The Retire Advocate < Back to Table of Contents December 2025 Letter from State Medical Associations: "The WISeR Model expands the burdensome prior authorization processes that physicians already experience in Medicare Advantage" October 31, 2025 Dr. Mehmet Oz Administrator Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, MD 21244 Dear Dr. Oz, On behalf of the undersigned state medical associations, we write to raise concerns about the prior authorization (PA) pilot under the WISeR model as it relates to Medicare. While our organizations appreciate the aim of the Centers for Medicare and Medicaid Services (CMS) to increase accountability, value in healthcare delivery for Medicare beneficiaries, and reduce spending on services deemed low-value or wasteful, we believe the current design of this pilot risks unintended consequences including delayed care, reduced access, and increased burdens on both patients and physicians. Moreover, we are deeply concerned by both the lack of operational details released to date and the pace at which CMS is advancing a program of this magnitude, particularly one that shifts critical decisions away from physicians and patients – without sufficient transparency, stakeholder input, or evidence it will improve patient care. Administrative burden placing barriers to patient access Our organizations are concerned that the WISeR Model expands the burdensome PA processes that physicians already experience in Medicare Advantage (MA) and the commercial insurance markets into Traditional Medicare. The demonstration represents significant departures from current standards and seems to conflict with CMS’ recent, highly laudable achievement of securing a commitment from the health insurance industry to fix the broken PA process, to include reducing the overall volume of PA requirements. PA has consistently been identified by physicians as one of the most burdensome and disruptive administrative requirements they face in providing quality care to patients. In a 2024 American Medical Association survey, 93 percent of physicians reported that PA causes care delays, 82 percent indicated that the process can lead to treatment abandonment, and an alarming 29 percent said that PA had led to a serious adverse event (hospitalization, disability, or even death) for a patient in their care. Beyond the risk for patient harm, expansion of PA requirements under the WISeR model will exacerbate the administrative burdens already associated with PA. Surveyed physicians reported major burdens associated with this process, with practices completing an average of 39 PAs per physician, per week. This significant workload requires practices to hire additional personnel, with 40 percent of the surveyed physicians reporting that their practice employs staff who work exclusively on PA. Growing evidence linking practice burdens to professional burnout for physicians and other health care professionals underscores the importance of addressing administrative workloads. The introduction of such PA protocols in Traditional Medicare also risks creating unnecessary delays in patient care, increasing practice expenses, and diverting time and resources away from direct patient care. Our organizations recognize that CMS intends to use artificial intelligence and machine learning tools in the WISeR Model to help identify potentially unnecessary services more efficiently and consistently than manual reviews alone. We appreciate that technological advances can appropriately create efficiencies when applied responsibly and transparently. However, reliance on AI and other automated tools raise significant risks if not governed properly. We are also concerned that the vendor incentive structure within the WISeR Model could result in excessive denials motivated more by the potential for vendor profit than by fair and balanced clinical judgment. When third-party entities are paid based on the volume of denied services, there is a clear risk that care that is medically necessary for certain patients will be inappropriately denied in pursuit of savings. Physicians are committed to delivering high-quality, evidence-based care to Medicare beneficiaries. However, the prior authorization pilot risks creating barriers to care, undermining patient outcomes, and imposing unsustainable administrative demands on practices. We respectfully urge CMS to cease implementation and work collaboratively with stakeholders to design payment processes that protect the Medicare Trust Fund while achieving value, without jeopardizing patient access. Sincerely, James Jameson, MD President, Arizona State Medical Association John Bastulli, MD, FASA President, Ohio State Medical Association Bridget Bush, MD, FASA President, Washington State Medical Association Peter Blumenthal, MD President, Medical Society of New Jersey Sumit Nanda, MD President, Oklahoma State Medical Association < Back to Table of Contents

The Retire Advocate < Back to Table of Contents June 2025 Protecting Our Assets, Protecting Our Asses – Part 3 Jeff Johnson "If all mankind were to disappear, the world would regenerate back to the rich state of equilibrium that existed 10 thousand years ago. If insects were to vanish, the environment would collapse into chaos.” E.O. Wilson Naturalist Edward Wilson recognizes a fundamental truth. Humankind’s pen- chant for hubris, our seemingly eternal quest to one up the natural world, has created the conditions for our own demise. As we continue to spew carbon into the atmosphere, we create climate chaos and species decline. To put a point on it, this is not good. And of course, while all of us will be impacted, not all of us will be impacted equally. Those countries, communities, and individuals that did the least to cause climate disaster will be disproportionately impacted by the climate chaos as well as by the inability to recover