August 2025 Original Medicare Prior Authorization Requirement In the Advocate August 2025: Robby Stern 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 THE ADVOCATE

Save Traditional Medicare stop WISeR The Trump Administration has been busy devising a new threat to your Traditional Medicare benefits. On January1, 2026 they are introducing a new control on Traditional Medicare in a six state demonstration program, which includes Washington State. This program, called WISeR, is an attempt to control your medicare benefits by requiring prior authorization before you and your doctor can make certain medical decisions. The administration is outsourcing these decisions to private companies whose compensation will be based on how much cost savings they can generate by limiting or eliminating patient procedures. PSARA opposes this demonstration and we are in good company. On this page you can access Senator Patty Murray’s video outlining her opposition, WA State Insurance Commissioner Patty Kuderer’s critique and concerns with the program, as well as the American Medical Associations letter in opposition to the program. This is an ongoing effort by the Trump administration to end traditional medicare in an attempt to further outsource Medicare to private equity companies. This despite the ongoing issues of private equities investments in the medical industry and Medicare advantage in particular. In late 2025 PSARA prepared a brief slide presentation (see bottom of this page) to provide more background on WISeR and what you can do to prevent it. This presentation will be updated after the November 2026 election. Please vote in November. Additionally, below are links to some late 2025 and 2026 Retiree Advocate Articles on WISeR. AARP, United Health Group, and WISeR , December 2025 Inside CMS’s Troubling WISeR Vendor List and the Power It Hands to Private Contractors , January 2026 The Fight for Medicare in 2026 , February 2026 PSARA Meets with Congressman Adam Smith to Talk About WISeR , May 2026 Sen. Murray's Speech to Senate Urging End to Trump Administration’s WISeR Program that is Delaying and Denying Seniors’ Health Care , August 2026 (Double click on the slide presentation to expand to full screen) Click here to hear Senator Patty Murray’s concerns on President Trump’s WISeR Program for Traditional Medicare beneficiaries On November 7, Rep DelBene introduced HR 5940, the “Seniors Deserve Smarter Care Act” that would prohibit implementation of WISeR. Rep Adam Smith on Cuts to Medicare and Medicaid Read WA State Insurance Commissioner Patty Kuderer’s critique and concerns with the WISeR Program Read the American Medical Association ’ s letter in opposition to WISeR On December 6th PSARA Board Members Robby Stern and Anne Watanabe (hosted by Dan Grey and Evegreen State College) discuss the attacks on Medicare and Medicaid. Click here to hear the interview 1/15

PSARA Talking Points (03/13/25 Update) Lobby Day Training Page Healthcare PSARA believes that comprehensive, affordable, accessible, and culturally appropriate health care is a fundamental human right. Highest Priority: SJM 8002 (Hasagawa), Urge Congress to Level the Playing Field between Original Medicare and Medicare Advantage. Status: Passed Senate 30-19. Hearing House Healthcare and Wellness March 21, 8:00 a.m. Sponsors: Hasagawa, Chapman, Stanford, Trudeau, Valde Medicare is a core part of our health care system, especially for seniors, but is in danger. Investors and private insurance companies are taking advantage of lax rules in the Medicare Advantage part of the program to increase profits and drive up costs – too often by limiting or denying access to needed care. Improving benefits in Original Medicare, the public part of the program, and cracking down on fraud and abuse in private Medicare Advantage programs will save billions in taxpayer money and strengthen our whole healthcare system. 1.5 million Washington residents are Medicare beneficiaries. When first enrolling, people must choose between Original Medicare and Medicare Advantage. Original Medicare has many advantages: beneficiaries can choose almost any doctor or hospital, and rarely experience delays or denials due to prior authorization requirements. However, Original Medicare has a 20% co-pay with no cap, so many purchase supplemental insurance which averages over $200 per month. · Medicare Advantage (MA) is private, usually for-profit insurance that has significantly lower monthly premiums than Original Medicare plus supplemental insurance, making it seem more attractive. But its plans have limited provider networks, often require prior authorization, and can end up being very costly for people needing extensive care. · Many seniors opt for MA plans, especially those with limited incomes, disproportionately people of color. However, when they face a complex problem like cancer or a stroke, many discover the doctor or hospital they want is out of network, and insu rance gatekeepers frequently delay or deny prescribed care, potentially causing serious harm. · Medicare Advantage insurers take significantly more money per beneficiary from the Medicare Trust Fund than Original Medicare, because they do their own risk assessment on each beneficiary and bill the Medicare Trust Fund upfront. Government and academic studies estimate that overpayments through upcoding, fraud and other abuses cost Medicare between $85 billion to $140 billion annually. SB 5291 (Conway): Strengthening WA Cares Act, by implementing the recommendations of the Long-term Services and Supports Trust Commission. Status: Passed Senate 38-31. Sponsors: Senators Conway, Saldaña, Cleveland, Frame, Nobles, Stanford, Valdez, C. Wilson; Reps.