CMA Alert – Omnibus Appropriations Bill, Drug Use Among Older Adults, More

1. Highlights from FY18 “Omnibus” Appropriations Bill: Some Good, Some Not-So-Good News
2. This Week in Healthcare Sabotage: Double Digit Rate Hikes Expected and Proposed “Conscience” Rules
3. Elder Justice Alert: New York Times Publishes Article on Drug Use Among Older Adults

Highlights from FY18 “Omnibus” Appropriations Bill: Some Good, Some Not-So-Good News

On March 23, 2018, the president signed the fiscal year (FY) 2018 appropriations “Omnibus Bill” into law. The Bill provides funding for services and supports on which older people and people with disabilities rely. Fortunately, many misguided proposals that would have significantly reduced funding for these critical programs were rejected. Older people, people with disabilities and their families can rest a little easier knowing that programs that help them live with dignity and security will continue (for now).  In particular, we are grateful that the following funding was included in the Omnibus:

• Funding increase for Medicare State Health Insurance Program
• Funding increase for National Institutes of Health
• Some Older Americans Act (OAA) programs also received additional funding, including supportive services and senior centers, National Family Caregiver Support Program and some nutrition programs

As Congress turns its attention to the fiscal year 2019 appropriations process, The Center for Medicare Advocacy will continue to fight against any cuts that will harm older people and people with disabilities. In the Administration’s FY 19 budget request, we’ve already seen harmful proposals to cut Medicare, Medicaid, Social Security disability programs, Medicare State Health Insurance Programs (SHIPS) and elder justice programs. Through sustained advocacy, these misguided proposals were defeated in the FY 18 Omnibus, and they must be defeated again in the FY 19 appropriations process.

As we highlight some of the bright spots in the 2018 Omnibus, we are concerned that the Money Follows the Person program was not extended and support to stabilize the health insurance Marketplace was not included. Money Follows the Person provides critical support to help older people and people with disabilities access home and community- based services. The health insurance Marketplace enables older people and people with disabilities – who aren’t yet eligible for Medicare – gain access to quality health insurance. We call on Congress and the Administration to work together to ensure both of the programs get the attention and funding they need.

• See the FY 18 Funding Table from the National Council on Aging at https://www.ncoa.org/wp-content/uploads/FY18-Senate.pdf

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This Week in Healthcare Sabotage: Double Digit Rate Hikes Expected and Proposed “Conscience” Rules

Politico reported this week that due to (1) Congress not taking measures to stabilize the Affordable Care Act (ACA) Marketplace, (2) the repeal of the individual mandate and the (3) “wild card” Administration proposals to allow short-term plans, insurers are preparing for double-digit rate increases. For months, we’ve been highlighting the harmful impact of expanding the use of short-term "junk" insurance plans that don’t comply with ACA coverage protections. These so-called insurance plans would leave consumers without any real coverage when they need care the most. Consumers who remain in the individual market, including those who are older or have pre-existing conditions, would be left with higher costs.

Also this week, in conjunction with other advocacy organizations, the Center submitted comments to the Administration’s Proposed Rule: Protecting Statutory Conscience Rights in Health Care. We shared the concerns of many advocates that this proposal is an attack on healthcare rights. As we expressed in our comments, this action is discriminatory, violates federal statue, fosters confusion, and causes real harm to real people. All Americans deserve access to affordable, quality health coverage. A better use of the Administration’s time and resources would be working to reduce health disparities and implementing the ACA.

We call on the Administration to stop undermining health coverage for millions of Americans, and instead, to work toward ending – not exacerbating – disparate access to care.    

• Read the Center’s full comments on the Proposed Rule here: https://www.medicareadvocacy.org/cma-comments-on-conscience-rules/

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Elder Justice Alert: New York Times Publishes Article on Drug Use Among Older Adults

Revelations have shed light on an opioid crises in the United States that remained largely hidden until recently. These drugs have affected the lives of children and adults nationwide. Unfortunately, the inappropriate use of medication – legally or illegally – is not limited to opioids in its multigenerational reach. As the New York Times reports in “A Drug Problem Among the Elderly,” the use of benzodiazepines has “risen among older people, even though they are particularly vulnerable to the drugs’ ill effects.”[1]

The article highlights that, in 1999, there were “63 benzodiazepine-related deaths among those 65 and older.”[2] In 2015, there were 431 deaths, with more than two-thirds of these deaths also involving opioid use.[3] An epidemiologist at the National Institutes for Health told the Times that, even without the opioid issue, “[w]ay too many older Americans are getting benzos. And of those, many—more than half—are getting them for prolonged periods.” The article adds that such use can lead to falls and fractures, or memory and other cognitive problems.[4]

The New York Times article, however, is not alone in finding alarmingly inappropriate drug use among the nation’s elderly. Human Rights Watch published a devastating report in February 2018 that found, on average, 179,000 nursing home residents are being given off-label antipsychotic medications every week.[5] Remarkably, these findings come in the wake of a decision by the Centers for Medicare & Medicaid Services (CMS) to place an 18-month moratorium on certain enforcement remedies for violations of standards of care related to pro re nata (PRN)[6] psychotropic drug use in nursing homes.[7]

• To read the New York Times article, please visit: https://www.nytimes.com/2018/03/16/health/elderly-drugs-addiction.html
• To read the Human Rights Watch report, please visit: https://www.hrw.org/report/2018/02/05/they-want-docile/how-nursing-homes-united-states-overmedicate-people-dementia
• To read the CMS memorandum rolling back enforcement remedies, please visit: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-18-04.pdf.

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