Quite a few years ago, a friend of mine (when a person starts a story saying this, it usually means that it’s really about the person themselves, not their friend), made a decision about which two senatorial candidates he was going to support. One candidate’s stance on issues was more extreme while the other candidate had a more moderate outlook. While my friend favored the more extreme candidate’s views on the issues, he realized that the more extreme approach was never going to make it into law, so he supported the more moderate candidate. This hope for bipartisan solutions seems to be a thing of the past. It seems that the extremists in both parties have much more impact on Washington than the moderates. It seems bipartisanism is a dying attribute. Due to favorable district design (i.e., gerrymandering) more and more House Districts are becoming safe for one party or the other. For a candidate to win the party’s nomination, the candidate needs to move to the far left or far right depending on the party in control. It seems that the only moderates to be found are those in competitive House Districts. While less prevalent in the Senate, the same dynamic prevails. This polarization is a reflection of our divided nation.

Now you may quickly take me to task pointing out the  debt ceiling bill that just passed, but I believe that this forced cooperation only occurred due to the fact that neither party wanted to be blamed for the country defaulting. It was, however, refreshing to witness the negotiations and the give and take in which  both sides participated. It does give me hope that there might be other places where there is enough common ground to pass some bipartisan legislation. So, what does all this have to do with whether your voice has a chance of being heard over the din of the extremists’ voices?

Decades ago, a large group of Americans were labeled the “silent majority”. I think this label applies even more today than it did back then. The only thing we hear, on every form of communication, is the radical, extreme, divisive, and disrespectful voices of those whose only goal is to be heard rather than to solve problems. I think there is a group of people, like “my friend,” who would rather see our politicians generate solutions that don’t completely satisfy either party (or himself) but contain elements championed by each party. I’m not crazy enough to think this has a chance to happen in the short term, but I think it has a chance to slowly bring both parties back toward the middle. But it can only happen if the silent majority speaks up.

As we have done in the past, Seniors Speak Out has prepared a poll that we hope you will take. One of the most powerful ways we can get our opinion to those in Washington is by having large participation in a poll that clearly identifies where we stand on particular issues. We focus on healthcare issues at Seniors Speak Out, so our poll questions focus on how you feel about certain aspects of your healthcare.

The poll asks what your biggest concern about your healthcare is, what should Washington’s healthcare priorities be, what concerns you have concerning prescription drug price controls, what method you use to contact your lawmakers and how convenient and accessible you feel Medicare is. We also give you a chance to add any comments you might have on each question. We really want to know how you feel. Your answers will give us a chance to communicate your feelings to those is Washington who impact your and my healthcare.

We will also be holding a Facebook Live event on June 15^th where I will host a special guest, Mark Gibbons from RetireSafe. We will discuss the poll and your responses to the questions. We will also discuss pertinent healthcare issues including threats to healthcare innovation and access. I hope that this poll and the follow-up Facebook Live event will give you the information you need and inspire you to contact your lawmakers and tell them how you feel. Contacting your lawmakers is a powerful way that you can make a difference.

You can take the poll by clicking here. You can sign up for the Facebook Live event by clicking here, and mark yourself as “going.” You can always go to our contact your lawmaker web page for an easy way to tell those who represent you in Washington how you feel.

I hope that you will take the opportunity to be active in how Washington regulates our healthcare. Take the poll, watch the Facebook live event, and then contact your lawmakers. These are great ways  you can be involved in your healthcare.

Best, Thair

Tomorrow, Wednesday May 31, is National Senior Health and Fitness Day. There will be over 100,000 seniors participating in local health and wellness events in over 1,000 different locations throughout the nation. This is the 30^th year that this national event has been in operation, and it continues to grow. This year’s theme is “Move More to Do More!” which is a nice way of saying to get your butt up off the couch and move. You’ll find the more you move the more things you’ll be able to do.

Since these local events are sponsored by different types of organizations there is no national central place on the internet where I could find what events are going on in my area. Some of you may have already received notices or have seen advertisements in your local sources of news and information concerning groups that are sponsoring events. I did find that when I googled National Senior Health and Fitness Day for my state I found three places that were doing special exercise events or special swimming events. The great thing about these events is they are free and even have some free food and drinks at some. That would be somewhat counterproductive for me, but since it is a special day maybe I can enjoy while exercising some restraint. The best thing about attending is the chance to see new health and wellness places that might interest you.

There were some pickle ball events which makes sense since this is the new rage for getting out and moving. There are new courts opening up and new organizations forming to support local leagues. I have put off trying out this new sport, but I have many friends who play and sing pickleball’s praises. Evidently it has the right amount of movement for older participants, and from what they say, it will help you move more without wearing you down. I’m sure I’ll be getting involved at some point. It does sound like the ideal sport for seniors.

There are some things I want to share that I thought were quite interesting. As I was searching for fitness day events, I used different search phrases and one I used to produce a great list of nation-wide health and wellness information sources by respected sources. I thought it would be useful to share these links and a little explanation with you. I’ve explored each link and they are safe and useful.

You Can Start Exercising After Age 60 — Here’s How

This link and the one below offer good first steps in starting an exercises program. This link offers information about how to get started and what to expect when you exercise after you’re 60.

How Older Adults Can Get Started With Exercise

This is another good source of information on starting an exercise program. It covers the following:

• How much activity do older adults need?
• How older adults can get started with exercise
• Four questions to ask your doctor about exercise
• How to set fitness goals
• Write a plan to add exercise and physical activity to your life

These steps are a great way to get started, a way to commit to turning your good intentions into action.