(HB 1415) Macri, Tharinger, Reed, Fey, Ormsby, Hill Washington took the lead in creating the first public long term care program in the country to address the growing crisis in elder care. As with any major program, continuing improvements are required. The substitute bill strengthens the program by adjusting provisions for workers who move out of state, providing automatic exemptions for military, and launching a pilot for supplemental insurance. The vast majority of people do not purchase private long term care insurance because it is expensive and too often cannot be relied on at the point when someone needs care. WA voters showed their support of WA Care by voting down the 2024 initiative to undermine the program (I-2124). S JM 8004 (Hasagawa): Requests that the federal government create a universal health care program or allow Washington State to implement one. Status: Passed Senate 30-19. Hearing House Healthcare and Wellness March 21, 8:00 a.m. Sponsors: Senators Hasegawa, Bateman, Lovelett, Nobles, Stanford, Trudeau, Valdez and Wellman. Despite gains in coverage, too many Washingtonians are struggling to both access and afford health care as premiums rise in the commercial health insurance market. Inadequate coverage and medical costs are the largest contributors to bankruptcies. Universal health care coverage will improve the health of our whole community. We must bring everybody in and leave nobody out of this basic right to health care. Workoers Rights PSARA supports legislation that promotes healthy families and workplaces. HB 1213 (Berry): Provides job protection for all workers using Paid Family & Medical Leave benefits. Status: Passed House 55-41. Sponsors: HB 1213 - Representatives Berry, Fosse, Reed, Obras, Fitzgibbon, Alvarado, Mena, Macri, Ryu, Farivar, Doglio, Simmons, Peterson, Street, Wylie, Pollet, Ormsby, Lekanoff, Salahuddin and Hill. SB 5539 - Senators Alvarado, Stanford, Frame, Nobles, Riccelli, Slatter, Trudeau, Valdez and C. Wilson. Washington had the best PFML program in the country when first passed. Since benefits began in 2020, hundreds of thousands of Washington workers and families have benefitted from parental leave, time to heal from surgeries or recover from cancer, and time to be with loved ones during health crises. But only about half of workers are guaranteed their jobs will be protected and health insurance will continue during their leaves. Low wage workers and workers of color are most at risk of being forced back to work too early in order to keep their jobs. Now job protection only covers those in companies with 50+ workers who have been in their jobs at least a year and worked at least 1250 hours in the previous year. This bill changes that to all workers who have been with their employer at least 90 days. Nine of the 13 other states with programs include job protections for most workers. The bill expands the small business grant program to cover health insurance premiums for employees out on PFML in companies with fewer than 50 employees. The bill also reduces the minimum claim from 8 to 4 consecutive hours and incorporates additional employer protections concerning coordination with FMLA requested by the business community. A broad coalition of labor, senior, health, and community groups support the bill. The Association of Washington Business (AWB) and other major business groups are neutral on the substitute bill, although a few business groups oppose. SB 5041 (Riccelli) Extends unemployment benefits to striking workers. Status: Passed Senate 28-21. Hearing House Labor and Workplace Standards 3-18 10:30 a.m. Sponsors: Senators Riccelli, Conway, Hasegawa, Saldaña, Salomon, Stanford, Dhingra, Nobles, Trudeau, Valdez, Bateman, Lovelett, Cleveland, Frame, Orwall, Pedersen, Slatter, Wellman and C. Wilson This bill would allow striking and locked out workers to collected unemployment insurance after 2 weeks out of work. UI provides a vital safety net for working families and their communities, allowing them to cover basic necessities. This bill will help level the balance of power between workers negotiating in good faith for fair working conditions and their better resourced employers, especially for lower wage workers. Most strikes are resolved quickly, within 2 weeks. Only 7 strikes in the past decade would have qualified, so the bill will have minimal impact on the UI trust fund. HB 1214 (Thai)/SB 5768 (Saldana): Expands eligibility for the Working Families' Tax Credit to include people 18 years of age or older. Status: SB 5768 Dead. HB 1214 Sponsors: Representatives Thai, Reed, Shavers, Farivar, Simmons, Pollet, Lekanoff and Scott. SB 5768 Sponsors: Senators Saldaña, Cleveland, Cortes, Dhingra, Frame, Krishnadasan, Nobles, Riccelli, Slatter, Stanford, Trudeau, Valdez and Wilson, C. Background: In 2021, the Legislature established the Working Families Tax Credit (WFTC) Program, based in part on the federal Earned Income Tax Credit (EITC) Program. It provides a refundable credit for retail sales or use tax paid by low-to-moderate income Washington residents who meet certain eligibility requirements. Under current law, to be eligible one must be over 24 years old, but under 65 years of age, or have a qualifying child. How does eligibility change under the proposed legislation? Expands eligibility for the Working Families' Tax Credit to include people 18 years of age or older without regard to filing with a qualifying child. For seniors still working, this is a critically significant benefit. Housing and Homelessness PSARA supports keeping people housed, building more low-income housing, and preventing homelessness in the firs place. HB 1217 (Macri)/ SB 5222 (Trudeau): provides renters and manufactured homeowners with predictability over their housing costs by limiting annual rent increases to no more than 7% a year. Status: HB 1217 Passed House 53-42 Senate Hearing Housing 3-19 1:30 p.m. HB 1217 (Macri) Sponsors: Representatives Macri, Ramel, Peterson, Berry, Mena, Thai, Reed, Obras, Farivar, Parshley, Ortiz-Self, Cortes, Duerr, Street, Berg, Taylor, Fitzgibbon, Doglio, Timmons, Tharinger, Fosse, Gregerson, Simmons, Wylie, Pollet, Kloba, Nance, Davis, Ormsby, Lekanoff, Berquist, Scott, Stonier, Hill SB 5222 (Trudeau) Sponsors: Senators Trudeau, Chapman, Bateman, Conway, Frame, Hasegawa, Lovelett, Nobles, Orwell, Pedersen, Riccelli, Robinson, Saldana, Slatter, Stanford, Valdez, Wilson, C. Why is rent stabilization needed? Washington is already one of the most expensive rental markets in the country, and many tenants receive excessive rent increases even while landlords are not performing basic repairs. Black, Indigenous, and other people of color households in Washington are disproportionately renters. In addition, data from the Census Bureau Pulse Survey in 2024 showed that Black renters in Washington receive higher rent increases than other demographic