression, and communicating effectively with health care professionals.  While further research is underway, rigorous evaluations have suggested that the program improves participants' overall health and energy levels and results in savings to Medicare through fewer hospital stays. CDSMP are specifically designed to be delivered by non-health professionals in community settings, such as senior centers, congregate meal programs, faith-based organizations and senior housing projects.  To access the full press release, click above.


President Obama Largely Inherited Today's Huge Deficits; Economic Downturn, Financial Rescues, and Bush-Era Policies Drive the Numbers

12/17:  The following is from a Dec. 16th analysis by the Center on Budget & Policy Priorities: Some critics charge that the new policies pursued by President Obama and the 111th Congress generated the huge federal budget deficits that the nation now faces. In fact, the tax cuts enacted under President George W. Bush, the wars in Afghanistan and Iraq, and the economic downturn together explain virtually the entire deficit over the next ten years.  The deficit for fiscal 2009 was $1.4 trillion and, at an estimated 10 percent of Gross Domestic Product (GDP), was the largest deficit relative to the size of the economy since the end of World War II. Under current policies, deficits will likely exceed $1 trillion in 2010 and 2011 and remain near that figure thereafter.  The events and policies that have pushed deficits to astronomical levels in the near term, however, were largely outside the new Administration's control. If not for the tax cuts enacted during the Presidency of George W. Bush that Congress did not pay for, the cost of the wars in Iraq and Afghanistan that began during that period, and the effects of the worst economic slump since the Great Depression (including the cost of steps necessary to combat it), we would not be facing these huge deficits in the near term.  For the full analysis, click above.


The First Lady on Health Insurance Reform & Older Women

12/16:  On November 13th, the White House hosted a meeting on health insurance reform and older women.  Among the speakers was First Lady Michelle Obama.  You can view this meeting in a 37 minute video by clicking above.


For Elderly in Rural Areas, Times Are Distinctly Harder

12/11:  The following is from a Dec. 10th New York Times article: Growing old has never been easy. But in isolated, rural spots like this, it is harder still, especially as the battering ram of recession and budget cuts to programs for the elderly sweep through many local and state governments.  Ms. Clark has been able to get help since her fall two winters ago because Wyoming, thanks to its energy boom, continues to finance programs for the elderly. But at least 24 states have cut back on such programs, according to a recent report by the Center on Budget and Policy Priorities, a Washington research group, and hundreds of millions of dollars in further cuts are on the table next year. The difficulties are especially pronounced in rural America because, census data shows, the country's most rapidly aging places are not the ones that people flock to in retirement, but rather the withering, remote places many of them flee. Young people, for decades now, have been an export commodity in towns like Lingle, shipped out for education and jobs, most never to return. The elderly who remain -- increasingly isolated and stranded -- face an existence that is distinctively harder by virtue, or curse, of geography than life in cities and suburbs. Public transportation is almost unheard of. Medical care is accessible in some places, absent in others, and cellphone service can be unreliable.  Even religion and the Internet are different here. Churches have consolidated or closed -- a particular hardship for older people, who tend to be avid churchgoers. And a lack of high-speed broadband service in many rural areas compounds the sense of separation from children and grandchildren, as well as the broader world.  The distance between friends is what gnaws most fiercely at George Burgess. Click above for the full article.


Congressional Negotiators Back 8% Funding Increase for LSC

12/10:  According to a Dec. 9th note from the Legal Services Corporation:  House and Senate negotiators have approved a consolidated appropriations bill for Fiscal Year 2010 that includes $420 million for the Legal Services Corporation (LSC) to promote equal access to justice and to provide for civil legal assistance to low-income Americans. The vast majority of the funding -- $394.4 million -- will be distributed in grants to 137 independent nonprofit programs across the nation to help low-income individuals and families who are trying to avert foreclosure or eviction, trying to escape from domestic violence or who have a pressing civil legal problem that places their security and safety at risk.  Overall, the appropriations bill increases LSC funding by $30 million from the current level. It also lifts a restriction on the ability of LSC-funded programs to pursue the recovery of attorneys' fees when it is permitted or required under federal or state law.  In addition to providing grants for the provision of civil legal assistance, the appropriations bill provides $17 million for management and grants oversight, $3.4 million for technology grants that improve access to legal assistance and self-help guides for the poor, $1 million for student loan repayment assistance to legal aid lawyers, and $4.2 million for the LSC Office of Inspector General.  The consolidated appropriations bill, which combines six annual appropriations bills for the fiscal year that began October 1, will go to the House and Senate for final approval and then to the president for his signature. An interim funding measure expires December 18.


U.S. Will Settle Indian Lawsuit for $3.4 Billion; Many elders will receive cash payments

12/9:  The following is from a Dec. 9th New york Times story:  The federal government announced on Tuesday that it intends to pay $3.4 billion to settle claims that it has mismanaged the revenue in American Indian trust funds, potentially ending one of the largest and most complicated class-action lawsuits ever brought against the United States.  The tentative agreement, reached late Monday, would resolve a 13-year-old lawsuit over hundreds of thousands of land trust accounts that date to the 19th century. Specialists in federal tribal law described the lawsuit as one of the most important in the history of legal disputes involving the government's treatment of American Indians. President Obama hailed the agreement as an "important step towards a sincere reconciliation" between the federal government and American Indians, many of whom, he said, considered the protracted lawsuit a "stain" on the nation.  As a presidential candidate, Mr. Obama said, "I pledged my commitment to resolving this issue, and I am proud that my administration has taken this step today."  For the agreement to become final, Congress must enact legislation and the federal courts must then sign off on it. Administration officials said they hoped those two steps would be completed in the next few months.  The dispute arises from a system dating to 1887, when Congress divided many tribal lands into parcels -- most from 40 to 160 acres -- and assigned them to individual Indians while selling off remaining lands.  The Interior Department now manages about 56 million acres of Indian trust land scattered across the country, with the heaviest concentration in Western states. The government handles leases on the land for mining, livestock grazing, timber harvesting and drilling for oil and gas. It then distributes the revenue raised by those leases to the American Indians. In the 2009 fiscal year, it collected about $298 million for more than 384,000 individual Indian accounts.  The lawsuit accuses the federal government of mismanaging that money. As a result, the value of the trusts has been unclear, and the Indians contend that they are owed far more than what they have been paid.  Under the settlement, the government would pay $1.4 billion to compensate the Indians for their claims of historical accounting irregularities and any accusation that federal officials mismanaged the administration of the land itself over the years.  Each member of the class would receive a check for $1,000, and the rest of the money would be distributed according to the land owned. In addition, legal fees, to be determined by a judge, would be paid from that fund.  Philip Frickey, a law professor at the University of California, Berkeley, who specializes in federal Indian law, said that of all the Indian land claims and other lawsuits over the past generation, the trust case had been a "blockbuster" because it is national in scope, involves a large amount of money, and has been long-running.  Click above to accesss the full Times article.  To access a related Washington Post article, click here.


House-Passed and Senate Health Bills Reduce Deficit, Slow Health Care Costs, and Include Realistic Medicare Savings; Congress Has Good Record of Implementing Medicare Savings; Medicare Savings in These Bills Are Similar to Those Implemented in the Past

12/8:  The following is from  Dec. 4th Center on Budget & Policy Priorities analysis: Health reform legislation that has passed the House in one form and is before the Senate in another is facing a series of attacks that, taken together, suggest the legislation would do little to control health care costs and would increase budget deficits. Many of these charges are exaggerated or simply incorrect, based on the Center's careful analysis of the legislation. In particular, a number of criticisms rest on a mistaken belief that, in recent years, Congress has repeatedly enacted provisions to achieve savings in Medicare and then generally blocked these provisions before they could take effect. Thus, critics say, no one should take seriously the provisions of the current bills that would produce Medicare savings. In fact, the Center's analysis of major legislation affecting Medicare that Congress has enacted over the last two decades shows that Congress has permitted the vast majority of Medicare savings to take effect. To access the full analysis, click above.


