Clinton and Trump are both wrong about Medicare’s ability to negotiate drug prices

By GEOFFREY F. JOYCE@SchaefferCenter and NEERAJ SOOD@SchaefferCenter

AUGUST 12, 2016

 Hillary Clinton and Donald trump agree that Medicare bureaucrats should be unleashed to negotiate lower prices with drug companies, and predict billions of dollars in savings as a result. In this political era when any common ground between these two adversaries should be venerated, it is a shame that we must point out that they are both wrong.

Unlike the traditional Medicare system, which sets reimbursement rates for thousands of procedures and services, the Medicare drug benefit program (Part D) uses private companies to manage the needs of its 39 million enrollees. The largest health plans in the country are participating in Part D and contract with one of four dominant pharmacy benefit managers to negotiate prices with drug companies.

These benefit managers do the same job for employers. For example, Caremark administers drug benefits for nearly 65 million Americans, including millions of Medicare beneficiaries. Express Scripts, the largest such company, negotiates drugs prices for more than 85 million members.

Using their considerable bargaining heft, the pharmacy benefit managers have already obtained good deals for the vast majority of drugs on the market. It seems unlikely that Medicare officials can do any better on their own. Who would you rather have bargaining for you, a private business executive representing 65 million to 85 million members, or a government bureaucrat representing roughly half as many? Total Medicare drug benefit costs are well below projections, a rarity for any government program. Let’s not mess this up.

So why do people believe drug costs are out of control and need government intervention? Because for some new highly effective drugs and some older ones that small numbers of patients depend on. For example, Express Scripts reported this spring that patented specialty drugs, including many cancer therapies, which are taken by only 1 to 2 percent of Americans now account for 37.7 percent of medicine costs for its clients. This is monopoly power at work. The pharmacy benefits managers can effectively negotiate only when several drugs are available to treat the same medical condition. The drug company can dictate terms when it has the best, or only, therapy on the market.When Clinton and Trump talk about Medicare exercising its clout to drive down prices, they are primarily targeting cancer and other specialty drugs. But Medicare can’t negotiate any better than pharmacy benefits managers with drug companies holding aces. Congress could enact legislation imposing federal price controls, dictating what a company can charge. But that has its own set of negative effects, including reducing incentives for developing new drugs and creating a new pricing bureaucracy subject to lobbying by patient advocacy groups and manufacturers. As we write in the Journal of Policy Analysis and Management, better options exist. Medicare can encourage greater use of contracts, in which insurers and government payers agree to buy quantities of drugs but receive rebates if the drug does not hit quality targets such as lowering average cholesterol levels by a certain percentage. In cases of curative medicines (as opposed to chronic ones such as high blood pressure drugs), Medicare could pay a premium to a drug company to secure a license, enabling much wider distribution and quickly realizing the health benefits while ensuring incentives for additional drug development.The FDA could enhance competition in specialty medicines by approving more biosimilar drugs. The agency has yet to issue clear guidelines on what clinical testing is required by biosimilar manufacturers. The Federal Trade Commission could require manufacturers to justify short-term price increases of drugs that have long been on the market but now face little competition. It could also examine drug company mergers or takeovers to ensure that they result in operating efficiencies that lead to reduction in prices, not price gouging.These approaches are not a campaign sound bite. Instead, the candidates should end their calls for Medicare to negotiate drug prices. It is a distraction and a non-starter for reducing the cost of medicines. 

Geoffrey F. Joyce, PhD, is director of health policy at the Leonard D. Schaeffer Center for Health Policy & Economics and professor at the School of Pharmacy at the University of Southern California. Neeraj Sood, PhD, is director of research at the Schaeffer Center and professor of public policy the Sol Price School of Public Policy at the University of Southern California. A longer version of this article appeared in the Journal of Policy Analysis and Management.

 

U.S. Says Florida Network Defrauded Medicare and Medicaid of Over $1 Billion

WASHINGTON — In the biggest health care fraud case the Justice Department has ever brought, prosecutors charged on Friday that the owner of a network of Florida nursing facilities orchestrated an elaborate scheme to defraud Medicare and Medicaid of more than $1 billion over the last 14 years.