groups. Advancing tenant protections like rent stabilization is critical to address the housing needs of BIPOC households. Evictions continue to rise on a year-over-year basis, with several parts of our state seeing higher eviction rates than before the pandemic. Rent increases are a key driver of evictions and homelessness. HB 1491 (Reed) promotes transit-oriented housing development. Status: Passed House 58-39. Senate Hearing Housing 3-14 1:30 p.m. Sponsors: Representatives Reed, Richards, Berry, Duerr, Cortes, Doglio, Ryu, Fitzgibbon, Alvarado, Davis, Ramel, Parshley, Mena, Peterson, Nance, Macri, Fosse, Kloba, Ormsby, Scott. HB 1491 Requires cities planning under the Growth Management Act to allow new residential and mixed-use development within a station area at certain transit-oriented development densities. Establishes affordability requirements and authorizes a 20-year property tax exemption for residential and mixed-use buildings constructed within a station area. Why is HB 1491 needed? This bill addresses the urgent need for housing by making it possible to build new and denser housing around the most used transit assets. Transit oriented development will help the state add significantly more homes while reducing sprawl, cutting pollution, and making communities more affordable to a range of incomes. Climate and Environmental Justice PSARA supports the right of all people to live and work in a clean and healthy environment. HB 1150 (Berry) /SB 5284 (Lovelett) improves Washington’s solid waste management program. Status: SB 5284 Passed Senate 27-22. House Hearing Energy 3-17 1:30 p.m. HB 1150 Sponsors: Representatives Berry, Donaghy, Ryu, Ramel, Farivar, Mena, Alvarado, Duerr, Reed, Fitzgibbon, Callan, Macri, Doglio, Fosse, Simmons, Street, Pollet, Kloba, Nance, Davis, Ormsby, Salahuddin and Hill. SB 5284 Sponsors: Senators Lovelett, Shewmake, Nobles, Bateman, Salomon, Saldaña, Stanford, Wilson, C., Frame, Pedersen, Hasegawa, Liias, Orwall, Slatter and Valdez. Background: In 2021, the Legislature established minimum recycled content requirements applicable to three categories of plastic products or products in plastic containers: trash bags, household and personal care product containers, and plastic beverage containers. Producers subject to minimum postconsumer recycling content (PCRC) requirements were required to register with Ecology and pay fees to cover Ecology's administrative costs related to minimum recycled content standards beginning in 2022. What improvements do the bills make? Establishes an extended producer responsibility program for covered packaging and paper products. Requires producers of covered packaging and paper products to join a producer responsibility organization. Specifies requirements related to planning, funding, enforcement, and outcomes for the program. Budget and Fiscal Reform PSARA supports a state budget that is transparent, pays a living wage to state workers, and provides services that help our people, economy, and environment thrive. New progressive sources of revenue are essential to prevent devastating cuts to programs that keep people across Washington housed, fed, and healthy. Please don’t pass a budget that further harms the very people already struggling and undermines our children’s future. We can make our tax system and state stronger now and in the long run by finally asking the very wealthy to pay their fair share of taxes. The legislature must pass a new 2-year for the biennium that starts July 1, 2025, but the state faces a multi-billion dollar shortfall due to inflation, increased caseloads, and slower tax revenue growth. Possible cuts include sharp reductions in health care affordability and access, fewer kids in childcare and preschool, furloughs for state employees, less support for foodbanks and housing, and cuts to almost all state programs, including senior services. The all-cuts budget of 2009 harmed the health and well-being of Washingtonians for years, and made our families and communities less prepared and resilient for the devastation of the COVID pandemic. The influx of federal funds and the strong, forward-looking budgets passed by our legislature during the early stages of the pandemic helped get our people and state through that crisis. Washington’s tax system is highly regressive, with low- and moderate- income Washingtonians paying at far higher rates than the wealthy. Small businesses also pay higher rates than large profitable corporations. Continued growth in economic inequality helps feed the state budget crisis. Possible new revenue sources include: HB 1319 Wealth Tax (Street) Creates a 1% tax on financial assets (stocks and bonds) over $100 million. Sponsors: Reps. Street, Macri, Ormsby (Office of Fiscal Management request legislation, requested by Gov. Inslee) Wealth inequality is skyrocketing, while our state struggles to fund educational opportunity, health care, and basic services. Middle class Washingtonians pay annual property taxes on their most significant asset – their home – while the main financial assets of billionaires and mega-millionaires go untaxed. A modest 1% tax on financial assets such as stocks and bonds would allow for ample funding of public education, childcare and early learning, higher education, and provide the services that will allow all our people to thrive. In previous sessions, the Dept. of Revenue estimated that a similar wealth tax proposed by Sen. Frame and Rep. Thai would raise up to $4.5 billion annually. This new tax would make Washington’s highly regressive tax system more fair. HB 1839 (Reed) Creating equity in high tech tax by removing the cap. Sponsors: Reps Reed, Pollet, Berg, Parshley, Scott, Ormsby and Hill. This bill will help stave off devastating cuts to education and vital public services, and make Washington’s tax system less regressive by asking our biggest and most wealthy corporations to pay a little more. The bill eliminates an arbitrary cap of $9 million for high tech companies with worldwide gross revenues over $25 billion in the advanced computing surcharge. The Dept. of Revenue estimates the bill will add $231 million in the 2025-27 biennium, and $404 million in 2027-29. Revenue from the advanced computing surcharge is dedicated to the Workforce Education Investment Account.

