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The Retire Advocate < Back to Table of Contents August 2025 CMS Expands Prior Authorization in Original Medicare Washington One of Six Designated States Robby Stern The Centers for Medicare & Medicaid Services (CMS) announced on June 27, “The CMS Launches New Model to Target Wasteful, Inappropriate Services in Original Medicare.” We know from a study by the Medical Payment Advisory Commission (MEDPAC) that Medicare Advantage (MA) overcharges the Medicare Trust Fund annually at least $80 billion per year. One would think wasteful inappropriate services must exceed that number or why would they be prioritizing expanding prior authorization in Original Medicare? (A PNHP study estimates overcharges are much higher, up to $140 billion annually.) MEDPAC estimates that up to $5.8 billion in Medicare spending in 2022 was spent on services with minimal benefit. Five billion eight hundred thousand is a lot of money, but it is approximately 7 percent of $80 billion overpayments to MA. We don’t know why they chose to focus on the much smaller amount possibly lost to ""fraud, waste, and abuse.” Maybe they are trying to level the playing field in the wrong direction. Maybe they secretly want more of us in Medicare Advantage so they plan to add more prior authorizations into Original Medicare. We don’t know their motives, but below are excerpts from what they did say. "The Centers for Medicare & Medicaid Services (CMS) is announcing a new Innovation Center model aimed at helping ensure people with Original Medicare receive safe, effective, and necessary care. Through the Wasteful and Inappropriate Service Reduction (WISeR) Model, CMS will partner with companies specializing in enhanced technologies to test ways to provide an improved and expedited prior authorization process relative to Original Medicare’s existing processes, helping patients and providers avoid unnecessary or inappropriate care and safe- guarding federal taxpayer dollars… “CMS is committed to crushing fraud, waste, and abuse, and the WISeR Model will help root out waste in Original Medicare,' said CMS Administrator Dr. Mehmet Oz. 'Combining the speed of technology and the experienced clinicians, this new model helps bring Medicare into the 21st century by testing a streamlined prior authorization process, while protecting Medicare beneficiaries from being given unnecessary and often costly procedures…. “Low-value services, such as those of focus in WISeR, offer patients minimal benefit and, in some cases, can result in physical harm and psychological stress,' said Abe Sutton, Director of the CMS Innovation Center. 'They also increase patient costs, while inflating health care spending.' "The WISeR Model will test a new process on whether enhanced technologies, including artificial intelligence (AI), can expedite the prior authorization processes for select items and services that have been identified as particularly vulnerable to fraud, waste, and abuse, or inappropriate use. These items and services include, but are not limited to, skin and tissue substitutes, electrical nerve stimulator implants, and knee arthroscopy for knee osteo- arthritis. The model excludes inpatient- only services, emergency services, and services that would pose a substantial risk to patients if significantly delayed. "Companies selected to participate in the model will operate in assigned geographic regions and must have clinicians with appropriate expertise to conduct medical reviews and validate coverage determinations. Importantly, while technology will support the review process, final decisions that a request for one of the selected services does not meet Medicare coverage requirements will be made by licensed clinicians, not machines. "Model participants will receive payments based on their ability to reduce unnecessary or non- covered services (inappropriate utilization) and lower spending in Original Medicare. … "The WISeR Model will not change Medicare coverage or payment criteria. Health care coverage for Original Medi- care beneficiaries remains the same, and beneficiaries retain the freedom to seek care from their provider or sup- plier of choice… The WISeR Model does not impact people enrolled in Medicare Advantage." Trying to cut through the bureaucratic writing, what they are saying is CMS is changing Original Medicare coverage(which they deny) by expanding the list of medical treatments recommended by our providers subject to prior authorization beginning in 2026. CMS will contract with private, no doubt for-profit companies that will determine if the recommended treatment is unnecessary or inappropriate and/or constitutes waste, fraud, and abuse. The contractor may utilize AI to make the determination subject to a final decision by a licensed clinician that works for the contractor. These companies are essentially “bounty hunters."" They are compensated based on their record of denying care and reducing spending in original Medicare despite the data that shows Original Medicare spends 22% less per patient than Medicare Advantage. Introducing “bounty hunters” into Original Medicare... what could possibly go wrong?! On June 23, HHS Secretary Kennedy and CMS Administrator Oz announced an insurance industry voluntary pledge to fix what they termed the broken prior authorization system in Medicare Advantage and Medicaid. The voluntary agreement with Medicare Advantage and Medicaid insurers addressed time limits for decisions on prior authorization. Standard decisions are to be made within seven days. Urgent medical requests are to be made within 72 hours. The appeals process for denials, if necessary, extends the time before the Medicare/Medicaid beneficiary receives the treatment the provider has recommended. This is a voluntary program for insurers participating in Medicare Advantage. The WISeR Model, which expands prior authorization in Original Medicare, is mandatory in the six designated states. Neither beneficiaries nor providers can opt out. PSARA will launch an effort, with our national allies, to stop WISeR before it starts in 2026." Robby Stern is President of the PSARA Education Fund and serves on the PSARA Executive Board. < Back to Table of Contents

