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Medicare and Medicaid were created as part of “The Great Society,” an era when the role of government in helping the vulnerable was not debated — it was a responsibility. Medicare, and Social Security are not “entitlement” programs.

In fact, according to a New York Times article, five states (Alaska, Arizona, Minnesota, New Mexico and Oregon) spend more than two-thirds of their Medicaid budgets for long-term care on home and community-based care.

A deeper investment in home and community-based care, which older adults and their families prefer (and can often be less expensive than nursing home care), should be an essential ingredient in Medicaid reform.

They can deploy the word “entitlement” negatively and stop there without examining who might be entitled and why.

So let’s invoke some history as we prepare for the entitlement reform battles of 2018 and beyond.

I fully expect to be part of a broad-based coalition of aging advocates who will mount a concerted effort to delay or fully waive “paygo” for this tax bill.

That effort may succeed since there have been bipartisan comments opposing an immediate trigger of ”paygo.” There’s another concern about such major cuts to Medicare: how they would undermine the great progress Medicare is making toward improved solvency.

And, he said, “I think the president is understanding choice and competition works everywhere, especially in Medicare.” Last month, Sen.

Marco Rubio (R-Fla.) said: “We have to do two things.

(The donut hole is the amount of prescription drug costs Medicare beneficiaries must pay out-of-pocket; in 2017, that means expenses between ,700 and ,950.) Front and center in any discussion of entitlement reform is the future of Medicaid, which is a larger program than Medicare and which dodged more bullets in 2017 than anytime in its 52-year history. Nearly one in five Americans — 74 million people — rely on Medicaid to stay healthy and independent.

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