Exercise Plan for Seniors: Strength, Stretching, and Balance – Healthline

Good balance is a big indicator of good health. I’ve talked about this in one of my earlier blogs. It is a simple but efficient way to start exercising. This link gives some great exercises for improving your balance.

Growing Stronger – Strength Training for Older Adults

This link is a whole book on strength training and as I started to do a quick review, I found myself reading more and more and thinking about the exercises they recommended. It is sponsored by the CDC and was developed at Tufts University. I’m not sure you can find a more comprehensive source of information on increasing strength for older adults anywhere, especially not for free. If you want to get serious about getting stronger, this is the way to go.

What Is SilverSneakers and Does Medicare Cover It? – Healthline

I’m a big fan of SilverSneakers because it offers access to wellness facilities, like gyms and swimming pools, and classes that can help us stay healthy. These benefits are covered by many Medicare Part C (Medicare Advantage) Plans and some Medigap (Medicare supplement) Plans. The SilverSneaker’s web site also offers online exercise classes and a great deal of information on exercise, diet, mental health, etc. Taking advantage of these benefits can be an economical way to accomplish your exercise goals.

I encourage everyone to get up and get involved in some of these fitness day activities. I look at National Senior Health and Fitness Day as another chance for us to be reminded of the importance of physical activity and maybe, just maybe, it will be the spark that motivates us to get off our duffs and start exercising.

Best, Thair  

Both Houses of Congress are scheduled to start their Memorial Day recess on Friday May 26^th, with the Senate coming back on Tuesday May 30^th and the House not returning until June 5^th.  That’s the schedule, but the debt ceiling deadline may throw a wrench into both schedules. Congress must raise the debt ceiling for the country to continue to pay its bills and the estimate for the money to run out if the debt ceiling is not raised is June 1^st. This means that both Houses could be staying longer in Washington or returning earlier than originally scheduled as this legislation is debated and voted on. In the recent past, when neither party has a majority in both Houses of Congress or the Presidency, it has become a time for both parties to try to use this bill to pass other policies that can be attached to this “must pass” bill. This year has been even more “entertaining” given the slim majorities in both the House and the Senate. Here’s where we stand right now.

The House, much to everyone’s surprise, passed a debt ceiling bill – the 2023 Limit, Save and Grow Act – that included long term debt reduction language and a reduction in funding for many civilian agencies. House Speaker Kevin McCarthy (R-CA) said his party’s plan would “prune” the “bloated, overgrown bureaucracy.” The Senate, where the Democrats hold a slim majority, said the bill was dead on arrival and the President said he would veto it if it passed both Houses. What the Housed-passed bill did do was bring the leaders of the House and the Senate into a meeting with the President to see if they could come to a compromise, since no one in Washington wants to bear the responsibility of our country defaulting on its debts. Defaulting would cause an economic implosion that would reverberate in all the world’s financial markets and would have a huge negative economic impact on our fragile economy as we try to tame inflation. While there have been signs that a compromise might be in the works, there have been pauses and posturing that prove a default is not out of the question. It seems unfathomable to me that our elected officials would allow our country to default but politics and the deep divisions in Washington and our country often cloud the vision of those who lead us and leads to illogical actions. I hope that reason prevails.

As our lawmakers try to find a way to avoid defaulting while also lowering our debt, I feel the need to get on my soap box about two things that this bill has reminded me concerning problems I’ve seen in the past. First, one of the sticking points in the negotiations is Republicans pressing for government aid recipients to be seeking work or working or participating in educational training of some kind, so-called “work requirements.” This has long been a much-debated policy, one that I have watched and even participated in. While it seems logical that if a person receives government aid but is able to work then they should work. Work requirements for Medicaid beneficiaries is one of the places where these requirements have proven to be a sticking point. When someone is receiving state supplied Medicaid benefits, where the Federal government supplies the bulk of the funding, then Washington can impose these type of eligibility requirements. It boils down to making sure the aid is given only to those who really need it. Regulating who should be required to work without withholding aid to those who really need it, is a hard and costly proposition but one that I feel should be pursued. Ronald Reagan once said, “I believe the best social program is a job.” It is simple in concept but difficult to implement. I think there must be a compromise that encourages people to use the aid they receive as a steppingstone to a job that frees them from requiring aid.

The other point I want to make is how proposed legislation is financed. As our country has dealt with our huge debt or big healthcare legislation, we have passed bills that often were paid for by changes in Medicare and/or reductions in drug prices. The Affordable Care Act did it and the recent Inflation Reduction Act also used healthcare savings as a way to pay for other programs. My position has always been, if you do things that eliminate waste and abuse or increase the efficiency of our government healthcare programs then the money saved should be used to improve healthcare programs such as lowering the out-of-pocket costs for the program beneficiaries or lowering our nation’s debt. It shouldn’t be used to pay for other programs.

Ok, I’ll climb down from my soap box and talk about a piece of legislation that really has a chance of coming up for a vote once the debt crisis is passed. This legislation deals with Pharmacy Benefit Managers (PBMs). These PBMs are third-party administrators who negotiate with drug manufacturers on behalf of health plans. Over the years they’ve gone from contractors that processed claims to powerful entities in the prescription drug supply chain. Some have said that the rebates negotiated by PBMs are not benefiting the ultimate beneficiaries. There have been multiple hearings and there is bi-partisan support to make the dealings of the PBMs more transparent. While this all sounds great, we must be careful that we don’t throw the baby out with the bath water and overlook the benefits that having these PBMs have provided. As always, the devil is in the details, but this legislation that deals with PBMs seems like it has the most chance of moving forward.

