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Finding the Consumer in the Midst of Medicare

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The consumer is often caught in the middle when it comes to a provider presenting a reasonably priced product while striving to stay out of the red.  The American government is no different when it comes to Medicare and its beneficiaries.  The Medicare program provided assistance to over 49,000,000 people in 2012,1 and this number is expected to continue to increase as Baby Boomers become eligible for the federal program.  Our government is currently struggling with how to assess this growing demand with limited financial resources.  In all the budget and deficit debates, it can be easy to forget the most important part of the equation which is the medicare beneficiaries.

Medicare recipients currently pay different premiums for each of the four parts of Medicare.  Most individuals do not pay a monthly premium for Medicare Part A if they or their spouse have paid into the Medicare system via payroll taxes.  Individuals that do not meet this criteria can purchase Part A for $441 per month.

Many people pay the standard premium of $104.90 per month for Part B, but some individual’s will have to pay more if their income from the previous two years is above $85,000.2  Premiums for Parts C and D differ depending on the individual plan that a consumer decides to purchase.  The four parts are designed to offer beneficiaries the most comprehensive insurance program that they can afford.

What if you can’t afford Medicare premiums and deductibles?  Federal assistance, in the form of Medicaid, is available for low-income individuals.  Medicare also has an Extra Help program available to assist with prescription drugs.  Some states also help their Medicare beneficiaries by means of two state programs:  the Medicare Savings Programs pays Part A and Part B deductibles while the State Pharmacy Assistance Program provides financial assistance for prescription drugs.3

Both federal and state governments have options available for Medicare beneficiaries who are limited by their financial resources.  However, the state programs are not offered in every state and some lower-income seniors may still find themselves receiving few health care options while individuals with more money have the ability to pick and choose an insurance plan that best fits their medical needs.  The federal plan that was originally created to help all seniors and other eligible citizens does not help all recipients equally.

Regardless of any underlying inequalities, Medicare is still a more affordable and efficient health insurance provider than many private companies.  In fact, Medicare is viewed quite favorably among the general public.  While more than half of Americans agree that the federal deficit should be corrected with a combination of increased taxes and decreased spending, 58% oppose any spending cuts to Medicare or Social Security.  Three quarters said the deficit could be cut without any major reductions to Medicare.4

The overall general approval of this welfare policy ensures, to a certain degree, that the program will continue to assist the elderly and the disabled in the struggle to have affordable health care.  General opinion also encourages politicians and policy makers to take a more unique approach when considering how to make the program easier on the government’s wallet without directly cutting funds.

Many different ideas are being tossed around in Congress when it comes to making Medicare more affordable.  Some propose adjusting the age requirement from 65 to 67.  Others argue that Medicare should be a means-tested program with higher income individuals testing out.  Some also argue that spending cuts can be removed from the equation all together if the issue of Medicare fraud is thoroughly corrected.  Consumers should expect to hear more about major changes to the Medicare program within the next few months but should not expect to see a decrease in their premiums or deductibles.

Medicare is a complex federal program and this complexity sheds some light onto how challenging it can be for consumers to afford health care in America.  This leads to an interesting debate on how to more effectively serve American citizens.  Should the focus be on reducing Medicare costs or on reducing the cost of health care as a whole?

There is a growing opinion that health care is an overall wasteful, inefficient, and poor quality institution that is in need of reform.  Such a reform could have huge implications for eligible Medicare beneficiaries and other Americans.  Unfortunately, it is much easier for politicians and Congress to discuss how to change Medicare rather than how to improve the entire American health care system.  In the meantime, consumers continue to get caught in the crossfire between the debate over Medicare coverage and Medicare cost.

Photo Credit: Medicare Prospective Payment System

1The Henry J. Kaiser Family Foundation. (2013). Total number of Medicare beneficiaries, 2012. Retrieved from http://www.statehealthfacts.org/comparebar.jsp?ind=290&cat=6&sub=74&yr=255&typ=1&sort=a&o=a

2Social Security Administration. Social Security Administration, (2012). Medicare premiums: rules for higher-income beneficiaries (SSA Publication No.05-10536). Retrieved from Social Security Administration website: http://www.socialsecurity.gov/pubs/10536.pdf

3Medicare Resource Center. (n.d.). Frequently-asked medicare questions. Retrieved from http://www.medicareresources.org/faqs/q-is-there-help-for-me-if-i-cant-afford-medicares-premiums/

4Wessel, D. (2013, January 24). Whose budget fix is more popular?. The Wall Street Journal. Retrieved from http://blogs.wsj.com/washwire/2013/01/24/whose-budget-fix-is-more-popular/?KEYWORDS=medicare

Britney Wiggins is a student at Meredith College in Raleigh, NC, and she is working toward a degree in Social Work with a focus on aging and older adults.

