- Reflections on the 8th Annual National Voices of Medicare Summit and Senator Jay Rockefeller Lecture
- New Study: High Nursing Home Staff Turnover Impacts Quality of Care
- CDC Declares Racism to be “Serious Public Health Threat”
- Last Week Tonight with John Oliver Tackles the Long-Term Care Crisis
On April 1, 2021, the Center for Medicare Advocacy held its eighth annual National Voices of Medicare Summit and Senator Jay Rockefeller Lecture. Due to the ongoing COVID-19 health crisis, the Summit and Rockefeller Lecture were held virtually for the second year.
Center for Medicare Advocacy Executive Director Judy Stein, and Georgetown University Professor and President of the Center for Medicare Advocacy’s Board of Directors, Judy Feder opened the Summit noting that the Center was celebrating its 35th anniversary on the very day of the Summit. The milestone was the backdrop of the discussions of where Medicare and health care have been, where they should be, and where we are headed. Ms. Feder declared that with 35 years of focus on Medicare, the Center was uniquely qualified to guide the discussion regarding “build[ing] Medicare back better,” as she applied a newly popular phrase to the Center’s mission. Feder noted the shift in public discourse in recent months, “we are in a new era with the nation, having recognized in November, that government actually matters; no program illustrates that more than Medicare.”
Stein called on the health policy experts, practitioners, attorneys and scholars assembled for the Summit, to note this momentous change as an opportunity to address long-standing issues in the Medicare program, “we thank you for joining us to think about how to help Medicare better serve all who rely on it, and how to open doors to quality, equitable health care, for everyone. This might just be our time to do so.”
Some Highlights from the Summit
- Challenges and Opportunities Facing Medicare and Health Care in the New Administration and Congress
Tricia Neuman, Senior Vice President for Medicare, Kaiser Family Foundation framed the discussion of this panel, as she provided some important Medicare statistics. She outlined the significant out-of-pocket costs for Medicare beneficiaries, an issue that, as she pointed out, has not gotten much attention from Congress.
In this panel, led by Center Associate Director, David Lipschutz, Chris Jennings, President, Jennings Policy Strategies and Amy Hall, Staff Director, Subcommittee on Health, Committee on Ways and Means, U.S. House of Representatives shared their experiences and insights with the audience in a lively discussion on their expectations of policy proposals, potential legislation and action aimed at expanding and improving the Medicare program.
The panel expressed optimism that beneficiary-oriented improvements to the Medicare program would now be possible given the change in makeup in Congress and the administration.
“There’s great excitement and, I would say, generally, significant motivation on Capitol Hill to do something significant in a broad array of areas,” Mr. Jennings said, citing the enactment of improvements to the ACA, along with proposals that would expand home and community based care and other health care priorities through expected infrastructure legislation, all of which is taking place so early in a new administration.
Ms. Hall echoed this optimism, urging advocates to push for beneficiary-focused reforms. “This is the year, this is the Congress, to really invest in Medicare and the beneficiaries,” Ms. Hall said. She specifically cited addressing Medicare prescription drug prices as “high on our priority list for this year.”
- Acknowledging Health Disparities and Advancing Health Equity
This panel, moderated by Kata Kertesz, Policy Attorney at the Center, who opened the panel highlighting the essential role that Medicare played in integrating hospitals, focused on disparities in care, suggestions for improvement, and our hopes for the future. With renewed focus on health equity brought about by the tragic burden of illness in communities of color during the pandemic, the panel presented the audience with a robust framework and discussion on the damaging, life-long impacts of long-standing disparities in care, as well as the challenges in mitigating the disparities, and the political will necessary to address them.
Ben Belton, Director of Global Partner Engagement, AARP, and inaugural Alfred J, Chiplin, Jr. Social Justice and Advocacy Award recipient, discussed health equity from a global perspective, and called for comprehensive policy solutions with early interventions that take a “life-course” approach. “[I]nequities across a few domains, such as health, education, employment, and earnings, are mutually reinforcing, so that policies reducing inequity in one area will spill over into the other areas,” he said.
Dr. Emily Cleveland Manchanda, Asst. Prof. of Emergency Medicine, Boston University School of Medicine and Director of Equity Initiatives, Dept. of Emergency Medicine, Boston Medical Center spoke about disparities nationally, particularly her experience as a clinician at a safety net hospital during the COVID-19 pandemic. She spoke to the “significant mismatch” between the hospitals that had the highest numbers of COVID-19 patients and their resources, and their ability to plan for caring for those patients, compared to hospitals that had additional financial resources and ability to make room available by postponing planned surgeries, but had fewer COVID-19 patients.
“Despite all of the advances that we’ve made in the past few centuries in terms of pursuing racial justice, we still have a very segregated healthcare system.” She called for improved data collection as a step to aid in identifying inequities, ensuring informed experts and stakeholders from the community review policy proposals to guide and predict potential inequities, and she cautioned against “colorblind” policies that often perpetuate disparities.
Robert Espinoza, Vice President of Policy, PHI provided insight from the perspective of the direct care workforce, and also cited limitations to data collection, including the challenges associated with small groups, such as for individuals who are “most marginalized, at the intersection of identities,” where the group size is too small to be adequately represented in research.