The other workings in Washington that I’ll be watching is the implementation of the Inflation Reduction Act. This will continue to be an area of focus that I’ll continue to watch. In the meantime, I hope you have some fun things planned for summer.

Best, Thair

Many of us, prior to the pandemic, never thought much about the Food and Drug Administration (FDA). Most of us knew they were the ones that approved drugs but that was about it. We didn’t have strong feelings about them one way or the other. They just did their job in the background, and we enjoyed safe medicine. The pandemic and the rapid accelerated approval of the COVID-19 vaccines thrust them into the spotlight and suddenly everyone, it seemed, had an opinion on how the FDA should operate. The FDA’s time-tested accelerated approval process came under scrutiny and rumors of political influence were rampant. Sadly, this ill-advised mistrust caused some people to turn their back on these lifesaving vaccines . . . vaccines that some estimate saved almost 20 million lives worldwide. With all this controversy some have begun to doubt that the FDA was still the gold standard for the safe and effective approval of medicines. I thought that it would be important to review where the FDA stands today in this very important role.

The FDA, as an organization, is tasked with using unbiased scientific facts to ensure the efficacy and safety of the medicines it approves. Its historical record has proven that the FDA has done an outstanding job. The unbiased requirement has sometimes been tested and the FDA has yielded to outside influences in the past, but this outside influence was not authored by politicians but by the patients themselves.

For example, in 1988, hundreds of AIDS activists surrounded the FDA Parklawn headquarters building to protest what they perceived as a slow and inefficient drug approval process that was preventing patients from receiving possibly effective medicines and costing patients their lives. These protests, organized by the AIDS Coalition to Unleash Power (ACTUP), publicized patients’ concerns to improve access to emergent therapies and pushed the FDA to develop a new accelerated approval process to accompany the new treatment regulations for Investigational New Drugs which was implemented in 1987. This change enabled these desperately ill patients access to these promising new therapies. This accelerated approval process has been used ever since when the circumstances dictate and was used effectively to quickly approve the lifesaving COVID-19 vaccines.

There was another extremely important outcome from these patient protests. In 1987, the huge cultural impact of the AIDS crisis was evident as the AIDS quilt was first assembled on the National Mall in Washington, D.C. In the coming years AIDS Walks were organized across the nation. This was a clear signal of how important the patient was to the FDA’s policy making process. The new Office of AIDS and Special Health Issues was developed to build a relationship with the patient communities, and the FDA made it a requirement to include at least one patient representative on every advisory committee. The advisory committees were also more open and transparent and allowed public comment, an opportunity that I have taken advantage of and testified numerous times.

Over the years, this refocus on the patient has made the FDA more effective and should have diminished the fears people had on the effectiveness of the accelerated approval process for the COVID-19 vaccines, but the din of misinformation and conspiracy theories fogged our vision and led to the lingering distrust that still prevails in some people’s minds. I think it is important to use our 20/20 hindsight to look back at our experience with the COVID-19 vaccine approval process and the resulting effectiveness and safety.

Historically, a typical vaccine takes five to ten years to develop and manufacture. The Pfizer/BioNTech mRNA vaccine was developed and was being administered in less than a year. Prior to this vaccine, the quickest vaccine development was the mumps vaccine, developed in 4 years. Some of the concern as to the safety of the new vaccine was certainly the result of this four-fold reduction in development time. It might not have been as clearly communicated as it should have been that the accelerated approval process and the emergency authorization rules were not altered. The same criteria and adherence to scientific fact that was used in the past was employed. This same methodology was brought to bear when the ensuing variants were discovered, and the vaccines were modified to address these new strains. There is one thing that I think people overlooked as they tried to evaluate the accelerated approval process. The process of developing an effective and safe vaccine wasn’t just the goal of the FDA. A huge company like Pfizer wasn’t about to ruin its business reputation by producing an unsafe vaccine in the spotlight of the pandemic. I suspect their criteria for success might have been more stringent than that of the FDA.

So . . . what was the outcome? The results of the 5.5 billion people worldwide that got the COVID-19 vaccine reveal an extremely safe and effective vaccine. Some have indicated that the COVID-19 vaccine is safer than some of the other vaccines that have been around for decades. Any ill effects on specific categories of people have been miniscule. For me, the results speak for themselves, the accelerated approval process was effective, safe, and timely. Suffering was reduced and lives were saved.

Are there things that can be done to improve the process? Absolutely! I do believe that there were instances of political influence that have crept into the FDA. For Americans to trust the FDA they need to see an impenetrable wall between Congress and the FDA. The voice of the patient needs to be not only heard but recognized. I’ve seen instances where the FDA leaders and advisory committees have only given lip service to the patients and their advocates. They listened to the AIDS patients and it made them better. They need to continue listening.

In reviewing the facts of the pandemic, my 20/20 hindsight has shown me that the FDA is still the gold standard for ensuring our medicine is safe and effective. The FDA needs to do everything within their power to resist any pressure from outside entities, may they be political or in the private sector. The lawmakers need to resist the temptation to alter the goals of the FDA or to influence them in any manner. We need an independent, scientific driven FDA if we expect them to maintain their standing as the gold standard.

