Friday, August 6, 2010

Relief for States Means More $ for Medicaid

Today, the Senate approved $26 billion in relief for states that are suffering budget shortfalls, including $16 billion in funding for state Medicaid programs. The economic downturn, and specifically higher unemployment rates, have increased the demand for Medicaid while also causing greater financial strain on states.

Additional federal money to states for Medicaid was first made available in 2009 through the American Recovery and Reinvestment Act, which included an increase in the Federal Medical Assistance Percentage (FMAP). The increased funding is due to expire, however, on December 31, 2010, and the legislation passed today by the Senate would extend the increased matching funds through June 2011. The House of Representatives, who are currently on August recess, will return to Washington, D.C., to vote on the financial aid package next week. 

Medicaid programs provide health coverage for low-income individuals, including Medicare consumers who qualify for Medicaid. People with both Medicare and Medicaid are known as dual-eligibles. Medicaid can help cover Medicare cost-sharing and fill in gaps in Medicare coverage, such as many long-term care supports and services. 

Read more about the FMAP legislation and today’s vote
Learn more about implications of proposed state budget cuts.
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Accelerating Electronic Health Records Adoption and Meaningful Use

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The following joint statement, by the National Coordinator for Health Information Technology, David Blumenthal, M.D.,M.P.P., and the Centers for Medicare & Medicaid Services' Principal Deputy Administrator Marilyn Tavenner, was issued today at a forum,"Accelerating Electronic Health Records Adoption and Meaningful Use."

The forum was sponsored by the Health Industry Forum at Brandeis University and Health Affairs:

"The goal of achieving widespread adoption and meaningful use of electronic health records by 2014 is established in the Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH), part of the American recovery and Reinvestment Act of 2009.

The HITECH Act directs the Centers for Medicare & Medicaid Services(CMS) to administer an incentive payments program that will make available significant bonus payments to eligible health care providers who adopt and demonstrate meaningful use of certified electronic health records (EHR).  In addition, the HITECH Act provides for leadership and
support for EHR adoption and use through the Office of the National Coordinator for Health Information Technology (ONC). 

"On July 13, final regulations were announced by CMS and ONC that define the incentive payments program, the meaningful use requirements for Stage 1 of the program, and the standards and certification requirements for certified EHR systems.

"However, the CMS and ONC regulations establish only the parameters of the federal program.  The public and private sectors can and must collaborate in furthering the goal of creating a 21st century electronic health information system in the United States.

"For that reason we are pleased and encouraged by today's announcement of significant initial steps by organizations across the spectrum of health care to support HITECH's goal of furthering the meaningful use of certified EHRs.  These entities include providers, payers and professional licensure bodies.  The individual programs announced today show both an appreciation of the challenges we face as well as initiative and creativity in applying the resources of these organizations toward meeting our goals.  The actions announced today are also built on the meaningful use structure, which provides alignment of our national efforts toward coherent technology adoption and toward improved health and health care goals.
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Income Level for Individuals Eligible for Legal Services Corporation Assistance

The Legal Services Corporation (``Corporation'') is required by law to establish maximum income levels for individuals eligible for legal assistance. This document updates the specified income levels to reflect the annual amendments to the Federal Poverty Guidelines as issued by the Department of Health and Human Services.

Effective Date: This rule is effective as of August 6, 2010.
Final Rule
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Treatment of Co-Occurring Alcohol Use Disorders and Depression/Anxiety Disorders

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The National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institutes of Health (NIH), invites applications to support research on the treatment of individuals with co-occurring alcohol use disorders and depression/anxiety. Anxiety disorders include generalized anxiety disorder, social phobia, and posttraumatic stress disorder. The scope of interest includes innovative pharmacological and behavioral treatments based on biological, psychological, behavioral, and social/cultural models of etiology and treatment of comorbid alcohol use disorders and depression/anxiety. In addition, this FOA accepts Comparative and Effectiveness Research applications which compares two or more different existing treatments in this comorbid population. This FOA is limited to depression and anxiety because of the high prevalence of these psychiatric disorders in individuals with alcohol use disorders. Mechanism of Support. This FOA will use the NIH Exploratory/Developmental (R21) award mechanism and runs in parallel with a FOA of identical scientific scope, PAS-10-251, that encourages applications under the R01 mechanisms Funds Available and Anticipated Number of Awards. Awards issued under this FOA are contingent upon the submission of a sufficient number of meritorious applications. NIAAA has set aside $1.5 million in total cost for fiscal year 2011, and expects that a total of up to six awards will be made for this and companions FOAs. The total amount awarded and the number of awards will depend upon the quality, duration and costs of the applications received .


Eligible Applicants

State governments
Public and State controlled institutions of higher education
Native American tribal governments (Federally recognized)
Native American tribal organizations (other than Federally recognized tribal governments)
Nonprofits having a 501(c)(3) status with the IRS, other than institutions of higher education
Nonprofits that do not have a 501(c)(3) status with the IRS, other than institutions of higher education
Private institutions of higher education
For profit organizations other than small businesses
Small businesses
Others (see text field entitled "Additional Information on Eligibility" for clarification)

Link to Full Announcement

http://grants.nih.gov/grants/guide/pa-files/PAS-10-252.html
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CABG, PCI More Common Now in Oldest MI Patients

By Todd Neale, Staff Writer, MedPage Today

The use of revascularization procedures is increasing rapidly among patients 80 and older admitted for an acute myocardial infarction, a retrospective Canadian study found.

