House Passes Short-Term Money Follows the Person Extension  
Ask Your Senators to Approve the Bill This Week!
 

Last week, the U.S. House of Representatives passed the bipartisan IMPROVE Act (H.R. 7217) by an overwhelming margin of 400-11. The bill includes a provision extending the Medicaid Money Follows the Person (MFP) program for three months. This short-term patch would help states bridge the current funding gap until Congress hopefully approves a longer authorization. Advocates should urge their Senators to support the IMPROVE Act, which could be considered in that chamber this week!
 
Since 2005, the MFP program has been instrumental in helping tens of thousands of older adults and people with disabilities transition from institutional settings to the community. New funding for MFP program expired in 2016, although states have been able to spend down existing MFP funding until the end of 2018—which is less than two weeks away! Advocates and lawmakers have been working to promote bipartisan bills in both the House and Senate that would provide additional funding for states to continue rebalancing their Medicaid long-term services and supports (LTSS) programs.
 
Since the MFP program began, nearly 90,000 people have used the program to transition from an institutional setting back to their community. Ongoing funding is essential to maintain the MFP program infrastructure in many states. While n4a and other national, state and local aging advocates have rallied around the importance of a long-term reauthorization for the MFP program, end-of-the-year and lame-duck congressional dynamics made that bid unlikely, hence the three-month extension.
 
Current Status of MFP Reauthorization
 
Earlier this year, Senators Rob Portman (R-OH) and Maria Cantwell (D-WA) and Representatives Brett Guthrie (R-KY) and Debbie Dingell (D-MI) introduced the bipartisan EMPOWER Care Act (S. 2227 and H.R. 5306) that would reauthorize MFP for five years. In the fall, the House Energy and Commerce Committee passed a shorter, one-year extension of the program.
 
Unfortunately, concerns about cost and the lack of an obvious legislative vehicle for the proposal meant that in order to provide any continuity for the program, lawmakers must first pass a shorter-term solution to keep funding flowing until the next Congress convenes in January.
 
The House passed this legislative patch last week, and the Senate could take action through a process known as unanimous consent (reserved for non-controversial bills) this week, but only if advocates make their voices heard now!
 
How You Can Take Action Now!
 

• Reach out and tell your Senators why MFP is so important to older adults and people with disabilities in your community! We are asking that state advocates call both the DC and local offices of your Senators and ask them to pass the IMPROVE Act. Outreach on MFP is especially important to Republican Senators Toomey (PA), Cruz (TX), Paul (KY) and McConnell (KY), who serve on committees that have jurisdiction over this issue. 
  
  Make sure to personalize your outreach with local facts about MFP—which may not be called MFP in your state—and success stories you can share. Make sure to clarify how MFP benefits older adults and people with disabilities in your community. 
   
• Make sure to say THANK YOU if your Senator has signed on as a supporter of MFP! If your Senator has already cosponsored the EMPOWER Care Act, thank them for their support and make sure to let them know that the Senate could pass the IMPROVE Act via Unanimous Consent this week! 
   
• Engage your community! Please encourage your providers, advisory boards and partners, and consumers to take action by engaging your Senators! Use the sample text below to encourage stakeholders to call and/or email their Senators. U.S. Capitol Switchboard: 202.224.3121. Email: www.senate.gov. 

MFP gives people the right to decide where they live and receive home and community-based services and supports. It provides assistance to help older adults and people with disabilities transition out of institutional settings back to the community, regaining their independence while saving Medicaid dollars.
 
Since 2005, MFP has assisted more than 88,000 people with moving back to the community, and has helped 44 states improve access to home and community-based services. MFP is a program that helps everyone win: individuals regain their independence, and state and federal governments save money because it costs less to provide services and supports in the community rather than in an institution.
 
Congress must extend funding for MFP or states will be unable to continue this vital cost-effective program that promotes independence for older adults and people with disabilities. Please consider supporting the IMPROVE Act (H.R. 7217) today!

 Thank you for your advocacy on this important issue!

Making a Final Push for FY 2019 Aging Funding
Congress Could Finalize This Week!
 

For the first time in many years, lawmakers are poised to pass a final FY 2019 funding bill for many Older Americans Act (OAA) and other aging programs by the October 1 start of the fiscal year. This week the House will take up a Senate-passed bill pairing funding for defense and the bulk of non-defense discretionary federal spending. But nothing is ever certain in Washington, DC these days, and your House lawmakers need to hear from YOU about why advancing this federal funding bill is so important for the older adults and caregivers you serve via OAA and other aging programs.
 
The $855 billion funding bill contains $178 billion for the Departments of Labor, Health and Human Services, Education and related agencies—including funding for the Administration for Community Living and its Administration on Aging. The measure preserves the historic FY 2018 increases for many OAA programs. It also provides additional increases for some aging line items, including for OAA Title VI Native American aging programs and Title III-C Nutrition services. (n4a primary members can see our recent Legislative Update for additional details on the compromise bill.)
 