Best, Thair

Lawmakers introduce legislation for a variety of reasons, which already indicates there’s a problem. One would think that the only reason legislation should be introduced is for the betterment of the citizenry, but sadly, that’s not always the case. Take the latest piece of legislation, the SMART Price Act, that is being introduced by U.S. Senators Amy Klobuchar (D-MN) and Peter Welch (D-VT). This proposed legislation would amend the drug fixing language in the Inflation Reduction Act (IRA). These two Senators worked hard to get the price fixing language into the IRA. I’ve talked a lot about this language that serves to block innovation and allows the government to insert itself into the extremely successful drug discovery process and dictate prices of new, life changing medicines. We discussed the IRA last month, at our latest Facebook Live event. Our special guest, former U.S. House Speaker Newt Gingrich, wondered why, when we are at the dawn of huge breakthroughs and new discoveries, our lawmakers are choosing to sign into law policies that will chill investors and limit breakthroughs. He voiced his opinion that this is the time we ought to be removing roadblocks to research and finding ways to increase resources for innovation, not discouraging it. Notwithstanding the impact of this price fixing approach, Washington passed this partisan bill, and the gears are turning in Washington to implement it.

So . . . a logical question may be, why do these two Senators and the other Democrats who have joined them think it is necessary to amend this new law? Which brings me back to the beginning of this blog—this bill has nothing to do with the betterment of our citizenry and everything to do with optics, getting re-elected and setting the stage for more restrictive laws and government intervention. The SMART Price Act (Strengthening Medicare and Reducing Taxpayer Act) expands the number and kinds of drugs that the government has the power to price fix. The bill has little chance of moving forward, but it does show the long-term goals of these Senators and the current Administration. In a recent blog I wrote about the insidious way a camel can worm his way into the warmth of his owner’s tent, with the first step being to insert his nose underneath the tent wall but with the final goal being to be completely inside. It seems that these two Senators looked at the price fixing language in the IRA, not as a final solution, but as the first step to slowly insert the government into every aspect of Medicare’s prescription drug program. The ink is barely dry on this bill before they want to increase the government’s power over our prescription drugs.

The SMART Price Act is very small as compared to the 274-page IRA, yet it would have an enormous impact on innovation and access to new medicines. The new legislation is a little over three pages long but dramatically changes the impact of the IRA. Here are four ways it increases the power of the government over our prescription drugs:

• It eliminates the long-standing law that prohibits the government from total control of the Part D program while also allowing the creation of a government created national formulary. I for one don’t want the government telling me what drugs I will and won’t have access to.
• It doubles the number of drugs subject to price controls in 2026 from 10 to 20 and increases the number from 15 – 20 to 40 drugs in 2027. There is no reasoning for the increases, no evaluation of the impact, no benefits itemized, just a promise to save patients money.
• It moves up the eligibility for Medicare Part B drugs to fall under price controls to 2027. These are the drugs that are often injected at the doctor’s office or hospital for diseases like cancer. Again, no justification for this change was offered.
• It reduces the exclusivity from price controls down to three years for many drugs. This virtually eliminates the benefits of competition from generics and biosimilars.

My logical mind looks at this legislation and I would hypothesize that, since its only reasoning for adoption is that the increase in the number of drugs and the decrease in the exclusion period would be to save money, we should double the numbers again, or better yet, to save even more money, why not put all our medicines under government dictated price controls? I think that’s exactly where these Senators are leading us.

I look at this legislation and all I see is a bid to increase the government’s role in our healthcare and nothing for the long-term betterment of Medicare beneficiaries. How quick we forget that this debate over whether a new prescription drug program should be government controlled or it should be a public/private partnership was conducted at the end of 2003 and the choice of a public/private partnership was adopted, a choice that cost 40% less than projected and has an almost 90% approval ratings by those who use it. We made the choice 20 years ago and it was a good one.

While this legislation has a small chance of passing, it will make the next watered down proposed legislation seem more palatable. Grandstanding, optics to get re-elected and power positioning do little to solve the problems in our country. It’s important that we pay attention to these insidious moves to insert the government into our healthcare. We’ll do our best to keep you alerted to these serious threats.

Best, Thair  

Six days ago, Seniors Speak Out held a Facebook Live event with special guest Newt Gingrich. We once again had the opportunity to talk with the former Speaker of the House to discuss the various legislative changes that directly impact seniors’ lives, such as their access to treatments and medicines. Our discussion also highlighted the importance of seniors making their voices heard about how Washington’s actions impact their healthcare. You can click here to see the entire half hour event.

I started the event by welcoming everyone reminding everyone that Seniors Speak Out was created by the Healthcare Leadership Council’s Medicare Today as a resource for older Americans, caregivers, and advocates to encourage seniors to advocate for themselves and ensure seniors are educated on healthcare issues and access needs.

I pointed out that the Inflation Reduction Act (IRA) will have a huge impact on seniors’ access to certain medications and treatments given that the new law includes government price controls which has already begun to discourage R&D investments in new treatments. In fact, recently, several major drugmakers announced they are suspending drug development programs out of concerns that IRA implementation will make it impossible to receive a return on investment.

I further discussed how Seniors Speak Out prioritizes senior advocacy and our goal is to provide resources to help seniors understand the healthcare policies that affect their lives and one of the best resources I know is former Speaker Newt Gingrich.