The case cited allegations of bribes to Miami doctors, hush money to witnesses, and laundering of huge profits through shell companies, providing insight on a lucrative Medicare black market that has surfaced in the last decade.....indicting  the owner of the medical facilities, Philip Esformes, and two others. Mr. Esformes’s lawyer said on Friday that the businessman, who runs about 30 health care facilities in Florida and other states, “strongly asserts his innocence. Prosecutors, however, described him as the “mastermind” of a conspiracy that cycled some 14,000 elderly people in and out of nursing homes and assisted-living facilities, whether they needed medical care or not.With the help of doctors, pharmacists, health care consultants and other medical personnel who got kickbacks for their roles, the facilities billed Medicare and Medicaid for high-priced drugs, medical procedures and health equipment that the patients either did not need or never received, prosecutors said.

In some cases, they charged, Mr. Esformes’s operation “preyed upon” the elderly patients by giving them narcotics so that they would have to remain longer in the care facilities to treat their addictions and “the cycle of fraud could continue.”

Leslie R. Caldwell, who leads the Justice Department’s criminal division, said “This was a whole network of people scratching each other’s backs, paying kickbacks and giving each other referrals. “It shows what people can do when they’re determined to put their hand in the Medicare pot” including doctors and pharmacists.

Mr. Esformes has faced legal scrutiny before in Florida and Illinois over the operations of his nursing and assisted-living facilities. In 2006, he and his partners agreed to pay $15.4 million to settle a civil lawsuit brought by federal officials over accusations of Medicare fraud in the Miami area.

Information for this posting was taken from a July 23, 2016 posting in the New York Times. Susan Beachy contributed reporting.

Ageism in Voter-ID Laws & How to Report It

A total of 33 states have laws requesting or requiring voters to show some form of identification at the polls this year. (West Virginia’s new law goes into effect in 2018). Of those,17 states will have restrictive voter-identification laws on the books for the first time in a presidential election, according to New York University’s Brennan Center for Justice.

Mostly, the impact on lower-income minorities and immigrants has been focused on new requirements that voters provide photo ID cards at the polls. But one group unexpectedly affected has been seniors–particularly black, Latino and other ethnic elders, who may have trouble obtaining required documents. Following is an overview of the elder impact in addition to good sources of information.

The Voter Disadvantage–Proving You Were Born

“Voter ID laws disadvantaging older persons place a burden on the voting rights of those most likely to participate in the electoral process,” said Daniel Kohrman, a senior attorney with the AARP Foundation Litigation office in Washington, D.C. That’s because older citizens vote at greater percentages than younger people.

“With voter IDs, you can imagine that especially for a lot of African American elders, who were born in segregated hospitals, their records may not exist any longer. So you will see, definitely, disproportionate impact for them,” stated Judith Browne Dianis, co-director of the Advancement Project, a racial-justice organization based in Washington.

Dianis added, “Also, for women elders who have to provide a marriage certificate that may be very old, or not exist any longer, to show the change in their name from their birth certificate, that may become a barrier.”

Other practical barriers to voting have emerged, such as Arizona’s decision to reduce polling sites in this year’s primary election from 200 to only 60, causing long lines and forcing many to travel long distances.

According to the Brennan Center, difficulties in states like Arizona and North Carolina primaries could provide “an early glimpse of problems in November — as voters face the first presidential election in 50 years without the full protections of the Voting Rights Act, which was designed to prevent discrimination in voting.”

Both Positive and Negative Changes

Since the U.S. Supreme Court nullified a key provision of the act in 2013, though, many states have actually strengthened their voter registration laws, such as initiating automatic voter registration for drivers and others interacting with government agencies.

The Brennan Center stresses that the trend this election year is toward greater access, including almost 425 bills pending in 41 states and the District of Columbia. (Some states have proposals going in both directions.)

