Howard Gleckman

The Centers for Medicare and Medicaid Services' long-awaited rule implementing the Medicaid work requirements Congress passed last summer will make

In 2032, just before the wheels come off, Congress will borrow trillions of dollars to patch the hole and buy time by creating a commission to study the problem.

Despite widespread agreement among financial experts and consumers on the value of life annuities for guaranteed lifetime income, very few retirees actually purchase them. These products are designed to combat the uncertainties of aging, such as outliving savings or market volatility, by providing a steady payment for life. However, a new NBER paper highlights that consumer reluctance stems from confusion with complex annuity types and behavioral biases like loss aversion, where individuals fear losing their initial investment if they die prematurely. To bridge this gap, experts propose policy changes, including defaulting a portion of retirement savings into annuities with an opt-out. They also suggest insurers simplify offerings, reframe them as longevity insurance, and improve financial literacy to help people understand their protective benefits.

President Trump's policies, including Affordable Care Act rollbacks and deep Medicaid cuts, threaten to strip health coverage from up to 3 million low- and middle-income individuals aged 50-64. Expired ACA subsidies are forcing hundreds of thousands, particularly those earning over 400% of poverty, to drop insurance. Additionally, new Medicaid work requirements could cause up to 2.6 million people aged 50-64 to lose benefits. These individuals, often with chronic conditions or disabilities, must prove their inability to work 80 hours monthly or their caregiver status, a complex process that will lead to many losing coverage. This will jeopardize their health, create financial burdens, and ultimately increase costs for hospitals and taxpayers.

A new federal report highlights the significant benefits of the Program of All-Inclusive Care for the Elderly (PACE). Participants in this fully integrated medical and long-term care model experienced fewer emergency department visits, hospitalizations, and deaths compared to those in standard Medicare Advantage plans. PACE, primarily for dual-eligible seniors, aims to help individuals remain in their homes by providing comprehensive services like adult day programs, onsite clinics, and in-home support. While evidence consistently shows PACE's high-quality, cost-efficient care, its growth is hampered by high startup costs, potential Medicaid funding cuts, states' "woodwork effect" fears, and consumer reluctance to change doctors. Despite these hurdles, PACE demonstrates a successful model for reducing healthcare costs and enabling seniors to age at home.

The DOJ said it will no longer enforce a nearly 30-year-old Supreme Court decision in a case called Olmstead v. L.C. ex rel. Zimring.

These Alzheimer's tests raise many important issues that patients and their physicians should carefully consider before requesting or administering them.

Two groups of lawmakers proposed commissions aimed at addressing the impending insolvency of Social Security. Unless carefully designed, these panels often fail.

Rising long-term care costs are fueling interest in public insurance programs. Washington State's WA Cares offers a front-end benefit ($36,500) via a 0.6% payroll tax. The proposed federal WISH Act, a catastrophic model, would provide $3,600 monthly after a waiting period. Initial WISH estimates of $200 billion (1.7% payroll tax) were too high. However, actuarial analysis reveals costs could be halved to around $100 billion (0.9% payroll tax) through design adjustments. These include replacing cash benefits with reimbursement, raising the eligibility age, linking benefits to the cost of living, differentiating home and nursing home care, and diversifying investment of program reserves. Such a program is crucial as most Americans cannot afford long-term care, straining existing systems like Medicaid, despite political hurdles for new federal initiatives.

This latest agreement would continue to assure that Trump and his sons would benefit from special tax treatment no other taxpayer has received.