from its effects. I remember listening to a college lecture in 1971 from an analyst from either the Pentagon or the Department of State. She laid out a scenario of future climatic shifts that would reduce the amount of arable land and potable water, causing massive human migration, species decline, and geo-political unrest. It is no longer hyperbole to recognize that we have crossed over the climate chaos threshold. While the ignorance of climate deniers and their disastrous policies make those pushing for carbon neutrality by 2050 seem reasonable, our hubris prevents us from recognizing the urgency of the moment, even as insects and birds vanish exponentially. We can’t wait for 2050 to act. We need to dramatically reduce carbon pollution and rapidly increase renew- able clean energy now. Our planet is seriously out of balance, egregiously out of equilibrium. I was struck by something I read from the Dalai Lama, that while humans “have the capacity to destroy the earth, so, too, do we have the capacity to protect it.” I believe that we can help the earth rebalance itself. But to do so we must act thoughtfully, equitably, and with a great sense of urgency and purpose. Financial Rebalancing There is an analogous concept of rebalancing in the financial world. Diversified financial portfolios are made up of a variety of assets in different risk classes, i.e., equities, bonds, real estate, hedge funds, government securities, etc. The overall goal for the long-term health of your portfolio is to establish a range of asset allocations that provide the best return for the least risk. You develop a target asset allocation range for different asset classifications and then track how your portfolio values match up to your asset allocations. If you can keep your portfolio in this preferred range over time, your portfolio will be in balance, providing the best returns for the least risk. Of course, as economic activity goes up and down and investment decisions change, asset values rise and fall on a daily, weekly, and quarterly basis. As a consequence, the values of your asset classes change from the targeted allocation you chose. Some will have grown higher than the target range and others fallen below the preferred range. So now what do you do? Well, it’s not rocket science. To rebalance your port- folio, to bring it back into equilibrium, you make strategic decisions to sell off certain assets from one classification and buy assets from another classification. [Note: It doesn’t work quite the same way for private-equity type investments. Often it is more prudent to hold the private-equity type investments until their normal wind-down, but importantly to not invest more]. Financial rebalancing of portfolios is a usual and customary practice. It hap- pens all the time. Washington State Investment and Pension Funds The Washington State Investment Board (WSIB) manages nearly $200 billion of state funds and public employee pension dollars. The WSIB has been a good care-taker of these funds for decades and has earned a positive national reputation as one of the best- managed state funds. The WSIB has approximately $5.5 billion invested in fossil fuel assets. This represents about 2.5 percent of its total portfolio. Given that fossil fuel assets have been significantly underperforming the broad stock market for quite some time; that the concept of financial prudence defined narrowly or more broadly, as laid out in article two of this series, war- rants selling off fossil fuel assets; that financial rebalancing is standard practice in the financial industry; and given the continued decline in the value of fossil fuel assets, there is no good reason not to rebalance our state’s Investment portfolio by selling off fossil fuel assets over the next several years and replacing them with assets that provide a better return for a lower risk. So Now Where Are We? In the first three articles of this series, “Protecting Our Assets, Protecting Our Asses,” we laid out the moral, economic, fiscal, employment, and social needs bases for rebalancing our state funds out of fossil fuels. We made the argument that it is important for our state and our public employee unions to lead the way in countering the financial industry’s $7 trillion investment in fossil fuels since the signing of the Paris Climate Accords. Rebalancing of fossil fuel assets will send a strong message to institutional investors to do likewise. We have also shown that by any measure of financial prudence our state funds and pension funds are not being well served by fossil fuel investments. Finally, we have shown that financial rebalancing is done as a matter of course in the financial industry. And that rebalancing our Washington State funds out of fossil fuels is not only a smart and financially prudent thing to do, it is a step towards rebalancing our earth – protecting both our assets and our asses. Jeff Johnson is a former President of the Washington State Labor Council and Co-President of PSARA. < Back to Table of Contents