The Senate overwhelmingly approved the bill last week in a vote of 93-7, and the House is expected to follow suit this week. In order to attract additional support on a tight timeline, appropriators also attached a provision to the measure that would continue current funding for discretionary programs that have yet to receive congressional approval (a continuing resolution), aiming to alleviate the threat of a partial government shutdown ahead of the November elections. The House is expected to take up the funding proposal as early as tomorrow.
 
It is important to reach out NOW to encourage your members to support funding for Older Americans Act and other aging programs!
 
We’re Almost There—Why We Need Your Advocacy
 
We expect that the House will pass this important funding this week, but there is some opposition from the House Freedom Caucus on the size of the package and the President on the amount of border wall funding, so it is critical that your lawmakers understand the value of OAA programs and the vital role they play in keeping older adults safe, healthy and living independently in their homes and communities. It is also important that your Representatives understand why it is essential that Congress avoid funding gaps and instead provide budget certainty to already constrained local aging programs and services.
 
We need all AAAs, Title VI Native American programs and all your local allies to raise our collective voices in support of advancing funding for Older Americans Act and other aging programs this week!
 
Action Steps:
 

• Contact your Representatives NOW to advocate for funding for OAA programs and services. The House of Representatives is taking a critical vote this week to advance the bulk of federal non-defense discretionary funding, and your lawmakers need to understand how important these programs are to older adults and caregivers in their districts. You can reach out using the following messages. 

Last week, the Senate passed an important measure to preserve FY 2018 increases to Older Americans Act (OAA) Subtitles III B, C, D and E, which means that older adults will continue to receive in-home services, home-delivered and congregate meals, transportation, caregiver supports, evidence-based health and wellness programs and other essential local services that enable them to maintain their health and independence for as long as possible. The bill also provides much-needed modest increases to OAA Title VI Native American aging programs in the areas of nutrition and caregiver supports.
 
We hope you will support funding for OAA and other essential aging programs when the House takes up the Department of Defense and Labor-HHS appropriations proposal this week. It is important that Members of Congress meet the FY 2019 October 1 deadline to provide funding certainty for critical OAA programs and services.

Federal funding for all of these aging services is essential to promoting and preserving the health and independence of millions of people, including the older adults and caregivers we serve in your district.

• Say THANK YOU if your Representative supports essential aging funding! It is important that lawmakers hear from constituents when they support funding and policy proposals that support the ability of older adults and caregivers to live with health and dignity in their districts and states. If you know that your Member of Congress supports vital OAA funding, please ensure that you thank them! 
   
• Engage your community! Please encourage your providers, advisory boards, partners and consumers to take action by engaging your Representatives today and tomorrow before the House considers this funding proposal. You can call the U.S. Capitol Switchboard at 202.224.3121 or find additional contact information online at https://www.house.gov/representatives. 

Note: as you reach out it’s also important to PERSONALIZE the emails you send and share anecdotes about how important federal funding is for the programs in your community.
 
Thank you for your advocacy on this important issue!

National Association of Area Agencies on Aging

The Eldercare Locator and n4a have launched a national public education campaign, in partnership with the Alzheimer’s Association and Dementia Friendly America, to ensure that older adults and their caregivers are aware of the many home and community-based services and other aging programs available in communities around the country to support individuals with dementia.

This topic is the focus of the annual Eldercare LocatorHome for the Holidays campaign, developed to encourage discussion of important issues affecting older Americans at a time of the year when family and friends often gather. Past campaigns have addressed the growing problem of social isolation and loneliness and focused on strategies to help older adults transition to a non-driving future.

To help educate the public and key stakeholders about this issue, n4a produced a consumer brochure, Living Well with Dementia in the Community: Resources and Support, and a handy toolkit with all of the resources that members of the Aging Network need to support the campaign in their communities. To order the brochure, please visit the Eldercare Locator online store.

On December 14, n4a hosted a webinar on the Home for the Holidays campaign and how agencies can get involved in helping to increase community awareness. The webinar featured presenters from the Eldercare Locator, Dementia Friendly America, the Alzheimer's Association, Metropolitan Area Agency on Aging and the Gila River Indian Community. View the webinar recording.

Toolkit:

• Press Release Template
• Sample Newsletter Article
• Social Media Toolkit
  • Publication Cover Image
• PowerPoint Presentation
• Graphics
  • Dementia By the Numbers
  • Age-Related Changes vs. Dementia

https://www.n4a.org/h4h2017

From The Harvard Gazette:

For low-income people, the darker colors on the bar and related map indicate the lowest life expectancy — fewer than 74.5 years. The lighter colors indicate a life expectancy of more than 77.8 years. Courtesy of David Cutler

Graphics courtesy of David Cutler

Being poor in the United States is so hazardous to your health, a new study shows, that the average life expectancy of the lowest-income classes in America is now equal to that in Sudan or Pakistan.