The Retire Advocate < Back to Table of Contents March 2025 Protecting our Assets and Protecting Our Asses Jeff Johnson "We can choose to walk through it, dragging the carcasses of our prejudice and hatred, our avarice, our data banks, and dead ideas. Or we can walk through lightly, with little luggage, ready to imagine another world. And ready to fight for it.” Arundhati Roy, “The pandemic is a portal,” Financial Times, April 3, 2020 Novelist Arundhati Roy likens the Covid pandemic to a portal which allows us the opportunity to make the same mistakes again and again or to envision a new world where we listen to and fight for our better angels. I believe her poignant imagery and prose brilliantly describe the choice we have facing climate change. Scientists have discovered five past catastrophic events in our history where the diversity of life has plummeted - five periods of species extinction. Given the current rate of species decline and cataclysmic climate disasters, some are arguing that we are entering the Sixth Extinction. The question is, are we just doomed? Or can we mitigate climate change? I believe that if we act thoughtfully, focus on the common good, and act with sufficient urgency, we can go through the climate portal fighting for an equitable, just, and sustainable economy and world. “Protecting Our Assets and Protecting Our Asses” is the first in a series of articles makingthe case for divesting from fossil fuel assets and investing in Green New Deal solutions. The Challenge In January 2016, fresh from being part of the US labor delegation to the Paris Climate Accords, I testified before the Washington State House Environmental Committee, saying that “climate change is an existential crisis.” Speaking as president of the Washington State Labor Council,AFL-CIO, I received raised eyebrows by a number of committee members and a few knowing nods from others. Eight years later, the horrifying devastation caused by hurricanes Helene and Milton in the Southeast and the multiple forest fires around Los Angeles should have convinced even the most skeptical among us that human-caused climate change poses an existential threat to life as we know it. Never, in our lifetimes, has the planet issued such a clear and resounding clarion call to do something. It does not take a rocket scientist to figure out that we are being told to leave fossil fuels in the ground; to make massive investments in non-fossil fuel renewable energy sources; to electrify our transportation infrastructure; to practice large scale regenerative agriculture; to invest in systemic energy retrofits to public and private buildings; and to figure out a global plan to address the accelerating climate refugee crisis. Unprecedented crises require unprecedented changes. We should invest in Green New Deal projects as if there were literally no tomorrow. Because if we don’t, our tomorrows will be pretty bleak. The Benefit Washington State Initiative 1631 was an attempt to go through the climate portal in an equitable, just, and sustainable way. Had 1631 passed, about $1.5 to $2.0 billion of clean energy projects a year would have been decided by a majority vote of environmental justice, labor, tribal, and environmental community leaders. These projects would have created tens of thousands of jobs with high labor standards – project labor agreements, prevailing wages, apprenticeship utilization standards, and local hire provisions. The initiative would also have created a “Just Transition” fund providing wage replacement, health care and pension benefits, and retraining benefits to displaced workers, keeping both workers and communities whole during the transition period. And of course, carbon emissions would have dramatically fallen, and there would have been no dubious carbon offsets to deal with. What Else Initiative 1631 was defeated by over $30 million contributed by the fossil fuel industry to sway the vote, and by not enough people recognizing the threat that climate change poses to our jobs, income, lives, and property. What has become increasingly clear is that climate change is a job killer, a budget killer, and a species killer. Every additional dollar invested in fossil fuels contributes to arable land becoming increasingly scarce; shrinking fresh water reserves; a further loss of jobs, lives, and property; and tens of millions of climate refugees fleeing for their lives. There is a moral imperative to divest from fossil fuels, since every dollar in- vested in fossil fuels accelerates climate disaster. There is an economic and budgetary imperative to divest from fossil fuels, since every dollar spent cleaning up climate disasters is a dollar not spent on education, health care, addressing poverty and inequality, affordable housing, or public safety. This, of course, translates into thousands of lost jobs and a declining quality of life for most of us. There is a fiscal imperative to divest from fossil fuels, since fossil fuels are consistently underperforming other assets. Sometime in the future, fossil fuel assets will become stranded assets. Financial prudence should, if nothing else, dictate replacing underperforming fossil fuel assets with climate-affirming assets with a promise of higher returns. I have hope that in Washington State we are prescient and bold enough to go through the climate portal by investing in the clean energy economy as if there were no tomorrow. We should dramatically reduce our public and private consumption of fossil fuels and divest our state funds and public and private union pension funds from fossil fuels as well. There is still time left to make good choices. How about we save our assets and our asses at the same time. Jeff Johnson is a former President of the Washington State Labor Council and the Co-President of PSARA. < Back to Table of Contents