Speaker Gingrich began by reminding us of how much our lives have changed since we put in place a system that encouraged the development of new innovative prescription drugs. He reminded us that these discoveries laid the groundwork for many life improving and life saving medicines and even produced the development of cures. He then wondered why, at this important juncture of new discoveries, our government would decide to enact policies that would restrict innovation. He pointed out that already, 24 drug manufacturers suspended or were going to suspend research on some drug research due to the IRA. He referenced a University of Chicago study that said these cuts to innovation would result in 18 trillion dollars in losses due to the cost of these unimpeded diseases. He conjectured that we should be implementing policies that accelerated innovation.

Speaker Gingrich referenced a book he authored in 2003 titled, “Saving Lives and Saving Money,” and he commented that the order of the title put saving lives in front of saving money because it is a critical moral issue, and he was worried that the current policies deal with the money at the expense of lives.

After these comments I pointed out that, despite the efforts of advocacy groups and seniors across the nation, our government passed the IRA, and it is now even more important for us to speak out to influence the implementation of the law to protect our access and innovation. I then asked Speaker Gingrich if he had any thoughts on how seniors can voice their opinions most effectively?

He quickly stated how important a constituent’s opinion is to lawmakers and he urged everyone to contact their member of Congress and their two Senators to make their feelings heard. He postulated that the reason they only allowed a short 30-day period for comment on the implementation of the drug provisions of the law is because they don’t want to hear from us. He said that these aren’t the people who are dealing with diseases. That’s why those of us who are impacted by these policies need to make our voices heard.

I then took some time to kind of “get into the weeds” on how the price setting portion of the IRA will hurt innovation. One way is that the price exclusivity for new drugs will be only seven years, reducing the time to recover R&D costs which, including drugs that never get approved, can be one to two billion dollars. I then asked Speaker Gingrich if he thought Washington could come up with a way to more soundly encourage innovation?

He responded saying that the first part will be the hearings that are conducted where the drug manufacturers can document exactly what these policies will do and how they will limit access. The second part will be finding ways to accelerate research, with a good first step being to enable tax credits, with a second step being to speed up the approval process. He commented how the drug approval process has gotten bogged down in regulations over the years and that there had to be a way to lower the time and cost of getting a drug approved without jeopardizing safety.

I interjected that if the hearings gave us an opportunity to see exactly where the research would be curtailed due to the IRA that we might then see how it would personally affect us. Speaker Gingrich noted that if the drugs that were discovered and developed decades ago weren’t available now that many people’s lives would have been impacted and much suffering would still be experienced. He stated that the cost in money and suffering would be enormous. He said that investors could invest in many areas and making it riskier to invest in healthcare is not what we should be doing. I then said that we often don’t account for the long-term savings that come from a new drug. Speaker Gingrich followed up with the statement that many of us who are retired can enjoy an active retirement because of these life-altering drugs and it would be a sad situation if we would deprive the next generation of new discoveries because of the policies we enact. He pointed out again that the study that predicted that the new policies in the IRA would cost our society 18 trillion dollars which is far more than what encouraging innovation would cost.

I then asked him how important was the input of his constituents during the time he was Speaker? He replied that many of his ideas came from groups in his home district. He was adamant that we should never underestimate the power we have as a constituent.

I brought the event to a close by encouraging seniors to contact their elected officials’ offices, submitting public comments on federal matters, voting, or volunteering in political events. We can all speak out on these things that affect our lives. You can find an easy way to contact your lawmaker by going to our web site at seniorsspeakout.org.

I hope you will join us again when we have our next Facebook Live event.

Best, Thair

Federal lawmakers are coming back from their spring break with a lot of items on their agenda which, from my point of view, is a dangerous situation. I’ve often thought it was a positive thing when, long ago, Congress had to go home in the summer to take care of their farms. But that fact of the matter is, there is a lot of things that Washington will be focusing on and some of them will have an impact on our healthcare.

If you’ve followed my recent blogs, you know that I’ve always been critical of Congress or the President usurping powers to either circumnavigate signed laws or to implement legislation to their own liking. It’s the reason I dislike the increase in Presidential executive orders and using so called “test projects” to implement nationwide programs. As I wrote in my last blog, the implementation of the Inflation Reduction Act (IRA) is falling into this category and it worries me and a lot of members of Congress a lot. It is something former Speaker Newt Gingrich and I will discuss in our Facebook Live event tomorrow (details below).

While there are some positive things in the IRA, one of them being the yearly $2,000 cap on our out-of-pocket drug costs starting in 2025, there are some negative things that are destined to have a long-term effect on the availability of new medicines. The price fixing portion that will stifle innovation is one of the most serious parts of the IRA. I talked last week about the comments Senator Manchin (D-WV) made complaining about the way the administration was implementing the IRA. There are others that are also mad about how President Biden is bending, or sometimes ignoring, the guidance and rules in this and other legislation.

Last September four Senators wrote a letter to the Administrator of the Centers for Medicare & Medicaid Services (CMS) asking how the government agency that is responsible for ensuring older Americans have access to life altering and life saving medicines can arbitrarily reduce access to an FDA approved Alzheimer’s drug. I talked back then about the bad precedent this overreach set and some members of the Senate agreed. It is a civilian agency exercising powers that they have no right to use. As predicted, there is now another situation where the misuse of power threatens to restrict the access to important cures.