Home Care Patients Worry Over Possible Cuts

12/7:  The following is from a Dec. 4th New York Times article: As they are across the nation, Medicare patients and nurses in this town in northern Maine are anxiously following the Congressional debate because its outcome could affect Medicare's popular home health benefit in a big way. The legislation would reduce Medicare spending on home health services, a lifeline for homebound Medicare beneficiaries, which keeps them out of hospitals and nursing homes.  Under the bills, more than 30 million Americans would gain health coverage. The cost would be offset by new taxes and fees and by cutbacks in Medicare payments to health care providers.  Home care shows, in microcosm, a conundrum at the heart of the health care debate. Lawmakers have decided that most of the money to cover the uninsured should come from the health care system itself. This raises the question: Can health care providers reduce costs without slashing services?  Under the legislation, home care would absorb a disproportionate share of the cuts. It currently accounts for 3.7 percent of the Medicare budget, but would absorb 10.2 percent of the savings squeezed from Medicare by the House bill and 9.4 percent of savings in the Senate bill, the Congressional Budget Office says. The House bill would slice $55 billion over 10 years from projected Medicare spending on home health services, while the Senate bill would take $43 billion.  Democratic leaders in the Senate and the House justify the proposed cuts in almost identical terms. "These payment reductions will not adversely affect access to care," but will bring payments in line with costs, the House Ways and Means Committee said. The Senate Finance Committee said the changes would encourage home care workers to become more productive. Click above for the full article.


Voices of Power: AARP's John Rother talks about AARP's endorsement of Obama's health care reform legislation

11/12:  On Nov. 12th the Washington Post did an interview with AARP's Director of Policy, John Rother, concerning AARP's endorsement of health care reform legislation.  Seniors have been the least supportive of health care reform legislation and AARP has taken some heat over their endorsement.  In the interview, Mr. Rother discusses why and how AARP feels such legislation will be a very positive thing for seniors. To read a transcript of the interview, click above.


AARP endorses House health-care bill

11/6: According to a Nov. 5th Washington Post report:  The AARP, the nation's largest and most influential association of older Americans, endorsed the House health-care bill Thursday morning and vowed to lobby House members in advance of Saturday's historic vote.  AARP vice president Nancy A. LeaMond said the House package, which would spend more than $1 trillion over the next decade to expand insurance coverage to millions of Americans who lack it, meets the group's chief goals for reform, including strengthening Medicare, the federal health program for people over 65.  "We can say with confidence that it meets our priorities for protecting Medicare, providing more affordable health insurance for 50- to 64-year-olds and reforming our health care system," LeaMond said in a briefing for reporters.  LeaMond praised House leaders for including a plan to close the coverage gap in Medicare prescription drug coverage known as the donut hole. Key Democrats said the endorsement, one of several expected today, could prove critical to pushing their vote count over the top.  To access the full story, click above.


Center for Medicare Advocacy Launches New Project - Removing a Major Barrier to Necessary Care:  The Medicare "Improvement Standard" Advocacy & Education Initiative

10/30:  The following is from the Center for Medicare Advocacy web site: The Center for Medicare Advocacy is launching a new advocacy and education initiative to eliminate the Medicare "Improvement Standard," which requires that Medicare beneficiaries be able to improve in order to qualify for coverage. The insistence that people must be able to get better unfairly restricts access to Medicare coverage and necessary health care.  Although the Improvement Standard conflicts with the law, it has become deeply ingrained in the system and ardently followed by those who provide care and those who make coverage determinations throughout the health care continuum. Beneficiaries are told Medicare coverage is not available if their underlying condition will not improve, if they have "plateaued," are not likely to improve, or if they need "maintenance care only". As a result it keeps people with debilitating, chronic conditions from receiving the care they need. This practice persists although the Medicare Act does not require improvement as a precondition to coverage for illness or injury. Further, the federal regulations state that "restoration is not to be the deciding factor" in making Medicare coverage determinations.  Everyday the Improvement Standard blocks access to Medicare and health care for real people. The people most affected by this barrier include people with Multiple Sclerosis, Alzheimer's disease, ALS (Lou Gehrig's disease), spinal cord injuries, diabetes, Parkinson's disease, hypertension, arthritis, heart disease, and stroke. Further, the erroneous standard disproportionately affects people who have low-incomes, as well as African-Americans and Hispanics.  With support from The Atlantic Philanthropies, the Center for Medicare Advocacy will begin a focused, collaborative effort to eliminate the Improvement Standard in Medicare policy and practice. This effort will include advocacy with the administration, litigation if needed, and a multi-faceted education campaign.  The Center for Medicare Advocacy, founded in 1986, is staffed by attorneys, other professional advocates, and a nurse. The Center's staff assists thousands of individuals in obtaining Medicare coverage and necessary health care each year. Armed with this experience, the Center works to obtain systemic change to eliminate unfair barriers to coverage and care. For decades, the Improvement Standard has been among the most significant obstacles facing the Center's clients, as well as the millions of other people with Medicare who have no legal representation. By removing this obstacle, we will open doors to needed medical and rehabilitative care for people with long term conditions and injuries.  This is the goal of the proposed project.  To learn more, click above.


Critics: DEA crackdown denies some patients pain medication

10/29:  The following is from a Washington Post article:  Heightened efforts by the Drug Enforcement Administration to crack down on narcotics abuse are producing a troubling side effect by denying some hospice and elderly patients needed pain medication, according to two Senate Democrats and a coalition of pharmacists and geriatric experts.  Tougher enforcement of the Controlled Substances Act, which tightly restricts the distribution of pain medicines such as morphine and Percocet, is causing pharmacies to balk and is leading to delays in pain relief for those patients and seniors in long-term care facilities, wrote  Sens. Herb Kohl (Wis.) and  Sheldon Whitehouse (R.I.).  The lawmakers wrote to Attorney General Eric H. Holder Jr. this month urging that the Obama administration issue new directives to the DEA and support a possible legislative fix for the problem, which has bothered nursing home administrators and geriatric experts for years. The DEA has sought to prevent drug theft and abuse by staff members in nursing homes, requiring written signatures from doctors and an extra layer of approvals when drugs such as morphine and Percocet are ordered for sick patients.  The law, however, "fails to recognize how prescribing practitioners and the nurses who work for long-term care facilities and hospice programs actually order prescription medications," Kohl and Whitehouse wrote. They concluded that delays can lead to "adverse health outcomes and unnecessary rehospitalizations, not to mention needless suffering." Click above for the full article.


Proposed long-term insurance program raises questions; Opponents warn plan could require vast infusions of cash

10/28:  The following is from an Oct. 27th Washington Post report: As congressional leaders haggle over the shape of a proposed government-run "public option" in health-care reform legislation, a quiet revolt is brewing against a different public insurance program -- a plan to create government insurance for long-term care.  The proposal is known as the CLASS Act, short for Community Living Services and Support. The idea has been around for years, and the late  Sen. Edward M. Kennedy (D-Mass.) pushed to have the measure included in the health-care overhaul package that passed the Senate health committee in July. A similar measure was also adopted by voice vote in one of the three House committees handling health care.  The idea is to create long-term care insurance that would be available to anyone, including those who are already disabled. People would be automatically enrolled, unless they chose to opt out, and would pay a premium in exchange for the opportunity to receive cash benefits to cover the cost of home care, adult day programs, assisted living or nursing homes after they had been enrolled for at least five years. Premiums and benefit levels would be set by federal health officials, but advocates predict that the program would provide beneficiaries with a minimal sum, around $75 a day.  The proposal has gained momentum in recent days as Democrats in both the House and Senate cast about for cash to help finance a final health package. Because the program would begin taking in premiums immediately but would not start paying benefits until 2016, congressional budget analysts have forecast that it would generate a nearly $60 billion surplus over the next 10 years, cash that would help the larger measure's balance on paper.  To access the full article, click above.