Meanwhile, though, at least 77 new bills — besides those passed in the 17 states — are materials in languages spoken by “more than 10,000 or over 5 percent of the total voting age citizens … who are members of a single minority language group, have depressed literacy rates, and do not speak English very well.”

Older voters need to be aware of other kinds of obstacles to exercising their right to vote. Despite most states having rules about who can assist you and under what circumstances, she said, “those are not always fairly applied.”

People can bring a family member or request assistance in filling out a ballot if reading it is a challenge, “or any aspect of the voting process is going to be impacted by health or other issues associated with aging.”

Voters of any age encountering trouble on election day can get legal advice for their state by calling 866-OURVOTE (866-687-8683). This hotline connects voters with a volunteer network of attorneys able to help, such as when a voter has been turned away from the polls. Often, she said, Latino citizens can be put on the line with a Spanish-speaking attorney.

People can also call the hotline for basic information, she said, such as on where to find their polling place, or what  material they will need to be able to vote?

Other services are also available, she said, such as the nonpartisan website,www.nonprofitvote.org. It provides every state’s rules, including how to register to vote, whether there’s an ID requirement, and what’s the rule for people with felony convictions.

Furthermore, she said, people can find essential information on the websites of their state board of elections or secretary of state’s office.

GOOD SOURCES helpful for reporting on voting issues — for better or for worse — in your areas.

National Conference of State Legislatures, website on “Voter Identification Requirements/Voter ID Laws” includes a searchable map of the United States, and sections with lots of basic factual information.

Nonprofitvote.org is one of several websites that provides the rules for every state, including how to register to vote, whether there’s an ID requirement, and what’s the rule for people with felony convictions, also an important issue in aging, since so many being released from prisons now are older.

“Voter ID Laws in the United States,Wikipedia.
(E-Mail: jed472@bellsouth.net)

Nursing homes turn to eviction to 

drop difficult patients By MATT SEDENSKY

http://www.gbonews.org/?

NEW YORK (AP) — Nursing homes are increasingly evicting their most challenging residents, advocates for the aged and disabled say, testing protections for some of society's most vulnerable.

Those targeted for eviction are frequently poor and suffering from dementia, according to residents' allies. They often put up little fight, their families unsure what to do. Removing them makes room for less labor-intensive and more profitable patients, critics of the tactic say, noting it can be shattering.

"It's not just losing their home. It's losing their whole community, it's losing their familiar caregivers, it's losing their roommate, it's losing the people they sit with and have meals with," said Alison Hirschel, an attorney who directs the Michigan Elder Justice Initiative and has fought evictions. "It's completely devastating."

Complaints and lawsuits across the U.S. point to a spike in evictions even as observers note available records only give a glimpse of the problem.

An Associated Press analysis of federal data from the Long-Term Care Ombudsman Program finds complaints about discharges and evictions are up about 57 percent since 2000. It was the top-reported grievance in 2014, with 11,331 such issues logged by ombudsmen, who work to resolve problems faced by residents of nursing homes, assisted living facilities and other adult-care settings.

"When they get tired of caring for the resident, they kick the resident out," said Richard Mollot of the Long Term Care Community Coalition, a New York advocacy group.

That is often because the resident came to be regarded as undesirable — requiring a greater level of care, exhibiting dementia-induced signs of aggression, or having a family that complained repeatedly about treatment, advocates say. Federal law spells out rules on acceptable transfers, but the advocates say offending facilities routinely stretch permitted justifications for discharge. Even when families fight a move and win an appeal, some homes have disregarded rulings.

"It's an epidemic," said Sam Brooks, who has litigated evictions for Community Legal Services of Philadelphia. "It's a hard thing to catch and it's a hard thing to enforce."

He reviewed three years of nursing home violations in Philadelphia and found only one case in which an operator was actually cited for an involuntary discharge, as evictions are known in long-term care parlance. The citation carried no fine, he said.

"It's a risk they're willing to take," he said, "because no one penalizes them."

