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Advocates Speak Out: Randy Munoz of Latino Diabetes Association

Randy Munoz is vice chair of the Latino Diabetes Association. He spoke with Seniors Speak Out’s Nona Bear about issues seniors in his area face, particularly those with diabetes. Below is an abridged version of the interview.

Nona Bear (NB): What community do you serve and how long have you been advocating for patients/seniors? How did you start?

Randy Munoz (RM): I have been a part of the Latino Coalition for ten years. A previous coworker told me about this association and started it on paper, but asked me to get it off the ground. At the time, even though diabetes was in my family, I did not know much about it. He suggested we learn about it together. I secured our very first funding of $5,000 from Kaiser and I got our office space donated. It was a long struggle and it continues to be so. I’ve been with the organization since the very beginning and am the Vice Chair. I’m looking to add a couple more members to the board.

logo (1)NB: Does the coalition serve people with diabetes of all ages?

RM: We serve people of all ages but are especially focused on adults and seniors – our parents, the mothers, and the grandmothers. They are the caretakers and caregivers of the family. You have to care for the caregiver. You have to educate them and give them resources because they are treating the children, the spouse, and the parents. It goes on for generations.

NB: You have been involved with senior advocacy for over 10 years, through Part D’s existence – what changes have you seen the Part D program make in the lives of seniors?

RM: It is a tremendous program. It’s one of the few programs that actually works and that seniors, historically, have been very happy with. But with dwindling resources and cuts unfortunately here in California with the governor moving medications over to HMOs, changes to the Part D program would have a negative effect for seniors, who are already struggling with out-of-pocket expenses. They have to make tough choices to pay for rent or for other relevant health costs. This is a real cause for concern for seniors.

NB: With regards to potential threats to the program, what are some issues that seniors still struggle with regarding the Part D program?

RM: It really goes back to their medication coverage and protecting and securing current benefit. It’s a real fear that seniors have. It’s really tough when you’re living on $700/$800 a month and even $1000. These seniors are living in poverty and these are the seniors that secured our future through wars and trials and tribulations, and now is our time to give back to them. The promise that we made to them is dwindling and that’s a shame. They shouldn’t live in fear, they should feel secure. They should have more, not less.

NB: What are some key questions seniors should discuss with their doctors and pharmacists in relation to their Part D coverage?

RM: Well, they should ask – What is my current coverage and how will the proposed changes to Part D affect us?

I don’t know if the doctors will know all the time, but they need to know the differences between the coverage of generic and brand name medications and their care. They really need to engage and need to bring a witness to their doctor so there are two sets of eyes and ears. They should try to take notes.

In our organization, we hand out a form for seniors to fill out with all their medications, dosages, and who their primary doctor and medical information is. They update it but they go so often it’s difficult to keep it updated. I wish they had a more high-tech tool to track it.

NB:  What impact would altering the Part D LIS program, that provides extra help to Medicare beneficiaries in need, to increase co-pays on brand name drugs have on your community?

RM: Not to sound over the top, but it will be detrimental to seniors, to their health, to their quality of life, and to their wellness leading to more disability and death. If it’s not broken, don’t try to fix it, especially when these elected officials don’t have to worry about their healthcare. These seniors are living beyond paycheck-to-paycheck. They have to save for everything and they have to make more and more tough choices.

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Advocates Speak Out: Mike Leventhal of Men’s Health Network-Tennessee

June is Men’s Health Month. To discuss some of the issues senior men face,, Seniors Speak Out’s Nona Bear recently spoke with Mike Leventhal of Tennessee Men’s Health Network. Below is an abridged version of the interview.

Nona Bear (NB): Can you tell us a little bit about the people you serve, in particular the senior community of men and your outreach there?

Mike Leventhal (ML): We were founded in Tennessee in 2003, and we are an affiliate of the Men’s Health Network in Washington, D.C. Tennessee Men’s Health Network is the premier agency in Tennessee that provides services targeted toward the health of men and boys. We have a presence in all 95 counties of Tennessee, and we collaborate with private and public health care partners to fulfill our mission of building healthy families.

NB: Tell us a bit about Men’s Health Month.

ML: June is Men’s Health Month, and National Men’s Health Week (NMHW) is the week that ends on Father’s Day, June 15th to 21st this year. NMHW is a special awareness period created by Congress in 1994 to heighten awareness of preventable health problems and encourage early detection and treatment of disease among men and boys. It should serve as a reminder to families to focus on the health of their fathers, brothers, and sons. There are hundreds of events taking place around the country and in Tennessee.

