LCAO - Candidates Speak Out On Senior Issues

Leadership Council of Aging Organizations
Presidential Candidates Survey

There is a great deal of discussion recently about the sustainability of the Medicaid program. Some have proposed a dramatic overhaul of the program, capping federal funding and undermining the federal and state obligations to provide quality, comprehensive health care for millions of seniors, people with disabilities, and children.

What do you think should be done to ensure the sustainability of the Medicaid program and improve it? Prior to full meaningful reform, would you support the continuation of a temporary increase in the Federal Medical Assistance Percentage (FMAP)?

Do you support a Medicare prescription drug benefit, and if so, will you commit financial resources in your fiscal year 2006 budget submission to address the serious deficiencies in the reported conference agreement and work to fix serious structural deficiencies? Specifically, senior organizations believe that the House and Senate bills and conference bill each have major deficiencies. The bills, for example, have a doughnut hole where beneficiaries get no insurance help. The bills are estimated to cause some employers to drop existing retiree coverage.

Structurally, we do not currently know the nature and details of the final bill, but most LCAO organizations oppose (a) artificial budget caps, (b) the lack of a dependable fallback delivery system, (c) an administratively complex means testing of the benefit (d) the failure to obtain more cost savings in prescription drug prices, and (e) competition between traditional fee-for-service Medicare and various types of managed care plans.

The Medicare program only covers about half the medical costs of seniors and the benefits package needs to be improved and modernized. The number of Americans enrolled in Medicare will double between 2010 and 2030 and the program will roughly double in cost. The program can be financed by (1) increased taxes, (2) provider payment cuts, either directly or through intermediaries such as managed care plans, (3) increased cost sharing by beneficiaries, or (4) a combination of the above.

What are your specific plans to help ensure the financial future of the Medicare program?

Social Security has been the cornerstone of the nation=s income protection system for nearly 70 years. It provides disability, retirement and life insurance protections to virtually all American workers and their families. The system is fiscally sound, efficiently managed and exceptionally reliable.

According to the Social Security Trustees, without any changes at all, full benefits can be paid until 2042. Even after that, incoming revenues will be sufficient to pay about 70% of obligations for decades thereafter. While Social Security is not in crisis, the sooner we act to ensure its continued long-term solvency, the more moderate the necessary adjustments and the more time individuals will have to adjust their retirement planning.

The Supplemental Security Income (SSI) program provides a basic safety net for 6.6 million needy aged, blind and disabled adults and children. However, benefits have remained unchanged for years, along with income caps and asset limits for determining eligibility, and outreach efforts to identify potential beneficiaries. Improvements to the program are needed to ensure SSI can adequately fill its role.

There are numerous options for securing Social Security=s long-term solvency. There are concerns, however, that some changes that have been suggested could do more harm than good by eroding the program=s essential protections, exposing workers and their families to unacceptable risks and having a disproportionate impact on certain populations.

We would appreciate your views on Social Security's future. Do you favor or oppose the following changes to Social Security?

Ideally, retirement security comprises Social Security, pensions and savings. While individuals who have employer-provided pensions rely on these benefits as an integral part of their financial security, there are serious questions about the strength of America's pension system.

Covered workers continue to experience erosion or elimination of their pension plans. Pension coverage rates have stagnated for the last several decades, and at any given time only half of the workforce is covered by a pension plan. Currently, there are few legal protections for workers who suffer losses through corporate bankruptcies, cutbacks in employer contributions, and conversion to "cash back" plans.

Do you favor establishing a system of federally-sponsored universal retirement savings accounts in addition to Social Security, financed with new dollars, rather than with funds diverted from Social Security?

What are some of your recommendations for helping to protect workers currently covered by defined benefit pensions and workplace savings plans?

The LCAO supports a national long-term care system that provides comprehensive services to people with physical and cognitive impairments to enable them to carry out activities of daily living and function at an optimum level.

This comprehensive long-term care system must be available to all people who need long-term care, regardless of age, income, geographic location, and regardless of whether they choose home and community-based care or require institutional care. The system should provide a comprehensive and flexible range of benefits in the least restrictive setting possible, and should respect the individual, cultural and ethnic differences and lifestyles among consumers and caregivers.

A myriad of services must be included in the long-term care system, including a range of home and community-based services, suitable and adaptable housing options, institutional care, if necessary; and rehabilitative services. Services provided must respect the rights and preferences of the individual in need, including consumer-directed services, and easy access to client grievance procedures.

Financing must be based primarily on a social insurance model and on a combination of federal taxes, state and local resources, and modest co-payments by consumers of these services. Cost-sharing must guarantee adequate financial protection to make it possible for an individual to maintain a home, and prevent impoverishment.

The system should recognize the primary role of family caregivers and support them with training, counseling, respite, social support services and financial assistance to enable them to carry out their caregiving responsibilities. Long-term care workers should be paid fair wages, provided appropriate education and training, and have reasonable working conditions and benefits, including health coverage

Do you agree that federal and state policies should allow people who need long-term care to receive the services and supports in the least restrictive setting possible, including the home and community?

How would your administration support and enhance current state efforts to move people from institutions to the community and to prevent premature or inappropriate nursing home placement? What, if anything, will you do to streamline or eliminate the home and community-based services waiver process for states under Medicaid? In addition, how would your administration support unpaid or family caregivers who provide the majority of long-term care to older people and people with disabilities?

Would your administration support, enhance or replace the current federal/state/local infrastructure to provide home and community-based services to older people (i.e. Older Americans Act programs and the aging network, SSBG, senior transportation programs, elderly housing programs, etc.), and how would your administration do this?

