Michigan Disability Resistance

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Tax cuts, cost increases to drain trust fund faster than previously expected.

Medicare's financial condition has taken a turn for the worse because of predicted higher hospital spending and lower tax revenues that fund the program, the federal government reported Tuesday.

In its annual report to Congress, the Medicare board of trustees said the program's hospital insurance trust fund could run out of money by 2026 -- three years earlier than projected last year.

A senior government official briefing reporters attributed the worsened outlook for Medicare to several factors that are reducing funding and increasing spending.

He said the trustees projected lower wages for several years, which will mean lower payroll taxes, which help fund the program. The recent tax cut passed by Congress would also result in fewer Social Security taxes paid into the hospital trust fund, as some higher-income seniors pay taxes on their Social Security benefits.

The aging population is also putting pressure on the program's finances.

In addition, he said moves by the Trump administration and the GOP-controlled Congress to kill two provisions of the Affordable Care Act are also harming Medicare's future. Those were the repeal of the penalties for people who don't have insurance and the repeal of an independent board charged with reining in spending if certain financial targets were reached.

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Bullying takes many forms, but when it involves a food that triggers severe allergies, it could be potentially deadly.

Once, when Brandon Williams, a 16-year-old from Kentucky, was on a trip with his bowling team, his teammate decided to eat some food from McDonald's on Williams' bed. One item had so much mayonnaise that it dripped onto Williams' bed and jacket. But for Williams, who was diagnosed with a life-threatening egg allergy when he was one, it was a potentially dangerous situation. "I told the person not to eat on my bed," Williams recalls. His teammate just smiled at him, then he shoved the mayonnaise-laden sandwich in Williams' face.

It's always the same. People wave food near Williams that they know he can't eat. They see him and yell, "Hey let's feed this guy egg." It's not original, all the jokes are the same kind of thing, Williams says, yet the bullying carries an undercurrent of risk. "It wouldn't be funny to break someone's arm to send them to the hospital," Williams says. "Why would it be funny to send someone to the hospital for an allergy?"

While it's hard to know for certain, it's unlikely that food allergy bullying is a new phenomenon. But the number of children diagnosed with food allergies is growing, which means it could harm more people. From 1997 to 2007, the number of children with food allergies increased by 18 percent, according to the Centers for Disease Control and Prevention. Hospitalizations associated with these allergies also continue to grow.

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My patient had struggled with bipolar disorder his entire life, and his illness dominated our years together. He had, in a fit of hopelessness, tried to take his life with a fistful of pills. He had, in an episode of mania, driven his car into a tree. But the reason I now held his death certificate — his sister and mother in tears by his bed — was more pedestrian: a ruptured plaque in his coronary artery. A heart attack.

Americans with depression, bipolar disorder or other serious mental illnesses die 15 to 30 years younger than those without mental illness — a disparity larger than for race, ethnicity, geography or socioeconomic status. It’s a gap, unlike many others, that has been growing, but it receives considerably less academic study or public attention. The extraordinary life expectancy gains of the past half-century have left these patients behind, with the result that Americans with serious mental illness live shorter lives than those in many of the world’s poorest countries.

National conversations about better mental health care tend to follow a mass shooting or the suicide of a celebrity. These discussions obscure a more rampant killer of millions of Americans with mental illness: chronic disease.

We may assume that people with mental health problems die of “unnatural causes” like suicide, overdoses and accidents, but they’re much more likely to die of the same things as everyone else: cancer, heart disease, stroke, diabetes and respiratory problems. Those with serious mental illness are more likely to struggle with homelessness, poverty and social isolation. They have higher rates of obesity, physical inactivity and tobacco use. Nearly half don’t receive treatment, and for those who do, there’s often a long delay.

For doctors, two related biases are probably at play. The first is therapeutic pessimism. Clinicians, including mental health professionals, often hold gloomy views about whether patients with serious mental illness can get better. This can lead to a resigned passivity, meaning that certain tests and treatments aren’t offered or pursued.

As Lisa Rosenbaum, a cardiologist at Brigham and Women’s Hospital in Boston, writes: “Many of us have internalized the directive to seek a test or procedure only if ‘there’s something you can do about it.’ For mentally ill patients with medical illness, however, this principle often justifies doing nothing.”

The second is a concept called diagnostic overshadowing, by which patients’ physical symptoms are attributed to their mental illness. When doctors know a patient has depression, for example, they’re less likely to think her headache or abdominal pain portends a serious illness.

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When a giant health care company wanted to save money, a foster baby paid the price.

e was born three months too early, unable to breathe or eat on his own. But after a year of intense care in a foster home in Mesquite, D’ashon Morris had grown into a bright-eyed toddler who loved to cuddle and crawl.

He was still very sick. But he was giggling, babbling, grabbing for toys. Doctors described him as “happy and playful” and told his foster mother he would be healthy by the time he went to kindergarten.

That was before a giant health care company decided he didn’t need round-the-clock nursing care to keep him from suffocating. The decision would save Superior HealthPlan as much as $500 a day — and cost D’ashon everything.

“He would have lived a perfectly good life,” says Linda Badawo, the foster mother who adopted D’ashon. “If only they were paying attention to what I was saying.”

Texas pays Superior and other companies billions of dollars every year to arrange care for tens of thousands of kids like D’ashon: foster children, disabled children, chronically sick children. The companies promise to improve the lives of these kids, as well as adults with severe medical conditions and disabilities.

But under a system set up by the state, every dollar the companies don’t spend on health care they can use instead to hire high-powered lobbyists, pay millions in executive bonuses, and buy other businesses.

The state knows some companies are skimping on care to make profits but has failed to stop it.

The Dallas Morning News spent a year investigating the way Texas treats fragile and ailing residents who rely on Medicaid, the government insurance program for the poor and disabled.

We reviewed more than 70,000 pages of documents, including patient medical records and material that state officials and the companies tried to keep secret. We crunched financial and insurance-industry data and talked to hundreds of families, doctors and policy experts.

We found that state officials are protecting a booming multibillion-dollar industry while the most vulnerable Texans wait in vain for wheelchairs, psychiatric drugs and doctors’ appointments. That system has failed countless disabled adults and sick children who can’t advocate for themselves.

Because of the recent resignations of its top officials, the state health commission said it could not make anyone available to discuss problems with corporate management of Medicaid. In a lengthy statement, it acknowledged many of the problems we found.

In response to our findings, the commission has asked the Legislature for more money to implement “a blueprint for protecting our fragile children in the Medicaid program and children in foster care,” including hiring 50 more people to help check on patients who might not be receiving adequate care.

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Today’s episode is on the future of independent living with guests Eli Gelardin and Allie Cannington. Independent Living is a philosophy and a movement driven by people with disabilities that started in the 1960s. As a result, Centers for Independent Living formed to provide peer-based services with hundreds currently all over the United States. Eli and Allie will describe what CILs do and their role in disability communities across the country and world. They’ll also discuss current challenges and their vision for the future of independent living.  

Transcript

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