The American Health Care Association, which represents nursing homes, defends the discharge process as lawful and necessary to remove residents who can't be kept safe or who endanger the safety of others, and says processes are in place to ensure evictions aren't done improperly.

Dr. David Gifford, a senior vice president with the group, said a national policy discussion is necessary because there is a growing number of individuals with complex, difficult-to-manage cases who outpace the current model of what a nursing home offers.

"There are times these individuals can't be managed or they require so much staff attention to manage them that the other residents are endangered," he said.

The numbers of both nursing homes and residents in the U.S. have decreased in recent years; about 1.4 million people occupy about 15,600 homes now. The overall number of complaints across a spectrum of issues has fallen precipitously in the past decade, though complaints about evictions are down only slightly from their high-water mark in 2007, the federal figures show. The share of complaints that evictions and discharges represent has steadily grown, holding the top spot since 2010.

Whatever a facility's reasons are, involuntary discharges leave families reeling.

When John Wilson, 61, was refused readmission to St. John's Pleasant Valley, a nursing home in Camarillo, California, the facility cited his family's repeated complaints about his care, his son Jeremy Wilson said.

The family sued to get Wilson back into the nursing home, but even when they prevailed, the facility refused. The younger Wilson said his father, who has Lou Gehrig's disease and is unable to speak or walk, was needlessly kept hospitalized for more than seven months until management changed and the home finally relented.

"What they look for and what they want is basically the family to drop Grandpa off at the front door and not be involved," he said. "They don't want anybody monitoring them, they don't want anybody complaining. They just want to take care of that person until they die and collect that check."

Dignity Health, the facility's parent company, said it could not discuss the specifics of the case but that patient care and safety are the top priority.

Advocates say hospitalizations are a common time when facilities seek to purge residents, even though the Nursing Home Reform Act of 1987 guarantees Medicaid recipients' beds must be held in their nursing homes during hospital stays of up to a week.

"You've got facilities that sometimes would prefer that they be rid of certain residents," said Eric Carlson, an attorney who has contested evictions for the advocacy group Justice in Aging. But when they don't have legal cause to move someone out, he said, sometimes "they try and take the easy way out and refuse to let the person back in."

Sara Anderson had been through several transfers of her father, Bruce Anderson, before he ended up at Norwood Pines Alzheimer's Care Center in Sacramento, California. Eventually, she said the facility began insisting it wasn't an appropriate setting for him. After being hospitalized with pneumonia, he wasn't allowed back, she said.

"They just rolled up the welcome mat when he was better," she said.

She saw the action as retaliatory after her repeated complaints about the facility's use of restraints on her 66-year-old father, who suffered a brain injury more than a decade ago during a cardiac arrest. When she appealed the facility's action and won, she said it still refused to let him back. Her father remains in a hospital.

"It doesn't matter if you win or lose it, there's not enforcement of these hearings. We didn't know that the hearing was pointless," she said.

Norwood Pines did not return calls seeking comment.

Federal law allows unrequested transfers of residents for a handful of reasons: the facility's closure; failure to pay; risk posed to the health and safety of others; improvement in the resident's condition to the point of no longer needing the home's services; or because the facility can no longer meet the person's needs.

Though that final category is often cited in evictions, advocates dispute how often it fits.

"The majority of the time, it's because the resident is considered difficult," said Tony Chicotel, an attorney for California Advocates for Nursing Home Reform, which represented Wilson and Anderson. "Federal law is pretty clear: They're all required to be able to provide comprehensive, basic care. Every nursing home that takes Medicare or Medicaid funding should be very good or great at providing dementia care."

Chicotel said involuntary discharges are almost entirely focused on Medicaid beneficiaries and that economics sometimes play a role in the ousters. Rather than a long-term Medicaid patient, many facilities would prefer to fill a bed with a private-pay resident or a short-term rehabilitation patient, whose care typically brings a far higher reimbursement rate under Medicare.

Vicki Becker of Sammamish, Washington, said she began receiving pressure from administrators at her mother's assisted living facility about two years ago to have the then-94-year-old transferred elsewhere. For the first six years she had lived in the home, she had paid more than $5,000 monthly. It was only after Becker's mother exhausted her savings and went on Medicaid that the facility initiated discharge proceedings, making her wonder if money was a factor.