AARP: Reform advocate and insurance salesman; Seniors group makes millions from royalties on health plans

10/27:  The following is from an Oct. 27th Washington Post report: The nation's preeminent seniors group, AARP, has put the weight of its 40 million members behind health-care reform, saying many of the proposals will lower costs and increase the quality of care for older Americans.  But not advertised in this lobbying campaign have been the group's substantial earnings from insurance royalties and the potential benefits that could come its way from many of the reform proposals.  The group and its subsidiaries collected more than $650 million in royalties and other fees last year from the sale of insurance policies, credit cards and other products that carry the AARP name, accounting for the majority of its $1.14 billion in revenue, according to federal tax records. It does not directly sell insurance policies but lends its name to plans in exchange for a tax-exempt cut of the premiums.  The organization, formerly known as the American Association of Retired Persons, also heavily markets the policies on its Web site, in mailings to its members and through ubiquitous advertising targeted at seniors.  The group's dual role as an insurance reformer and a broker has come under increasing scrutiny in recent weeks from congressional Republicans, who accuse it of having a conflict of interest in taking sides in the fierce debate over health insurance. Three House Republicans sent a letter to AARP on Monday complaining that the group was putting its "political self-interests" ahead of seniors.  GOP lawmakers point to AARP's thriving business in marketing branded Medigap policies, which provide supplemental coverage for standard Medicare plans available to the elderly. Democratic proposals to slash reimbursements for another program, called Medicare Advantage, are widely expected to drive up demand for private Medigap policies like the ones offered by AARP, according to health-care experts, legislative aides and documents. Republicans also question the high salaries and other perks given to some top AARP executives, who would not be subject to limits on insurance executives' pay included in the Senate Finance Committee's health reform package. Former AARP chief executive William Novelli received more than $1 million in compensation last year. ... Several top AARP officials also said they have no idea whether the group might gain insurance business as a result of the proposed reforms. "We wouldn't know it, and we wouldn't really care," Certner said. "The advocacy is what drives what we do here, and not the other way around."  Click above for the full article.


Charlevoix Housing Commission becomes 32nd in Michigan to adopt smoke-free policy and 129th in the nation

10/23:  On October 20th, the Charlevoix Housing Commission adopted a smoke-free policy for its 62-unit Pine River Place apartments for the elderly and disabled.  The policy went into effect immediately for all new residents and current residents who are not smokers, as well as guests and staff.  Current residents who are smokers are exempted from the policy for as long as they live in their current unit.  Under this new policy, secondhand smoke and other damage caused by smoking or tobacco products will not be considered ordinary wear and tear, and some or all of the resident's security deposit may be retained by the housing commission to cover costs of damage caused by smoking or tobacco products; damage above and beyond the amount of the security deposit may be billed to the resident.  Further, it is the resident's responsibility to take steps to keep smoking residue from building up in units, including more frequent cleaning and wall washing, etc.  Annual inspections of units will be utilized to ensure that apartment residents are following this part of the policy.   Charlevoix becomes the 32nd public housing commission in Michigan to adopt a smoke-free policy.  It has been our pleasure working with Rob Harrison, the Executive Director of the Charlevoix Housing Commission on this policy.  Charlevoix is a located in northern Michigan on Lake Michigan, and is known as "Charlevoix the beautiful".  The 32 Michigan housing commissions with smoke-free policies have about 56 apartment buildings/developments and over 60 townhouses/scattered site units.  A total of at least 4,158 apartment units are covered by the local Michigan housing authority smoke-free policies.  More are in the pipeline. There are now at least 129 housing authorities in the U.S. with smoke-free policies for some or all their buildings.  To access a copy of the list of 129 housing authorities in the U.S. that have adopted smoke-free policies for some or all their buildings, click above.


Hidden Costs of Medicare Advantage; Plans' Free Perks Are Subsidized By Government

10/19:  The following is from an Oct. 15th Washington Post article: Seniors in this Sun Belt retirement haven and across the country revel in the free perks that private insurance companies bundle with legally mandated benefits to entice people 65 and older to forgo traditional Medicare and sign up for private Medicare Advantage policies.  The trouble is, the extra benefits are not exactly free; they are subsidized by the government. And some of the plans pass their costs on to seniors, who pay higher co-pays and additional fees to get care.  "It's a wasteful, inefficient program and always has been," Sen. John D. Rockefeller IV (D-W.Va.) said at a recent hearing. At its core, Rockefeller added, Medicare Advantage is "stuffing money into the pockets of private insurers, and it doesn't provide any better benefits to anybody."  President Obama has proposed cutting more than $100 billion in subsidies over 10 years, a contentious component of health-care reform that will be fought in earnest as the bills move through Congress. But unlike some issues that touch off partisan sparring, Medicare Advantage has an unlikely band of bipartisan defenders who have already battled to restore $10 billion of the proposed reductions.  In a health-care debate defined by big numbers and confusing details, the prospect of losing benefits such as a free gym membership through the Silver Sneakers program is tangible, and it has spooked some seniors, who are the nation's most reliable voters and have been most skeptical about reform.  Medicare Advantage was established in the 1970s (under a different name) when private insurers convinced Congress that they could deliver care at lower costs than Medicare. The program blossomed in the late 1990s when Congress bolstered it with millions in additional federal subsidies to for-profit HMOs. It has proven popular among younger, active seniors who had managed-care plans as workers, and about a quarter of Medicare's 45 million beneficiaries are enrolled.  Many private plans require no additional monthly premiums, yet the government pays an average of $849.90 in monthly subsidies to insurance companies for a person on Medicare Advantage, according to the Kaiser Family Foundation. That is about 14 percent more than the government spends on people with standard Medicare, according to the nonpartisan Medicare Payment Advisory Commission.  "The promise of Medicare Advantage and Medicare HMOs was to save the government money, to save consumers money, all the while providing additional benefits and coordinating care," said Joseph Baker, president of the Medicare Rights Center. "That promise has been unfulfilled overall because the plans are overpaid by the federal government at this point."  Click above for the full article.


Health Insurers Emerge as Obama's Top Foe in Reform Effort; Targeting Seniors with Ads Warning of Cuts in Medicare

10/19:  According to an Oct. 14th Washington Post article: Now they have an enemy.  For months, President Obama and his administration waged their fight for a health-care overhaul without a clear opponent, even courting the industry executives and interest groups that helped kill reform efforts 15 years ago.  But attacks on the leading Democratic reform plan this week by the insurance lobby left little doubt that two of the most powerful institutions involved in the debate -- the White House and the nation's insurance companies -- have abandoned any real hope of forging a compromise. What was a tenuous truce has turned quickly into an all-out battle, with both sides ratcheting up the hostilities.  As the Senate Finance Committee on Tuesday approved a 10-year, $829 billion bill to remake the health-care system, Obama's top advisers and the insurers moved into a more intense stage of conflict.  "The insurance industry has decided to lead the charge against health reform, and everyone recognizes their motives: profits," said White House deputy communications director Dan Pfeiffer. "We are going to make sure they can't sink this effort at the last minute." ... The insurers, however, showed no sign of being chastened. America's Health Insurance Plans, an industry trade group, opened a fresh line of attack with a multistate advertising campaign warning that senior citizens enrolled in private Medicare plans could lose benefits under the legislation.  "Is it right to ask 10 million seniors on Medicare Advantage for more than their fair share?" the television spot asks. "Congress is proposing $100 billion in cuts to Medicare Advantage. The nonpartisan Congressional Budget Office says many seniors will see cuts in benefits."  The Finance Committee's bill would reduce spending on the plans AHIP cites by $113 billion over the next decade, which could mean reduced insurer profits, higher co-payments by beneficiaries or fewer extra benefits such as eyeglasses and gym memberships.  "We want to begin to build an awareness of the potential implications to seniors," said AHIP President Karen Ignagni.  She declined to say how much money would be spent on the commercials airing in six states, but one advertising analyst said the industry has enough cash to pose a serious threat. "They can spend whatever they feel they need to influence this," said Evan Tracey, president of the Campaign Media Analysis Group. "Seniors are a very important group politically."  The insurance sector and health maintenance organizations spent more than $116 million on lobbying in the first six months of this year, according to an analysis by the nonpartisan Center for Responsive Politics.  "It's pretty clear now, they intend at the eleventh hour to launch a very expensive and misleading campaign against reform," Pfeiffer said. Click above for the full article.