For more than a quarter century, Puget Sound Advocates for Retirement Action (PSARA) has been active in fighting for older Americans, their children and their families. Working together for justice, equal rights and dignity for all of us in our retirement years. For more than a quarter century, Puget Sound Advocates for Retirement Action (PSARA) has been active in fighting for older Americans, their children and their families. We engage in a variety of activities and educational work, including the production and distribution of our monthly newsletter, The Retiree Advocate . Our efforts are based on the belief that seniors, our children and grandchildren need and deserve: A lifelong, adequate, dependable income; Comprehensive, affordable health care, including prescription drug coverage; Taxes and utility bills we can handle Access to affordable housing, transportation, and social services; Support for our family care-giving responsibilities, and Quality time to relax and enjoy life with family and friends. This is your cordial invitation to join. If you wish to become a PSARA member, or renew your PSARA membership, you can write in via the U.S. mail, or join on-line with a credit card. For detailed information, please go to the “Membership and Renewal ." PSARA Board Members PSARA Officers Membership & Renewal Donate Contact Us Partner Organizations Social Security Works Strengthen Social Security The Stand - Washington State Labor Council Washington Fair Trade Coalition Just for Fun

Play Video Facebook Twitter Pinterest Tumblr Copy Link Link Copied Return to Oral Histories Main Page An Interview With Frankie Manning (From the April Retiree Advocate) "Before we integrated hospitals, the majority of Black people who died in the hospital died because the Black hospitals and wards were not well equipped..." By Angie Bartels From the time she was a child, a question gnawed at Frankie Manning’s mind. She was too young to express it, and besides, those things weren’t talked about at that time, but nonetheless, she wondered why “you would have people cook your food, but they couldn't sit at the table and eat with you.” Her grand-father was the last member of his family born into slavery, and what she did un-derstand from him and her parents was that all people had value, not because of the color of their skin, but because they are human beings. Ms. Frankie was born in Caldwell, Texas, a small town near College Station, which is home to Texas A&M. She was one of 10 children and grew up in the 1940s and 50s in this largely rural area when much of the United States was segregated. “And of course, all of health care was segre-gated. My family had lots of animals, and we grew all our food during those times. One of the things I learned is to take care of animals. And I was surprised as a teen-ager when I went to a hospital where one of my teachers was having her first child. I saw the conditions, and I thought it was fascinating that people treated humans less than we did our animals. It was one of the things that influenced my decision to become a nurse. The rest of my life is history, because I spent the last 60 years working as a nurse and nurse manager.” Ms. Frankie attended St. John School of Nursing in Tulsa, Oklahoma, and gradu-ated in 1960. She quickly realized that all Black people were segregated into one part of the hospital called the Black wards – one for men and another for women. All of the Black patients were mixed in together regardless of diagnosis, whereas on the white wards, patients were divided into areas such as Med-Surg, Labor and Delivery, Infectious Disease, Mental Health, and so on. On the Black wards, there was absolutely no privacy. When the ward filled up, patients were discharged. “I noticed on my very first night at work that everything about the Black wards equipment, while the Black wards had old rusty things. Even the linen was sub-standard, and there was never enough of it on the Black wards. The supply closet was very limited, and you had to borrow. The white wards had separate clean and soiled utility rooms, while these rooms were combined into one on the Black wards, creating a high risk for infection and contamination. The big one was that a patient right out of surgery could be placed in a room with somebody who had an infection. That did not happen on the white wards – we always separated them out. You had to work twice as hard on the Black wards because of lack of resources. “I've known great nurses, no matter what color they are, great doctors, no matter what color they are. And much of this has nothing to do with color as much as it has to do with how human beings are valued. And I can tell you, before we integrated hospitals, the majority of Black people who died in the hospital died be-cause the Black hospitals and wards were not well equipped. They certainly weren't staffed well at all. You would have acute care wards in Black hospitals run by nursing assistants or LPNs, because there weren't enough nurses who would work on the Black wards, there weren’t enough nurses period.” Ms. Frankie chose to work on the Black wards because she knew she was a good nurse, and she wanted to give Black people the same quality care that the whites received. She said that Black people in the community often received little or no medical care at all. There were few Black doctors and nurses, and many people who did go to the hospital died. So there was little incentive or trust in the system. Those who survived their hospital stay often came home with secondary problems, such as infections that were contracted in the hospital. “When I went to Dover, Delaware, in 1962, I was the first RN who worked on the Black ward. All the rest were LPNs. So the standards for providing care to Black people were very poor. We had a staph outbreak, and it was primarily with our babies. We were taking the newborns out of the nursery to be with their mothers in the ward. The mothers were in the same ward as people with all kinds of infec-tions. The babies were coming back into the nursery with staph. We even had a baby who died. So that motivated us to change. I was in charge of the newborn nursery at the time. I said to the admin-istration 'We are not going to take the babies out to the ward,' because once I learned what we were doing, that