The Retire Advocate < Back to Table of Contents December 2025 We Remember Linda Warren Sadly, we have to report that Linda Warren, wife of our long-time PSARA Executive Board member Mike Warren, passed away on October 23. PSARA members will remember her accompanying Mike to all the PSARA events. She was, as Mike said, “always there.” If we were fortunate enough to sit by her at PSARA sing-alongs, we remember she had a lovely voice. When she attended Smith College, she sang in their Glee Club, touring Europe with them. Later, Linda sang in the choirs of Blessed Sacrament Catholic Church, Seattle First Baptist Church, and Temple De Hirsch. She even joined a medieval madrigal group, Pastime Singers. Linda earned a BA in psychology from Smith College, a Masters in Social Work from the UW, and worked for more than 40 years as a dedicated social worker at Harborview and Highline hospitals. Through this work, she met Mike, and eventually they married. Deepest sympathies to Mike and all the Warren family. < Back to Table of Contents

The Retire Advocate < Back to Table of Contents February 2025 Medicare Advantage Gaming the System Diane Archer UnitedHealth now employs or contracts with about 10 percent of the physicians in the US. It’s one way UnitedHealth maximizes Medicare Advantage profits, report Anna Wilde Mathews, Christopher Weaver, and Tom McGinty for the Wall Street Journal. UnitedHealth incentivizes its physicians to include additional diagnoses codes on Medicare Advantage patient records, which enables UnitedHealth to receive higher Medicare payments. UnitedHealth advises its physicians to check their Medicare Advantage patients for certain diagnoses. So, in Eu- gene, Oregon, one physician explained that before he could move from one patient to another, he must enter into a software system whether his patient had any of a list of diagnoses. In many cases, the diagnoses had nothing to do with the patient, such as hyperaldosteronism, which is a hormone condition related to high blood pressure. Rather than ensuring their doctors focus on treating Medicare Advantage patients for the conditions these patients are reporting, UnitedHealth is focused on having its doctors document as many conditions as possible that will increase the company’s Medicare payments. UnitedHealth does nothing to ensure its doctors document additional conditions for their patients in traditional Medicare. That’s not surprising. Because of the way Medicare pays insurers in Medicare Advantage, adding diagnoses codes to traditional Medicare patient records would hurt UnitedHealth financially. The Wall Street Journal found that patients leaving traditional Medicare for Medicare Advantage in the three years ending 2022 had many more diagnoses in their medical records once they were in Medicare Advantage. Their “sickness scores” typically increased 55 percent. To put it succinctly, once in Medicare Advantage, from a sickness perspective, patients effectively had HIV and breast cancer. While UnitedHealth does more than other insurers to raise sickness scores for its Medicare Advantage patients, other insurers raised scores by 30 percent for new patients in Medicare Advantage. There is no evidence what- soever that entering more diagnoses into Medicare Advantage enrollees’ medical records benefits patients in any way. In fact, UnitedHealth doctors do not use the company’s diagnoses software for patients outside of Medicare Advantage. By the Wall Street Journal’s calculations, United’s Medicare Advantage enrollees who saw UnitedHealth physicians had such high sickness scores that UnitedHealth benefited financially to the tune of $4.6 billion over three years. This insurer gaming of the Medicare payment system must end. Among other things, it is gouging taxpayers, depleting the Medicare Trust Fund, and driving up Medicare Part B premiums. This article summarizes an investigative piece first published in the Wall Street Journal. This article appeared in Diane Archer’s January 11 Just Care weekly newsletter. Diane Archer is the founder and President of Just Care USA, and a senior advisor to Social Security Works for Medicare policy. < Back to Table of Contents

The Retire Advocate < Back to Table of Contents September 2025 Lawmakers Oppose WISeR Program Expanding Prior Authorization in Medicare Wendell Potter and Rachel Madley In a previous post in HEALTH CARE un-covered, the newsletter from the Center for Health & Democracy (CHD), Rachel Madley, PhD, Director of Policy and Advocacy for the CHD, laid out why the Centers for Medicare & Medicaid Services’ new Wasteful and Inappropriate Service Reduction (WISeR) Model is bad news for patients in Traditional Medicare. She warned that it would import one of the worst aspects of Medicare Advantage -- aggressive prior authorization run by private, profit-driven contractors -- into a program that has long prided itself on letting doctors, not algorithms, decide what’s medically necessary. Madley’s piece explained why WISeR is dangerous: It hands prior authorization in Traditional Medicare to private companies that profit by denying