For such patients living in Quebec, rates increased for both percutaneous coronary intervention (from 2.2% to 24.9%) and coronary artery bypass grafting (from 0.8% to 3.1%) from the mid-1990s through 2006, Louise Pilote, MD, PhD, of McGill University in Montreal, and colleagues reported online in CMAJ.

And despite a similar rise in the prevalence of comorbidities in this population, one-year mortality declined from 46.5% to 40.9% (P<0.001), possibly related to the greater use of revascularization procedures and recommended medications.

"Substantial numbers of revascularization procedures are now being performed in very old patients for whom such procedures were not even considered a decade ago," they wrote. "In the context of an aging population and limited healthcare resources, it is imperative to determine whether such drastic changes in practice are cost-effective."
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Healthcare Reform Law Will Extend Life of Medicare Trust Fund from MedPage Today

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By Emily P. Walker, Washington Correspondent, MedPage Today

The healthcare reform law significantly improved the outlook for Medicare, the program's trustees said Thursday in their annual report.

Medicare's hospital trust fund will be solvent for 12 years more than projected last year, almost entirely because of savings from healthcare reform, said the trustees, which include Health and Human Services (HHS) Secretary Kathleen Sebelius, Labor Secretary Hilda Solis, Treasury Secretary Tim Geithner, and Commissioner of Social Security Michael J. Astrue.

"The outlook for Medicare has indeed improved greatly compared to this time last year, thanks to the Affordable Care Act," Sebelius said at a Thursday morning press conference.

Because of the projected savings under the healthcare reform law, Medicare's Hospital Insurance Trust Fund is not scheduled to be exhausted until 2029, the trustees said. While Medicare is still not financially sustainable in the long term when faced with an aging population, the report offers a rosier view than last year's report, which predicted bankruptcy of the Hospital Insurance Trust Fund in 2017.
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Thursday, August 5, 2010

News Analysis - In Push to Detect Early Alzheimer’s Markers, Hopes for Prevention - NYTimes.com

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by Gina Kolata

Will Alzheimer’s disease, a terrible degenerative brain disease with no treatments and no clear guidelines for diagnosis before its end stages, become like heart disease? That might mean early markers of risk, analogous to high cholesterol levels, that predict who is likely to get it. And it might mean drugs that actually prevent it.

That is the hope behind new diagnostic guidelines being proposed by the National Institute on Aging and the Alzheimer’s Association.

In July, when the groups first announced their proposed guidelines, they were met with some skepticism and anger. Why suggest ways of diagnosing the disease before a person even has symptoms? Why tell people they are doomed?

And are those early diagnosis guidelines just a sop to pharmaceutical companies so they can start marketing expensive, and perhaps not very effective, new drugs?

So the Alzheimer’s Association, with participation from the National Institute on Aging, held a conference call on Wednesday to clarify their position.
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New Data on Medicaid Enrollment and Costs, Medicaid Managed Care, Health Insurance Premiums, HMOs, and More

August 5, 2010
Data Update
Statehealthfacts.org has recently added new and updated data on Medicaid & CHIP, Medicare, Health Coverage & Uninsured, Health Costs & Budgets, Health Insurance & Managed Care, Providers & Service Use, Health Status, and Demographics & the Economy. You can also view a list of all recent updates.
Medicaid & CHIP
  • Medicaid Expansion under Health Reform New
    New data from the Kaiser Commission on Medicaid and the Uninsured (KCMU) and the Urban Institute on the projected impact of the new health reform law on both Medicaid enrollment and costs by 2019 are now available for all states and the nation.
  • Medicaid Managed Care
    Updated state-by-state data from the Centers for Medicare and Medicaid Services (CMS) as of June 30, 2009 on the total number of Medicaid beneficiaries enrolled in managed care plans and enrollment by plan type are available.
Medicare

  • Medicare Enrollment New
    New data from the Centers for Medicare & Medicaid Services (CMS) on Medicare enrollees with Medicare hospital insurance and/or supplementary medical insurance as of July 2008 have been added and are available for all states and the nation. Also new from CMS are data on enrollees with end stage renal disease (ESRD) as of July 2008.
Health Coverage & Uninsured
  • Private Sector Coverage
    The most recent data from the Agency for Healthcare Research and Quality’s (AHRQ) Medical Expenditure Panel Survey (MEPS) on the percentage of firms offering health insurance to employees and of firms offering health insurance coverage by firm size have been added for 2009.
Health Costs & Budgets
  • Employer-Based Health Premiums
    Updated data on employer-based insurance premiums based on AHRQ’s Medical Expenditure Panel Survey (MEPS) are now available by state. These include the average annual cost for single coverage, family coverage, and employee-plus-one coverage for 2009. The average share of the premium contributed by employees and employers are also available for all coverage types.
Health Insurance & Managed Care