there was an infant who died because of this, it made no sense to me. The chief of pedi-atrics agreed with me, and that caused a big stir in the hospital. But we moved the Black mothers over onto the white mater-nity ward, and after a couple of months, people stopped talking about it, and the babies got to be with their mothers." Ms. Frankie loved working with veter-ans. By 1965, when the Medicare Act was passed by Congress, she was working in a US military hospital in Japan where patients were not segregated by race. The Medicare Act required hospitals to desegregate in order to receive Medi-care reimbursement. Over a period of just a few months, hundreds of hospitals throughout the United States closed their Black wards and integrated their Black patients into the general hospital population. Ms. Frankie went on to have a very prolific career in nursing and nursing leadership. “We cannot eliminate Medicare or Medicaid. We have to make health care accessible to everyone, regardless of the sickness or ability to pay. My vision for an improved health care system would be one that is not so fragmented. When you’re in the hospital you see one doctor, the hospitalist; when you’re discharged, you have to go to many specialists. It’s crazy and so expensive! And we have to figure out how we can provide mental health care just like we provide care when someone cuts their leg, for instance. It’s unfortunate that we don’t treat many people beyond the emergency room. We have the knowledge and the resources to help our brothers and sisters. We can fix this, but unfortunately, it’s a matter of economics.” Ms. Frankie Manning, RN, BSN, MNA, worked over 60 years as a nurse, nurse manager, and adjunct professor at the University of Washington, Seattle Pacific University, and Seattle University Schools of Nursing. She is currently retired and a longtime member of PSARA. Angie Bartels is PSARA's Membership VP. This is one of a series of interviews she's doing with PSARA members.

PSARA Letter to the Washington State Congressional Delegation RE: The US National Climate Assessment Report Hold Hearings to shine a light on the Trump Administration's attempt to block the report. In the Advocate August 2025: PSARA Letter to the Washington State Congressional Delegation July 12, 2025 TO: Washington US Representatives and Washington Senators in the US Congress RE: The US National Climate Assessment Report The National Climate Assessment (NCA) is the US government’s preeminent report on climate change in the United States. It was set into law by the US Congress in 1990 and there have been five reports since then, released every four years. Although the National Climate Assessment is required by Congress, in April, the Trump administration announced it was canceling funding for the US Global Change Research Program, which coordinates the report. All the authors working on the upcoming Sixth National Climate Assessment, set for release in 2028, were also dismissed. The US Global Change Research Program's website was taken offline, along with all five editions of the National Climate Assessment and a wide range of information detailing how human- amplified climate change is impacting the United States. The most recent assessment, NCA5, was released in 2023. The report lays out the basic science of climate change, examines how climate change will affect 17 national-level topics, and includes 10 regional chapters covering the entire United States. The national reports are not only peer reviewed by other scientists, but examined for accuracy by the National Academy of Sciences, federal agencies, the staff and the public. The NCA gives close attention to current and future risks, how those risks can be reduced, and implications for society under different future scenarios. The most recent report, issued in 2023, included an interactive atlas that zoomed down to the county level. This lets Americans explore the impacts of climate change in their own back yards. Counties, cities, and states find it useful in planning future needs and in devel- oping budgets. Local officials say the report has helped them decide about upcoming needs - whether to raise roads, build seawalls and even move hospital generators from basements to roofs. Climate change is affecting people’s security, health and livelihoods in every corner of the country in different ways, with minority and Native American communities often disproportionately at risk. All of these reports have been taken offline by the Trump administration as of July 1. This is part of the cutback and cancellation of any work on climate change. The effect of this foolish ac- tion was brutally clear when over 100 people were swept away in the flash flood on Guadalupe River in Central Texas on July 4. Climate change will continue to make storms stronger and fires larger and faster moving. Thousands more will die from these catastrophic events. We need more resources focused on prevention and mitigation and we need them now! What specific actions are you taking to protect people and infra- structure from extreme weather events caused by climate change? We want to see public meetings and congressional hearings on this subject. It impacts the entire country. The hearings should include scientists and experts who provided the analysis for past NCA reports and those who used this critical data for planning and public health and safety at the state level. We are calling on you, our Washington State Representatives and Senators to the US Congress, to restore the National Climate Assessment as directed by congress in 1990. BACK TO THE ADVOCATE