care -- exactly as they do in MA. It uses AI and “technology-enhanced” reviews that have been shown to spike denial rates. It offers companies a cut of the “savings” they generate, creating a built-in incentive to say no. It paves the way for more and more services to be put behind prior authorization walls. And now, there’s a sign that her warning is resonating and that momentum is building against CMS’s latest experiment. Last month, Representatives Alexandria Ocasio-Cortez (D-New York) and Lloyd Doggett (D-Texas) led 40 of their colleagues in a letter to CMS urging them not to start the model. The law makers wrote, “We are concerned that this effort could erode the quality of coverage provided by Traditional Medicare and result in the delay and denial of necessary health care." And “Giving private for-profit actors a veto over care provided to seniors and people with disabilities in Traditional Medicare, even as a pilot program, opens the door to further erosion of our Medicare system. We therefore strongly urge you to immediately halt the proposed WISeR model and instead consider steps to address the well-documented waste, fraud, and abuse in the Medicare Ad- vantage program.” And just last week, a bloc of House members sent a letter to CMS Administrator Dr. Mehmet Oz urging the agency to cancel WISeR before it starts. The letter, led by Representative Suzan DelBene (D-Washington) and signed by 19 other members, pulls no punches: WISeR, they wrote, will “likely limit beneficiaries’ access to care, increase burden on our already overburdened health care workforce, and create perverse incentives to put profit over patients." The political significance of this is hard to overstate. The members of Congress who signed these letters have, in some cases, been reliable defenders of Medicare Advantage, an industry that now takes more than half of all Medicare dollars (plus billions in overpayments each year) while using prior authorization to deny necessary care at alarming rates. For them to publicly oppose a CMS initiative that so closely mirrors MA practices suggests some- thing important: insurers may be losing some of their go-to allies on Capitol Hill. And it’s not just the Dems. The letters’ concerns echo those raised by Republicans in recent years, too. And that’s including some of Medicare Advantage’s biggest boosters. Former Representative Mark Greene, MD (R-Tennessee) led a bill with Representative Kim Schrier that would require physicians of the same specialty to review prior authorizations. And Senator Bill Cassidy (R-Louisiana), Chair of the Senate Health, Education, Labor, and Pensions Committee, stated that prior authorization is being “abused” by health insurance companies. The fact that opposition is now coming from both sides of the aisle demonstrates that this model may not be the antidote to prior authorization concerns that its proponents are touting it as. Both letters reinforce those warnings, citing data from HHS’s Office of Inspector General showing that 75% of denied prior authorization requests in MA were overturned on appeal, which is proof that many initial denials were inappropriate. They also question why CMS would contract with the very companies (often MA insurers them- selves) that have been caught breaking Medicare rules to boost profits. For years, insurers have been able to rely on a bipartisan wall of protection for Medicare Advantage. With Democrats and Republicans saying “enough," that could mean that the wall is starting to crack, and it’s not just WISeR that’s in jeopardy. It’s the whole model of using private contractors to ration care in the name of “cost control.” WISeR is scheduled to launch in January 2026 in six states: New Jersey, Ohio, Oklahoma, Texas, Arizona and Washington. If CMS doesn’t reverse course, it will mark a turning point and Traditional Medicare will begin to look and feel like private Medicare Advantage plans. But if the growing opposition is any sign, CMS may find itself pursuing other models to improve Traditional Medicare without using flawed methods from MA. Postscript : Thank you to Reps. Jayapal and Smith for signing the letter initiated by Reps. Ocasio Cortez and Doggett. Thank you to Rep. DelBene for initiating a second letter and to Reps. Randall and Strickland for signing that letter. Both letters called for cancellation of the WISeR program which tar- gets Washington Medicare beneficiaries. Wendell Potter is a former high ranking insurance executive and founder of the Center for Health & Democracy (CHD). Rachel Madley was the former health care policy staff person for Rep. Pramila Jayapal and now serves as Director of Policy and Advocacy for CHD. To subscribe to CHD’s newsletter, google search HEALTH CARE un-covered. < Back to Table of Contents

The Retire Advocate < Back to Table of Contents May 2025 Remember-ing Retired House Speaker Frank Chopper Frank was a long-time member of PSARA. He was extraordinarily gracious and generous with his time when PSARA members came to lobby day in Olympia. Below are some remembrances of Frank from PSARA leaders. Jeff Johnson Jeff is the retired president of the Washington State Labor Council, AFL- CIO, and presently serves as the co-president of PSARA: On November 3, 1998, Initiative 688, written and backed by labor, raised Washington’s state minimum wage to the highest in the country and was the first minimum wage to be indexed to inflation. Passing by 66 percent, and bringing out an additional 3 percent of the vote, broke Republican control of the House, creating a 49-49 tie and making Frank Chopp Co-Speaker of the House of Representatives. In March of 2001, labor convinced Tom Campbell (R-Spanaway) to cast his vote for Frank’s budget, passing