  • Health Maintenance Organizations (HMOs)
    Updated state-by-state data from Healthleaders Inc. on the number of HMOs operating in each state, total HMO enrollment, and HMO penetration rates have been added for January 2009 and July 2009.
Providers & Service Use
  • Access to Care
    State-by-state data from the Centers for Disease Control and Prevention (CDC)’s Behavioral Risk Factor Surveillance System (BRFSS) on the percentage of adults reporting not seeing a doctor due to cost are available for 2009.
Health Status
  • Child and Teen Mortality
    Updated 2007 data from the Annie E. Casey Foundation on the death rates for children ages 1-14 and teenagers ages 15-19 are available for all states and the nation. The child and teen mortality data are also available in trend form for 1990-2007.
  • Obesity
    The latest CDC data from the BRFSS on adults who are overweight or obese have been added for all states and the nation for 2009. Data are also available by gender and race/ethnicity.
  • Physical Activity
    Updated state-by-state data from the CDC’s BRFSS on adult participation levels in physical activity for 2009 are now available.
  • Diabetes
    New BRFSS data from the CDC on the percentage of adults diagnosed with diabetes in 2009 have also been added and are available for all states and the nation.
  • Adult Vaccinations
    Other 2009 data from the CDC’s BRFSS include the percentage of the elderly who have ever had a pneumonia vaccine and the percentage of the elderly who had an influenza vaccine in the past year.
Demographics & the Economy
  • State Budget Shortfalls New
    New data on projected state budget shortfalls for state fiscal year (SFY) 2012 have been added and are available for all states and the nation from the Center on Budget and Policy Priorities (CBPP). Data on state budget shortfalls for SFY 2011 and SFY 2010 have been updated.
  • Unemployment
    The most recent data on unemployment rates have been added from the Bureau of Labor Statistics (BLS) for all states and the nation for June 2010.
  • State Fiscal Distress
    Measures of aggregate state rankings in foreclosures, unemployment, and food stamp participation have been updated with the latest information from the BLS and RealtyTrac.



Statehealthfacts.org is a Kaiser Family Foundation website.

Report: 'Stigma' at State Department for those seeking mental health treatment

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by Josh Rogin

The State Department is moving to improve how it handles mental health services for employees coming back from high-stress or high-threat postings, but there's still a great deal of stigma attached to seeking this kind of help and the department needs to do more, according to a new internal report.

"Employees believe there is still a significant stigma attached to seeking mental health assistance," the State Department Office of Inspector General (OIG) said in a report released last week. The OIG called on State to remove the stigma by issuing a high-level statement encouraging returning diplomats to use the mental health tools at their disposal.

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Wednesday, August 4, 2010

TIME GOES BY | Reverse Mortgages - Part 5: The Mandatory Counseling Session

by Ronni Bennett

On Wednesday, I participated in the counseling session required by the U.S. Department of Housing and Urban Development (HUD) of all HECM (FHA insured) reverse mortgage applicants. A lender may not begin the mortgage process until it receives the certificate, signed by the counselor and applicant, that counseling has been completed.

The counseling is invaluable. My only complaint is that it should be done BEFORE you look for a lender. I did a lot of research and study, then used the HUD website to retrieve a list of local HUD-approved lenders, but my work would have been much more efficient if I'd had the counseling first – including some direction in how to choose a lender which the counseling includes.

If you get as far as choosing a lender before the counseling, the lender is required to give you a list of nine HUD-approved counselors to choose from. I didn't know that, so I asked the National Council on Aging (NCOA), a HUD-approved HECM counseling intermediary, for a recommendation.

The NCOA takes HUD-approved reverse mortgages seriously and offers trained counselors for no fee to low-income participants and for a $125 fee to higher-income applicants. The fee can be rolled into the reverse mortgage along with closing costs, home appraisal, etc., and the fee is waived with NCOA counselors unless you go through with obtaining a HECM.

The goal of this post today is not to provide you with details of the workings of HECM reverse mortgages, but to explain what you can expect from the counseling session.

My Counselor

Counseling may be done in person or by telephone. A face-to-face meeting is advisable if you are relatively uninformed about how HECMs work. In my case, I already had a lot of information so I was offered a phone session with Buz Zeman, a HUD-authorized counselor affiliated with NCOA.

He is also the director of Housing Options for the Elderly, Inc. (HOPE) in St. Louis, Missouri, and a veteran, since 1993, of 3,000 HUD HECM counseling sessions who also trains incoming HUD counselors. There isn't much he doesn't know. He was thorough, patient and an all-around good guy – a smart, impartial coach to obtaining a reverse mortgage.

In our first conversation last week, he asked some personal questions that would aid him in preparing for our counseling session: my age, income, marital status, estimated value of my home, whether there is a mortgage or other encumbrances, etc. All information is confidential and never disclosed to an applicant's lender.
We set a date and time for the counseling and Buz emailed a packet of information that included:
  • A letter confirming our appointment along with a list of the included documents for my review
  • A sample certificate of having completed the counseling
  • An overview of reverse mortgages
  • A list of the topics to be covered during the counseling session
  • A loan analysis including estimates and comparison – as examples - of the several versions of HECMs that I might choose from
  • Amortization tables showing examples of how much money would be paid out and left as equity over a period of years
  • Benefits checkup – other kinds of financial help that may be available locally
  • Going green and Energy Start information
  • Information you should know about after getting a reverse mortgage
Counseling will determine if you are eligible for a reverse mortgage and help you make an informed choice, but counselors do not recommend specific loan products or specific lenders.

The Counseling Session

Buz telephone at the appointed time and he began with his explanation of the counselors role. He then went through the personal and property eligibility requirements - currently, most co-op apartment are excluded but, according to Buz, should be included soon.

Then we went through the details of how a reverse mortgage works and in great detail, the numbers in the example reverse mortgage types he had prepared for me. I printed these out so I could follow along more easily than onscreen and make notes as we spoke.

Personalized HECM Details

This isn't easy stuff even if, like me, you have done extensive homework on reverse mortgages before the counseling. Buz's estimates came on a page with three examples of possible loan types I might choose from, side-by-side so I could compare.

He explained how the loan amount and interest rate are arrived at and how, if you choose an adjustable mortgage, it can change in the future. The loan principal limit is an estimate at this point that will change depending on the appraised value of your home which you won't know until you have begun the loan process.
[By the way, interest rates are very low right now, but there is no guarantee that will remain so in our volatile economic climate so this is a good time to do it if you have been considering a reverse mortgage.]

