National Conference Gives Advocates Tools to Show Why Safety Net Programs Need Public Funding

Published on 2007/11/07

Forgotten Americans: The Future Low-Income Older Americans spotlights dangers facing safety net programs and urges advocates to make the case for public support of Social Security, Medicaid and Medicare.

To celebrate 35 years and 21 years of advocacy, respectively, the National Senior Citizens Law Center and the Center for Medicare Advocacy invited leading policy experts and activists to a day-long conference on Forgotten Americans: The Future Low-Income Older Americans to think creatively about how the next 21 to 35 years might affect the lives of our clients. The result was a thought-provoking analysis and re-commitment to advocacy for low-income older people.

You can watch the webcast or read a transcript of the conference on the Kaiser Health Network's website: http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=2294.

You can read copies of the presenters’ thought-provoking papers on the Justice Partnership website: http://www.justicepartnership.org/ForgottenAmericansConference/Documents.html.

Conference Speakers

A distinguished group of speakers urged advocates to build alliances and to educate the public about the dangers of believing simplistic arguments that the private sector can deliver more reliable, efficient and cheaper alternatives to government funding and accountability for Medicaid, Medicare and Social Security. They also shone a spotlight on an increasingly hostile, activist wing in the federal court system that is seeking to diminish safety net programs and civil rights.

Tricia Neuman, D. Sc., Vice President of the Kaiser Family Foundation and Director of their Medicare Policy Project, framed the day with a pithy and disturbing overview of demographic trends among older, low-income Americans. While the percentage of elderly people who are poor has dropped since the 1960's, due largely to the advent of Medicare and Medicaid, African-Americans, Latinos, women, and those 75 years and older have long-standing, higher rates of poverty. Against this historical background, Neuman presented data indicating out-of-pocket health spending for seniors is increasing much faster than income, raising serious issues for older people who tend to be on fixed incomes. Currently, older people spend about three times more than the under-65 age group for health care. Dr. Neuman closed her remarks by pointing to the serious neglect of long-term care policy, commenting that “there is no serious discussion underway in the area of long-term care financing that is targeted to people of modest means.” For the full presentation, see: http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=2294

For an abbreviated summary of her remarks see: http://www.justicepartnership.org/ForgottenAmericansConference/Documents/NeumanPresentation.pdf

Marilyn Moon, Ph.D. Vice President for Research at the American Institutes for Research, addressed the question of whether poverty rates were on the rise for older Americans. Although Dr. Moon said that it is difficult to project poverty rates into the future, she demonstrated that the risks of become poor were increasing. Moon pointed out that, given that the threshold for poverty is quite low, someone who is at the 200-percent-of-poverty level – a truly modest income — actually has little protection if costs go up or if retirement income shrinks. Moon presented evidence that retirement benefits are becoming less secure. Companies are moving away from funding retiree benefits and toward programs like 401(k)’s that put the responsibility and risk on the individual. People of modest means are less likely to be able to afford or participate in these programs. At the same time, health care costs will rise, creating a double squeeze. Finally, she set the tone for the rest of the day by opening up examination of the history of publicly-funded and privately managed health care programs targeting special populations—in this case, Medicare Advantage Programs. For the full presentation, see: http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=2294

For an abbreviated summary of her remarks see: http://www.justicepartnership.org/ForgottenAmericansConference/Documents/MoonExecutiveSummary.ltrhd.pdf

Robert Greenstein of the Center for Budget and Policy Priorities presented future scenarios for spending growth in all three major safety net programs (Medicaid, Medicare and Social Security), while warning of several ways that financing of federal programs in general are in danger. He also predicted the current climate change legislation will increase the costs of consumer goods across the board, hitting those on fixed incomes and Social Security and SSI beneficiaries particularly hard. He urged advocates for poor people to get involved now in coalitions seeking legislation to slow down climate change, so that poor people might be protected from the negative effects of efforts to address the dangers of climate change. For the full presentation, see: http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=2294

For a summary of his remarks, see: http://www.justicepartnership.org/ForgottenAmericansConference/Documents/GreensteinPresentation.pdf.