the first Democratic budget in seven years, essentially giving Frank control of the House. In November, 2001, labor-supported candidate Brian Sullivan won a special election in the 21st LD, giving Frank and the Democrats full control of the state House. Frank liked to tell the story of how his grandparents met on a picket line outside the mines in Roslyn, WA. In 2002 he was able to honor that history by helping to shepherd four collective bargaining bills through the legislature, giving full collective bargaining rights to state employees and giving over 60,000 workers a real voice at the workplace. Frank was a complex man, and not always easy to work with. But he was a champion for the poor and for afford- able housing. His leadership at the Freemont Public Association (Solid Ground) and the Washington State legislature has left an indelible mark on the less fortunate among us. Frank had so much more he wanted to give. He will be missed. Sretan put, voda Frank Chopp! Marily Watkins Marilyn is on the Board of the PSARA Education Fund and on PSARA's Government Relations Committee. She retired as the Policy Director of the Economic Opportunity Institute: Frank was a master of the long game. In 2002, with our state in recession and facing a budget shortfall, he taught me a key lesson for winning new policy. The coalition I worked with was pushing an early version of paid family and medical leave. When we met with Frank, he said there was no way he could pass it that year. But instead of leaving it there, he added, “Come back with something I can pass.” We came back with the Family Care Act, and it did pass. Since then, Washington workers have had the right to use their sick leave or any other employer-provided paid time off to care for a sick family member. It was still a long path to winning comprehensive paid family and medical leave, but along the way, the Washington Work and Family Coalition, partnering with local coalitions, helped win paid sick leave for all workers in Seattle, Spokane, and Tacoma, then statewide. Finally, in 2017, Speaker Chopp presided over passage of our state’s landmark paid family and medical leave program. These advances have served as models for other states, helping mil- lions of workers and families across the country. Pam Crone Pam is the chairperson of PSARA’s Government Relations Committee and a retired lobbyist for PSARA: I lobbied for 20 years in the Washington State Legislature. Seventeen of those years were during Frank’s long tenure as House Speaker. Being summoned to Frank’s office has been likened to getting called to the principal’s office in junior high. The reason for the summons wasn’t always clear beforehand. Perhaps you had done some- thing really great or terribly wrong? Approaching the Speaker’s Office hop-ing for the former, the experience was always significant, and one walked out abundantly clear as to what the expectations were for a future course of action. Frank exuded energy and power. No one worked harder in the Legislature than he did. His legislative successes were legion, and he knew how to communicate those successes to Washingtonians, ensuring healthy majorities session after session. I always respected and admired how he mentored ranks of smart and eager young people, providing them a front-row seat in making policy and navigating politics. I cared for him deeply and the loss is great. Angie Bartels Angie is PSARA’s Membership Vice President: Frank Chopp was a very close friend and colleague of my husband, Tony Lee, deceased. While Frank was Speaker of the House, he recruited Tony to work at Solid Ground and lead the Statewide Poverty Action Network as the director and lead advocate. Together, these two incredibly talented men worked tirelessly (with others of course) over many years drafting legislation and garnering the support of other state legislators to pass laws in support of low-income residents of our state. This included health care, employment, workforce training, union support, early childhood education, equity in education, prisoner’s rights, services and rights for immigrants, and so much more. Occasionally we had large meetings at our house of advocates and supporters. I remember one occasion when Frank was sponsoring legislation to increase and improve mental health services. He gave a very emotional speech about the need for services to ease the suffering of the people affected and their families. As he spoke about his own sister’s mental health condition and how it affected their family, Frank wept. Through his tears, or in spite of them, Frank spoke boldly and valiantly of the work he was preparing in the legislature. I was very moved by this presentation, and it changed how I viewed Frank. His persona, in my eyes, of the mythical hero melded with the sensitive human being that he was. I don’t think I’ve ever met anyone who has fought harder or given more of himself for the people of the state of Washington. Rest in peace Frank. Your legacy lives on. < Back to Table of Contents