Elder Financial Abuse Case: Brooke Astor's Son Guilty in Scheme to Defraud Her

10/9:  The following is from an Oct. 8th New York Times report: The son of Brooke Astor, the legendary New York society matriarch, was convicted on Thursday of stealing from her as she suffered from Alzheimer's disease in the twilight of her life.  Barring an appeal, the jury's verdict means that Mrs. Astor's son, Anthony D. Marshall, an 85-year-old war veteran who fought at Iwo Jima, can be sentenced to anywhere from 1 to 25 years behind bars.  Mr. Marshall was found guilty of 14 of the 16 counts against him, including one of two first-degree grand larceny charges, the most serious he faced. Jurors convicted him of giving himself an unauthorized raise of about $1 million for managing his mother's finances. Prosecutors contended that Mrs. Astor's Alzheimer's had advanced so far that there was no way she could have consented to this raise and other financial decisions that benefited Mr. Marshall.  A second defendant in the case, Francis X. Morrissey Jr., a lawyer who did estate planning for Mrs. Astor, was convicted of forgery charges.  Mr. Marshall was found not guilty on two counts: the other grand larceny charge, which stemmed from the sale his mother's Childe Hassam painting, and falsifying business records.  Mrs. Astor, whose fortune was estimated at more than $180 million when she died two years ago at 105, may have been best known for channeling large sums toward New York charities and cultural institutions like the Metropolitan Museum of Art and the Bronx Zoo.  The verdict drew the curtain on a trial that lasted longer than had been expected. The jury of eight women and four men sat through more than 19 weeks of testimony and arguments in State Supreme Court in Manhattan, hearing detailed accounts of Mrs. Astor's luxurious life of summers on an estate in Maine and dinners with diplomats. They heard testimony from Henry Kissinger, Barbara Walters and Annette de la Renta, among others. ... The prosecutor, Elizabeth Loewy, asked that bail be increased to $5 million from $100,000 but the judge, Justice A. Kirke Bartley Jr., refused. He set sentencing for Dec. 8.  Click above to access the full article.


Waterloo Region, Ontario adopts smoke-free policy for affordable housing

10/9:  Historic news from the Waterloo Region of Ontario.  On October 6th, the Community Services Committee of the Regional Municipality of Waterloo (which includes the cities/townships of Waterloo, Kitchener, Cambridge, Wellesley, North Dumfries, Wilmot, and Woolwich) voted to approve a smoke-free policy for all buildings and property of "regionally owned community housing" in the Waterloo Region.  The policy covers about 2,700 units of "social housing", also known as "affordable or low and moderate income housing".  The Waterloo Region Housing manages 2,591 community housing units owned by the Region of Waterloo, many of which are elderly and disabled housing.  These units are located in Kitchener, Cambridge, Waterloo, Woolwich and Wellesley.  The new policy will receive final approval at the October 14th Regional Council meeting, and the approval is certain since the Community Services Committee that voted on October 6th is a committee of the whole of the Regional Council.  The new policy is historic because it is the first such public housing policy in Ontario and only the second in all of Canada.  With over 2,700 units, it is also constitutes one of the largest impact policies in the country.  The policy says that all new leases signed by residents after April 1, 2010 will include a provision saying that no smoking will be allowed inside their units or in common areas, and outdoor smoking by the resident will be restricted to at least 5 meters away from any windows, entrances or exits to the building.   Ontario provincial laws prevent the smoke-free policy from applying to current residents.  Therefore, the buildings covered will have to transition to being fully smoke-free over time, as current smokers move out.  Notwithstanding the "grandfathering" of current smokers, this is a very important victory and will, undoubtedly, serve as a catalyst for other governmental units across Canada to also adopt smoke-free policies. The push for this policy began with resident complaints of secondhand smoke intrusions into apartment units.  In the spring of this year, representatives of the Waterloo Region Housing Division and the Tobacco Program of the Region of Waterloo Public Health, together with tenants and the legal department, conducted a detailed study of the matter, met with residents, conducted resident surveys, and produced a report which was presented to the Community Services Committee.  Among the key players in this process were:  Mary Sehl, Manager of Tobacco Programs for the Region of Waterloo Public Health; Irwin Peters, Manager of Waterloo Region Housing; and Laurie Nagge, Public Health Nurse in the Tobacco Program.  Many others were also deeply involved in this victory, including Pippa Beck of the Non-Smokers Rights Association, and other tobacco control leaders across Ontario and Canada.  Jim Bergman of the Smoke-Free Environments Law Project of The Center for Social Gerontology, Inc. had the pleasure to have also worked with the Waterloo Region folks, and he was invited to speak at the October 6th hearing, together with Brian King of the Roswell Park Cancer Institute in Buffalo, NY.  The agenda for the meeting, with a link to the smoke-free housing report, can be accessed by clicking above.


Legal Aid Programs Turn Away One Person for Every Client Served

10/1:  The following is from a Sept. 30th Legal Services Corporation note:  Nearly a million poor people who seek help for civil legal problems, such as foreclosures and domestic violence, will be turned away this year by the nation's largest nonprofit legal aid network because of insufficient resources, the Legal Services Corporation (LSC) projects in a report released today.  The report is the Corporation's second analysis of the "justice gap" in America -- the difference between the level of civil legal assistance available and the level that is necessary to meet the legal needs of low-income individuals and families.  For every client served by LSC programs, another person who seeks help is turned away, the report concludes. The conclusion reaffirms a 2005 report by LSC that also found 50 percent of potential clients seeking help from LSC-funded programs were not served because of a lack of resources.  "This nation is built on the promise of equal justice under law, but there is a justice gap in America. We must do more to close the justice gap and provide equal access to justice for all Americans, regardless of their economic status," LSC President Helaine M. Barnett said.  "Many of these Americans in need of legal assistance are the most vulnerable among us -- they are trying to escape from domestic violence, trying to avert foreclosure and homelessness, trying to qualify for disability benefits, trying to recover from natural disasters. Legal aid saves lives and makes communities stronger," LSC President Barnett said.   The report projects that LSC programs will not be able to meet the legal needs of about 944,000 poor people seeking assistance in 2009, slightly more than the programs served in 2008. In one category --  foreclosures -- LSC-funded programs are projected to turn away two for every person served. Programs also will take up fewer than half of the requests for help with employment and family law matters, the report shows.  Despite increased appropriations from the Congress in recent years, state and local government funding and contributions from charitable donors and foundations declined during the recession. Funding from Interest on Lawyers' Trust Accounts (IOLTA), in particular, has dropped significantly in many states.  LSC is the single largest funder of civil legal assistance to low-income individuals and families across the nation, operating as a federally-funded nonprofit organization that promotes equal access to justice. The Corporation funds 137 nonprofit civil legal aid programs with 918 offices to ensure the provision of high-quality legal assistance to the poor.  Click above to download the full report in pdf format.