Seattle’s 42nd Annual MLK Celebration: We Rise Against Project 2025 Seattle’s MLK Jr. Organizing Coalition invites PSARA members to Seattle’s 42nd Annual MLK Day Celebration. The election underscores the need to mobilize against broad and sustained assaults on human and civil rights under the incoming administration, as outlined in Project 2025. We expect a robust turnout for the Career and Opportunity Fair, Community Workshop Series, rally, and march on January 20, and the community discussions taking place in the preceding week. The day begins with the MLK Career and Opportunity Fair, where job seekers take steps toward exciting career opportunities and meaningful connections. Over 50 vendors include companies ready to hire, apprenticeship programs, and organizations focused on career exploration. Attendees can polish their resumes with coaching, attend career workshops, or simply explore opportunities. We’re creating an inclusive, welcoming space with multilingual support and accommodations for all attendees, plus snacks and hospitality. The Fair kicks off at 8 a.m. on January 20 at Garfield High School. We’ll build pathways to success while honoring Dr. Martin Luther King Jr. ’ s legacy of equity and economic justice. This year’s MLK Community Workshop Series builds bridges between movements and communities to build solidarity and resist threats to democracy and justice. We’ll offer 15 workshops on the morning of MLK Day (January 20 from 9:15 - 10:40 a.m.) at Garfield High School. We’ll also host standalone workshops on Thursday, January 16 and Saturday, January 18 to support deeper presentations and community discussions on critical topics. Workshop information will be posted on the MLK Coalition website. Please look for detailed information on the site starting in early January, and be sure to check back for any changes and additions. A printed workshop brochure will be available on site at Garfield. Our Monday workshops will focus on strategies and resources for effective movement building. Among the offerings are: Choosing Your Cause Well-Being for Activists Support for Immigrant Justice While the Movement Is Under Threat Keeping Us Safe in Seattle’s Surveillance City Creating Community-Centered Housing and Economic Systems Climate Justice Panel: People of Color on the Frontlines Strategies for Countering Right-Wing Movements Building Solidarity in Opposition to Project 2025 Healing Together: A Community Event for Violence Prevention Cultural Reconnection: Return to the African Homeland Building Support for African American Reparations Reclaiming Education: BIPOC Youth Leading the Way to Transformation For the past two years, we’ve piloted more extended community discussions on urgent community issues in the week preceding MLK Day. This year, we’ll hold two. JR to 25 : We Cannot Turn Back centers on the state’s troubling juvenile rehabilitation plan, including new facility construction, which doesn’t address the paucity of therapeutic services and staff’s inability to control violence at its facilities. Sponsored by Team Child and Kids Are Kids, the event begins at 5:30 with a community meal followed by discussion from 6:30 - 8:30 p.m. The event takes place at Washington Hall on Thursday, January 16. A community discussion on youth gun violence will be held on Saturday, January 18 from 1 - 3 p.m. at the Northwest African American Museum. Please join community leaders, activists, and families as we learn about causes and dynamics of youth gun violence, who perpetrates it, how we are affected by it, and strategies to mobilize against it. The event will be followed by a community meal at 3 p.m. and a program organized by the MLK Coalition’s Young Leaders program at 4 p.m. Following the Monday morning workshops, the rally will begin at 11 a.m. in the Garfield gym. Our focus this year will be on Project 2025 and youth gun violence. We will honor the legacy of the late Dr. Maxine Mimms, the visionary founder of the Evergreen State College’s Tacoma campus. The Reverend Dr. Kelle Brown will be among our speakers. The march will leave Garfield High School at 12:30 p.m. Please dress warmly and come with your signs, banners, bullhorns, and whatever else you need to make your presence visible and powerful. Please check the MLK Coalition website for final details on transportation, food, and other details. This is the time to stand in solidarity for our rights! Let’s flex our political muscle. Please join us, and bring 10 of your friends and allies.

In the Advocate May 2025: Cindy Domingo Resisting Immigrant Deportations – This Is Just the Beginning Cindy Domingo Two hundred fifty people packed Seattle’s International Association of Machinists Local 751 union hall on May 3rd, with another 60+ online, to de- liver a powerful message to the Trump administration that they would resist deportations occurring at a massive level in the US. In a show of unity, a multi-racial crowd of Asian Americans, Latinos, and white people coming from over 150 organizations/affiliations listened to three different panels composed of immigrant rights organizations and advocates, elected officials, lawyers, educators, and representatives from faith-based organizations, labor, and community-based organizations. The new organization Standing for Democracy was the convenor of the conference, which was cosponsored by another 20 organizations, including PSARA and the major statewide immigrant rights organizations NW Immi- grant Rights Project and Washington Immigrant Solidarity Network. Opening keynote speaker Rosalinda Guillen, Executive Director and cofounder of Community to Com- munity, provided a vision for Standing for Democracy as she recalled the history and work of the Washington State Rainbow Coalition (WSRC) of the 1980-90’s. WSRC, often portrayed as a multi-racial movement that had an inside/outside Democratic Party strategy, was part of Jesse Jackson’s Rainbow Coalition, but maintained its independence from Jackson. The WSRC developed a comprehensive forward- looking program, which encompassed a local, state, national, and international platform that guided its domestic and foreign policies that remain relevant today. Elected officials and political candidates coming to the WSRC for endorsements were measured by that program. For many during that period, the WSRC became the model of what participatory democracy could look like in the context of a progressive program and party. Presentations by County Council member Teresa Mosqueda and Congresswoman Pramila Jayapal (via video message) both signaled that the first 100 days of the Trump administration’s policies are quickly moving us towards fascism. The attacks on immigrants, misinformation, denial of due process, and Trump’s seizure of power held by Congress and the Courts is the classic playbook of dictators and authoritarian regimes. Both women called on conference attendees to continue to resist and organize because it is the power of the people that will stop the dismantling of our democracy. The conference