The Retire Advocate < Back to Table of Contents August 2025 How To Make America Sick The Trump administration’s plan to “Make America Healthy Again” will make Americans’ health worse. Donald M. Berwick, MD. Reprinted from the Center for American Progress website. It might seem obvious that the United States, the wealthiest country on earth, would have the best health and health care. But we do not. Not even close. So when President Donald Trump, Secretary of Health and Human Services Robert F. Kennedy Jr., and their allies in Congress propose to “Make America Healthy Again,” it’s easy to get on board. The trouble is that their plan won’t work. In fact, it will make Americans’ health worse. They are currently proposing to cut Medicaid and Medicare, decimate public health structures, withdraw support for food security and other basic needs, and harm the environment all of which is dead wrong from a scientific viewpoint. There is no disputing that America’s health care system needs a dramatic overhaul. U.S. life expectancy ranks 49th globally at more than four years lower than that of the world’s healthiest countries. Our children’s health ranks 36th among the 38 richest nations. Not a single U.S. state has an average life expectancy longer than that of comparably wealthy nations. If the goal is to make America as healthy as other wealthy nations, it would be hard to do worse than we are doing right now. And for that terrible performance, the United States spends twice as much per capita on health care as the average wealthy country—with more than 110 million Americans struggling with medical debt. So, yes, by all means, let’s “make America healthy.” However, unlike how the Trump administration and RFK Jr. are going about it, doing so requires following the science. In 2015, the revered British epidemiologist Michael Marmot wrote “The Health Gap,” arguably the best playbook for making any country healthier. The book summarizes decades of research on why health varies enormously among places with ostensibly similar conditions. The gap in health outcomes can be between nations, between sub- groups within nations, and even across the tracks in a single city. For example, Black Americans had a lifespan six years shorter than that of white Americans in 2021; residents of west Chicago live 14 years less than residents of the Chicago Loop; and across the city of Boston, lifespan varies by more than two decades. Marmot sorts known causes of health gaps into buckets including early childhood experiences, education, workplace conditions, supports to the elderly, and community “resilience”; he also looks at the impact of attributes such as food security, housing security, transportation systems, clean air, compassionate criminal justice systems, and recreational opportunities. Through that lens, a scientifically guided plan for “making America healthy” is simple to devise: Invest in what drives health. This is why what RFK Jr. and the Trump administration are doing makes no sense. Watch the administration, and it would be hard to find a better way to “make America sick.” It’s like “opposite day”: Every single component of the Marmot playbook is being not only neglected but controverted through the administration’s actions. Let’s run the list. Kids Healthy societies tend to place their bets on safe perinatal care, strong supports for the early years—say, from birth to age 3—and school readiness, which means not only helping children but also their parents. Contrast that with the House-passed One Big Beautiful Bill Act that instead cuts food stamps by nearly $300 billion and enacts a historic $793 billion cut to Medic- aid and the Children’s Health Insurance Program, which cover 50 percent of the children in America. Education People in countries and regions with strong educational systems, especially those that include girls and women, tend to live longer. Overall, the U.S. education system ranks 31st in the world, and it varies widely, with many schools performing poorly and many students underachieving. This is neither the teachers’ fault nor the students’. It boils down to ensuring that all children and youth, regardless of where they live or how wealthy their families are, have access to the highest quality education. The proper response would be to pour resources into delivering on that promise. On the contrary, the Trump administration’s plan calls for slashing funding for the Department of Education, cutting support to K-12 programs, and eliminating federal subsidies for student loans. Workers Job security is also foundational to national health. Unionization, which has been backwatered in the United States, is one straight shot to improving worker power. So is raising the federal minimum wage far above its embarrassingly low level of $7.25 per hour, instituting stronger legal protections for workers’ rights, and establishing more equity in tax and compensation policies. The Trump administration, meanwhile, seeks to abolish the Consumer Financial Protection Bureau, hamstring the Department of Labor, reduce bargaining rights for federal workers, weaken worker protections, and cut the essential food assistance and health care programs that the working class relies on, all to give massive tax cuts to the wealthiest Americans. Seniors How a nation supports its aging and elderly population affects not only how long and well its older citizens live, but also the health and well-being of a country’s entire population. The Trump administration claims to want to protect Medicare—a mainstay of security for those age 65 and older in the country—but study the details of what the president and his congressional allies are doing so far, and you will find steadily weakening protections for coverage, reduced access to care, and thousands of dollars more in out-of-pocket costs. For example, Medicaid, which has been torpedoed by the Trump-signed reconciliation bill, is the primary payer for 63 percent of people in nursing homes. Where are the elderly Americans who rely on that care supposed to go? Communities Healthy communities help ensure access to nutrition, housing, safety, mobility, and opportunity for everyone. The Trump administration is already weakening every one of those things and is poised to damage them further. The administration is hurting public transportation systems and rolling back environmental controls for particulate air pollution. It is also publicly in favor of coal and against wind power, against public housing expansion, against mental health supports to help reduce violence, and has backpedaled on criminal justice reform. Conclusion President Trump and Secretary Kennedy can preach all they want about making us healthy again, but their rhetoric is no substitute for facts. The right way to “Make America Healthy Again” is to invest in the infrastructure, programs, and priorities that we know, based on scientific evidence, will actually improve health—the very same ones that the Trump administration seems intent on destroying. Donald M. Berwick, MD, is President Emeritus and Senior Fellow at the Institute for Healthcare Improvement, and a former Administrator of the Centers for Medicare & Medicaid Services (CMS). < Back to Table of Contents