Becker hired a lawyer and enlisted the help of the local ombudsman to fight the eviction. Though the facility eventually dropped the discharge case, it left her feeling as if her mother's rights had been violated.

"It was her home," she said. "What an awful thing to do to somebody."

Glenn Hotchkiss of Temperance, Michigan, unsuccessfully fought the transfer of his mother, a dementia patient, from a nearby home to one about 35 minutes away. He's able to visit far less often because of the distance.

"It's pretty much an emotional roller coaster," he said. "If you have money, you don't get involuntary transfers."

Manpower levels are another factor, according to Charlene Harrington, a University of California-San Francisco professor whose research has focused on nursing homes.

"These worst homes are allowed to have staffing at just dangerously low levels," she said. "If they had staffing at the level that's recommended, they wouldn't be having problems with these patients."

But Gifford of the industry association said the most difficult patients present nursing homes with "a very tricky balancing act" between meeting their needs and denying care to other residents.

"The question becomes, how much do you expect every home to meet every single need in the country out there," he said.

Whatever the explanation, the eviction process can be harrowing.

Penny Monroe's 89-year-old mother came to love her nursing home in Okemos, Michigan, enjoying ceramics classes, trips to the mall and luncheons. News of an impending eviction gave her panic attacks. "She cried and she told them, 'If you send me home, I'm going to die,'" Monroe said. "She was afraid."

Even months after it was resolved, she remains uneasy that she could be thrown out.

Richard Danford of the Center for Independence of the Disabled, who directs the New York City Long Term Care Ombudsman Program, said even small changes can be hard on the most fragile residents, and so an eviction can be devastating.

"It can be traumatic to move a person from one room to another in the same facility, never mind a whole new place," he said. "The most common reaction is a sense of panic."

Agyemang Bediako knows the feeling well. After breaking both legs in a jump from a burning building, he found himself recovering at a New York City nursing home. He said he was still undergoing rehabilitation when the facility told him it would be discharging him to a homeless shelter.

"I was panicked," he said, describing his thoughts before an ombudsman successfully appealed his case: "What am I going to do? I couldn't even eat. I became depressed. I wanted to kill myself."
(e-mail: jed472@bellsouth.net)

0

Entitlements According To Trump:Sources on Donald Trump and Social Security

1. ENTITLEMENTS ACCORDING TO TRUMP

The Donald said again this week that he would not cut Social Security. That’s what they all (of both parties) say, keeping in mind that President Obama wanted his unsuccessful Grand Bargain with the GOP to include future reductions. 

 “A Trump presidency would threaten programs like Social Security (.http://tinyurl.com/z3wghjq) Here’s how we know,” by Michael Hiltzik, Los Angeles Times (May 16): “Donald Trump’s supposed commitment to protect Social Security, Medicare and Medicaid is one of the positions said to set him apart from Republican orthodoxy, which has the knives out for all such programs. During his campaign launch last June, Trump pledged to ”save Medicare, Medicaid and Social Security without cuts.” During a Republican debate in March, he said, “It’s my absolute intention to leave Social Security the way it is. Not increase the age and to leave it as is.”

Hiltzik continues, “But as Zaid Jilani of the Intercept points out, the staff appointments of the presumptive GOP presidential nominee point in exactly the opposite direction. Among Trump’s top advisors are two men who have campaigned for years in favor of privatizing or otherwise cutting Social Security, Medicare, Medicaid and disability benefits.”

 “House Republicans Don’t Like Trump,[http://tinyurl.com/hyg5ond] But That Won’t Stop Them From Voting For Him,” by Matt Fuller, Huffington Post (May 13): “Republicans are learning that squaring their positions on issues like debt, Social Security and Medicare with those of the presumptive GOP nominee requires some contortions more complicated than Trump’s combover.”