The Retire Advocate < Back to Table of Contents March 2026 Federal Government Walks Back Home Care Nursing Hours Carla McLean Older people and their families need to pay attention to recent changes in staffing in nursing homes. Decades of work on this issue resulted in the Biden administration mandating 3.5 hours of care per resident per day and an RN on site at all times. Although the number was lower than supporters wanted, at least it was a win. Because of lawsuits on the part of corporations, the guidelines were never implemented. In July, as part of Trump’s budget bill, Medicare was prohibited from implementing the new staff standards before 2034, and then the Centers for Medicare and Medicaid Services repealed the standards completely. It is estimated that these regulations could have saved 13,000 lives a year, according to an analysis by University of Pennsylvania researchers. Nursing homes have usually had a hard time filling vacancies for staff due to low pay and poor working conditions. According to Sen. Elizabeth Warren’s website, “the average nursing home loses more than half of its nursing staff within a year due to poor pay, lack of benefits, high workloads, inadequate training, poor management and lack of career advancement.” It is clear that these changes could be due in large part to donations by 40 nursing home entities of $250,000 each to Trump’s campaign, with some like Ensign Group donating $750,000, and NHS Management giving $600,000 ( NYT , 1/28/26). All of these would eventually total nearly 4.8 million for MAGA Inc, the super PAC. According to Sen. Warren's website, CEOs for three of the largest publicly-traded nursing homes were paid nearly $70 million in 2023, on top of $650 million in dividends and compensation for shareholders and executives between 2018 and 2022. The White House made final the repeal of the minimum staffing regulations by putting the old rules back in place. An RN is required to be on site only eight hours a day, and staffing levels have no minimum numbers in the nation’s 15,000 nursing homes; instead, they say they must be “sufficient to meet patients’ needs,” which certainly is too vague to help patients much. As reported by the New York Times (Jan. 17, 2026), Sam Brooks, director for the National Consumer Voice for Quality Long-Term Care, said, “It’s clear CMS has no interest in ensuring adequate staffing.” Senators Warren, Sanders, Blumenthal, and Schakowsky wrote, “It is insulting that the for-profit nursing home industry, which receives billions of taxpayer dollars annually to run its operations, appears to prefer lining the pockets of its executives and shareholders rather than creating sustainable conditions for nurses and staff. The basis of your opposition to minimum staffing standards appears to be quite simple: greed.” Since most people want to “age in place," a major concern is the cost and availability of home care help. On this front, there was another rescinded regulation, even more unexpected than the nursing homes staffing rules. In July, the Department of Labor re-turned to a policy of excluding home care workers from the federal Fair Labor Standards Act (FLSA). That act mandated that workers receive the federal minimum wage (which is currently only $7.25 an hour) and get overtime pay. This seemed to treat home care workers as teenage babysitters with no particular skills. After 40 years of lobbying, the Labor Department included home care workers under the labor act in 2013. However, there were many complaints of non-compliance and home care agencies have had to pay about $158 million in back wages. But in July that department said it would return to 1975 regulations, saying it “hindered consumer access to care.” With the anticipated $914 billion cut to Medicaid in the next decade, it is clear that the United States has never committed to funding long-term care of seniors. Although Harris and Trump tied at 49% among voters 65 and older in the 2025 election ( AARP.org ), those Americans who helped return Trump to the White House may die from a lack of care, not only in nursing homes but also at home. < Back to Table of Contents

The Retire Advocate < Back to Table of Contents May 2026 Fighting Food Insecurity in the Face of Climate Chaos Jeff Johnson As climate chaos increasingly ravages the planet, producing sufficient, high-quality, and local food is becoming more precarious. Soaring temperatures, droughts, and flooding are taking farmland out of production and causing both food shortages and food prices to rise. Food insecurity and hunger are global crises. According to the “2025 Global Report on Food Crises,” more than 295 million people suffered from acute food insecurity around the world in 2024. On April 8 the Washington State Department of Ecology announced a drought emergency due to dismal snowpack in the mountains this past winter. In seven of the past ten years, parts of, or all of, the state have suffered drought conditions. This has reduced the quantity of food produced, lowered the quality in some cases, and increased food prices. I want to share with you a couple of examples of how some have adapted to help address part of the problem. The Atlas Mountains In March, my wife Becki and I stayed with a Berber family in the Atlas Mountains in Morocco. The Imlil valley sits at about 6,000 feet and is the gateway to Mount Toubkal, the highest mountain in northern Africa. Berber settlements in the high Atlas date back to prehistoric times. Rock engravings reveal a culture that developed an agrarian society in this rugged terrain. The river valley and terraces carved into the lower third of the mountains supported an abundance of vegetables, e.g., carrots, cucumbers, potatoes, turnips, and radishes. Their dwellings were constructed with red clay, stone, and the wood from cedar, juniper, and pine trees. Over the past twenty years, climate change has dramatically reduced the amount of snow pack and water available for irrigation. Instead of growing vegetables on the terraced mountain sides, fruit trees that require less water and less frequent watering have been planted. After thousands of years, they can no longer produce all the vegetables that they need in the high Atlas Mountains. They now grow apples, cherries, plums, and quince to sell in other parts of the country and Africa, and import vegetables to supplement what they can no longer grow. A partial solution for now. San Juan Island Living on a small island creates opportunities. Four years ago, I volunteered to be on the Board of the Farmers Market. Shortly thereafter, I was drafted to be its president. A lesson learned, be careful what you volunteer for in a small community. Small scale farming on an