The Retire Advocate < Back to Table of Contents March 2025 SJM 8002 Hearing in Washington State Senate Tim Wheeler In a crowded hearing room in Olympia, WA, on Feb. 11, Sen. Bob Hasegawa (D-Seattle) introduced SJM-8002, addressed to President Trump and the US House and Senate. The Senate Joint Memorial 8002 urges the lawmakers in Washington D.C. to enact a law to halt Medicare Advantage overcharges and fraud and to “level the playing field” by adding benefits to traditional Medicare and capping out-of-pocket expenses. Hasegawa told fellow Senators and a crowd that included members of PSARA, “This memorial comes from the people themselves. They drafted this legislation.” Medicare was enacted in 1965 as a “public good,” Hasegawa added, “one of President Lyndon B. Johnson’s star programs” to benefit all senior citizens, paid for from a payroll tax on employees and employers. More than $1.6 trillion has accumulated in the Medicare Trust Fund, a target for runaway Wall Street greed. “Unfortunately, there is a move to privatize Medicare,” he continued, with Medicare Advantage permitted to pocket 15 percentof every Medicare dollar in administrative costs and profits. “No one has explained to me how Medicare Advantage provides more efficient healthcare while also collecting 15 percent in profits,” he said. Traditional Medicare administrative costs are under two percent. There are no profits. This Senate Joint Memorial 8002, if approved by the Washington State Legislature, demands that Congress enact and Trump sign a law to terminate Medicare Advantage profiteering and preserve original Medicare. Ed Weisbart, a retired physician and Vice President of Physicians for a National Health Program, hailed the Hasegawa measure. Speaking via Zoom from St. Louis, he stressed the importance of recouping the tens of billions – some estimates are as high as $140 billion – stolen from the Medicare Trust Fund by Medicare Advantage providers and using the money to help finance expanded Medicare benefits. Karen Richter, PSARA Co-President, told the hearing that PSARA strongly supports SJM-8002. “Leveling the playing field,” she said, “would scrub overcharging and fraud from the Medicare system while allowing Medicare beneficiaries a real choice about which program they would prefer." A level playing field will give traditional Medicare recipients the same benefits provided to Medicare Advantage enrollees –now just over half the 60 million Medicare recipients. Legislation is needed, said Richter, to restore Medicare “as the public good it was created to be in 1965 and to continue the tradition of Medicare being the lowest cost and most effective health care program in the United States.” Anne Watanabe, speaking for the PSARA Race and Gender Equity Committee, also endorsed SJM 8002. “Unsurprisingly, higher percentages of seniors of lower income and seniors of color enroll in private Advantage plans,” she said, because they can’t afford supplemental insurance to cover the 20 percent not covered by traditional Medicare. They discover too late “that their private advantage plans impose limits on coverage or limited networks, especially in rural areas. Medicare Advantage profiteers delay or deny treatment recommended by their doctors….” Ellen Menshew, a PSARA member from Clallam County, cited Olympic Medical Center (OMC) in Port Angeles, a public hospital that provides urgent care from Neah Bay on the Pacific coast to Quilcene near Hood Canal. “OMC is more than just a healthcare provider,” she said “It is a lifeline. As the largest employer in our county with 1,500 employees, OMC plays a crucial role in our local community. “The most glaring common denominator in the failure of rural hospitals is the impact of for-profit corporate insurance companies,” Menshew continued. These profiteers impose “delays, denials, and slow payments….leaving providers struggling to maintain financial stability and forcing hospitals into mergers or total acquisitions...” The result, she charged, is reduction in services, staff cuts, and ultimately “a decline in the overall health and well being of the community.” The presentations by PSARA leaders and allies both in oral and written testimony were compelling. Two days after the hearing, SJM 8002 was passed out of the Senate Health and Long-Term Care Committee with a “do pass” recommendation. The Republicans on the Committee voted against it. Now legislation goes to the Senate Rules Committee, this is empowered to send the bill to the floor of the Senate for a vote by the entire Senate. Here is the link to SENATE JOINT MEMORIAL 8002: https://lawfilesext.leg.wa.gov/biennium/2025-26/Pdf/Bills/Senate%20Joint%20Memorials/8002-Medicare.pdf#page=1 Tim Wheeler is a veteran activist and journalist, a member of PSARA's Executive Board, and a leader of PSARA organizing in Clallam County. < 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