reflected the willing- ness of people to come together to de- fend immigrants but also peoples’ need to develop concrete strategies and plans to further disrupt Trump’s over- all move towards fascism. As Jayapal stated, the attacks against immigrants are about all of us and all our democrat- ic rights. While Standing for Democracy in Washington State is just beginning, some ideas from the conference are already taking form. Out of the conference panel on litigation strategies, a group of lawyers led by Attorney Michael Withey are developing a legal “Strike Force” that will use various tools like the Freedom of Information Act (FOIA) to uncover information on the strategies of ICE and local police forces in Washington State. As a sanctuary state, local police forces are not allowed to cooperate with ICE on sharing information on immigrants or cooperating on arrests for federal civil immigration violations. Information from FOIAs could lead to further lawsuits to stop illegal activity. King County Councilmember Jorge Baron, a longtime leader on immigration policy in Washington State and nationally, and Mosqueda both called upon Standing for Democracy and attendees to assist in developing and supporting policies that resist the Trump administration’s attacks on im- migrants, diversity/equity/inclusion, and programs such as Medicaid, Social Security, and Medicare. Washington State has already been targeted by Trump for severe federal budget cut- backs. Although that policy has been contested in court, the two Councilmembers along with Seattle City Councilmember Alexis Mercedes Rinck, who presented on the allies panel, need a strong movement to develop new revenue to support core programs for working class people of our state and those most impacted by poverty and racism. Organizers for Standing for Democracy are considering going to the vari- ous organizations that cosponsored the conference and others across the state who are interested in building an inter- sectional movement to resist Trump’s anti-democratic policies and his moves toward fascism. There are many organizations operating throughout Washington State that work on a variety of issues, including in rural Washington and in municipalities of various sizes. These organizations do great work in their communities. As a new organization, we want to know how we can move forward together without usurping what others are doing already. One of the ideas that evolved out of the Social Forum model was the concept of Peoples’ Assemblies where communities of particular areas or sectors come together to develop their own platform based on their experiences, knowledge, and aspirations. This model has the potential of develop- ing a statewide platform similar to the Washington State Rainbow Coalition. Another tool that the National office of Standing for Democracy has developed, which was tested at the conference, was a curriculum on fascism that could potentially be adapted for use in particular sectors or communities. Standing for Democracy is holding a follow-up Zoom gathering on May 22. It is open to conference attendees who would like to further develop ideas and strategies for working together to grow our movement. Cindy Domingo is PSARA's Co-VP for Outreach and a veteran activist with LELO (Legacy of Equality, Leadership, and Organizing) and APALA (Asian Pacific American Labor Alliance). BACK TO THE ADVOCATE

Rev. Dr. Robert Jeffrey, Sr. Jayza Duhon Celebrate Juneteenth with PSARA Saturday, June 14, 1:00 p.m. - 3:00 p.m. New Hope Missionary Baptist Church PSARA welcomes all to our annual Juneteenth celebration on Saturday, June 14, from 1–3 p.m. We are honored to hold our event at New Hope Missionary Baptist Church, located at 124 21st Ave, Seattle. The Rev. Dr. Robert Jeffrey, Sr. and his congregation have graciously allowed us to have this celebration at their beautiful historic Black church in the heart of Seattle’s Central District. Our theme this year is “With Hope We Unite, Resist, and Overcome.” The Juneteenth holiday celebrates the historic day of June 19, 1865, when Union troops arrived in Texas to declare the end of slavery, some two years after Lincoln’s signing of the Emancipation Proclamation. Today, as waves of racial hostility and injustice sweep across our country, we gather on this day to stand together and lift each other’s spirits while we renew our commitment to resist and overcome racism and hatred. Our celebration includes presentations by Rev. Jeffrey, Sr., MLK Labor leader Shaunie Wheeler, PSARA leaders Claude Burfect and Larry Gossett, and musical performances by members of the New Hope Choir and soloists Jayza Duhon and Laila West. We will have books on display, curated by Rhonda Gossett, and refreshments for attendees. We are grateful to the Abe Keller Peace Education Fund for a generous donation to help us put on this event. Please join us on June 14 at 1:00 p.m. for this special event! BACK TO THE ADVOCATE

PSARA Oral Histories Project PSARA members have a wealth of experience in their respective professions and communities including their roles in labor, social justice, racial justice and environmental movements. Angela Bartels has been collecting the oral histories of PSARA members and documenting those interviews in PSARA’s monthly publication the Retiree Advocate. Those interviews are now recapped in the Oral Histories section of our website. The written summaries of the interviews are provided here and in some cases video of the interview are included. Bob Barnes Swimming Against the Current: making hard choices during the Vietnam War. Bob Barns talks about facing life changing challenges during the Vietnam war. View Story Frankie Manning "Before we integrated hospitals, the majority of Black people who died in the hospital died because the Black hospitals and wards were not well equipped..." View Story Lou Truskoff Lou Truskoff talks about his early years, his love of Music and integrating music into the labor movement. View Story Larry Gossett A Story of the Great Migration North, Housing discrimination in Seattle and how Black Power Captured Larry Gossett’s Soul While in VISTA . View Story Frieda Takamura Frieda Takamura has been and activist on a range of issues most importantly fighting for social Justice Listen to Frieda's Story Frank Irrigon Mud on their hands: Frank Irigon talks about his time in the military and working with Seattle's Asian Student Coalition protesting the construction of the King Dome. View Story Thursten Muskelly Thursten Muskelly discusses his work in the labor movement and particularly with the American Federation of Government Employees Local 1170 organizing in Seattle. View Story Tony Lee Friends of Tony Lee, Peter Costantini and Tom Berry, recount their work creating the Team Tony Lee during the 2022 election helping to flip the third WA State Congressional District View Story Gary Owens Gary Owens recounts his time with the labor movemet and the Black Panthers. View Story