Costs and Fees

We went through the fixed costs and fees, and those that are variable – the latter being the lender's “margin” (interest rate), monthly service fee if you choose a variable rate loan and its “set aside,” origination fee and closing costs. These are subtracted from the final principle amount of the loan.

Like I said, there is much to learn in the details of this which involves a lot of numbers and percentages, but Buz patiently explained each item with excellent analogies that made it easier to understand.

I had been given similar estimates from the three lenders I had contacted. Most of the numbers were near matches to Buz's except for the loan origination fee of which there is a large spread of nearly $3600 among the three. Buz explained that although the origination fee is capped for most HECMs at two percent of the home appraisal, in recent months as HECMs have become more popular, some lenders have been reducing this charge (and/or some others) to be more competitive, which is a good reason to shop for a lender.
Buz noted that occasionally exorbitant title company fees have been discovered. This should not vary much from what a counselor has estimated for you and you can question these costs.

It helped a lot when Buz explained costs that are familiar from forward mortgages and those that are unique to reverse mortgages.

An important consideration is closing costs that can vary widely from lender to lender, but they should be close to your counselor's estimate. If they are much higher, you should consult your counselor. In my case, I have the list of closing costs from my recent purchase of this home so I will be able to compare those with the itemized list I will get when I apply for a reverse mortgage with a lender.

Prior to our counseling session, I had typed out a list of questions I had. Most of those were answered as Buz talked me through the possible loan terms and he carefully explained those that remained. This part of the counseling took up most of our time together.

Other Counseling Topics

He also explained tax implications. No income tax is paid on reverse mortgage income (it is a loan, after all) and interest is not deductible. Important: food stamps, SSI. Medicaid payments and a few other benefits can be negatively impacted.

Sometimes there are options other than a reverse mortgage that may be more sensible depending on personal circumstances and intended use of the funds. Those were clearly explained too along with the borrower's obligations.

Obligations include keeping property taxes, homeowner's insurance, flood insurance (if required in your area) and repairs up to date.

Buz and I covered many other details of reverse mortgages, but these are the major points. Buz also assured me that if I have more questions he is available by phone and email to answer them.

Choosing a Lender

You should definitely shop for a lender to get the best deal. Even a .25 percent difference in an interest rate can translate into an increase or decrease of thousands of dollars in the principal amount available to you from a reverse mortgage. And as mentioned above, some lenders are currently reducing costs in the name of competition, but this could change in the future.

Each lender you speak with should give you a written preliminary cost estimate on all the kinds of reverse mortgages that are available. Later, when you have chosen a lender, you will receive a Good Faith Estimate (GFE) which will be as close as possible to the final figures, although they can change slightly in the interim between receiving the GFE and closing.

Fraud is a common concern in regard to reverse mortgages; they have had a poor reputation. This should not be so. The vast majority of HECMs abide by HUD regulations, but there are occasional exceptions. From the preliminary material Buz emailed before our session:
”HUD has learned of a fraud scheme involving HECM loan officers. In one scheme, the loan officer arranges for the title company to pay the loan proceeds through two checks. One check is sent to borrower and the other is kept by the loan officer.

“In another scheme, the loan officer persuades the senior to sign over loan proceeds to the loan officer for future disbursement to the HECM borrower...

“The proceeds received from a loan should be paid directly [and only] to the borrower or should be deposited into the borrower's bank account.”
I don't know if all counselors do so, but Buz included in his package to me a list of lender deceptive practices that should be a red flag to anyone considering a HECM. Among them:

• Pressure to buy other financial products and services with the proceeds from your reverse mortgage
• The suggestion that a HECM is a “government benefit.” It is not; it is insured by the federal government
• The suggestions that a HECM will provide income for life. Funds are available only for as long as you live in your home
• A lender who pressures you to act quickly
• A lender that obligates you to fees before you receive the Reverse Mortgage Counseling Certificate

Bottom Line on Counseling

Buz cautioned that all counseling is not created equal so shop for a counselor as you do for a lender. If a prospective counselor tells you, for example, that the session can be done in less than hour, it will not be useful or worthwhile.

Although HUD requires training for all their approved counselors, Buz says it is not always adequate. HUD is working to improve training and certification, but meanwhile you should choose carefully to get the full benefit. Any good counselor should send you a package similar to what I have outlined before the session.

Personally, I recommend finding a counselor through the NCOA. It is an excellent advocate organization for elders that takes its mission seriously.

As mentioned above, I am convinced that counseling makes more sense to be done prior to shopping for a lender. Buz and the NCOA agree and are pushing for that to become standard.

I could not be more pleased with the counseling I received from Buz. Even with the research I had done before our session, I learned a lot that I hadn't known. He gave me alternative ways to think about some of the details and choices I was considering and I came away from our conversation feeling thoroughly grounded – so much so that I wish I had a Buz Zeman for other aspects of my life.

Thanks to Buz and my own research, I have decided to go forward with the HECM, and the next post in this series will report on the loan process.

The TGB Reverse Mortgage Series
Part 1: One Reason For a Reverse Mortgage
Part 2: The Basics
Part 3: Finding a Lender
Part 4: Do Not Fear HECMs

TIME GOES BY | Reverse Mortgages - Part 5: The Mandatory Counseling Session
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TIME GOES BY | GRAY MATTERS: Obama and Elders

by Saul Friedman, Gray Matters and TGB Reflections

It may be said that Barack Obama, among his other firsts, has become the first president of the Internet age. The Internet, specifically the World Wide Web, did as much as anything in his campaign to help him win the presidency. And with some unprecedented techniques, he has governed through the internet - explaining his positions, publicizing his major proposals, making promises on issues such as Medicare and Social Security, and assuring prospective voters that his is one of the most open and tech-savvy administrations.