island in the rain shadow of the Olympic Mountains and increasingly impacted by climate change, can be hard. Living on an island that is largely dependent on its food from the mainland, has a housing shortage, and not enough family wage jobs, can be hard. Over the past three years we have created various strategies to help community members in need. Small-scale organic farmers deal with the vagaries of agriculture in a climate-changing world and food insufficiency. The first strategy was to create a grant program for farmers to increase regenerative agricultural practices to improve the health of the soil, conserve water, and produce higher quality food. Through our Agricultural Guild, we give out small grants to farmers for things like cover cropping, rotational grazing, no-till soil preparation, composting, reducing artificial fertilizers, and increasing plant diversity. A second strategy was creating the Fresh Bucks program. We raise private dollars and then give individuals ($20) and families ($40) on each farmers market day (every Saturday, April-November, and two Saturdays a month, December-March), to purchase organic fruit and vegetables, meat, fish, eggs, dairy, and seeds to eat. Fresh Bucks go to individuals/families earning less than 200% of the poverty level by family size, and then are used to make purchases from local farmers. In 2024, we distributed $28,000 in four months. In 2025 we distributed $55,000 in seven months. This year we expect to distribute $75,000 for the entire year. The Fresh Bucks program helps two vulnerable island communities and helps decrease food insecurity. Finally, we have created a co-op table at the farmers market where market staff sell the produce of backyard gardeners and small farmers who don’t have either enough produce or the ability to staff a table at the market. This gets more food into the hands of community members year-round, and, through Fresh Bucks, helps reduce food insecurity and raises the income for small farmers. Jeff Johnson is a retired president of the Washington State Labor Council and Co-President of PSARA. < Back to Table of Contents

The Retire Advocate < Back to Table of Contents October 2025 Alert Your Community to this New Threat to Medicare: WISeR Rick Timmins Writing a letter to the editor of your local newspaper is a good way to inform your community about important issues and to suggest actions that will address the problems. It’s simple to do. Select the newspaper most read in your community and go to the “Opinion” page or the “Letters” page to find instructions for submitting a letter. The Everett Herald, for example, asks you to submit your hard copy letter to: Letters Section, The Daily Herald, P.O. Box 930, Everett, WA 98206. You can email the letter to: letters@heraldnet.com . You need to include your name, address and daytime phone number. The paper will not share this with anyone, but uses the information to verify your identity. The Herald has a limit of 250 words. The Seattle Times provides the following instructions: “Join the discussion at let- ters@seattletimes.com . Please include your full name, address and telephone number for verification only. Letters are limited to 200 words.” When writing a letter, focus on one topic. Remember to adhere to the word limit. Be conversational, not academic. It is best to explain how the situation affects you personally. Your members of Congress (or their staff) read the local papers and are alerted when their name comes up. If it’s relevant, include your Representative’s or Senator’s name and either express thanks for their action or tell them why it is important that they act. We are asking you today to write a letter to your local newspaper, expressing opposition to the WISeR Model, which is adding requirements for prior authorization in Original Medicare. Prepare by reading Robby Stern’s article “CMS Expands Prior Authorization in Original Medicare” in the August, 2025, issue of The Retiree Advocate and Wendell Potter’s and Rachel Madley’s article “Lawmakers Oppose WISeR Program Expanding Prior Authorization in Medicare” in the September Advocate. With that information, you’re ready to write your letter. Below is a sample letter with 250 words (too many for the Times.) Use this as a template. Include examples of harm suffered from prior authorization by you, your family or friends. Call out your Congressperson if she/he hasn’t signed a letter of opposition. Stir up your community! Example of a Letter to the Editor: Contact your Representatives and Senators now and tell them to stop the WISeR (Wasteful and Inappropriate Service Reduction) program by co- sponsoring the Resolution introduced by Representatives Pocan and Schakowsky. This Resolution demands that the Center for Medicare and Medicaid (CMS) withdraw this program, which requires prior authorization (PA) for certain procedures recommended by physicians for their patients who are on Traditional Medicare. Authorization would be determined by private companies using algorithms or artificial intelligence (AI). These companies will be paid based on how much money they save Medicare-an outrageous incentive to deny necessary care. In Medicare Advantage plans offered by private insurance companies, where PA is already prevalent, patients often face extended delays or denials with coverage deci- sions based on algorithms or AI-driven processes rather than individual medical needs. Misuse of prior authorization by insurance companies, resulting in declining health and even death of patients, has been documented in investigative reports and in Senate hearings. More than 32 major healthcare systems will no longer accept Medicare Advantage, often due to prior authorization requirements. Profit-driven companies prioritize cost-saving measures over what is best for the patient. About half the Medicare beneficiaries, including me, have chosen Traditional Medicare instead of Medicare Advantage because we trust our doctors with our healthcare more than private insurance companies. We must demand that all of our Representatives co-sponsor the Resolution introduced by Representatives Pocan and Schakowsky, and protect access to timely, medically necessary care for our seniors on Traditional Medicare. Thank you, [Your Name] Editor's note: Representatives DelBene, Jayapal, and Smith have already co-sponsored the resolution. If you live in their districts, your letter to the editor could urge people to thank them for their stand. Rick Timmins is a retired veterinarian and a member of PSARA's Level the Playing Field task force. < Back to Table of Contents