The Retire Advocate < Back to Table of Contents March 2025 Photo Spread < Back to Table of Contents

The Retire Advocate < Back to Table of Contents May 2025 We Want to Hear From You! Tell Us About your Experiences with Social Security Have you experienced unacceptably bad results when contacting (or trying to contact) the Social SecurityAdministration (SSA)? Years of underfunding by Congress has left the Agency with 57,000 employees, the lowest staffing in 50 years. At least7,000 more are being cut right now. Offices are being closed. Hold times on the toll-free number are way too long, andthe MySSA website has been crashing. One million disability claims and appeals await decisions, processing times have tripled, and 30,000 applicants die each year while waiting for a final decision. PSARA wants to share powerful personalstories about degraded services and harm to workers and their families with our elected repre- sentatives and/or the press. At the same time, we want to hear from you about what SSA programs and services mean to you and to your family, andwhat would happen if they were lost or further eroded. Retirees, disabled individuals, their spouses and dependent chil- dren, and surviving spouses and children in the event of a worker’s death, all rely on timely and compassionateservice delivery. The same is true for clients who apply for Medicare and Supplemental Security Income. Incomeverifications needed to qualify for other programs, and referrals to these providers, are also vitally impor- tant. Help us save Social Security and restore service delivery. Please share your personal stories with organizer@psara.org . < Back to Table of Contents

The Retire Advocate < Back to Table of Contents December 2025 2026 Washington State Legislative Session Yes, It Really Is That Time Again Pam Crone There is still time to register and attend our 2026 PSARA Legislative Conference. The conference is virtual (on Zoom) so the entirety of our Washington State membership may participate. The conference is Thursday, December 4, at 12:30. The conference will highlight comments from John Traynor, WSLC Government Affairs Director, and Nancy Sapiro, PSARA’s lobbyist. We will review our 2026 Legislative Agenda, consider and discuss the current politi- cal landscape and context, and organize for pre-session meetings with our legislators in district. Please plan to attend. Our goal is to lay the groundwork for a successful advocacy plan for the upcoming session. 2026 Legislative Context The 2026 session is the second year of a two-year legislative cycle. It is only 60 days long rather than 105. Session begins January 12 and is scheduled to end March 12. Bills that did not pass in the first year retain their same number and are reintroduced. The operating budget for the two-year biennium was negotiated and passed in the first year. The second year is also an election year. Applying all of this to the 2026 session means that the policy goals will likely be more modest. Traditionally, legislators will pass a supplemental budget that “tweaks” the 2025-27 operating budget rather than write an entirely new budget. Both the majority and minority parties will base their messaging on the session outcomes to better advance their party’s chances in the general election. The majority Democrats will want to show they can govern, end on time, and largely stay away from the controversial. The minority Republicans will be looking for “gotcha” moments. The above brief big-picture analysis is based on conventional wisdom. As we know, though, these are not normal times. Our democracy hangs in the balance. The harmful impact of the other Washington’s passage of H.R. 1 (Big "Beautiful" Bill) is beginning to be felt. Those impacts will be felt by us all and particularly by the most vulnerable among us, including seniors’ retirement security. As of this writing, we are still in a government shutdown. SNAP benefits have been cut off. Huge Medicaid cuts are looming. The Trump agenda continues to be one of retribution to his perceived enemies, including not just individuals, but blue states like ours. PSARA 2026 Legislative Agenda The Government Relations Committee drafted a proposed agenda to be approved by the Executive Board at its November meeting. We will unveil the full agenda at the Legislative Conference Dec. 4. The agenda centers around policy priorities that we began in 2025 that we will try to get to the finish line. Some potential highlights of our 2026 legislative agenda include the following: • Level the Playing Field Resolution • No Coal Act • Protect Against Healthcare and Other Budgetary Cuts to Essential Services • Progressive Revenue We will also stand ready to advocate for all community members in Washington State, protecting people as best we can from the cruelties of the current administration. Session Advocacy Plan Nov. 6: GRC finalizes draft legislative agenda Nov. 20: PSARA E Board approves it Dec. 4: Virtual Legislative Conference Dec. 5 - Jan. 11: Members meet with legislators in district Jan. 12: 60-day session begins Weekly: Legislative updates on our website Weekly: Check-ins with our lobbyist, all Executive Board and other committee members invited to attend March 12: Session ends Dates TBD: Two Phone-in/email campaigns on PSARA priorities Dates TBD: Small group Olympia vis- its for any hearings of import and rallies Dates TBD: Virtual Legislative session review and debrief Advocacy matters! Please attend our Legislative Conference December 4 so you are up to speed and ready to go, advocating for our 2026 legislative priorities. Click here to Register. Pam Crone is a retired PSARA lobbyist and Chair of PSARA's Government Relations Committee (GRC) < Back to Table of Contents