“Centrist Democrats:[http://tinyurl.com/gw75gad] We can work with President Trump,” by Burgess Everett and Seung Min Kim, Politico (May 16): “Some centrist Democrats say they’re ready and willing to work with the business mogul should he defeat their party’s nominee.”

 “Trump adviser now says Medicare and Medicaid changes are on the table,”[http://tinyurl.com/zlgvxqj] by Harris Meyer, Modern Healthcare (May 12): “From the start of his race for the Republican presidential primary run last year, Donald Trump repeatedly has promised that unlike other Republican candidates, he would not touch Medicare, Medicaid or Social Security. It’s been one of his core appeals to older working- and middle-class voters. But as the presumptive GOP nominee has shown over and over again, he’s very flexible in his rhetoric and policy positions.”

“… ‘Trump needs a very large portion of the over-60 vote, and he’s not going to go near any change in Social Security or Medicare,’ Robert Blendon, a professor of health policy and political analysis at the Harvard School of Public Health, said last week.  ‘Trump is a dealmaker,’ Chris Edwards, an economist and budget expert at the libertarian Cato Institute.”

But — “’Before you know it, (Trump) will be back saying he will protect these programs,’ Blendon said Thursday. ‘He is courting conservatives . . . But he will be back on message by the general campaign. He has taken a very strong stand on this issue and cannot afford to have anti-Medicare cuts ads in the general election.’”
(e-mail: jed472@bellsouth.net)

How Secure Is Your Social Security

Recently I heard from a well-informed source about a change that is going to take place by eliminating the word "entitlement" from the Social Security Act.  The word "entitlement" is a legal term that mandates the government to keep paying social security and Medicare regardless as to whether or not the social security trust fund has money.  Eliminating the word "entitlement" is going to open the door for the government to reduce payment to present retirees and possible denied payment to future social security recipients. Propaganda will  focus on the fact that social security is running out of money and to convince younger workers that social security is not going to be there for them.

Talk to "privatize" social security is nothing new. But, the reality of actually reducing or denying payment?  I felt that I needed more proof so I decided to check it out on SS.Gov. And, there it was, plain as day. Congress can change the rules regarding eligibility; the rules can be made more generous, or they can be made more restrictive; and benefits which are granted at one time can be withdrawn. Following is what appeared on their website in the Supreme Court case of "Flemming vs Nestor.

The fact that workers contribute to the Social Security program's funding through a dedicated payroll tax establishes a unique connection between those tax payments and future benefits. More so than general federal income taxes can be said to establish "rights" to certain government services. This is often expressed in the idea that Social Security benefits are "an earned right." This is true enough in a moral and political sense. But like all federal entitlement programs, Congress can change the rules regarding eligibility--and it has done so many times over the years. The rules can be made more generous, or they can be made more restrictive. Benefits which are granted at one time can be withdrawn, as for example with student benefits, which were substantially scaled-back in the 1983 Amendments.

There has been a temptation throughout the program's history for some people to suppose that their FICA payroll taxes entitle them to a benefit in a legal, contractual sense. That is to say, if a person makes FICA contributions over a number of years, Congress cannot, according to this reasoning, change the rules in such a way that deprives a contributor of a promised future benefit. Under this reasoning, benefits under Social Security could probably only be increased, never decreased, if the Act could be amended at all. Congress clearly had no such limitation in mind when crafting the law. Section 1104 of the 1935 Act, entitled "RESERVATION OF POWER," specifically said: "The right to alter, amend, or repeal any provision of this Act is hereby reserved to the Congress." Even so, some have thought that this reservation was in some way unconstitutional. This is the issue finally settled by Flemming v. Nestor. 

In this 1960 Supreme Court decision Nestor's denial of benefits was upheld even though he had contributed to the program for 19 years and was already receiving benefits. Under a 1954 law, Social Security benefits were denied to persons deported for, among other things, having been a member of the Communist party. Accordingly, Mr. Nestor's benefits were terminated. He appealed the termination arguing, among other claims, that promised Social Security benefits were a contract and that Congress could not renege on that contract. In its ruling, the Court rejected this argument and established the principle that entitlement to Social Security benefits is not contractual right. 