When Medicare is the piggy bank

9/30:  The following is from a Sept. 28th Associated Press report:  Medicare is looking like a big fat piggy bank for health care overhaul.  President Barack Obama and the Democrats want to pay for much of their plan to cover the uninsured by cutting hundreds of billions from the Medicare budget over the next 10 years.  From its inception, the health plan for seniors has been kept afloat by taxes out of workers' paychecks. Now, Medicare savings would count toward helping uninsured working-age children and grandchildren afford their own coverage.  Most seniors are willing to help younger generations. But having reached that point in life when you have to spend more time in the doctor's office than you'd prefer to, older Americans worry the cuts will mean lower quality care.  The proposed cuts to hospitals, nursing homes and other providers are bigger than any Congress has imposed since the late 1990s. However, in percentage terms, they're far from the largest ever. And Democrats are also proposing to spend tens of billions to improve Medicare prescription coverage and preventive care.  "Seniors should definitely be paying attention," said Mark McClellan, who ran Medicare under President George W. Bush. "There's some redesign, some improvements, but unquestionably there would be some adverse impacts. It's a mixed bag, but it's not like the sky is falling."  Click above for full article.


HUD's Non-Smoking Policy Notice for Public Housing Could Stamp Out Tobacco for Good

9/30:  The following is from a news note on the web site of the American Association of Homes & Services for the Aging (AAHSA):  Public and Indian housing authorities are permitted and "strongly" encouraged to implement non-smoking policies -- including smoking cessation at lease renewal -- the U.S. Department of Housing and Urban Development (HUD) announced July 17, 2009, signaling that an agencywide shift toward smoke-free federally assisted housing may be in the offing.  AAHSA views this as an encouraging development given that, as HUD noted, elderly populations -- which make up 15 percent of the residents living in public housing -- are especially vulnerable to the adverse effects of smoking. Even though HUD's notice only applies to public and Indian housing, it's possible that HUD's multifamily office could follow suit with similar guidance.  Until that time, the PIH notice provides guidance that can be helpful for providers interested in having smoke free environments in senior housing.  Environmental Tobacco Smoke, officials said, can migrate between multifamily housing units, causing respiratory illness, heart disease, cancer and other ill effects. Fire is another concern. Federal data show that in multifamily buildings, 26 percent of fire deaths in 2005 were smoking-related -- the leading cause of fire deaths.  "By reducing the public health risks associated with tobacco use, this notice will enhance the effectiveness of the Department's efforts to provide increased public health protection for residents of public housing," HUD said.  PHAs have wide latitude to stamp out smoking, as long as they stay within state and local laws, HUD said. More than 114 PHAs and housing commissions around the country have gone non-smoking in one or more apartment buildings so far, according to the Smoke-Free Environments Law Project at The Center for Social Gerontology, a Michigan-based organization that keeps a running tally of smoke-free policies in public housing.  With this new notice, there could be a broad proliferation of non-smoking public housing policies around the country.  Click above to access the AAHSA note.


Editorial:  Medicare Scare-Mongering

9/29:  The following is from a Sept. 27th New York Times editorial:  It has been frustrating to watch Republican leaders posture as the vigilant protectors of Medicare against health care reforms designed to make the system better and more equitable. This is the same party that in the past tried to pare back Medicare and has repeatedly denounced the kind of single-payer system that is at the heart of Medicare and its popularity.  For all of the cynicism and hypocrisy, it seems to be working. The Republicans have scared many older Americans into believing that their medical treatment will suffer under pending reform bills.  The general public believes that, too. The latest New York Times/CBS News poll of 1,042 adults found that only 15 percent believe changes under consideration would make the Medicare program better, while 30 percent think they would make it worse.  That does not mean that Medicare will be untouched under the Democrats' plans. The Obama administration and Congressional leaders are hoping to save hundreds of billions of dollars by slowing the growth of spending in the vast and inefficient Medicare system that serves 45 million older and disabled Americans. The savings would be used to help offset the costs of covering tens of millions of uninsured people.  But far from harming elderly Americans, the various reform bills now pending should actually make Medicare better for most beneficiaries -- by enhancing their drug coverage, reducing the premiums they pay for drugs and medical care, eliminating co-payments for preventive services and helping keep Medicare solvent, among other benefits. The main exception, a fully justified one, is that some of the 10 million people enrolled in private plans that participate in Medicare -- the Medicare Advantage program -- might suffer a dilution or elimination of the extra benefits they get that other beneficiaries do not. ... We have long championed Medicare. And we believe elderly Americans, and all Americans, should closely examine the proposed health care reforms.  But the Republicans have done far too good a job at obscuring and twisting the facts and spreading unwarranted fear. It is time to call them to account. President Obama and the Democrats in Congress have to make the case forcefully that health care reform will overwhelmingly benefit Americans -- including the millions of older Americans who participate in Medicare.  Click above for full editorial.


U.S. Health Insurers Say They Face Gov't Gag; CMS Tells Private Medicare Insurers Not to Send Political Propaganda to Beneficiaries

9/23:  According to a Sept. 22nd Reuters article: Health insurers accused the U.S. Medicare agency on Tuesday of political interference in a battle over whether the industry can lobby its customers directly over healthcare legislation.  The Centers for Medicare & Medicaid Services (CMS), which oversees the Medicare program for the elderly and disabled as well as privately run Medicare alternatives, said on Monday it was investigating a letter Humana Inc sent enrollees about efforts to overhaul the nation's healthcare system.  Humana's letter, sent in an envelope citing important plan information, told customers the Democrats' bills could hurt "millions of seniors and disabled individuals <who> could lose many of the important benefits and services that make Medicare Advantage health plans so valuable," according to CMS.  The agency also warned other insurers against sending potentially misleading health reform mailings to customers. America's Health Insurance Plans, the industry lobby group, called the CMS action a "gag order." ... CMS dismissed the criticism, saying it wanted to ensure companies do not violate marketing rules or improperly use protected Medicare mailing lists.  "Our goal is to safeguard beneficiaries' personal information," agency spokesman Peter Ashkenaz told Reuters.  Democratic Senator Max Baucus had urged CMS to get involved and later welcomed the investigation of what he called "scare tactics" by Humana. Click above for the full Reuters article.  A Washington Post article stated: The big insurer Humana triggered the HHS crackdown with a letter to Medicare enrollees claiming that health reform proposals could hurt "millions of seniors and disabled individuals" who "could lose many of the important benefits and services that make Medicare Advantage plans so valuable." The letter was sent in envelopes marked "important information about your Medicare Advantage plan -- open today!"  HHS wrote to Humana last week instructing it to stop the mailings, and it wrote to all Medicare Advantage plans Monday, saying "such communications are potentially contrary to . . . federal law." The government regulates communications between the health plans and their members.  To access the Post article, click here.


Harry Reid threatens to cancel October break unless Republicans agree to faster pace; Appropriations bills not likely to be completed by Sept. 30th

9/16:  According to a Sept. 15th The Hill article: Congress has only been back in session for a week, but Senate Majority Leader Harry Reid is already warning he may cancel the next break because of a lack of GOP cooperation.  Reid (D-Nev.) has warned Republicans that they need to pick up the legislative pace or he will cancel the weeklong Columbus Day recess next month.  Reid told Senate Minority Leader Mitch McConnell (R-Ky.) that the Senate will stay in session straight through October if Republicans slow the floor debate on appropriations bills and other issues. ... Reid has repeatedly voiced frustration over Republican efforts to slow floor proceedings. He asked Republicans to cooperate in passing spending bills funding the departments of Transportation and Housing and Urban Development.  "This will be only our fifth appropriations bill we will have done," Reid said.  "We have many more to do. I have trouble comprehending people not letting us finish these bills and then complaining that we have to do a continuing resolution to fund government."  Democratic leaders have hoped to avoid combining unfinished appropriations bills into a massive omnibus package. It appears certain, however, that lawmakers will not be able to pass all the bills needed to fund the federal government by Sept. 30, when the fiscal year ends.  Click above for full article.