NB: In honor of that, what messages do you have for Medicare aged men in particular?

ML: When it comes to aging men, we really try to encourage them to take advantage of the health care system available to them. Many seniors don’t fully take advantage of all the benefits offered through Medicare. We encourage everyone to schedule an appointment with their physician, learn more about their health needs, and join us in our efforts to advocate for the health and wellness of men and boys.

NB: What challenges do older men face in accessing health care and being adherent to their medications?

ML: Many men in Tennessee, especially seniors, are economically insecure and struggle with the rising cost of housing, food, and of course health care and medicine. We urge men to choose a Part D program with the best formulary to meet their health care needs. We have a resource center and library on our website,, to assist anyone interested in learning more.  Patients should ask about generics, as well as opportunities to order online. Both can be cost savers.

NB: For people who are enrolled in Medicare Part D, are you seeing a large amount of satisfaction?

ML: Most all of the Part D enrollees I meet are really satisfied with their health care.  In fact, many aging men have confided in me that they wouldn’t know what to do without it. We’ve all heard the horror stories of seniors having to make a decision between buying groceries or refilling their prescriptions. With Medicare Part D, that is not nearly as much of a concern as it has been in the past.

NB: You mentioned in particular an issue about access of all types for people that live in rural areas. What advice could you give to both men and women enrolled in Medicare Part D in rural areas around the United States about access?

ML: In many rural communities there are social agencies that provide transportation for seniors to and from doctors’ appointments. It takes a lot of planning on behalf of the patients, that is always going to be an issue, but there are services available to those seniors living in rural communities, including the opportunity to refill prescriptions via mail.

NB: As you know there are many proposals which would change the structure of Medicare. How would older men react to that?

ML: I have to ask, “If it’s not broken. why fix it?” That’s our position on those changes. None of the seniors I have talked to about Part D benefits want to see it change. They like it as is.

NB: Imposing mandatory rebates and removing the non-interference clause are issues of contention.

ML: Men’s Health Network is concerned that rebates will drive up costs taking us back to those horror story days prior to Part D. Clearly this would not benefit the program and likewise non-interference would also drive up the costs of Part D. Both of these would negatively impact the health of patients. 

NB What worries you the most about the health of older men and the future of Medicare?

ML:  A lot of my married friends like to remind me that married men tend to live longer. Unfortunately many Tennessee seniors are single and don’t have a spouse or a loved one to take care of them or oversee their health needs. This all comes back to educating men on the importance of regular checkups and taking your medications as prescribed. Having a Part D plan that fits your needs is certainly key to reaching that goal.  

NB: What gives you hope?

ML: There are many members of Congress, especially in the Tennessee delegation, who are fighting to prevent any kind of changes to Medicare Part D. The fact that they are on the front lines fighting for Tennessee seniors and fighting to maintain Medicare Part D gives me hope.

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Dear White House: Nutrition is Critical Component of Healthy Aging

The 2015 White House Conference on Aging (WHCOA), to be held this summer, is a work in progress with great and promising potential. It will be the sixth Conference on Aging in history, the second one held this century, and aims to shape aging policy for the next decade.

One of the four issue areas of focus for the Conference is healthy aging. The WHCOA website says that this includes exercise, health screenings, and immunizations, as well as not smoking—in short, a greater focus on prevention. Prevention is a topic which I often discuss, though my focus is more on nutrition. I recently had the opportunity to address this at an Ohio forum hosted by the Benjamin Rose Institute on Aging, which was held as a lead up to the listening forum held in the area by the WHCOA. The main point I made was that good nutrition practiced throughout the lifespan can lead to healthier aging.

This summer, we also celebrate a number of anniversaries of key programs, including the 50th anniversary of the Older Americans Act (OAA). The OAA’s largest program focuses on nutrition and encompasses the congregate and home-delivered meals programs as well as education. It is documented that the OAA reduces food insecurity and isolation, but there is another benefit yet undocumented: how much it saves Medicare and Medicaid.

Why is resolving the nutrition issue so important? For one thing, the three major chronic diseases that impact 87 percent of seniors—diabetes, hypertension, high cholesterol or some combination—can be prevented and/or managed with appropriate nutrition interventions. Overall, lack of good nutrition drives up health care costs.