Puget Sound Advocates for Retirement Action (PSARA) 2024 Washington State Legislative Agenda. PSARA Government Relations Committee The Government Relations Committee is an active and engaged committee of volunteers that believes PSARA’s advocacy will make a difference in forming our state’s policies and priorities. We meet year around and are open to all PSARA members. Our work helps to center PSARA’s advocacy priorities and lead our members to greater activism in making Washington a healthier and more equitable place to live and thrive. We advocate for the quality of life and well-being of all Washingtonians and particularly seniors emphasizing retirement security, economic and social justice, revenue reform, climate justice, healthcare and housing affordability. Click here to see PSARA’s 2026 Legislative Agenda. Here is a breakdown of the key activities and functions of the GRC. Meetings: We meet the first Thursday of every month at 12:30 by zoom (Please contact organizer@pasara.org to attend). In addition, during the legislative session we meet weekly with our lobbyist for timely updates that guide our advocacy for the next week. Membership : While the GRC includes members with specific issue expertise, we are open to any member interested in advocacy. Preparation for Legislative Session: As the legislative session approaches, the GRC doubles down in its work, creating and finalizing our legislative agenda, planning our fall conference, and organizing for Lobby Day. Crafting the Legislative Agenda: The GRC leads the work in creating a comprehensive state legislative agenda that reflects the priorities and concerns of PSARA members. We do this by consulting other PSARA committees, polling our members and meeting with allies. Legislative Conference in the fall: The conference is open to all members, where we introduce the legislative agenda, build excitement and strategize. Relationships with Legislators and Lobby Day: We engage with legislators throughout the year building relationships and bridges to better meet our advocacy goals. On Lobby Day during the session, we meet in Olympia with our legislators to advocate for our legislative agenda. Action Alerts: The committee uses action alerts to mobilize PSARA members to contact their legislators about specific bills. In summary, we encourage interested PSARA members to join us and help make change happen.

Bills PSARA Supported During 2026 Legislative Session (Final outcome for Bills supported by PSARA) PSARA is a multi-generational grass roots organization advocating for all people, and seniors in particular, being able to live their lives with economic security, dignity, and respect. Listed Below are the Bills supported by PSARA and their 2026 Legislative outcome. Thank you to all who support PSARA’s work. Healthcare PSARA believes that comprehensive, affordable, accessible, and culturally appropriate health care is a fundamental human right. Promote Leveling the Playing Field in Medicare, SJM 8002 : Passed Protect against healthcare program cuts and advance immigrant health equity and food security (budget) Creating an apple health employer assessment.SB 6173 : Dead Making improvements to transparency and accountability in the prior authorization determination process (Regulate the use of Prior Authorization in healthcare decisions,) SB 5395 /HB 1566: 5395 Passed Climate and Environmental Justice PSARA supports the right of all people to live and work in a clean and healthy environment. Divest Washington State Investment Board funds from fossil fuels, No Coal Act SB 5439 : Dead Increase environmental justice by improving government decisions, Curb Act HB 1303 / [NS1] SB 5380 : Dead Removing a tax exemption for the replacement of equipment for data centers.. SB 6231 / HB 2708 : 6231 Passed PSARA opposes the following four bills: Integrating Advanced Nuclear Energy into the State Energy Strategy HB 2090 / SB 5821 : Dead Authorizing certain public entities to contract for the capability of renewable or non emitting electric generation projects HB 2103 / SB6004 : Dead Fiscal Reform and Revenue PSARA supports a state budget that is transparent, pays a living wage to state workers, and provides services that help our people, economy, and environment thrive. Millionaire Tax SB 6346 : Passed Well Washington Fund. HB 2100 / SB 6093 : Dead Housing and Homelessness PSARA supports keeping people housed, building more low-income housing, and preventing homelessness in the first place. Workers’ Rights and Economic Justice PSARA supports legislation that promotes healthy families and workplaces. Creating a wage replacement program for certain Washington workers excluded from unemployment insurance. SB 5626 /HB 1773 : Dead Expand Working Families Tax Credit, Expanding eligibility for the working families' tax credit to everyone age 18 and older.HB 1214 /SB 5768 : Incorporated in Millionaires tax bill Concerning the Washington future fund pilot project.(Baby Bonds) HB 1661 /SB 5541 : Dead Provide greater security to Washington workers against ICE practices on the job (Concerning immigrant worker protections.Act) SB5852 /HB 2105 : 2105 Passed Placing agricultural employees under the jurisdiction of the public employment relations commission for the purpose of collective bargaining.SB 6045 /HB 2409 : Dead Community Safety and Justice PSARA supports legislation that promotes community safety and justice for all of our community members. Concerning the use of face coverings by law enforcement officers. (Ensure proper identification of law enforcement -No Secret Police Act) SB5855 /HB 2173 : 5855 Passed Concerning driver privacy protections. HB2332 /SB6002 : 2322 Passed