Mr. Espinoza highlighted the demographics of the direct care workforce, which is predominantly women, people of color and immigrants, and is an aging workforce, with one in four aged 55 or older. Therefore, this group, which plays such an integral role in supporting and caring for our loved ones, struggle with health inequities of their own. “Direct care workers in supporting older adults and people with disabilities, who are themselves marginalized, are shaping health outcomes and health equity for their clients and residents, but also direct care workers. . .. are facing their own inequities related to health and well-being,” Mr. Espinoza stated.
- Voices of Medicare
The Need for Oral Health in Traditional Medicare
Wey-Wey Kwok, Center Senior Attorney, highlighted “a glaring coverage gap” in Medicare. She explained that due to CMS’s broad interpretation of the statutory exclusion on dental, “traditional Medicare, with very few exceptions, does not cover preventive basic restorative dental procedures or dentures.” Ms. Kwok noted that most people on Medicare do not carry any form of dental coverage.
She described the dire need for oral health, and the many tragic affects this lack of oral health has on overall health and quality of life. The Center has been working in coalition with medical and advocacy partners for many years to push for coverage for oral health care in traditional Medicare, including preventive services, while continuing work on the urgent need for medically essential oral health coverage.
Challenges with Medicare Advantage
Mary Ashkar, Center Senior Attorney, presented about the challenges beneficiaries have experienced when trying to access necessary care from their private Medicare Advantage plan. She shared the story of an extremely ill beneficiary who was denied coverage, and received a $90,000 bill, for out-of-network emergency care that would have been covered had she been in traditional Medicare and not a private plan. The Center successfully represented the family and obtained a favorable Administrative Law Judge decision that required the plan to cover the emergency services that it initially denied, but not without extreme stress for the beneficiary and her family, and only after the beneficiary’s death.
The example Ms. Ashkar shared illustrates some of the risks associated with enrollment in a private Medicare Advantage plan. “[The] disadvantages of Medicare Advantage can have real-life devastating consequences. And, unfortunately, the disadvantages are typically highlighted when somebody becomes sick, and is most in need of that uninterrupted care,” Ashkar said.
- 2021 Senator Jay Rockefeller Lecturer – Dr. Donald Berwick
The Center for Medicare Advocacy recognize Dr. Donald Berwick as the 2021 Sen. Jay Rockefeller Lecturer, for his extraordinary public service and leadership in advancing access to affordable health care and justice for all. Ms. Stein presented the award to Dr. Berwick, President Emeritus and Senior Fellow at the Institute For Healthcare Improvement and previous Administrator of the Centers for Medicare & Medicaid Services, thanking him for his commitment to health care as a human right, and as a “healer who recognizes the humanity in all.”
Dr. Berwick is an advocate and thought-leader for high-quality, equitable health care. His lecture focused on the type of analysis and thinking that is necessary to make health care better all over the world, demonstrating that health care is a component of social justice. In calling for change he noted that there is “no other Western nation that has not made healthcare a human right.”
He spoke passionately about the moral values structure that leads to inequities in all facets of our lives, and how when those are combined over a lifetime, vast inequities in health outcomes result. His holistic approach to addressing these concerns includes focusing on climate change, ratifying major human rights treaties, eliminating food insecurity and homelessness, addressing the cycle of racism, immigration reform, taking on incarceration rates and more broadly criminal justice reform, voting systems, as well as supporting social insurance health programs like Medicare. “We need to restore dignity, order, justice, equity to the democratic institutions. . . in our government and the rule of science. So that we work with facts. And the facts say health can be found in the social determinants; that’s where we need to invest in an all-of-government effort,” he stated.
When asked about the risk to traditional Medicare through the efforts to increase enrollment in private Medicare Advantage, he expressed concern. “[T]he momentum toward privatization of Medicare is the biggest threat to social insurance I’ve seen. . . it’s a gold rush and it needs to stop.”
- Invitation to Celebrate 35 Years of Medicare Advocacy
Ms. Stein was joined by Center Development Manager Jeff Wiseman to thank sponsors and attendees for their continued support, especially during this challenging year during, the global health crisis. With over 350 attendees throughout the afternoon, the Summit participation was inspiring – and it was truly a National Summit, with registrants from all 50 states and Washington DC.
The Summit concluded with a surprise for Ms. Stein, as Center staff, board members and friends joined in applause to congratulate her on 35 years of devoted advocacy on behalf of all Medicare beneficiaries, and for her leadership in flighting for quality health care for all. Sen. Jay Rockefeller added his kind words to honor and celebrate Ms. Stein and congratulate the Center on 35 years of tireless advocacy. “[T]o look at you and to look at your happiness and look at your fulfillment and all that you’ve done, is a complete inspiration” Rockefeller said.
- Thank you!
The Center for Medicare Advocacy thanks all of our attendees, presenters, and especially our generous sponsors – The John A. Hartford Foundation; AARP; Alzheimer’s Association; Santa Fe Group; SEIU; Christopher and Dana Reeve Foundation; Connecticut Community Care; Graham Healthcare Group; and Powers Law Firm. Your participation makes the National Voices of Medicare Summit & Sen. Jay Rockefeller Lecture possible and successful. We look forward to working together to advance access to quality health care for all – and to further exploration together next year (hopefully in person again)!