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Disability

Colin Kaepernick and How Self Care Must Go Pro

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For years, permanently injured players have been left to figure out how they will financially support their families and how they will carry on with their lives after committing years to football. Currently, the NFL is settling numerous lawsuits from former players who claim that their disabilities resulted from injuries on the field. But that’s not the only controversy stirring in the NFL.

In Fall of 2016, San Francisco 49ers quarterback Colin Kaepernick knelt during the national anthem. At the time, many believed the media would quickly move on to another more trendy story. Afterall, he wasn’t chanting or picketing. He was simply kneeling. But as weeks passed, white anger slowly unveiled itself, and patriotism took the main stage. Critics saw Kaepernick’s quiet gesture as a radical protest. Yet, he still knelt game after game.

Kaepernick proved his physical ability early in his professional career by leading the 49ers to the Super Bowl in 2013. At that time the public didn’t know that Kaepernick had a metal rod placed in his left leg prior to his rookie year. Still, he attended and did well in practices. But in 2015, he injured his left shoulder and would later report injuries to his thumb and knee.

Working with such disabilities would prove challenging to most people, particularly for professional athletes who are required to demonstrate physical grit day after day. When Kaepernick’s scoring record took a hit, questions arose as to whether he was worth his contract. But Kaepernick saw himself as more than just damaged goods. He had something else to offer: a perspective on the value of black lives in America.

By kneeling, Kaepernick demonstrated ownership of his body, a black body that has been endangered for a time that is too long to measure. That is a radical act of self-care. The concept of self-care, for a long time, was viewed as a luxury accessible to an elite few. And, self-care is publicly declaring that your life matters beyond what your performance on the football field.

In a recent interview, Buffalo Bills running back LeSean McCoy said he thinks that Kaepernick was released because he’s not a great player, not because he didn’t stand for the anthem. He added that from the perspective of a team owner, Kaepernick isn’t worth the distraction if he can’t play well. However, star quarterbacks Aaron Rogers and Cam Newton came out in support of Kaepernick. Both stated he should be starting in the NFL, but he isn’t due to his protest of the national anthem.

I’d argue that even when athletes play well, there is a general discomfort with them expressing resistance to racism. They usually are told to stick to the game, proving once again that a working, non-resistant black body is most favorable (and profitable) in this society.

The NFL has a longstanding history of utilizing bodies for financial gain, in particular, black bodies. It is a marketplace for bodies. Bodies that can be negotiated and sold and traded in the name of increasing revenue. I hear sports fans say often that certain teams don’t win because the owners ‘don’t want to spend the money’. However, Kaepernick was recently released from his contract, something for which he seemed prepared.

According to the New York Times, NFL players are becoming permanently disabled after suffering head traumas. Those injuries have caused concussions, dementia, and chronic traumatic encephalopathy. Now, some players’ wives have created at least one space, in the form of a private Facebook group, where they share their experiences and gain strength from each other as they become caregivers and advocates for men who once were larger than life. I believe that this generation of athletes will begin to demand more than money for play. They will demand the right to safety and self-care, and they will begin to plan for their legacies and quality of life off the field.

Athletes are human and imperfect. For many, they are heroes which must be a compliment, but it must also be a lot of pressure. This next generation of athletes will need to employ a high degree of self-care if they want to have a productive career and higher quality life after retirement.

Athletes inspire us because of their consistency and their unmatched desire to win. I’ve never met an athlete who thought second place was good enough. They want to be the best. Their drive is a metaphor for how many of us want to live our best lives.

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Hurricane Irma: Two Things Helping Professionals Need to Know About People with Disabilities

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Photo: AP

The state of Florida has called for 17,000 volunteers to help out with the post-Irma recovery process, but there’s one population that are often forgotten in the crush of storm evacuation and disaster recovery efforts, and that is people with disabilities.

Recently, at a social work conference, I was told “disability is not a social work issue,” which is a shocking statement, given that over one-fifth of the United States’ population has a disability according to the Centers for Disease Control. All too often, people with disabilities are left feeling invisible in our society – and as helping professionals, we need to right this wrong. In order to begin to do this work, especially given the impact of Hurricanes Irma and Harvey on our country, here are two things helping professionals need to know about people with disabilities.

Storms such as Irma and Harvey are very likely to have a disproportionate impact on people with disabilities – see Professor Rabia Belt’s commentary on this topic. During Hurricane Katrina and surely many others, it came to light that many people with disabilities were unable to evacuate due to mobility limitations, equipment needs, staffing needs, requirements for service animals or just having a low income.

We know that people with disabilities are much more likely to live in poverty in this country, and this can really take a toll during storm evacuations and disaster recovery. In fact, during Katrina, 155,000 people with disabilities aged 5 and up lived in the cities hardest hit by the storm – and unfortunately, a disproportionate amount of Katrina’s fatalities involved this population. Helping professionals need to see people with disabilities – and seek them out prior to, during and after a storm.