From the beginning of his campaign through his first year in office, he has had great help from a booming, left-leaning blogosphere including Move-On, the Center for American Progress, Buzzflash, Common Dreams, The Daily Kos, Crooks and Liars, Firedoglake and the very profitable Huffington Post.

George Bush could have used the net but as in most things worldly, he seemed ignorant about the internet and oblivious about its uses; and there seemed to no one able to teach him, if he was teachable.

Towards the end of his presidency some corporations helped found a couple of phony grass roots groups and sites such as Freedomworks.org, which was run by lobbyist and former House Majority Leader (under Newt Gingrich) Richard Armey, who helped create the Tea Party movement and now seeks the privatization of Social Security and Medicare, among other right-wing causes.

During Bush's tenure, Armey got money from corporations, to bring in audiences to the White House to support some of Bush’s initiatives; I doubt that Bush knew. But Bush and Vice-President Dick Cheney did not use or need the internet as long as they had the cheerleaders of Fox (faux) News.

Now with no Bush to love, Fox has continued to have more influence that the pro-Obama blogs in its scurrilous campaigns, with Glenn Beck, Rush Limbaugh and Bill O’Reilly to cripple the Obama presidency. Think of what Fox did to Georgia Agriculture Department official Shirley Sherrod; it was a television lynching and Fox has still not owned up to its crime.

Obama has had relatively friendly relations with networks like MSNBC, and its commentators, Rachel Maddow, Chris Matthews and Keith Olbermann. But they have not been Obama toadies, for they have been critical of the president and his policies, especially his compromises, when warranted. But they have not resorted to the kind of loony, hateful vindictiveness seen on Fox.

In an effort to bypass the mostly wrongheaded and irrelevant mainstream media, Obama has depended on several well done, professional web sites to get his messages of accomplishments across. The site www.change.org, ended with the beginning of Obama’s presidency.

It became the president’s perennial campaign site, Organizing for America, where people can link with the Democratic Party, sign up for the latest news from the administration, volunteer to help Democratic campaigns, read the White House analyses of new legislation such as the Wall Street reforms and the latest battles in the Congress. If you sign up, you’ll get periodic updates and you may be asked to contribute to Democratic organizations.

When last I looked at the site, it was linked to just about every social networking service, under the heading, Obama Everywhere. And I watched a fair but simplistic YouTube presentation on what the Wall Street reforms mean to homeowners. It does not include the giveaways to banks as a result of Republican opposition and Obama’s compromises.

If you want to know more than that, try financialstability.com which is a private search engine for financial planning and advisors. I don’t know if they have financial ties to Democrats.

As the administration perfects its internet strategy, it has created sites specific to the messages it wishes to deliver. The newest and most useful is HealthCare.gov which was launched earlier this month by the Department of Health and Human Services.

The site was designed for relatively simple searching to learn what the new health care reforms are offering and how to find private insurance. You may choose your state and find coverage options for yourself and your family and you can familiarize yourself with the new regulations that prohibit cancellation of your insurance if you get sick or refusal of coverage for a pre-existing condition.

Also, there is some handy information on what is now the law: Adult children can stay on their parents’ insurance until age 26. If you enroll in Medicare on a private plan, after September 23, most preventive tests, mammograms, prostate tests, colonoscopies and immunizations, will be free – no deductibles, or co-insurance.

And I guess you know by now that if your Part D drug coverage finds you in the dreaded doughnut hole, let HHS know and the government will ease your pain with a $250 check. Beginning next year the law calls for the gradual closing of the hole. The site has a link to one of the better nonprofit advocacy sites, The Center for Medicare Advocacy.

All this internet stuff is good, but the White House internet machine and its blogger allies are missing an important audience that Obama has overlooked to his political peril. Older people, who should be his natural constituency are not as enamored with Obama as many younger voters. One reason they are ignored; most of elders don’t use the internet. And the Obomans have, from the start, gone after the votes and enthusiasm of younger people.

But older people are the most consistent voters and their number is growing. The latest Pew Research poll reports that older voters are inclined this year to vote Republican by a 52-41 margin, Even voters over the age of 49 say they’ll vote Republican by a 45-43 margin.

Only young voters say, by a 57-32 margin, they’ll vote Democratic. Pew says Obama’s approval rating has dropped this summer by nine points among white independents and 12 points among women over 50.

Those figures for older voters, which reflect how they voted in 2008, suggest they will be voting against their interests for the Republicans promise to privatize Medicare and dismantle Social Security. But the older generation, may not believe those threats and may be more concerned about and afraid of the huge federal debt. They are, after all, still recalling the Great Depression.

Beyond that, Barack Obama’s youth and his cool and cerebral style, according to many commentators, are not connecting with the older generations. Their members of Congress hold meetings about the health care reforms, but they reach only a few people.. And the Medicare manuals they will get can be confusing.
Older people don’t care much about the reforms in private insurance, which they don’t use.

While more and more older Americans are taking to the internet, large numbers depend on the mails, television, their neighbors and doctors to figure out how the health reforms will or won’t affect them.
I’m not aware that HHS is reaching out to older people with mailings. And all they know is that they don’t want the government messing wit their Medicare.