The Retire Advocate < Back to Table of Contents April 2026 War Is a Racket, by Maj. Gen. Smedley Butler, USMC Mike Andrew War Is a Racket is not a new book. In fact, it’s almost 100 years old. It’s still a timely book, though; more so now than ever. Its author, Smedley Butler – US Marine Corps Major General, two-time winner of the Congressional Medal of Honor for actions in combat, law-and-order Public Safety Commissioner of Philadelphia in 1924 and 1925, Republican candidate for US Senate from Pennsylvania, anti-New Dealer – was the unlikeliest pacifist ever. That’s why War Is a Racket is still intriguing. How did this professional soldier become an anti-militarist? Butler was considered the front-runner for Commandant of the Marine Corps in 1930 but was passed over for promotion due to his reputation for contrariness. He then retired and began to write and lecture about war profiteering by big business. In 1931 he ran for US Senate as a progressive Republican, but was defeated by the incumbent Republican, James Davis, who ran on an anti-immigrant, pro-eugenics platform. As a candidate, Butler spoke in favor of immediate payment of the veterans’ bonus. World War I vets had been promised a “bonus” for their service, but that benefit came in the form of US bonds that didn’t mature until 1945. In the midst of the Great Depression, with many of them out of work, veterans began demanding immediate payment of their bonuses. In June 1932, some 43,000 “bonus marchers” descended on Washington, DC, to demand their payments, setting up encampments in Anacostia Flats. On July 19, Butler toured the camp and spoke to the marchers, telling them they’d been good soldiers and had a right to assemble and lobby Congress “as much as any corporation.” On July 28, DC police shot and killed two marchers. When the remaining marchers began to resist police, the Hoover administration ordered Gen. Douglas MacArthur to disperse the demonstration, which he did with tear gas, bayonets, and a cavalry charge. Fifty-five veterans were wounded and 135 arrested. Butler, like many ordinary Americans, was shocked by the disproportionate use of force. He declared himself a “Hoover-for-Ex-President” Republican. In the 1932 election, Franklin Roosevelt soundly defeated Hoover for the presidency, sweeping into office with huge Democratic majorities in the US House and Senate. Butler was not a fan. Even FDR, he thought, was too cozy with big money. Shortly after the election, when the country was getting its first taste of the New Deal, Prescott Bush – yes, the father of George H. W. Bush – approached Butler with a proposal. Bush asked Butler to meet a bond salesman, Gerald P. MacGuire. According to Butler, he met MacGuire twice in secret. At the meetings, he said, MacGuire told him that a group of businessmen, backed by $3 million, a private army of 500,000 veterans, and J. P. Morgan's bank, planned to over-throw Roosevelt and establish a fascist dictatorship. Butler was asked to lead the coup. Gen. Hugh S. Johnson would then be installed as head of state. Butler spilled the beans to the New York Times . When the story broke, the US House established a special committee to investigate. Butler testified in a private session and the committee reported that “[t]here was no question that these attempts were discussed, were planned, and might have been placed in execution..." and that the "committee was able to verify all the pertinent statements made by General Butler, with the exception of the direct statement about the creation of the organization. This, however, was corroborated in the correspondence of MacGuire with his principal, Robert Sterling Clark….” However, there were never any follow-up investigations and never any criminal indictments as a result of Butler’s testimony. In 1935, Butler published War Is a Racket. It’s still in print. Order it through your favorite bookstore or a library near you. While you wait for it to be delivered, enjoy this quote: "War is a racket. It always has been. It is possibly the oldest, easily the most profitable, surely the most vicious. It is the only one international in scope. It is the only one in which the profits are reckoned in dollars and the losses in lives. A racket is best described, I believe, as something that is not what it seems to the majority of the people. Only a small 'inside' group knows what it is about. It is conducted for the benefit of the very few, at the expense of the very many. Out of war a few people make huge fortunes." Mike Andrew is the Executive Director of PSARA and Editor of the Advocate < Back to Table of Contents