Bruce Vladeck, MD and former head of what is now the Center for Medicaid and Medicare Services, analyzed the core issues in private-public partnerships, and pointed advocates to areas that he hoped they would address. Vladeck noted that Medicare in particular was a public-private partnership from the beginning; the question is how much and what parts of delivery and quality control are contracted out or kept within the government’s purview. The private sector, he noted, is set up to mobilize investment quickly and on a large scale. If an initiative fails to make the projected profit, there is a strong risk that investors will withdraw. The history of the nursing home industry is a case in point, he said. Another dynamic at play, said Vladeck, is that private partnerships insulate public officials from political pressures by taking on responsibility for tough decisions such as setting drug formularies. Vladeck went on to analyze two cautionary tales: the new Medicare Part D program as well as other parts of the Medicare Modernization Act and Medicare Advantage plans. He urged that a yardstick or standard be established so that these programs could be measured against one another or against public sector alternatives. For the full presentation, see: http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=2294

Barbara Kennelly, President of the National Committee to Preserve Social Security and Medicare, gave a rousing talk about her experience working with Congress from the inside and now on the outside to protect Social Security from privatization. She provided compelling evidence that the American people do not understand what social insurance is, and do not believe that the government can play a beneficial role in controlling costs and providing security either in the health care or pension arenas. For full presentation, see: http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=2294

For a summary of her remarks, see: http://www.justicepartnership.org/ForgottenAmericansConference/Documents/KennellyPaperOct2007.ltrhd.pdf

Theodore Marmor, Professor Emeritus, Public Policy and Management, Yale University, urged advocates to remind the public of the reasons why Medicare and Social Security were started to begin with, rather than being drawn into battles over long-term projections about their sustainability forty years from now. The Canadian system, said Dr. Marmor, proves that “there are means by which programs of this sort are sustainable.” The problem, he argued, is the lack of political will among US leaders to increase taxes and control costs at the same time. For the full presentation, see: http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=2294

For previously published background papers, see:

http://www.justicepartnership.org/ForgottenAmericansConference/Documents/MarmorPaper.pdf and http://www.justicepartnership.org/ForgottenAmericansConference/Documents/MarmorPaper2.formatted.pdf

Simon Lazarus of the National Senior Citizens Law Center turned the focus away from Congressional action for a moment, instead training the spotlight the role of the courts in “making or breaking the great entitlement programs.” He warned that, while the American people are shifting left on issues related to health security, the courts are shifting right on many public funding issues, consumer protections and civil rights. He made the case that conservative-activist members of the judiciary are using highly technical, relatively arcane and obscure doctrines to eviscerate civil rights law and safety net programs, challenging Congressional intent and authority in the process. He presented some hope in legal theories being tested now in the courts, but concluded that fighting in court is not enough. He urged legal and political advocates to join together to bring the court’s rulings to the attention of the public and to the bar of politics. For the full presentation see: http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=2294

For the full paper, see: Will the Roberts Supreme Court Shred America's Health Safety Net?

Timothy Jost, Robert L. Willett Professor of Law, Washington and Lee University Law School, and member of the Semmel Federal Rights Project Advisory Panel,rounded out the picture of the role of the judiciary with an enlightening history of entitlement programs and Supreme Court rulings on the right of individuals to seek justice in the court if benefits are cut off. For the full presentation, see: http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=2294

Gill Deford and Sally Hart, staff attorneys at the Center for Medicare Advocacy, summarized the history of public interest Medicare litigation. For the full presentation, see: http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=2294

For a copy of the paper, see http://www.justicepartnership.org/ForgottenAmericansConference/Documents/LitigationPaper.ltrhd.pdf

For more information about the Justice Partnership between NSCLC and the Center for Medicare Advocacy, see the Justice Partnership website: http://www.justicepartnership.org/index.html