Write to saulfriedman@comcast.net


TIME GOES BY | GRAY MATTERS: Obama and Elders

TIME GOES BY | Big Brother is Out to Control All Elders' Money

by Ronni Bennett

Recently, Cowtown Pattie of Texas Trifles blog sent me an eight-page brief [pdf] from the Center for Retirement Research at Boston College titled What is the Age of Reason? In Pattie's words, it is a “chilling read” and she is not wrong.

The four authors of this brief are identified as a senior financial economist with the Federal Reserve Bank of Chicago, a senior economist with the Federal Reserve System, a professor of finance at New York University and another professor at Harvard.

Among them, they acknowledge funding from the National Science Foundation (NSF) which is a federal agency and the National Institute on Aging (NIA), a division of the National Institutes of Health that describes itself as “leading the federal effort on aging research.” Bear with me – it's important that you know the genesis of this document.

The authors note that the views expressed in the brief
“do not represent the policies or positions of the Board of Governors of the Federal Reserve System, the Federal Reserve Bank of Chicago, or the Center for Retirement Research at Boston College.”
Whether the views of the NSF or NIA are represented is not stated.

Four of those eight pages of the brief are a title page, references and endnotes, so there's not much text.
The majority of the brief, including four graphs, gives a short overview of studies the authors analyzed which, they say, show “The prevalence of both dementia and cognitive impairment without dementia rises rapidly with age” and that older adults make more financial mistakes than mid-age adults.

All right - so far, so good in that this is true for SOME old people, although the information is nothing new. This is what academics do – slice and dice each other's work, sometimes to good effect and sometimes not, and issue thousands of briefs every year most of which sink into oblivion. But then the authors get to their conclusions ominously titled, “Possible Policy Responses”:
“In response to this problem, several policy approaches are possible and government intervention is probably desirable, although the ideal form of intervention remains unclear.” [emphasis added]
The authors immediately dismiss their first and only benign policy suggestion for government intervention - to strengthen financial disclosure requirements to the public – by stating that “we are skeptical that improved disclosure will be effective in improving financial choices.”

Then the brief begins to get scary – remember, this all targets elders. The second suggestion involves “financial driving licenses,” the requirement to pass a test before being allowed to make non-trivial financial decisions. They ask a whole bunch of feasibility questions including the all-important, Who would be required to take the test?

Well, not me; I will resist clear to the barricades. Reading this brief, I'm beginning to have some sympathy for the teabaggers who object to too much government.

In their final suggestion, the authors step all the way across the line into totalitarianism with “mandatory advance directives” in which adults would be required by a certain age to sign a document placing management of their assets with a third party if they become incapacitated.

That's already too much to stomach, but it gets worse.
“...a fiduciary could be appointed to approve all 'significant financial transactions' involving the principal’s funds after the principal reaches a designated age.” [emphasis added]
In regard to that diabological idea, the authors admit that “it might be perceived by some older adults as an unfair restriction targeted against them.”

DUH!

Not content to pull Social Security out from under elders (as too many in Congress are currently attempting to do), now they are thinking up ways to take everything else old people have.

As I noted above, thousands of such studies are written each year and most sink out of sight before the ink is dry. Some of them sometimes work their way through the bureaucracy to become policy or law. I have no confidence that this one, that would give the government or its appointees access to trillions of dollars in elder assets, will disappear.

Remember that two of these researchers work for federal agencies involved with monetary policy of commercial and investment banking, two others with major universities that are paid to supply the federal government with policy research, and the funding for this project comes from two other federal agencies.

Read the brief for yourself here [pdf].


TIME GOES BY | Big Brother is Out to Control All Elders' Money
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An Alternative to the Feeding Tube - The New Old Age Blog - NYTimes.com

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The Times reports today on a new option in palliative care called “comfort feeding only.”

At issue: Feeding tubes do not necessarily prolong life in patients with advanced dementia, and surveys indicate that a vast majority of nursing home residents say they would rather die than live with a feeding tube.

But medical orders like “no artificial hydration and nutrition” — used to indicate that the patient should not be given a feeding tube — are often interpreted as “do not feed.” And few people can tolerate the idea that a loved one may be starving to death.

Comfort feeding offers another alternative.

“Just imagine someone interacting with the patient, talking to them, cueing them into eating,” said Dr. Joan Teno, a professor of community health at Brown University’s medical school, “as opposed to someone walking to the bedside and pouring a bottle of Ensure down the feeding tube.”

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Being There, Without Leaving Home - The New Old Age Blog - NYTimes.com

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by Paula Span

At the Selfhelp Benjamin Rosenthal Senior Center in Queens, a social worker, Rachel Itzkowitz, is leading the weekly current events class, guiding participants through a series of discussions. What did they think about that shooting at the Mexican border? About higher compensation for first responders injured on Sept. 11? And what about the controversy over building a Muslim community center near the World Trade Center site?

With backing from Microsoft and the city’s Department for the Aging, Selfhelp has created a “virtual senior center” for about a dozen low-income elderly people, with six more scheduled to join the party at the end of the summer.

Even with big touch-screen monitors and an easy-to-use interface (called It’s Never Too Late), it took twice-a-week training for a couple of months before the new users could manage the equipment. Most had never used a computer. One who’d never learned to type found the QWERTY keyboard confusing, so Microsoft substituted one with keys in alphabetical order. The group has taken advantage of adaptations like magnifiers and screen readers that read text aloud.

Bringing older people online proved to be, in other words, a labor-intensive undertaking. But Selfhelp’s vice president for senior communities, Leo Asen, is convinced that the benefits justify it.