The Fiscal Commission Is a "Death Panel" for Medicare and Social Security (This is a reprint from PSARA’s March 2024 Advocate) By Jaisri Lingappa and Robby Stern Jaisri Lingappa Robby Stern Republicans and a few “business” Democrats in Congress are determined to set up a fast-track process to cut Social Security and Medicare. They know from experience that they can’t do this out in the open – their previous attempts resulted in massive public outcries. Indeed, polling from Data for Progress last month showed that 70 percent of voters, including 71 percent of Republican voters, oppose the idea of cutting Social Security and Medicare. Instead, the GOP is using a backdoor approach to achieve their goal by demanding a bipartisan fiscal commission to examine potential cuts to Social Security and Medicare as a means of reducing the debt. The House Budget Committee voted on Jan 18, 2024, to advance this fiscal commission (HR 5779) to the floor of the House. The legislation provides that the commission will develop its recommendations behind closed doors. Four non-voting members of this 16-member commission would be from outside of Congress. Thus, the discussions that will decide the fate of these critical social insurance programs will be held in secret with a small number of unelected individuals influencing the outcome. The favorable vote of two of the Democrats appointed to the commission is all that it will take to forward the proposal to Congress. The commission’s voting process is designed to make it likely that the recommendation will be to cut earned benefits, a stated goal of the Republican Party. The legislation also sets up a fast-track vote by Congress on the commission’s recommendations, with a limit of a two hour debate, no amendments permitted, followed by an up or down vote in each chamber. Removing the vote from the democratic process provided by “regular order” means our elected representatives will be prevented from proposing changes to the commission recommendations. Initially, the GOP intended to insert this bill into one of the two budget bills that need to be passed to keep the government running. As of this writing, one of those bills remains to be voted on and could still be linked to the fiscal commission bill. But even if the budget passes without this bill, there will be many other opportunities for the fiscal commission legislation to be pushed through, including during the lame-duck session after the election. So voters will need to stay vigilant. The White House has called the commission a “death panel for Medicare and Social Security.” Biden likely had the fiscal commission in mind when he said during his March 7 State of the Union speech: “If anyone here tries to cut Social Security or Medicare or raise the retirement age, I will stop them.” He went on to say “I will protect and strengthen Social Security and make the wealthy pay their fair share!” Currently the wealthy pay into Social Security only for their first $168,000 in wages annually. The White House wants to raise that cap. Moreover, in a March 7, 2024, fact sheet, the White House proposed to “modestly increase the Medicare tax rate on income above $400,000” and close loopholes in existing Medicare taxes. These proposals would go a long way in funding Social Security and Medicare without increasing the debt or increasing the tax burden on lower- and middle-income earners. Even though President Biden appears to be on our side, it would not be wise to count on a Presidential veto in the event that Congress passes the fiscal commission legislation as part of another piece of “must pass” legislation. Shortly after President Biden’s State of the Union speech, former President Trump showed his willingness to consider cuts to Social Security and Medicare in a CNBC interview. This is no surprise. The GOP has long prioritized cuts to Social Security and Medicare, with strategies such as raising the eligibility age, reducing cost-of-living adjustments, and reducing benefit amounts. We should not take any chances. We must prevent the bill enacting the fiscal commission from passing the full House of Representatives, since it would then have a high likelihood of being passed in the Senate. And we shouldn’t stop at just preserving Social Security and Medicare. A big part of what is needed is to make these programs work better. Excellent legislative proposals exist that would fix the Social Security funding gap and even expand benefits for the first time in 50 years. And to fix Medicare, we need to “Level the Playing Field” between the Medicare Advantage plans offered by the for-profit insurance industry and Traditional Medicare, which is currently hamstrung by rules limiting what it can offer. PSARA will try to keep you as up-to-date as we can on the attacks that are being mounted on Social Security and Medicare and what we can do to deny success to those who attack the programs while cynically saying they are saving them. Jaisri Lingappa is a University of Washington Professor Emeritus of Global Health and a member of PSARA's Jefferson County Organizing Committee. Robby Stern is President of the PSARA Education Fund and a member of PSARA's Executive Board

Civil Rights Reflection: Medgar Evers Pool and the Naming of Public Places Mark Epstein discusses his recent civil rights tour of four Southern states and the all to brief life and death of Medgar Evers. Read

The Retire Advocate < Back to Table of Contents August 2026 Sen. Murray's Speech to Senate Urging End to Trump Administration’s WISeR Program that is Delaying and Denying Seniors’ Health Care The Retiree Advocate reprints her speech in full: Senator Patty Murray “I wanted to talk today about not just how Republicans are making health care more expensive, but also how they are making it just plain worse for seniors. President Trump came into office saying that he wouldn’t cut Medicare. But that was clearly a lie. Because right now, his administration is trying to privatize Medicare — in part, by putting AI between Medicare beneficiaries and their health care! “In January of this year — under Secretary Kennedy’s and Dr. Oz’s leadership — CMS began this pilot program that uses AI to require prior authorization in Traditional Medicare. For the first time ever. And it is set to run for 6 years. They call it the Wasteful and Inappropriate Service Reduction model — well, they got the wasteful and inappropriate