Boise City/Ada County Housing Authority becomes 3rd Idaho housing authority to go smoke-free

9/15:  The Boise City/Ada County Housing Authority (BCACHA) has adopted a smoke-free policy for all of its 3 buildings, with 214 units of elderly, disabled and family housing.  The policy will be effective on November 1, 2009. Idaho is taking a real lead on smoke-free multi-unit housing for low-income people.  Together with the Nampa Housing Authority and the Caldwell Housing Authority, I believe they now have their three biggest housing authorities in Idaho all with smoke-free policies for all their housing.  Nampa was first in the fall of 2007, and Caldwell followed on January 1, 2009. Congratulations to all the Idaho folks who worked on this.  We're pleased to have been able to play a small part in this.  To access the BCACHA web site click above.  To access our listing of smoke-free housing authorities, click here.


Understanding the New Census Data:  Poverty Rose, Median Income Fell, & Job-Based Health Insurance Weakened in 2008

9/15:  According to a Sept. 10th analysis by the Center on Budget & Policy Priorities:  Median household income declined 3.6 percent in 2008 after adjusting for inflation, the largest single-year decline on record, and reached its lowest point since 1997.  The poverty rate rose to 13.2 percent, its highest level since 1997.  The number of people in poverty hit 39.8 million, the highest level since 1960.  The number of people who are uninsured jumped by 682,000...and reached 46.3 million.  The figures for 2009, a year in which the economy has weakened further and unemployment has climbed substantially, will look considerably worse, and the figures will likely worsen again in 2010 if, as many economic forecasters expect, unemployment continues to rise in that year.  To access the full analysis, click above.


Politics and the Age Gap

9/14:  The following is from a Sept. 13th New York Times analysis: American politics has been defined by gender gaps, racial gaps, geographic gaps and the gap between the religious and the secular.  Now comes the geriatric gap. As the population ages and the nation faces intense battles over rapidly rising health care and retirement costs, American politics seems increasingly divided along generational lines. The question is how real and defining this gap is going to be -- whether in 10 or 20 years it will prove as consequential or intense as, say, the gender divide, particularly as it was played out last year with the presidential campaign of Hillary Rodham Clinton.  As distasteful as the notion of intergenerational conflict may seem, the fight over health care -- not to mention the election of health care reform's current chief proponent, President Obama -- suggests that something is going on. Older Americans are more likely to oppose Mr. Obama's initiative than any other age group. The White House views this dynamic as one of the biggest obstacles to tamping down public concerns about its approach and assembling a legislative coalition to get a bill passed in Congress. Older voters were one of the few groups Mr. Obama did not win in the presidential election last year, leaving him and his party particularly reliant on younger voters, who do not show up at the polls as reliably as older people do. They have a dimmer view of his presidency than the rest of the nation.  And there is no reason to think that whatever tensions have been unearthed with this fight are going to end once it is resolved. Mr. Obama has signaled his intention to tackle the long-term financial problems of Social Security, another issue the elderly play an outsize role in, and they tend to be resistant to change there, too.  Click above for full article.


Monroe Housing Commission becomes 31st in Michigan to adopt smoke-free policy and 125th in the nation

9/11:  On September 8th, the Monroe Housing Commission voted unanimously (5 to 0) to adopt a smoke-free policy for all their buildings.  The policy is to go into effect November 1, 2009 for all residents, including current residents who are smokers.  The housing commission has a 7-story, 148 unit, high-rise for elderly and disabled (River Park Plaza), and a 115-unit family housing building (Greenwood), plus 30 single family houses; a total of 293 units.  The policy will allow smoking outdoors, but only in designated areas, if any.  It was a great pleasure working with Nancy Wain, the Executive Director of the Monroe Housing Authority on this.  Adoption of this policy makes Monroe the 31st housing commission in Michigan to adopt a smoke-free policy and the 125th in the nation.  To access a copy of the list of 125 housing authorities in the U.S. that have adopted smoke-free policies for some or all their buildings, click above.


Data Fuel Regional Fight on Medicare Spending

9/8:  The following is from a Sept. 8th New York Times article:  For years, health policy experts have said health care spending is much higher in New York City and Boston because doctors and hospitals there provide more services, practicing medicine in a more intensive way.  But new government data show that Medicare costs per patient in those cities are slightly below the national average when the numbers are adjusted for the cost of living and other factors.  The new numbers add fuel to a raging debate over what Congress should do to reduce geographic disparities in Medicare spending. The debate involves a combustible mix of health policy and money.  As part of any bill to revamp health care, President Obama and Democratic leaders in Congress say they want to reward doctors and hospitals for providing higher-quality, lower-cost care. But their efforts have touched off a fight within the Democratic Party, pitting urban lawmakers against rural lawmakers and creating a major new hurdle for health legislation.  Click above for full article.


IN WISCONSIN, A PIONEERING PROGRAM:  The Unwitting Birthplace of the 'Death Panel' Myth

9/8:  The following is from a Sept. 4th Washington Post article: This city often shows up on "best places to live" lists, but residents say it is also a good place to die -- which is how it landed in the center of a controversy that almost derailed health-care reform this summer. The town's biggest hospital, Gundersen Lutheran, has long been a pioneer in ensuring that the care provided to patients in their final months complies with their wishes. More recently, it has taken the lead in seeking to have Medicare compensate physicians for advising patients on end-of-life planning.  The hospital got its wish this spring when House Democrats inserted that provision into their health-care reform bill -- only to see former Alaska governor Sarah Palin seize on it as she warned about "death panels" that would deny care to the elderly and the disabled. Despite widespread debunking, those warnings have led lawmakers to say they will drop the provision.  "It's really distressing," hospital official Bud Hammes said. "These things need to be addressed."  President Obama's health-care initiative was nearly consumed by the furor over that provision, and Republicans continue to argue that the legislation would ration care for the elderly. The debate has underscored how fraught the discussion is on end-of-life care in a country where an optimistic ethos places great faith in technology and often precludes frank contemplations of mortality. That tendency has a price tag: A quarter of Medicare costs -- totaling $100 billion a year -- are incurred in the final year of patients' lives, and 40 percent of that in the last month.  But the controversy has had most resonance where it arguably took root, in this town of 52,000 where nearly everyone of a certain age has an advance-care directive.  To access the full article, click above.


Senator Ted Kennedy was long-time supporter of legal services for elderly

9/4:  The Board of Directors and the Co-Directors and staff of The Center for Social Gerontology, Inc. mourn  the loss of Senator Ted Kennedy as a great leader, especially in support of the elderly and of legal services for the elderly.  Since the early 1970s, Senator Kennedy held U.S. Senate hearings on the delivery of legal services for the elderly and strongly supported increased legal services for the elderly.  He was a champion on these issues long before most of his colleagues in Congress, and he never stopped working on these issues. In the reauthorization of the Older Americans Act in 2000, it was Senator Kennedy who saved Title IV's section dealing with legal services for the elderly, when House members tried to eliminate it.  As in so many other areas of public policy, his leadership will be extremely difficult to replace.  For a NY Times obituary, click above.


LSC on the Passing of Senator Edward M. Kennedy

9/4:  The following is from an Aug. 26th Legal Services Corporation press release:  Sen. Edward M. Kennedy (D-Mass.) will be remembered at the Legal Services Corporation and at civil legal aid organizations throughout the nation as a champion for equal access to justice, LSC President Helaine M. Barnett said today.  "Senator Kennedy's longtime support for LSC was invaluable and consequential for the clients and communities that are served by LSC-funded legal aid attorneys every day," LSC President Barnett said. "In addition to civil legal assistance, his extraordinary career in public service focused on legislation and issues of utmost importance to the poor -- employment, health care and education."  For the full LSC press release, click above.