Stay tuned for next year’s date!
National Voices of Medicare Summit & Sen. Jay Rockefeller Lecture 2022
We’ve witnessed COVID-19 ravage our nation’s nursing homes and claim the lives of over 182,000 residents and staff, accounting for one-third of the nation’s death toll. In some states, the percentage of deaths is much higher. In Connecticut, for example, deaths in long-term care facilities account 55 percent of the state’s total deaths. The Center for Medicare Advocacy recently released a report – Geography Is Not Destiny: Protecting Nursing Homes from the Next Pandemic – which, in part, examines how COVID-19 was able to devastate nursing homes. Staffing shortages and high rates of staff turnover were cited as important factors. While exacerbated by the pandemic, these issues have existed for decades.
Analysis published in a recent Health Affairs article – “High Nursing Staff Turnover In Nursing Homes Offers Important Quality Information” – reveals a glimpse of the extent of the staff turnover challenges nursing homes across the country faced before the pandemic. Drawing upon Payroll Based Journal (PBJ) data from 2017-2018, the study found Registered Nurses (RNs) and Certified Nursing Assistants (CNAs) had the highest turnover rates in nursing home facilities. The average turnover rates for RNs was 140.7 percent, while for CNAs it was 129.1 percent. The study also found that facilities with the lowest CMS overall star ratings (one-star) had the highest median turnover rates (135.3 percent), while the facilities with the highest ratings (five-star) had the lowest median turnover rate (76.7 percent).
The Center’s report highlights multiple factors for this high staff turnover, ranging from a pattern of poor working conditions, low pay with little or no benefits, and physically demanding and mentally exhausting jobs.
High staff turnover can hurt the quality of care residents receive resulting in diminished health outcomes. The Health Affairs article states that high turnover rates lead to more rehospitalizations and more frequent use of physical restraints. Additionally, it asserts that high turnover rates could also lead to increased infection control violations, potentially increasing COVID-19 outbreaks in nursing homes.
 KFF, “State COVID-19 Data and Policy Actions” (updated April 12, 2021), available at: https://www.kff.org/coronavirus-covid-19/issue-brief/state-covid-19-data-and-policy-actions/
 Gandhi, A., Yu, H., & Grabowski, D., “High Nursing Staff Turnover in Nursing Homes Offers Important Quality Information” (2021) Health Affairs, 40(3), 384-391. doi:10.1377/hlthaff.2020.00957
COVID-19 has infected over 30 million Americans and claimed the lives of 560,000. According to the Centers for Disease Control and Prevention (CDC), the impacts of COVID have disproportionately impacted communities of color, highlighting generations of structural inequities.
In a public statement, the CDC’s Director, Dr. Rochelle Walensky, declared that racism is a “serious public health threat” and “a fundamental driver of racial and ethnic inequalities” in the U.S.. The CDC has launched a new initiative focusing on these inequalities called “Racism and Health”. A dedicated website, according to the statement, will serve as the hub for the agency’s work in the area – such as studying the impacts of social determinants on health outcomes – and will be a catalyst for public and scientific dialogue.
“Confronting the impact of racism will not be easy,” acknowledges Dr. Walensky. “I know that we can create an America where all people have the opportunity to live a healthy life when we take responsibility and work together.”
Advancing health equity is a core pillar of the Center for Medicare Advocacy’s mission. The Center has been concerned about the racial and ethnic minority disparities, especially during the pandemic. Its report, Geography Is Not Destiny: Protecting Nursing Home Residents from the Next Pandemic, highlighted a recent study finding that nursing homes that had disproportionately more racial and ethnic minorities tended to have inadequate nurse staffing, limited financial and clinical resources, and more care deficiencies – all of which most likely provided fertile ground for COVID-19 to take root.
 KFF, “COVID-19 Coronavirus Tracker” (Updated April 12, 2021), available at: https://www.kff.org/coronavirus-covid-19/fact-sheet/coronavirus-tracker/?utm_source=web&utm_medium=trending&utm_campaign=covid-19
 CDC, “Media Statement from CDC Director Rochelle P. Walensky, MD, MPH, on Racism and Health” (April 8, 2021), available at: https://www.cdc.gov/media/releases/2021/s0408-racism-health.html
If you’re looking for a quick long-term care primer, Last Week Tonight with John Oliver recently cast its unyielding eye on the long-term care industry. Oliver provided a powerful and clear-eyed analysis of the challenges facing our nation’s older adults and those with disabilities struggling to receive quality long-term care. The show’s report spanned nursing homes, assisted living, and home care, highlighting issues such as staffing shortages, reimbursement rates, gaps in oversight, and challenges with CMS’s Five-Star Quality Rating System. Oliver argues for national reforms – including increased investment in home and community-based services – along with providing “rigorous guardrails and oversight” to ensure funds are spent properly. “The longer we continue to ignore this,” warns Oliver, “the worse it’s going to get.”