I feel that in light of the upcoming election, this is a timely topic. I have yet to hear any of the supposed candidates address the issues such as social security, Medicare, or affordable senior housing, just to name a few. Now is the time to speak up, ask questions......and demand answers. And, most of all, when casting your vote, proceed with caution.
(e-mail:jed472@bellsouth.net)

Huge Percentage of Elderly Fear Becoming Homeless

The National Healthcare For the Homeless notes that the homeless population in the United States is aging, mirroring general population trends. The U.S. Census Bureau projects that the current elderly population will double by 2050, resulting in approximately 89 million people over the age of 65. Similar trends are expected for those experiencing homelessness, according to projections by the Homeless Research Institute.  It is estimated that elderly homelessness will increase by 33% in 2020 (44,172 in 2010 to 58,772 in 2020). By 2050, the elderly homeless population is projected to more than double, with 95,000 elderly persons expected to be living without stable housing. Although a number of safety net programs exist for the elderly, those between ages 50 and 64 often fall through the cracks despite having similar physical health to those much older due to daily stress, poor nutrition, and living conditions. In 2011, almost one-quarter of U.S. individuals below the poverty level were over the age of 62, demonstrating the financial instability of older and elderly adults. Two prominent studies have confirmed the prevalence of first time homelessness among older and elderly adults. The first, a study of three international cities (including Boston), found the majority of elderly participants to be newly homeless with a history of stable adult employment and private living accommodations. Among these individuals, common causes of homelessness included: financial problems, mental health problems, relationship breakdown, physical health problems, and issues related to work.

There has been no additional funding since 2010, therefore federal rental assistance programs have not kept pace with the growing need. Currently 37% elderly or disabled households in need receive no assistance. When housing costs consume more than half of household income, low-income families are at greater risk of becoming homeless. And being homeless and living on the street invites dangerous situations.

Compared with the overall locations of Florida's low-income older population, elder-occupied government-subsidized rental housing units are concentrated in fewer counties. On the basis of several standards, these affordable housing units are judged to be unfairly located, resulting in most of the state's low-income elderly population living in counties that are under served by these accommodations. Government-subsidized affordable rental units available to older persons are unequally and unfairly distributed throughout Florida's counties.

A wealth gap is not new in Palm Beach County, where for decades the wealthiest enclave in the U.S. is but a 50-minute drive from some of the poorest people in the nation. But there are many signs that it is worsening. As noted in the Palm Beach Post 9/19/11 "We are probably the richest county here in Florida," .....and there are certainly areas in the Belle Glade area that look like a Third World country. It's just not right to have people living that way, especially here in Palm Beach County..... you may have the highest inequality in Palm Beach County, compared to any other part of the state".

President Obama and the U.S.Congress recently reauthorized the Older American Act, a vital piece of legislation that supports programs and services such as home cooked meals, disease prevention, health promotions, caregiver support, transportation,etc for approximately 11 million individuals and their families. Noticeably missing was funding for low income housing . Every eight seconds until 2026 somebody is turning 65, bringing the total to seventy million.

We have a severe crisis of affordable senior housing in Florida, with a wait list of five years. To make matters worse, some of those lists are closed...which promises even a longer wait.

It is vital that each of the Presidential candidates be well informed of the issues and support an expansion of affordable senior housing. A recent study of the Harvard’s Joint Center for Affordable Housing noted  that the country is not prepared to meet the housing needs of this aging population. Therefore it is critical that you and others know the candidate’s record and position on issues that are important to older Americans. Since 67% of the people over 65 have no pension or savings, and live just on their social security, affordable housing is an important step to avoid becoming homeless.

The most effective way to bring about change is to make the effort to let our elected officials know of the hardships so many of our seniors are or will be facing. Therefore I welcome your comments and would be interested in hearing if you or someone you know is finding it difficult to find affordable housing. Names are not necessary.....just the voices.
(e-mail:jed472@bellsouth.net)