A recent letter sent to the Secretary of the Department of Health and Human Services (HHS) and the Administrator of CMS signed by 18 U.S. Senators talked about the Administration again seeking to override an important part of the FDA’s responsibility, the Accelerated Approval Program. This important FDA tool allows for specific medicines to receive special accelerated focus to quickly get life saving and life changing medicines to patients. HIV/AIDS and cancer treatments have gotten to patients faster due to this program. Our COVID-19 vaccines benefitted from this program and saved millions of lives. We’ve trusted the FDA to keep our medicines safe and they remain the worldwide gold standard for keeping our medicine safe, yet the Administration wants to lower payments and restrict access to medicines that have been approved through this proven program, once again overstepping their powers and overriding an efficient FDA.

When we talk about IRA implementation there are more and more instances of the implementation deviating from the legislation. One of these worrisome areas is the actual funding for the implementation. While many in Washington would like to reduce the size of government (and many of us outside Washington desire the same), the IRA authorizes the spending of 3 billion dollars for the implementation of IRA. That money is unaudited and unregulated and is a huge amount of money. Two House committee chairs and a Senate committee ranking member recognized accountability concerns and sent a letter to the HHS Secretary and the CMS Administrator asking them for some accounting of this huge amount of money. Their statements in the first part of the letter succinctly relays their feelings:

“Americans deserve fiscally responsible and accountable leadership, not bureaucratic bloat. Unfortunately, the so-called Inflation Reduction Act (IRA, Pub. L. 117-169) enacted last year has doubled down on the recent trend of federal expansion and excessive expenditures.”

This accurately spells out why the ever-growing government is a real threat to our healthcare independence.

As detailed above, many members of Congress are dissatisfied with the way the administration is using any method it can to further its own agenda. It’s a clear case of our government dictating more and more of how we receive our healthcare. My topics of my blogs over the years have always leaned toward less government and specifically less government control. The Administration, in the implementation of IRA and in other Administration initiatives, has shown that they will usurp whatever power they require to enact their agenda and expand government control of our healthcare.

Tomorrow, former Speaker Newt Gingrich and I will talk about some of these subjects. I’m looking forward to Speaker Gingrich’s perspective on IRA implementation and especially on the parts of the legislation that will impact us the most. I invite you to join me for our Facebook Live event, tomorrow, April 18 at 2:30 PM ET. We will discuss the importance of seniors advocating for healthcare policies that will impact their lives. We plan to use this conversation as a time to review Congress’ recent legislative activity, such as IRA, and how this would affect seniors’ access to innovative treatments and medicines. You can find the event details by clicking here. Mark yourself as “going” on the event page if you plan on tuning in to our live event.

I hope you take the time to tune in.

Best, Thair

One of the basic tenets of our constitution is the checks and balances that limit the power of each of the branches of our government. I see red flags when legislation or rules or guidance are proposed that seek to bypass these checks and balances or when the implementation of a signed law does not adhere to the law’s provisions.

This happened a little over 13 years ago when the Affordable Care Act (ACA), often called Obamacare, was being debated. The ACA established an Independent Payment Advisory Board – an unelected, administration appointed board, to make healthcare cost and payment decisions without any judicial oversight or control. It was this lack of adherence to the basic checks and balances that caused me to fight against that part of the ACA and advocate for it to be fixed. I’m thankful that this board was never formed and was ultimately eliminated.

I’m beginning to see this lack of adherence to the statutes and protocol in the implementation of the Inflation Reduction Act (IRA) and I’m not the only one who’s concerned. Senator Joe Manchin (D-WV), in an opinion piece in the Wall Street Journal, said that he was concerned President Biden wasn’t implementing the IRA as the bill instructed. In reference to the IRA Senator Manchin said;

“Yet instead of implementing the law as intended, unelected ideologues, bureaucrats and appointees seem determined to violate and subvert the law to advance a partisan agenda that ignores both energy and fiscal security. Specifically, they are ignoring the law’s intent to support and expand fossil energy and are redefining “domestic energy” to increase clean-energy spending to potentially deficit-breaking levels.”

I tend to pay attention when a Democrat calls out his party’s administration for not following legislation that was legally signed into law.

I also see the administration ignoring the accepted protocol for the release of rules and guidance as the IRA is implemented. The agency responsible for the healthcare portions of the IRA is the Centers for Medicare & Medicaid Services (CMS). Either through bill language or by direction of the administration, CMS was instructed to use administrative guidance to implement the negotiation provisions. Using administrative guidance means that they can bypass the notice-and-comment requirement of the Administrative Procedure Act or Medicare statute. This process does not require comment periods for public input which means that some significant areas of the guidance are being issued as final and immediately effective. But, CMS states that it is “voluntarily soliciting comment on certain topics” in the guidance. This seems to be the reverse of the bait-and-switch technique, they switch the rules and then try to bait you into forgetting about it by offering a chance to comment on certain topics in a short amount of time.

This approach was used when CMS released the Medicare Drug Price Negotiation Program: Initial Memorandum a few weeks ago on March 15^th. This 91-page document revealed details and rules that could have a huge impact on the amount of money that will be invested in the future toward discovering medicines that could improve or extend our lives. Yet we are given only 30 days to analyze this complex document and then we can only comment on certain parts of the memorandum. Page two of the memorandum states, “In the revised guidance, CMS may make changes to any policies, including policies on which CMS has not expressly solicited comment, based on the agency’s further consideration of the relevant issues.” CMS is not obligated to seek input from stakeholders, like me and you, and they can make changes to any policy based on their “further consideration of the relevant issues”. This is a perfect example of the government giving seniors a chance to speak out – except when it’s not convenient.