part right! “The ‘WISeR’ Model uses AI to deny vulnerable seniors the care they need and that their doctors recommend. Not only that, but the for-profit contractors that conduct this prior authorization are paid a percentage of the cost of care that they deny. They are literally incentivized to rip health care away from seniors because that is better for their bottom line. When your business model relies on denials, denials are what seniors are going to get — and that is perverse. “WISeR was rolled out in the beginning of this year in my home state of Washington and five other states, without safeguards, and without any transparency, and without the best interest of Medicare beneficiaries at the heart of the program. “President Trump is saying: forget the doctors who went to medical school and took an oath to do no harm — AI knows better when it comes to health care decisions for our seniors. The consequences of that poor judgement are real and they are life threatening. “I hear from Medicare patients in Washington state all the time who are suffering in debilitating pain for weeks because they are not getting the care they need, thanks to this harmful model. “Patients like Joanne—she’s a Medicare beneficiary from Quilcene, Washington. She went to her doctor for severe pain and an MRI showed that a herniated disc was pressing on her sciatic nerve. Joanne’s doctor prescribed an epidural injection to help ease that pain. This was standard, routine care — care that, before this year, she would have been able to get quickly after it had been recommended by her doctor. “But because of this WISeR model, she had to wait 6 weeks to get approval. That means that thanks to WISeR, Joanne had to deal with unnecessary, un[treated] pain for six weeks. Because of this nonsense delay, her day-to-day life was disrupted — and the burden fell on her then to fight for the care she needed. “This is simply outrageous! But that is also WISeR working by design. And that is a direct impact of the Trump administration’s actions. “We’ve seen way too many stories like Joanne’s from states that have been selected for this pilot program — no way should an algorithm decide if seniors should get the care that they need. “That’s why I joined my colleagues in introducing a resolution to overturn this model. And I want all of my colleagues to join me in voting for it so we can make sure seniors in my state and all over this country can once again receive their health care on time, without interruption. “Let’s just use our common sense: it is clear as day that some AI model should never be at the wheel making health care decisions left and right. “And it’s not just patients I hear from, I’ve met with health care providers all over my state. Whether it’s a rural hospital or a doctor in Seattle—no one has had anything good to tell me about prior authorization in Traditional Medicare. “Now I ran for office exactly because I believe regular people deserve a say in how their government is run—and that is especially true when it comes to the government deploying AI technology. “I don’t know any senior, Republican or Democrat, who asked President Trump to let AI decide if their doctor-recommended treatment was necessary. Of course, AI can help make things more efficient or do good things, but that’s not what the WISeR model is doing! “So, let’s get to the crux of it, as a country, we make a promise to American seniors: if they paid their taxes throughout their careers, they earned their Medicare coverage. Full stop. WISeR breaks that promise to seniors with these senseless, AI driven prior authorizations that deny and delay care. “Let me be clear, many seniors choose traditional Medicare over other options because traditional Medicare rarely requires prior authorizations. People choose traditional Medicare because they want to make their health care decisions with their doctor—not with a private company that’s out to make a profit. “Simply put, the WISeR model — which again delays and denies necessary care to Medicare patients — it is reckless and irresponsible. “I want my Republican colleagues to join us in voting to get rid of WISeR once and for all, because Mr. President, this should not be a partisan issue. “We all have seniors in our states that deserve the highest level of care, without having to deal with red tape and delays. Thanks to Trump, AI is getting in between seniors and their health care: in Arizona, in New Jersey, in Ohio, in Oklahoma, in Texas, and my state of Washington. “We have an opportunity to stop this harmful, experimental pilot program before more seniors are harmed. No senior in America should have to appeal their pain and suffering to a machine. “To my colleagues, if it was your spouse or parent who needed care, who would you want to decide if they get their treatment? Their doctor or a for-profit algorithm? Would you want them to suffer in pain for weeks for care they are entitled to? “I know what my answer is. Let’s maintain the promise of Medicare. Let’s pass this resolution.” The Retiree Advocate thanks Sen. Murray for her advocacy on behalf of Medicare beneficiaries and her staff for sending us a copy of her speech. Senate Republicans unanimouly defeated the eflort to terminate the WISeR pilot. < Back to Table of Contents