The federal and state governments, together with individuals and families, all bear some financial responsibility for long-term care. How should these responsibilities ideally be distributed? Do you support the federal government bearing an increased burden? If so, how?

The Older Americans Act (OAA) has been the foundation of services for older adults in the United States since its inception in 1965 and forms the nucleus of our national system of home and community-based services for older Americans. The OAA provides funding to states for a range of community planning and service programs to older Americans at risk of losing their independence. OAA programs provide a wide range of home and community-based services that include home care, protective services, congregate and home-delivered meals, adult day care, transportation, case management, legal counseling and state long-term care ombudsman services. For over 30 years these services have successfully enhanced the ability of millions of older persons to live independently in their preferred environments, their homes and communities.

Since 1980 there has been substantial loss in the OAA program's capacity at the state and community level to provide services to older Americans, due to several factors, including rising costs, an increasing number of frail older persons in need of more extensive services, and inadequate federal funding. The need to increase federal funding of OAA programs and services will only continue to grow more critical with the coming retirement of 77 million baby boomers and the demand for long-term care expected to more than double by 2030.

What initiatives would you advance to support and augment the Older Americans Act and the vital services it provides tmillions of older adults?

Social Services Block Grant

Title XX of the Social Security Act, the Social Services Block Grant (SSBG), provides flexible funding to allow states to provide a wide range of critical services to low-income and vulnerable older adults, persons with disabilities, children and families. Services provided for older adults under the Social Services Block Grant include home care, protective services to prevent abuse and neglect, congregate and home-delivered meals, adult day care, case management, legal services and transportation. For over twenty-five years communities nationwide have maximized the flexibility of SSBG funds to address service gaps and leverage additional resources.

The authorized funding level established in the 1996 Welfare Reform Act, effective through 2002, was $2.38 billion. However, since then SSBG cuts have dramatically reduced funding for critical services in local communities. In FY 2003, funding for SSBG was reduced to $1.7 billion to offset increases to funding priorities under the Transportation Equity Act for the 21st Century (TEA-21).

Would you support the restoration of the Social Services Block Grant authorization level to at least its pre-welfare reform level of $2.8 billion and restore the ability of states to transfer 10% of TANF (Temporary Assistance to Needy Families) funds to SSBG?

Senior Employment Program

The Senior Community Service Employment Program (SCSEP), Title V of the Older Americans Act, allows older workers to improve their economic well-being and provide valuable services in their communities at senior centers, nutrition sites, day care centers, libraries and elsewhere. Title V has proved its value and worth over the years as a dignified way for low-income seniors, who may have outmoded work skills, to move off welfare rolls and onto payrolls. Many enrollees use their SCSEP community service employment and training to become gainfully employed in the private sector. This experience and training is particularly important as unemployment is rising and pension benefits for some older workers are diminishing.

Would you support a ten percent increase in SCSEP funding, which would provide over 6,000 additional jobs for low-income Americans age 55 and older?

Senior Volunteer Programs

For more than 30 years, the Federal Government has supported the work of senior volunteers through organized activity to provide service to neighbors and communities through the programs of the National Senior Service Corps (Retired and Senior Volunteer Program, Senior Companion Program, Foster Grandparent Program). Today, the programs administered by the Corporation for National and Community Service include more than 500,000 older Americans in activities ranging from companions for homebound seniors and literacy tutors in schools to aides in hospitals and environmental cleanup. In fiscal year 2003, the National Senior Service Corps was funded at slightly more than $215 million.

What plans do you have to support and, further, what other plans would you implement to make the best use of seniors as a resource in service to their communities and, specifically, would you support a goal of doubling the number of senior volunteers sponsored through the National Senior Service Corps over the next five years?

Housing

Housing security is critical to the health and well being of older adults. The home and community-based system will not succeed without the provision of affordable and accessible housing for older adults. Greater coordination needs to occur between housing and service providers to guarantee that support services, such as meals, personal assistance and housekeeping, as well as health services, are readily available and easily obtainable. Authorized funding for senior housing does not begin to meet the need.

How important will it be to your administration to maintain and increase the supply of low-income senior housing we have in this country and what would you do to make sure health and housing services fit together for these people?

Transportation

Finding necessary transportation is difficult for most elderly, particularly for those living in suburban or rural communities where destinations are too far to walk, public transit is non-existent or poor, and private transportation, if available, is limited or prohibitively expensive. Most older adults are reluctant to rely on friends and family even for the most essential transportation needs - access to health and social services. The result is often increasing isolation and deterioration in health and quality of life. Transportation is not only a critical part of the service delivery system but is also essential in order for older adults to maintain their independence. Current estimates suggest that there is approximately $1 billion per year in unmet transportation needs for seniors.

Please describe your plans to promote senior transportation as a priority within your Administration, and specifically do you support substantial increases in funding for the Federal Transit Administration's Section 5310 Program, the major transportation program for the elderly which is currently funded at $90 million?

In recent years, courts have undermined enforcement of long-established, vital safety net protections critical to older Americans, including Medicaid, the Age Discrimination in Employment Act, the Americans with Disabilities Act, the Nursing Home Reform Act, and others.

What will your administration do to ensure full protection for the rights and welfare of our nation's seniors?

Recent government studies show that more than 20 percent of nursing homes have been cited for harming residents and that the actual number is probably much higher; that more than 90 percent do not have enough nursing staff to provide adequate care.

What steps will your administration take to address staffing problems in nursing homes and other long term care facilities?

The federal budget faces enormous deficits, which threaten the availability of resources for programs important to seniors. A series of tax cuts have been passed over the past three years, which have been criticized as contributing to these large deficit projections.

Would you support modifications of any of these cuts and, if so, which ones in particular?