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The Outlier - The New Old Age Blog - NYTimes.com

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by Paula Span

I was about to post a hail-and-farewell to the veteran journalist Daniel Schorr, who died last week, not only because of his long and distinguished broadcast career, but also because I’d heard him capably analyzing the news on NPR’s “Weekend Edition” just a couple of weeks ago. He was about to turn 94.

I reconsidered, though, when I realized that this constitutes a sin I’ve accused others of committing: glorifying the exceptions, the folks who remain active and productive until days before death. I once heard a gerontologist call them “supergeezers,” an improvement over the stereotype of useless seniors in rocking chairs — but a stereotype, nonetheless.
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Monitoring Elderly Parents - NYTimes.com

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It used to be that parents kept tabs on their children. But The Times reports this morning on new technology making it possible for adult children to monitor, to a stunningly precise degree, the daily movements and habits of their aging parents.

The purpose is to provide enough supervision to make it possible for elderly people to stay in their homes rather than move to an assisted-living facility or nursing home, and in truth many of the systems are godsends for families. But, as with any parent-child relationship, all loving intentions can be tempered by issues of control, role-reversal, guilt and a little deception — enough loaded stuff to fill a psychology syllabus.
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Tuesday, August 3, 2010

Family Relations: An International Comparison - The New Old Age Blog - NYTimes.com

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by Paula Span
Compared with elderly parents and adult children in five other industrialized nations, Americans are twice as likely to have “disharmonious” relationships, a new multinational study has found. And we’re correspondingly less likely to have “amicable” relationships marked by strong affection and relatively free of conflict.

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CareOregon: Transforming the Role of a Medicaid Health Plan from Payer to Partner - The Commonwealth Fund

CareOregon, a Portland, Oregon-based nonprofit Medicaid health plan, developed two innovative programs to help optimize care for its enrollees: a patient-centered medical home initiative in safety-net clinics and a multidisciplinary case management program for members at high risk of poor health outcomes. To implement these programs, the health plan emphasizes the use of learning communities through which independent providers can acquire, share, and practice techniques to achieve three goals: improve population health, enhance the patient experience of care, and reduce the rate of increase in the per capita cost of care. These goals are the focus of the Triple Aim, an Institute for Healthcare Improvement initiative that is helping CareOregon define and reach its goals. By partnering with health care providers to create and pursue a common vision for improving primary care delivery, CareOregon is transforming its role from payer to integrator of care on behalf of its members.

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The Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey: Views on Delivery System Innovation and Improvement - The Commonwealth Fund

Nearly nine of 10 leaders in health care and health care policy believe current financial interests and lack of incentives for integration are significant barriers to the growth of accountable care systems. The latest Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey finds strong majorities of leaders report that providing special payment arrangements and incentives to providers—like those in the Patient Protection and Affordable Care Act—will be effective strategies for fostering coordination and integration in health care delivery. More than eight of 10 leaders feel that developing performance metrics, implementing provisions to increase transparency and public reporting, and establishing an Innovation Center within the Centers for Medicare and Medicaid Services should receive high priority from the Secretary of Health and Human Services. Survey respondents support development of a national accreditation system for accountable care organizations and public utility-type regulation of payment rates in areas with insufficient market competition.

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Local celebrities welcome Scottish service for older gays - PinkPaper.com

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One of Scotland’s first services aimed at older gay people has been endorsed by a string of celebrities, describing it as a “service desperately needed”.

LGBT Age will tackle social exclusion and isolation through social, befriending, information and advocacy services, as part of the LGBT Centre for Health and Well-being.

Garry McGregor, LGBT age coordinator, said support for the scheme was “testament” to the need for an age-linked programme.
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Monday, August 2, 2010

Advisory Council on Employee Welfare and Pension Benefit Plans; Nominations for Vacancies

Section 512 of the Employee Retirement Income Security Act of 1974 (ERISA), 88 Stat. 895, 29 U.S.C. 1142, provides for the establishment of an Advisory Council on Employee Welfare and Pension Benefit Plans (the Council), which is to consist of 15 members to be appointed by the Secretary of Labor (the Secretary) as follows: three representatives of employee organizations (at least one of whom shall be a representative of an organization whose members are participants in a multiemployer plan); three representatives of employers (at least one of whom shall be a representative of employers maintaining or contributing to multiemployer plans); one representative each from the fields of insurance, corporate trust, actuarial counseling, investment counseling, investment management, and accounting; and three representatives from the general public (one of whom shall be a person representing those receiving benefits from a pension plan). No more than eight members of the Council shall be members of the same political party.

Members shall be persons qualified to appraise the programs instituted under ERISA. Appointments are for terms of three years. The prescribed duties of the Council are to advise the Secretary with respect to the carrying out of his or her functions under ERISA, and to submit to the Secretary, or his or her designee, recommendations with respect thereto.

The Council will meet at least four times each year. The terms of five members of the Council expire on November 14, 2010. The groups or fields they represent are as follows:

(1) Employee organizations (representing an organization whose members are participants in a multiemployer plan);

(2) employers (representing employers maintaining or contributing to multiemployer plans);

(3) accounting;

(4) insurance; and

(5) the general public.

The Department of Labor is committed to equal opportunity in the workplace and seeks a broad-based and diverse ERISA Advisory Council. Accordingly, notice is hereby given that any person or organization desiring to recommend one or more individuals for appointment to the Advisory Council on Employee Welfare and Pension Benefit Plans, to represent any of the groups or fields specified in the preceding paragraph, may submit recommendations to Larry Good, ERISA Advisory Council Executive Secretary, Frances Perkins Building, U.S. Department of Labor, 200 Constitution Avenue, NW., Suite N-5623, Washington, DC 20210, or to good.larry@dol.gov.