I know that many organizations are working to comment on this possibly life changing document. It is a complicated document and is lacking in detail in some areas and contradictory in others. I will try to keep you abreast of these comments.

There is a way you can be heard, a way you can speak out. You can write your Senators and member of the House of Representatives to tell them that the CMS is misusing its power when it dictates on what policies we can comment on and ignoring the notice-and-comment requirement of the Administrative Procedure Act. You can do this by clicking here which will take you to our Seniors Speak Out – contact your lawmaker web page.

You can also make an appointment to speak face-to-face with your lawmakers. It is a great way to get to know them and for them to get to know you. I can guarantee it will be a rewarding experience.

Also, I invite you to join me for our Facebook Live event on April 18 at 2:30 PM ET. Former Speaker of the U.S. House of Representatives Newt Gingrich will sit down with me to discuss the importance of seniors advocating for healthcare policies that will impact their lives. We plan to use this conversation as a time to review Congress’ recent legislative activity, such as the Inflation Reduction Act, and how this would affect seniors’ access to innovative treatments and medicines. You can find the event details by clicking here. Mark yourself as “going” on the event page if you plan on tuning in to our live event.

I hope you decide to speak out, no matter how inconvenient our government may make it. It’s an important way we can make democracy work.

Best, Thair

It’s the end of March. The spring equinox, the “official” indicator of spring, has passed yet there’s still some, me included, who beg to differ with the calendar. I moved from Virginia four years ago where I lived for a total of 28 years. My kids grew up there and we enjoyed the early springs, and the April cherry blossoms. This year spring came early in Virginia after a very warm winter and the cherry blossoms bloomed in March. That was NOT the case in the west.

The west, especially the southwest, has been plagued by a multi-year drought. The dams in my home state of Utah were almost empty, which is a real problem because they supply most of the water for this high desert state. The governor of Utah got into a little trouble for mixing religion and politics by urging Utahns last fall to pray for rain. Whether it was prayer or a quirk of El Niña this was a record year for snow and rain in Utah and most of the west. Some of the ski resorts, in this greatest snow on earth state, have over 700 inches of snow. This has certainly been a tale of two different cities/states between the east and the west. While the timing of the transition from winter to spring may be different depending on where we live, we will still have the same problems to deal with if we are burdened with allergies, which is the subject of my blog today. As we transition into the season of allergies, there are things we should pay attention to that can help us avoid some of the impact of allergies.

Allergies impact many of us. They are one of the most common medical conditions. It is estimated that over 100 million Americans are affected by different types of allergies. Hay fever, the most common allergy, affects 26% of adults and 19% of children. Many allergy symptoms are seasonal. When I was young I developed mild allergy symptoms that occurred every other August. Now that seems to me to be an extremely specific plant blooming allergy. Each of us is either affected by allergies or we know someone close to us who is.

If you live in the east, you might not have been ready for the early onset of allergies that came from the early spring. Spring is when many allergies start and will continue through summer and early fall. There isn’t a cure for allergies, but they can be controlled through a good allergy treatment plan based on your medical history, the results of allergy tests, and symptom severity. Many people with asthma are also affected by allergies. Allergies can be a trigger for an asthma attack. Allergic reactions and asthma attacks are caused when your body senses that the pollen or allergens that enter your body are harmful, and releases antibodies to combat the allergens. Too much of these antibodies cause inflammation and swelling. Older people may be especially affected by allergies especially if they are also asthma sufferers.

The good news is there are some things we can do to lesson the impact of allergies on our life. Below are some everyday steps, recommended by the Asthma and Allergy Foundation of America, that will reduce our exposure to the most common allergen, pollen.

• Check pollen counts or forecasts daily and plan outdoor activities on low pollen days.
• Keep windows closed during pollen season or peak pollen times.
• Use central air conditioning or air cleaners with a CERTIFIED asthma & allergy friendly® filter and/or HEPA filtration.
• Remove your shoes before entering your home.
• Limit close contact with pets that spend a lot of time outdoors. Wipe furry animals off when they come inside or bathe them weekly (if appropriate).
• Dry laundry in a clothes dryer or on an indoor rack, not on an outdoor line.
• Wear a mask outside to block much of the pollen in the air from getting into your nose, mouth, and lungs.
• Wear sunglasses to limit the amount of pollen that gets into your eyes.
• Cover your hair with a hat or other hair covering when outdoors so pollen doesn’t collect in your hair.
• Change and wash clothes after outdoor activities.
• Shower before bed to keep pollen out of your bedding.
• Wash bedding in hot, soapy water once a week.
• Clean your blinds or curtains regularly.
• Vacuum your carpets, rugs, and fabric furniture once a week. (A CERTIFIED asthma & allergy friendly® vacuum will trap pollen, dust mites, and pet dander and stop it from spreading in the air while vacuuming.)

As you can see these are all ways to limit your contact with pollen. Some people already remove their shoes when they come indoors but I think they were trying to eliminate dirt rather than pollen. Many of us have pets but I never considered that they could also transport pollen.

There are over-the-counter medicines that can greatly decrease the impact of allergies. Consult your doctor as to which would be best for you. Even over-the-counter medicines can interact with prescription medicines. You might consider taking these medicines a couple of weeks before the allergy season starts, depending on what your healthcare provider recommends.