Given these realities, it is important to design disaster preparedness and recovery efforts so that they are accessible to all – including people with disabilities in keeping with the Americans with Disabilities Act. In the disability community, stories about people with mobility limitations, nursing needs, and service animals being refused shelter or assistance are making the rounds. We must do better.

The National Council on Disability wrote an extensive report on the topic of disaster preparedness, and it provides great guidance for disaster planning and recovery efforts – be prepared! There is also specialized guidance on how to create accessible programs and spaces for people with disabilities during and after a devastating storm in a way that promotes self-determination.

People with disabilities do not want to be victims, and helping professionals should support their self-determination during evacuations, sheltering and recovery. Portlight Inclusive Disaster Strategies, an organization based in the southern United States, is the go-to source for assistance with people with disabilities during these storms. Please use their hotline for assistance with your clients with disabilities 1-800-626-4959.

Their motto is drawn from the disability civil rights movement, “nothing about us without us.” As you gear up to provide help before, during and after these storms, keep this motto in mind and let it guide your practice. We can do better for people with disabilities, and we will.

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A Teacher’s Response to Charlottesville for Social Workers in Practice with People with Disabilities

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Charlottesville Black Cop

Officer patrols in front of a recent KKK rally in Charlottesville, Va. – Jill Mumie

I am currently teaching a course on social work practice with people with disabilities.  The course uses an intersectional lens, acknowledging the fact that people have many intersecting social identities that can result in varying types of privilege and oppression.  As such, I had to provide some venue for my students to address the Charlottesville violence and hate speech.  The following is a discussion prompt I provided for them to respond to, and I thought other social work educators might be interested in seeing this so that they could use it and/or modify it for their own courses.  Feedback welcome!

Discussion prompt: As we are part of a course on social work practice with people with disabilities in the United States of America, I would be remiss not to address the events of this past weekend in Charlottesville, Virginia. As you have already likely gathered, there are important links between the White nationalist/Nazi actions in Virginia, and the work we do as social workers with people with disabilities – who often have intersecting marginalized social identities.

Many of the perspectives held by members of White nationalist/Nazi groups are clearly identifiable as racist, sexist, homophobic, anti-Semitic and even Eugenic in nature.  Therefore, as social workers practicing under our particular Code of Ethics, we need to respond. If you need some quick resources to learn more about the dynamics that led to the Charlottesville rally and violence, you can check out the “Charlottesville Syllabus” at this link.

As disability-aware social workers training to view the world through an intersectional lens, we need to acknowledge and act on what has happened in Charlottesville. That means that we need to engage in discussions – often difficult in nature – with our families, our co-workers and with our clients. Let’s start with our work with clients.

One prominent disability civil rights activist, Rebecca Cokley, has noted that when terrorist incidents like this occur, people with disability count the minutes until ableist claims about the ‘crazy’ person who engaged in terrorist acts roll in. That may be an important place for you to start a conversation with a client with a disability in a week like this one. In this essay, Ms. Cokley points out another important link between disability and trauma.  She calls for the disability community (and disability service providers) to reach out to those whose disabilities came about as a result of trauma, such as the people who were injured and impaired by the car driven by the White nationalist/Nazi from Ohio. Her essay is short, easy to read and compelling and you can find it here.

It is also important to remember, however, that our work is not just direct care work. Remember, the NASW Code of Ethics states that we must fight for social justice, as it is a core value in our profession. We need to do more than discuss these difficult topics amongst ourselves, we also need to take a stand on them. I am fond of the idea that if we are not part of the solution, we are part of the problem.

It is important to move beyond ideas of ourselves as “good” people and work towards actively addressing the webs of oppression that exist in our world, little bit by little bit. Here is an example about how ADAPT, the national disability civil rights organization, has taken a stance on the events in Charlottesville. Where might you be able to stake your claim to your own stance?  Check out these ideas for 10 ways to fight hate from the Southern Poverty Law Center.

Finally, I want to leave you with a challenging set of questions. Although there are many facets to the NASW Code of Ethics, let us remember that the mission of the social work profession is rooted in a set of core values, including the idea that there is dignity and worth in every person.  How would you respond to a client with a disability who actively identified as a White nationalist/Nazi if you were to be assigned such a client today? What if she didn’t want to work with you because you were a woman of color?  What if she had been arrested for street fighting during the “Unite the Right” rally and was open about her wish to “hurt Leftists?”  Based on your training thus far in this social work program, how would you approach your work with this client?

How would you respond to a client with a disability who actively identified as a White nationalist/Nazi if you were to be assigned such a client today? What if she didn’t want to work with you because you were a woman of color? What if she had been arrested for street fighting during the “Unite the Right” rally and was open about her wish to “hurt Leftists?”  Based on your training thus far in this social work program, how would you approach your work with this client?

Please leave your comments about this discussion prompt and how it might be improved or expanded upon.  All feedback is welcome.

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