Recommendations must be submitted on or before September 17, 2010. Recommendations may be in the form of a letter, resolution or petition, signed by the person making the recommendation or, in the case of a recommendation by an organization, by an authorized representative of the organization. Recommendations should include the position for which the nominee is recommended and the nominee's full name, mailing address, phone number, and e-mail address. The recommendation also must state that the candidate will accept appointment to the Council if offered. Nominees will be contacted to provide information on their political affiliation and their status as registered lobbyists. Nominees should be aware of the time commitment for attending meetings and actively participating in the work of the Council. Historically, this has meant a commitment of 15-20 days per year.

FR Doc 2010-18897
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``Add Us In'' Program

AGENCY: Office of Disability Employment Policy, Department of Labor. Announcement

Type: New Notice of Availability of Funds and Solicitation for Grant Applications. The full announcement is posted on http://www.grants.gov.

Funding Opportunity Number: SGA 10-05.

Key Dates: The closing date for receipt of applications is September 1, 2010 via http://www.grants.gov. Funding Opportunity Description: The U.S. Department of Labor (``DOL'' or ``Department''), Office of Disability Employment Policy (ODEP) announces the availability of approximately $2.3 million to fund up to four cooperative agreements with consortia ranging from $500,000 to $625,000.

The objectives of this new initiative, Add Us In, are:
(1) To increase the ability of targeted businesses to employ adults and youth with disabilities;
(2) to develop and evaluate replicable models, strategies and policies that would ensure that youth and adults from targeted populations with disabilities have access to a broader range of employment and mentoring opportunities; and
(3) to form and strengthen connections between targeted businesses, diversity-serving organizations, youth-serving organizations and disability-serving organizations, building a national and local network of experts skilled in serving individuals with disabilities.

These objectives will be accomplished through the competitive funding of consortia tasked to design, implement, and evaluate innovative systems models that support integrated employment opportunities for people with disabilities within targeted businesses.

For the purposes of this solicitation, the target population consists of members of the following groups: African American, Asian American (including Asian Americans of West Asian decent, e.g., India, and Asian Americans of East Asian decent, e.g., Japan and Korea), Latino or Hispanic American, federally recognized Tribes and Native American communities (including American Indians, Alaska Natives, Native Hawaiians, and other Native Pacific Islanders (including American Samoan Natives)), Lesbian, Gay, Bisexual, Transgender (LGBT) individuals, and women.

A targeted business is a for-profit enterprise such as a sole proprietorship, partnership, corporation, or joint venture of any kind, regardless of size, physically located in the United States or its trust territories which is at least 51 percent owned, operated and controlled on a daily basis by a United States citizen (or citizens) who are members of a target population.

The full Solicitation for Grant Application is posted on http:// www.grants.gov under U.S. Department of Labor/ODEP. Applications submitted through http://www.grants.govor hard copy will be accepted. If you need to speak to a person concerning these grants, you may telephone Cassandra Mitchell at 202-693-4570 (not a toll-free number). If you have issues regarding access to the http://www.grants.gov Web site, you may telephone the Contact Center Phone at 1-800-518-4726.
FR Doc 2010-18762
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Bone Density May Predict Prostate Cancer in Old Age from MedPage Today

By John Gever, Senior Editor, MedPage Today

Bone scans might help identify men at high risk for aggressive prostate tumors as they age, researchers said.

Starting at about age 70, men in a long-term prospective cohort study who were diagnosed with high-risk prostate cancers tended to have relatively high levels of bone mineral content when measured up to 35 years earlier, reported Stacy Loeb, MD, of Johns Hopkins University, and colleagues.

The findings, from a longitudinal study of 519 men that began in 1958, were reported in the July issue of the British Journal of Urology International. "Although the biology underlying this association requires additional study, these findings suggest that host factors in the bony milieu may be related to prostate cancer development and the progression to advanced disease," Loeb and colleagues wrote.
They noted that the frequency of bone metastases in patients with prostate cancer suggested some biological association between these tumors and bone. The researchers also cited a previous study suggesting a link between higher bone mineral density and prostate cancer incidence, although the connection seemed weak.
In the current study, Loeb and colleagues looked at data from the Baltimore Longitudinal Study of Aging, in which participants have undergone comprehensive medical exams about every two years since 1958.
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Book Review - Long for This World - The Strange Science of Immortality - By Jonathan Weiner - NYTimes.com

By ABRAHAM VERGHESE-July 30, 2010

In his remarkable Pulitzer Prize-­winning book, “The Beak of the Finch,” Jonathan Weiner followed Peter and Rosemary Grant, biologists who had spent years studying birds in the Galápagos Islands. Their work showed that finches evolve rapidly in response to changes in the food supply, a discovery that ran counter to Darwin’s idea that natural selection operates only very slowly. Weiner’s portrait of this scientific couple worked well as a narrative portal to that story of evolutionary biology.

In his new book, “Long for This World,” Weiner makes similar use of another brilliant theoretical scientist, the English gerontologist Aubrey de Grey, a tireless proselytizer for radical life extension. But unlike the Grants, de Grey emerges on the page as someone who can be taken only in small doses. “Medievally thin and pale,” as Weiner puts it, with a luxuriant beard that recalls “Father Time before his hair turned gray” or “Timothy Leary unbound,” he is given to provocative statements that can turn into sermons. Nevertheless, with de Grey as his main character, Weiner explores the fractured, fuzzy science and pseudoscience of immortality.
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Long for This World: The Strange Science of Immortality The Beak of the Finch: A Story of Evolution in Our Time