And the problem is only getting worse. For example, the number of food insecure seniors has more than doubled since 2001, from 2.3 million to 5.3 million. We spend $157 billion per year overall on disease-related malnutrition in the United States; a malnourished patient’s medical costs will be 300% higher. A National Health Interview survey of 10,000 adults with chronic illness found that one in three reported being unable to afford food, medicines or both. In fact, typical medication non-adherence (not taking medications as instructed) is 50 percent. Fortunately programs like Medicare Part D help ensure seniors can access their medications, but we are not doing enough to address hunger and malnutrition.

Thus, these problems of food insecurity, hunger and malnutrition and growing number of older persons affected must be addressed. Some solutions and ideas to consider: 

  • Declare food insecurity, hunger and malnutrition as domestic emergencies, which could allow greater resources to be applied to their reductions. Calculate the overall cost to government of these three.
  • Expand access to healthy foods in all federally funded nutrition programs; reduce price disparity between cheap bad food and expensive good food.
  • Add basic nutrition screening, interventions and other information into the electronic health records of the future.
  • Modernize the locations where older adults get their meals and offer related health services.
  • Expand medical nutrition therapy to include diabetes.
  • Expand Affordable Care Act Essential Health Benefits to include nutrition screening and therapy.
  • Reexamine goals of Healthy People 2020 and build in a stronger emphasis on malnutrition prevention.

In the end, the WHCOA must produce a stronger call to collective action on healthy aging and determine what individuals, families, communities, and the private sector can do to help solve this rampant problem. This is a critically important topic to address as a society which accomplishes healthy aging is stronger in all regards. I commend the WHCOA for including this as a goal, but would like to ensure that good nutrition is also a central focus.

To learn more about the WHCOA, learn more about the four focus areas, and get involved, visit the website.

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Keeping Medicare Strong: Support the Repeal of IPAB

I am a senior on Medicare with high blood pressure and elevated cholesterol. Like millions of my peers I take medicines daily for both conditions and work hard to prevent anything else from jeopardizing my health. 

There are four things I want when I need medical care: 

  1. I want to have access to a provider who is current with the best practices and best treatments available;
  2. I want my provider to have accurate information about my health, to listen to me when I describe symptoms or ask questions, and to be able to give me the tests I need for diagnosis; 
  3. I want my provider to provide me with the pros and cons of all my options when I receive a diagnosis; and
  4. I want to have access to the health care services and treatments I need through my Medicare coverage. 

 Standing squarely in the way of this is something called IPAB, the Independent Payment Advisory Board set up by the health care reform act to make decisions about Medicare spending.  

IPAB is made up of unelected bureaucrats who are solely tasked with cutting costs to Medicare. They have no responsibility to maintain quality of care or improve Medicare in any way other than cutting spending. In the coming years, IPAB could determine which procedures and medications are covered by Medicare and ultimately even dictate to doctors what treatments are available to their patients.

Moreover, since IPAB members are not elected, seniors (and voters generally) will have no direct way to fight back against these changes. Even Congress would face huge obstacles in trying to block IPAB’s actions. Truly, IPAB is a Medicare beneficiary’s nightmare. It is not what we signed up for. It is not what we have been promised and it is certainly not what we deserve!

Fortunately, there is strong, bipartisan support in Congress to repeal IPAB and restore the responsibility of ensuring Medicare’s solvency back to the hands of elected officials.  This ensures accountability and the ability to exercise your voice.

Over 500 consumer, patient, veteran, provider, and senior advocacy groups are supporting the effort to repeal IPAB. If you believe, as I do, that the decisions impacting your health should be made solely by you and your doctor, then please speak out!

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Advocates Speak Out: Rob Gundermann of Alzheimer’s and Dementia Alliance of Wisconsin

Rob Gundermann is public policy director for Alzheimer’s and Dementia Alliance of Wisconsin. He spoke with Seniors Speak Out’s Nona Bear about issues seniors are facing in Wisconsin. Below is an abridged version of the interview.

Nona Bear (NB): What community do you serve and how long have you been advocating for patients?

Rob Gundermann (RG): We are based in Madison, Wisconsin and formed in the 1980s. Originally, we were part of the Alzheimer’s Association, and then years ago, we split off and created our own group.

NB: What changes have you seen the Part D program make in the lives of seniors?

RG: We’ve seen a tremendous change. When I started, we didn’t have any drug programs, so we were seeing people choose between buying food or their medicine. We also saw people cutting their dosages in half to make them last longer. So having this program where people can get their drugs affordably is tremendously helpful. Through Medicare, we have people going in to get their conditions addressed earlier and overall this is saving us money.

NB: What are some issues that seniors still struggle with regarding the Part D program?