The Retire Advocate < Back to Table of Contents June 2025 North Olympic Peninsula 2025: Rural Resistance! Lisa Dekker Like the rest of Washington State, Clallam County and the Peninsula are reeling from the harms happening now – and those yet to come – from this corrupt regime and their flagrant refusal to follow the law. But we are not taking this lying down. Our residents and our leaders are determined to resist. Olympic National Park, just outside Port Angeles, gets thousands of visitors each year and is an economic engine for the region. It was already unable to meet basic maintenance needs, and reduced staffing will make it worse. In addition, although $80 million was al- ready allocated by Congress to replace the Hurricane Ridge Day Lodge that burned down in 2023, delivery of those dollars is now uncertain. For many years Port Angeles has been a gateway for Canadian visitors via the Coho/BlackBall Ferry that connects us to Victoria, B.C., just 12 miles away. But now, the absurd tariffs and territorial threats coming from #47 have resulted in an understandable backlash of Canadians deciding not to spend their tourist dollars here. This will have grave economic consequences for our restaurants, hotels, and small businesses this summer unless the tariffs are undone. Likely the most unconscionable harms to individuals here would be the drastic cuts to Medicaid in the current Republican budget. With 20 percent of our adults and more than 37 percent of our children dependent on Medicaid in Clallam County alone, the devastation would be felt by thousands here on the Peninsula. So how are we fighting back? There have been sizeable rallies in Port Ange- les, Sequim, and Port Townsend (Jefferson County) that have many new faces and an enthusiastic response from the community. Indivisible Sequim, first begun in 2016, has had a surge of new members and has backed several rallies. One of the largest gatherings in Port Angeles, and the one with the most young people, was a raucous and upbeat march supporting the Olympic National Park and Park staffers who had been abruptly laid off. Clallam Democrats have become re-energized. With the leadership of their Chair, PSARA member Ellen Menshew, they have hosted timely forums and promoted many rallies. With a new online newsletter, Clallam Democrats Rising, plus a blog, a presence on Substack and Blue Sky, and an events calendar, the Dems are keeping members informed and involved. Our three County Commissioners even did their bit with a letter to Senators Murray and Cantwell and Congresswoman Emily Randall, reminding them of the impacts being felt here and asking that they “do all that they can to support our community.” We don’t know what’s next, but here in the northwest corner, we saw that despair became righteous anger, then hope, and now resistance. We are determined to fight back. Lisa Dekker is PSARA's Co-VP for Outreach and a leader of PSARA's Clallam County organizing committee. < Back to Table of Contents

The Retire Advocate < Back to Table of Contents May 2026 Recognizing Vannetta Molson PSARA member Vanetta Molson, a retired nurse, was honored by the Mary Mahoney Professional Nurses Association (MMPNO) at their March 11 luncheon. Vanetta was a former member of PSARA's Executive Board and former Treasurer of the PSARA Education Fund. Vanetta was also a member of the Black Panther Party's Seattle chapter, the first chapter organized outside the Bay Area. In the photo, she poses with retired King County Council member and PSARA Executive Board member Larry Gossett. Larry offered a touching testimonial for Vanetta at the luncheon. Named after Mary Mahoney, the first African American graduate nurse in the USA, MMPNO was founded in 1949 with the goals of providing mutual support for African American nurses, and offer-ing scholarships to students pursuing careers in nursing. < Back to Table of Contents

The Retire Advocate < Back to Table of Contents June 2025 Final Legislative Budget Overview Pam Crone The 2025 Washington legislative session ended on April 27. The information below reflects the final legislative budget. The Governor has until May 20 to sign the budget and exercise his veto authority. The budget does not be- come final until he acts. This overview was prepared before the Governor has taken action. As a reminder, the Governor has line-item veto power, meaning he can eliminate funding but cannot add new spending or shift dollars around. Over the final weeks of the session, the Legislature returned to the drawing board multiple times to draft a budget that included new revenue to navigate a $16 billion deficit projected over the next four years. Why did the Legislature have to return multiple times to the drawing board? The Governor repeatedly and consistently expressed opposition to a wealth tax, as well as concerns about relying too heavily on new revenue to balance the budget. As a result, the final budget includes more, and deeper, cuts. Another major concern is the potential impact of looming federal Medicaid reductions. Although these cuts are largely unpopular – effectively reducing healthcare access for many Americans while further lining the pockets of the wealthy – the Repub- lican-controlled House continues to move closer to a budget proposal that includes them. If these cuts are en- acted, the Governor is expected to call a special legislative session to address the resulting healthcare crisis. Current Budget Snapshot: Final operating budget: $77.8 billion Four-year outlook: $7 billion in total reductions New revenue (2025–2027): $4.3 billion New revenue (2027–2029): $4.4 billion Rainy Day Fund: $2 billion remaining Cash reserves: $225 million Investments in K–12 Education: $750 million for special education services $213 million for materials, supplies, and operating costs $200 million in local effort assistance for low-income school districts Investments in State Workers: Approximately $1 billion to fund and approve collective bargaining agreements for state employees Housing Investments: $605 million to the Housing Trust Fund $117 million in grants to local governments to offset lost document recording fee revenues Maintaining Core Services: $93 million for emergency food assistance organizations $27.9 million for senior nutrition programs $20 million to expand resources for crime victims Pam Crone is a retired lobbyist and Chair of PSARA's Government Relations Committee (GRC). < Back to Table of Contents