Montana Court to Rule on Assisted Suicide Case

9/2:  According to a September 1st New York Times story:  Robert Baxter was by all accounts a tough man. Even in the end, last year, as lymphocytic leukemia was killing him, Mr. Baxter, a 76-year-old retired truck driver from Billings, Mont., fought on. But by then he was struggling not for life, but for the right to die with help from his doctor.  "He yearned for death," his daughter, Roberta King, said in a court affidavit describing her father's final agonized months.  Now, in death, Mr. Baxter is at the center of a right-to-die debate that could make Montana the first state in the country to declare that medical aid in dying is a protected right under a state constitution.  The state's highest court on Wednesday will take up Mr. Baxter's claim that a doctor's refusal to help him die violated his rights under Montana's Constitution -- and lawyers on both sides say the chances are good that he will prevail.  Washington and Oregon allow physicians to help terminally ill people hasten their deaths, but in those states the laws were approved by voters in statewide referendums, and neither state's highest court has examined the issue of a constitutional right to die.  In Montana, the question will be decided by the seven-member State Supreme Court.  A lower-court judge ruled in Mr. Baxter's favor last December -- on the very day Mr. Baxter died -- and the State of Montana appealed the ruling.  The legal foundation for both sides is a free-spirited, libertarian-tinctured State Constitution written in 1972 at the height of a privacy-rights movement that swept through this part of the West in the aftermath of the 1960s. Echoes of a righteous era are reflected in language about keeping government at bay and maintaining individual autonomy and dignity. "The dignity of the human being is inviolable," the drafters declared.  Lawyers on both sides say the Montana Supreme Court has a tradition of interpreting the State Constitution with that sentiment in mind, with privacy rights and personal liberty often outweighing other concerns. The court ruled in 1997, for example, that Montana's anti-sodomy laws were unconstitutional invasions of privacy.  Click above to access the full story.


Smoke-Free Public Housing: It's Legal, Profitable & HUD Supports It

9/2:  On August 26, 2009 at the Texas Housing Association Annual Conference in Fort Worth, TCSG Co-Director Jim Bergman gave a presentation of the above title. The presentation focused on smoke-free policies in public housing, with special attention to the HUD notice issued on July 17, 2009 in which HUD strongly encouraged public housing authorities (PHAs) to adopt smoke-free policies for some or all their buildings. Included in the 56-slide PowerPoint presentation was additional information on ways in which HUD was now encouraging PHAs to adopt smoke-free policies, including in their 2009 Healthy Homes Strategic Plan and in their scoring for the award of HUD stimulus funds to PHAs.  Also included in the presentation was information on the cost savings and fire prevention reasons for adopting smoke-free policies, as well as demographic and marketing reasons for doing so.  Examples were provided of public housing and other affordable housing entities that have adopted smoke-free policies, as well as housing industry trends.  To access the 56-slide PowerPoint presentation, click above.  To access a pdf copy of the presentation, with 6-slides per page, click here. To access a copy of the HUD July 17, 2009 Notice click here.


HUD issues notice strongly encouraging public housing agencies to adopt smoke-free policies

8/6:  On July 17th, the federal Department of Housing and Urban Development (HUD) issued a Notice (PIH-2009-21 (HA)) titled "Non-Smoking Policies in Public Housing".  The notice stated that HUD "strongly encourages Public housing Authorities (PHAs) to implement non-smoking policies in some or all of their public housing units." The notice goes on to encourage PHAs to adopt smoke-free policies in their buildings, including in common areas and in individual units.  The HUD notice describes the health problems associated with secondhand smoke and also points out the additional costs to PHAs of rehabbing units in which smokers have lived.  This is an extremely important statement by HUD and is likely to encourage many more PHAs to adopt smoke-free policies.  Already about 120 PHAs have adopted smoke-free policies for some or all their buildings.  To access the HUD notice on TCSG's SFELP site, click above.


Medicare's Mixed Legacy

7/13:  The following is from a July 5th NY Times article in the Week in Review: Should the government get in the health insurance business?  The question will be debated fiercely in coming months as President Obama and some Democratic lawmakers push for the creation of a government-run plan to compete with private insurance companies for the business of nearly 50 million people who are without insurance. ... It won't be the first time. The federal government is already in the health insurance business in a big way, providing coverage to more than 45 million elderly and disabled people through Medicare. (Another government plan, Medicaid, is run and financed in combination with the states to provide health care to about 60 million poor people.)  How closely a new public plan would resemble Medicare is unclear. Still, Medicare's record offers insights into the benefits and pitfalls of public health care. While it has driven down costs though its sheer market dominance, Medicare has also been extremely slow in using its power to encourage or compel more effective health care. And, of course, providing health care for older Americans has been expensive. Medicare is expected to represent an estimated 13 percent of next year's federal budget.  Medicare has evolved into the bedrock of health insurance for America's elderly population since it was created in 1965.  For the full article, click above.


More and more public housing authorities adopting smoke-free policies; almost 120 currently have such policies

7/13:  TCSG's Smoke-Free Environments Law Project maintains an up-dated listing of all the public housing authorities/commissions in the U.S. that we know of which have adopted smoke-free policies for one or more of their apartment buildings.  The listing is done largely in the order in which the policies have been adopted.  As of May, 2009, at least 114 local housing authorities had adopted smoke-free policies for some or all of their apartment buildings, with about 96 being adopted since the beginning of January, 2005; an average of over 1.8 per month. That constitutes an increase in the number of housing authorities with smoke-free policies of about 660% in 53 months.  The 17 states with such policies include Michigan (29), Minnesota (19), Maine (18), Colorado (11), California (7), Nebraska (6), Washington (5), New Hampshire (3), Oregon (3), Alaska (3) New Jersey (2), Wisconsin (2), Idaho (2), Florida, Montana, Indiana, and Kentucky.  To access the listing, in pdf format, click above.


Term Saw High Court Move to The Right; Roberts-Led March Likely to Continue, with Kennedy the Swing Vote

7/2:  The following is from a July 1st NY Times analysis:  Chief Justice John G. Roberts Jr. emerged as a canny strategist at the Supreme Court this term, laying the groundwork for bold changes that could take the court to the right even as the recent elections moved the nation to the left.  The court took mainly incremental steps in major cases concerning voting rights, employment discrimination, criminal procedure and campaign finance. But the chief justice's fingerprints were on all of them, and he left clues that the court is only one decision away from fundamental change in many areas of the law. Whether he will succeed depends on Justice Anthony M. Kennedy, the court's swing vote. And there is reason to think that the chief justice has found a reliable ally when it counts. "In the important cases, Kennedy ends up on the right," said Thomas C. Goldstein, a student of the court and the founder of Scotusblog, which has compiled comprehensive statistics on the current term. The two justices agreed 86 percent of the time. ... Chief Justice Roberts has certainly been planting seeds in this term's decisions. If his reasoning takes root in future cases, the law will move in a conservative direction on questions as varied as what kinds of evidence may be used against criminal defendants and the role the government may play in combating race discrimination. The two newest justices, Chief Justice Roberts and Justice Samuel A. Alito Jr., both appointed by President George W. Bush, agreed 92 percent of time, the highest rate for any pair of justices. But Justice Alito often wrote concurring opinions to underscore or try to extend conservative rulings, especially in criminal cases. He may well now be the court's most conservative member.  "Alito is staking out some room to the right of the chief justice," said Pamela Harris, the executive director of the Supreme Court Institute at Georgetown University Law Center, "and you would have thought there is no such room." ... The court was remarkably polarized in the 74 signed decisions it issued this term, dividing 5-to-4 or 6-to-3 in almost half of them, up from roughly a third in the three previous years. The court reversed lower courts about three-quarters of the time, up from two-thirds in the last term.  Justice Kennedy was in the majority 92 percent of the time and in all but 5 of the 23 decisions in which the justices split 5-to-4. Those decisions were, moreover, often divided in the expected way: in 16, all four members of the court's liberal wing were on one side and all four of its conservatives were on the other.  And in between them was Justice Kennedy, the most powerful jurist in America. He joined the liberals 5 times and the conservatives 11. That was a significant shift to the right: in the previous term, Justice Kennedy voted four times each with the liberals and the conservatives in cases divided along the traditional ideological fault line.  Justice Kennedy swung right in the cases that really mattered.  To access the NY Times article, click above.  To access a Washington Post analysis, click here.