RG: The issue I hear about most often is getting the donut hole filled. In Wisconsin, it’s even more complicated as we work with the system we had in place before Part D, our state program Senior Care. We’re still figuring that all out.

The number two issue though is the preferred drug list. Alzheimer’s is unique since there are only a few drugs to choose from to treat the illness. The latest generation drugs are better than the older generation, so we’re trying to get people on those medications. However, if seniors pick the wrong plan or the preferred drug changes on their plan, that becomes a big problem.

NB: Are people aware that the Medicare donut hole will be closed?

RG: Not yet, and currently there’s a lot of uncertainty because people aren’t sure where the ACA is headed. There needs to be more outreach to explain that this donut hole will close in time.

NB: You mentioned the importance of picking the right plan. Are your patients aware they can change plans during the course of the year if they have a one or two star plan? Does that impact your population?

RG: It absolutely does. As the coverage changes, their medications might not be covered. Part of our job is to educate them and make sure they review their plans before that window closes and make needed changes. That’s an issue that I think a lot of seniors in general need to be educated more about.

NB: What are some key questions seniors should discuss with their doctors and pharmacists in relation to their Part D coverage?

RG: They should ask about generics and mail order as two ways to save money. We also find some medications where it’s not any more expensive to get a higher dose, so you can get a higher dose and cut it in half to your actual prescribed dose to save costs, but obviously that’s something you should discuss with your doctor and pharmacist.

NB: How do you think changes to Part D would impact your constituents?

RG: We have two big concerns with potential changes to Part D. One is limitations on current medications. Aricept and Namenda are the two most recent drugs for Alzheimer’s. We are afraid that these medications could be removed from the preferred drug list and that there won’t be an alternative for patients. The other issue is ensuring there is access to new drugs, ones that could potentially stop the progression of the disease, through Part D, so that they are a treatment option for all, not just those who can afford to pay for the medication out of pocket.

NB: How would any changes to Low Income Subsidy affect the people you serve?

RG: Changes would reduce their ability to get their drugs and could delay the point at which they start taking these drugs. The goal with dementia is get patients on medications as soon as possible, so you can slow the onset of symptoms and delay institutionalization.

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Advocates Speak Out: Michelle Grossman of Community Health Charities of Nebraska


Michelle Grossman is president and CEO of the Community Health Charities of Nebraska. She spoke with Seniors Speak Out’s Nona Bear about issues seniors are facing in her area. Below is an abridged version of the interview.

Nona Bear (NB): How long have you been advocating for patients/seniors?

Michelle Grossman (MG): The Community Health Charities of Nebraska was founded in 1972 and is based in Omaha, Nebraska. We focus on uniting donors in the workplace with trusted health charities, working closely with groups including the Alzheimer’s Association, March of Dimes Foundation and the American Diabetes Association to advocate for individuals of all ages, ethnicity and social identity.

NB: What are some issues that seniors still struggle with regarding the Part D program?

MG: Right now, because the program works so well, people are concerned that it could be taken away from them. There is also concern with the Medicare donut hole, but people are learning more and more that it is eventually going to be closed.

NB: What is most important to the people you serve in terms of Medicare?

MG: I think access and choice are huge – the fact that patients can pick something that is tailored to and best fits their needs, as opposed to a generic cookie cutter type of plan, is very important.

NB: What changes have you seen the Part D program make in the lives of seniors?

MG: It has been really great to see people have the opportunity to access prescription drugs they need at affordable prices. It’s great to see them living longer, healthier lives because they are given access to medication that they really need.

NB: Have you also seen any specific changes for those people who qualify for the Low Income Subsidy or LIS program? Do they now have better access?

MG: Yes, we’ve seen negative health conditions decrease and diminish for people who couldn’t afford medication before but now can through the LIS program. Patients have become stronger and more productive members of society since their health has improved through better access.

NB: Any other points you’d like to make about Part D in your community or looking forward, items you wished people would be looking to about Part D?

MG: Part D is doing well as it is currently structured. People for the most part are satisfied, and we really do need to keep it in place as it is so that we don’t jeopardize what we’ve already given our seniors. They deserve it. They’ve earned it. And it’s important that we protect this program for them.

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Speak Up! The White House is Listening

In February, the White House Conference on Aging kicked off the first in a series of regional forums ahead of the national conference in Washington, D.C. scheduled for later this year. The once-a-decade conference has been held since the 1960s with the main goal of improving the quality of life for older Americans. It also serves as an opportunity to discuss policy solutions to common obstacles including: healthy aging, long-term care, retirement security and elder justice.