A Harvard analysis of 1.4 billion Internal Revenue Service records on income and life expectancy that showed staggering differences in life expectancy between the richest and poorest also found evidence that low-income residents in wealthy areas, such as New York City and San Francisco, have life expectancies significantly longer than those in poorer regions.

While those differences can be chalked up, in part, to healthy behaviors — low-income residents in New York City smoke and drink less, exercise more, and have lower rates of obesity than the poor in other cities — it’s unclear what other factors might contribute to the difference, said David Cutler, the Otto Eckstein Professor of Applied Economics and a professor at the Harvard Kennedy School and the Harvard T.H. Chan School of Public Health.

“It’s not an overwhelming correlation with medical care or insurance coverage,” he said. “It’s not that the labor market is getting better — it’s not correlated with unemployment, or the expansion or contraction of the labor force, or how socially connected people feel. The only thing it seems to be correlated with is how educated and affluent the area is, so low-income people live longer in New York or San Francisco, and they live shorter in the industrial Midwest.”

Among men, that gap is 15 years, roughly equivalent to the life expectancy difference between the United States and Sudan. For women, the 10-year difference between richest and poorest is equivalent to the health effects from a lifetime of smoking. The study is described in a paper published in the Journal of the American Medical Association online on April 11.

“This paper really has two missions,” said Cutler. “One is to present this data, but the other is to create this data set so it can then be used by policymakers and researchers everywhere. This data has never been looked at with this level of granularity before.

The richest American men live 15 years longer than the poorest men, while the richest American women live 10 years longer than the poorest women, according to the Health Inequality Project. Graphic courtesy of David Cutler.

“Previously, we could say what life expectancy was like in Massachusetts as compared to Michigan, but the problem is that Massachusetts is much richer than Michigan, and we know mortality varies with income,” he continued. “What we wanted to do was compare the same people in both cities — a shopkeeper in Detroit with a shopkeeper in Boston, not a biotech executive. That’s what we can do with this data that people haven’t been able to do previously.”

Cutler and his co-authors, including former Harvard Economics Professor Raj Chetty, now at Stanford University, collected federal tax records from 1999 through 2014, and sorted people into 100 percentiles according to income. By matching that income data with death records, the researchers were able to calculate the mortality rate and subsequent life expectancy at age 40 for each income level.

While researchers have long known that life expectancy increases with income, Cutler and others were surprised to find that trend never plateaued.

“There’s no income [above] which higher income is not associated with greater longevity, and there’s no income below which less income is not associated with lower survival,” he said. “It was already known that life expectancy increased with income, so we’re not the first to show that, but … everyone thought you had to hit a plateau at some point, or that it would plateau at the bottom, but that’s not the case.”

Cutler and Chetty then examined how life expectancy changed over time, and found that while life expectancy has increased for the wealthiest, it has edged up only slightly for low-income Americans.

“The increase has been approximately three years at the high end, versus zero for the lowest incomes,” Cutler said. “This is important, because it has major implications for Social Security policy. People say, ‘Americans are living longer, so we ought to delay the age of retirement,’ but … it’s a little bit unfair to say to low-income people that they’re going to get Social Security and Medicare for fewer years because investment bankers are living longer.”

When they laid the data over maps of the United States, Cutler and Chetty again found unexpected results, with low life expectancy concentrated not in the Deep South, but across the Midwest Rust Belt.

“What emerges strongly is that there is a belt from West Virginia, Kentucky, and down through parts of southern Ohio, through Oklahoma and into Texas — it’s not a story of the Deep South,” Cutler said. “The variability in where high-income people live longest is not as large and is much less geographically concentrated. You don’t see this same type of belt — it’s scattered all over.”

Going forward, Cutler, Chetty, and their co-authors have made the data publicly available in the hope it will spur further research into whether certain public policies or other economic indicators are associated with longer life expectancy. Cutler believes it also underscores some worrying truths about economic disparity in the United States.

“These differences are very, very troubling,” Cutler said. “The magnitude is startling. You might expect two or three years of life differential — which is roughly what we would get by curing cancer — but 10 or 15 years … it’s an immense difference. We don’t know exactly why or what to do about it, but now we have the tools to ask those questions.”

The research was supported by the U.S. Social Security Administration by a grant to the National Bureau of Economic Research as part of the SSA Retirement Research Consortium, the National Institutes of Health, the Social Sciences and Humanities Research Council of Canada, the Smith Richardson Foundation, and the Laura and John Arnold Foundation.

You can read more on this article here.