An old familiar lifestyle is gone in a puff; Low-income tenants face smoking ban in Vancouver county apartments

7/1:  The following is from a June 27th Columbian article: In 1988, they banned it in airplanes. In 1994, in offices. In 2006, the bars.  And this month, they finally banned smoking in Teri Richard's apartment building.  "When I grew up, there was a big ashtray on everybody's table," said Richard, 53, sitting under a small corner of awning that stretches 25 feet from the nearest door.  Though Richard and a handful of her neighbors are only the latest of millions of tenants across the country to choose such indignities for the sake of an addiction, these tenants have an unusual landlord: the Vancouver Housing Authority.  The new decision by Clark County's subsidized housing agency to ban smoking in some of its properties reflects Washington's successful crusade to drive down cigarette use. ... After years of debate, the VHA banned smoking indoors and on the balconies of Richard's building at the start of June. The company that manages the property has left notes on apartments but is still working out how the new rules would be enforced. On Wednesday, Columbia House in the Hough neighborhood will become the VHA's second smoke-free property. The agency might roll the ban out to others of its dozens of buildings across the county , VHA deputy director LaVon Holden said in May.  Most public housing agencies are doing the same, she said.  "It is just a standard of the business," said Holden, a former smoker. "We are becoming a culture that is less tolerant of secondhand smoke, because we now know the downside."  The decision will save the agency about $1,900 for every two-bedroom apartment that doesn't have to be scrubbed and repainted every time a smoker moves out, Holden said.  Smokers' habits had been making life less nice for some of the Esther Short building's nonsmokers, who are a majority of the tenants. Click above for full article.


House Appropriations Committee Would Raise Federal LSC Funding to $440 Million, but Lift Only the "Attorneys' Fees Restriction," Despite Obama Recommendation to Also Lift Private Money Restriction and Class Action Restriction; Issue Now Moves to Senate

6/12:  According to a June 12th note from the Brennan Center for Justice: On June 4, 2009, the House Appropriations Subcommittee on Commerce, Justice, Science and Related Agencies (CJS), which has jurisdiction over funding for LSC, considered its annual appropriations bill.  The bill, which was passed out of the Subcommittee the same day, raised LSC's total funding level to $440 million, up from $390 million in FY 2009, a 12.8% increase. Authored by the Chair of the CJS Subcommittee, Representative Alan Mollohan (WV), the bill also removes the restriction that currently prohibits LSC grantees from using LSC funds to seek attorneys' fee awards -- a limitation that had been included as a rider to the LSC appropriation every year since 1996.   The bill does not lift any of the other LSC funding restrictions. The full bill passed the full House Appropriations Committee on June 9, 2009, with no changes to the LSC provisions, and now awaits passage b y the full House.  The bill's call for increased funding is a greatly welcomed boost, especially because the economic downturn has substantially increased legal need while reducing the availability of other legal services funding. However, the bill does not lift other LSC restrictions, specifically, it does not lift the restriction on non-LSC funds, and it does not lift the restriction on class actions.  Pres. Obama's detailed budget had called for removal of these two additional restrictions.  In the Senate, the CJS Appropriations Subcommittee has yet to produce an FY 2010 appropriation bill, but is expected to turn to this now.  The CJS Subcommittee is free to draft its own bill, and could do so along the lines of the President's budget.  Senator Barbara Mikulski (MD) chairs the Senate's CJS Subcommittee.  Once both the House and Senate have passed their respective CJS bills, differences between the two versions will likely be addressed and reconciled by a conference committee.  For further info from the Brennan Center, click above.


At least 112 public housing authorities now have smoke-free policies for some or all their apartment buildings; About a 660% increase in past 53 months

6/2:  TCSG's Smoke-Free Environments Law Project maintains this up-dated listing of all the public housing authorities/commissions in the U.S. that we know of which have adopted smoke-free policies for one or more of their apartment buildings.  The listing is done largely in the order in which the policies have been adopted.  As of May, 2009, at least 112 local housing authorities had adopted smoke-free policies for some or all of their apartment buildings, with about 94 being adopted since the beginning of January, 2005; an average of about 1.8 per month. That constitutes an increase in the number of housing authorities with smoke-free policies of about 660% in 53 months.  The 17 states with such policies include Michigan (28), Minnesota (19), Maine (18), Colorado (11), California (7), Nebraska (6), Washington (4), New Hampshire (3), Oregon (3), Alaska (3) New Jersey (2), Wisconsin (2), Idaho (2), Florida, Montana, Indiana, and Kentucky.  To access the listing, in pdf format, click above.


Bipartisan Group of Senators Support $45 Million Increase for LSC

6/1:  According to a May 22nd Legal Services Corporation press release:  Fifty-three Senators have signed on to a letter asking key appropriators to provide at least $435 million for the Legal Services Corporation in fiscal year 2010-a $45 million increase over current funding levels and the amount requested by President Obama. Forty-five Democrats, six Republicans and two Independents signed the letter.  Senator Ted Kennedy (D-Mass.) was the lead sponsor of the letter and has sent similar letters requesting increases for LSC for at least the last eight years. Senator Kennedy is Chairman of the Health, Education, Labor and Pensions Committee, which is responsible for conducting oversight of the Corporation.  The letter notes that the increase for LSC is necessary to meet "the greater need that exists today because of the economic crisis, which has increased the number of foreclosures, the numbers of the unemployed, and the number of individuals and families who now qualify for federally funded legal aid." The letter also points out that current funding levels are still far less, in real dollars, than what LSC received nearly 15 years and 30 years ago.  "Without continued increases in federal funding," concludes the letter, "many more of our most vulnerable citizens will be denied assistance in the future. We urge you, therefore, to fund the Legal Services Corporation at no less than $435 million for the coming fiscal year to help meet this critical need." Click above to access the full press release.


President announces intent to nominate Kathy Greenlee as Assistant Secretary for Aging

5/5: According to a May 4th Administration on Aging press release: President Obama announces intention to nominate Kathy Greenlee as U.S. Assistant Secretary for Aging. The Administration on Aging is pleased to report that on Friday, May 1, 2009, President Obama announced his intent to nominate Kathy Greenlee, Kansas Secretary of Aging, for Assistant Secretary for Aging, U.S. Department of Health and Human Services. Kathy Greenlee has served as Secretary of Aging for the state of Kansas since January 2006. In that capacity, she has led a cabinet-level agency with 192 full-time staff members and a total budget of $495 million. Her department oversees the state's Older Americans Act programs, the distribution of Medicaid long-term care payments and regulation of nursing home licensure and survey processes. Ms. Greenlee has served on the board of the National Association of State Units on Aging since 2008. From 2004-2006, Greenlee served as State Long-Term Care Ombudsman in Kansas, and prior to that, was the state's Assistant Secretary of Aging. From 1999-2002, Greenlee served as general counsel at the Kansas Insurance Department. During her tenure there, she led the team of regulators who evaluated the proposed sale of Blue Cross/Blue Shield of Kansas, and oversaw the Senior Health Insurance Counseling for Kansas program. Greenlee also served as Chief of Staff and Chief of Operations for then Governor Kathleen Sebelius. She is a graduate of the University of Kansas with degrees in business administration and law. Once nominated, Ms. Greenlee must be confirmed by the U.S. Senate. To access the press release, click above.