White House, garden and fountains in foreground

White House, garden and fountains in foreground (h/t Huffington Post)

The aim of the regional events, the first of which was held in Tampa, is to give senior advocates an opportunity to highlight key policy areas that are critical to older Americans and address the most pressing challenges related to aging.

As a longtime advocate for the aging, I am truly excited for these forums. Any opportunity to generate ideas for action that improve the lives of older Americans is worthwhile. Here are some ways for you to get involved:

  • Make sure advocates in your area know what obstacles you are facing and what matters most to you as a senior. YOU may not be able to attend the forum but some advocates will be invited and can better address your issues if they are aware of your priorities and problems. 
  • Watch the forum live on webcast.
  • Stay informed as more events around the conference get scheduled. Join the mailing list to learn about listening sessions, webinars and opportunities for public engagement.
  • Check out the White House Conference on Aging website to share your own stories and speak out about programs that make your life easier.
  • Use social media to speak out on what is important to you as a senior using hashtag #SeniorsSpeakOut or #WHCOA.

The many events planned in conjunction with the White House Conference on Aging are a great opportunity to get involved, and I look forward to raising important issues surrounding aging including the importance of elder justice, nutrition, long-term care, legal services, and elder abuse prevention, as well as the importance of senior health and well-being. I encourage you to strongly voice your support and create momentum around the upcoming discussions on improving seniors’ lives.

Don’t forget to keep an eye out for the next White House Conference on Aging forum, which will be May 28 in Boston, Massachusetts.

Seniors are the most important voice in the fight to enhance and protect what works for them, so don’t miss an opportunity to work with your advocates to speak out!

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Keeping Part D Strong: The Value of Choice

Consumer choice is one of the most powerful tools in any marketplace. Don’t like the service at Restaurant A? No problem, there are many others waiting to serve you. Department Store X is having a great sale and Store Y isn’t…I know where I’m going to shop.

As consumers and smart shoppers, we vote with our pocketbook every time we make a purchase, and by doing so, we affect the market that wants our business. While we embrace the importance of competition in many other types of commerce, we often overlook its importance in health care.

For Medicare Part D, choice is a critical part of the program design. In fact, there was initial concern there would not be enough plans offered. However, as you know, the opposite happened. Many companies entered the Medicare Part D marketplace and continue to provide seniors like you with a wide variety of plan options so you can find one that best meets your individual needs.

Choice — and the resulting competition among plans — has made you the real winners by keeping premiums steady, program satisfaction high and making Medicare Part D a successful public-private initiative.

Some want to change this successful program – to limit choices or undermine the elements of consumer empowerment that have made it so successful. Attempts to weaken and disrupt Part D’s competitive structure do not serve the best interests of the seniors like you who benefit from the program. As Part D beneficiaries, we need to stand firm to protect this program which is fundamental to our health and well-being.

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Seniors Spoke Out…And Were Heard! 

THANK YOU to every senior and supporter who spoke out during the recent budget debate.  While a senator proposed making harmful changes to the Medicare Part D program, the Senate did not vote on the proposal, choosing to keep Part D in its current form. No doubt, this was due to all of your hard work to protect this vital program. Because of advocates like you, Part D remains intact and will continue to provide seniors access to affordable medications. 

Stay tuned to Seniors Speak Out and share your stories and photos with us about how Medicare helps you live life to the fullest. You never know when we may need to speak out again!

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Keeping Part D Strong: Don’t “Fix” a Successful Program

In George Washington’s time, doctors frequently treated patients by bleeding them with leeches. Just as this procedure didn’t produce successful outcomes, “bleeding” Medicare Part D is a misguided attempt that would be equally unsuccessful. 


Medicare Part D is a rare commodity, a government program that is healthy and works well! Here are some reasons why:


1)     Seniors like the program, consistently giving it a near 90% satisfaction rate;

2)     Research demonstrates Part D contributes to reductions in hospitalizations; 

3)     Consumers are empowered by many optionsamong coverage plans;

4)     Premium costs have been relatively stableover the past five years.

5)     The net federal spending for the program was nearly 50 percent less than anticipated by CBO projections.


If you rely on the Medicare prescription drug program, now is the time to keep up with policy threats to the program and get involved to ensure your access to prescription drugs is not threatened. We can’t let this vital program, which protects the health of tens of millions of seniors and people with disabilities, be endangered by misguided changes. As the old adage goes, if it ain’t broke…