If you do not get complete relief from medicines that treat allergy symptoms, talk with your allergy doctor about immunotherapy. Immunotherapy is a long-term treatment that can help prevent allergic reactions or make them less severe. It can change the body’s immune response to allergens.

Allergies can have a huge impact on our quality of life but there are things we can do to lessen their impact. Being able to go outside without being stuffed up is nothing to sneeze at.

Best, Thair

President Biden’s State of the Union address had a very interesting back and forth concerning either party’s willingness to cut Social Security (SS) and Medicare. The President accused the Republicans of planning to cut these important programs and some in the audience said he was misinformed (OK, some called him a liar). In the end the President determined that neither Republicans nor Democrats would cut these programs. Unfortunately, it seems that neither side is convinced the subject is dead.

While the President is still talking about the Republicans cutting SS and Medicare, he hasn’t identified any direct planning documents or legislation that indicates the Republicans have some concrete plans. On the other hand, the Centers for Medicare & Medicaid Services (CMS) has introduced some proposed rules, that the Biden administration supports, that will cut Medicare beginning next year. Those cuts on will lower the benefits or raise the premiums on almost half of the Medicare recipients. My focus here isn’t on Democrats or Republicans – it’s on Medicare cuts that will affect older Americans in 2024.

We need to have some basic understanding going forward to really understand what this means. As we all know, Medicare is available to everyone over 65 but each of us has a choice on how we will receive those benefits. We can sign up to traditional Fee-for-Service Medicare and, if we choose and pay a premium to enroll in supplementary insurance that will reduce our out-of-pocket costs, or, we can sign up for Medicare Advantage, which is another way to receive our Medicare benefits. The point is, Medicare Advantage is Medicare. If you are cutting Medicare Advantage, you are cutting Medicare.

Bear with me while I explain how Medicare Advantage operates. CMS has authorized private insurance companies to assume the responsibility for covering all the Medicare benefits for seniors, and this is called Medicare Advantage (MA), or sometimes called Medicare Part C. The government pays the insurance company a set amount for providing these benefits. This set amount is determined by determining the average cost for each beneficiary under traditional Medicare and then the insurance companies make competitive bids on what they will charge to provide coverage. This year the average bid was 83% of the traditional Medicare cost. The MA insurance company then will get a rebate of the difference, 17% in this case, to use for added benefits or lower premiums. As you know, there is a lot of competition during the open enrollment season to sign you up to a MA program. This competition has led to some added benefits and low premiums to the extent that almost half of the Medicare eligible seniors have chosen Medicare Advantage.

It’s important to note some important points concerning Medicare Advantage:

• An estimated 52% of MA beneficiaries live on an annual income of less than $25,000, compared to 38% of fee-for-service Medicare beneficiaries.
• Almost 34% of MA beneficiaries are minorities, compared to 16% of traditional Medicare.
• A larger percentage of Latino and black beneficiaries choose MA than the white population.
• MA beneficiaries with prediabetes were diagnosed nearly 5 months earlier than traditional Medicare.

I’m not here to sell Medicare Advantage. MA isn’t for everyone, but, as you can see, MA serves an important segment of older Americans, and it is Medicare for almost half of America’s seniors and shouldn’t be subject to cuts.  

These cuts will come in a few different ways. One of these is a series of complicated changes in the payment model which will, in the end, reduce the rebate the insurance companies get for charging less than traditional Medicare. Since these rebates are used for added benefits, like gym memberships and dental coverage and/or a reduction in premiums, there will be pressure on the insurance companies to reduce benefits and/or raise premiums. One study estimates the proposed rules will result on average in a 10 to 15% reduction in payments to providers. A different third-party study estimated that these proposed rebate cuts will reduce benefits by $45 a month per beneficiary. When you multiply this by the 30 million seniors that rely on Medicare Advantage you begin to see the impact these cuts will have.

Another way this proposed rule cuts MA is CMS’s proposed elimination of approximately 2,300 diagnostic codes which will have a significant impact on vulnerable populations suffering from diabetes mellitus and their associated complications, rheumatoid arthritis, and depressive disorders. One of the codes eliminated is Peripheral Vascular Disease, which impacts 12-20% of Americans over 60 (8.5M). If not detected and managed early, patients would suffer increased pharmaceutical expenses, specialist costs, hospitalizations, and undesirable patient experience, all of which could easily be prevented. This is just one of the codes to be eliminated. While some health plans may not use these cuts and they and their beneficiaries may not be impacted, the health plans that most beneficiaries have will be negatively impacted.

There is one other thing that bothers me a lot about these proposed cuts. Most of the talk about SS and Medicare cuts had to do with proposed legislation that would go through the normal subcommittee and committee hearings with the input of stakeholders and the checks and balances of passing legislation. The cuts proposed by CMS, with the Biden administration’s blessings, will not be governed by any of these checks and balances and, if not stopped, will happen in 10 months.

The proposed rule will cut rebates for beneficiaries and eliminate payment for 2,300 diagnostic codes, impacting the vulnerable population that the Administration claims to care most about, all with a stroke of a pen and without any legislation. It’s not right and it’s not fair

In the past I have fought when they proposed cuts to traditional Medicare, and I will continue to fight to stop the cuts to Medicare Advantage. These are lifesaving benefits for older Americans that should be strengthened, not cut.

In my last blog I talked about the best ways to contact your Members of Congress and provided some links to make it easy. Go to the blog and see how to best let your voice be heard. Take the time to tell those who represent you in Washington that you don’t want them to cut Medicare.

Best, Thair