Search Results
Please enter search terms in the box below.   This search is site wide including Retiree Advocate issues from January 2025 forward for pre 2025 issues of the Advocate please go to the Advocate Archives

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

The Retire Advocate < Back to Table of Contents January 2026 Report from PSARA’s Second Annual Public Discussion in Tacoma Threats to Traditional Medicare - The WISeR Project. Threats to Social Security Dan Grey The Tacoma Chapter of PSARA hosted its second annual public discussion, entitled “Social Safety Net Under Attack: Fighting to Save and Improve Medicaid, Social Security, and Medicare.” The well-attended event was held on Saturday, December 6 at the beautiful campus of Evergreen State College in Tacoma. Barb Church shared a moving land acknowledgment on behalf of the Puyallup Tribe of Indians. Lynne Dodson spoke about the proud history of this college in Tacoma, thanks to its first president, the late Maxine Mimms. Lynne also spoke about the mission of PSARA and recognized the co-sponsors for the event, including Pierce County Labor Council, University Place Indivisible, Indivisible Tacoma, and Indivisible Gig Harbor, as well as newly elected Tacoma City Councilwoman Latasha Palmer. The three featured panelists from the PSARA Board were Pam Crone, Anne Watanabe, and Robby Stern. Pam started by speaking about the dangers to Original Medicare beneficiaries due to the WISeR project. Washington is one of 6 states in the WISeR ((Wasteful and Inappropriate Service Reduction Model) program. The pilot program expands prior authorization in original Medicare and reimburses artificial intelligence (AI) contractors based on how much money they save the Medicare Trust Fund, i.e. by denials of care. WA Representative Suzan DelBene has introduced HR 5940 to stop WISeR. Her bill is called “Seniors Deserve Smarter Care Act.” Pam reported that WA Senator Patty Murray will also be introducing a Senate bill to stop WISeR. We were all encouraged to ask Senator Maria Cantwell to support efforts to halt WISeR even before it begins in January 2026. Anne then spoke about the well documented, devastating cuts that Trump "Big Beautiful Bill" has for Medicaid in our state. Anne added to the discussion of WISeR and compared it to a home invasion robbery where the effects are dire and immediate. The longer-term goal of privatization of Medicare is comparable to “termites who work 24/7, and you know what they’ve done when the house collapses.” All spoke to the need to “level the playing field”, by making coverage in Original Medicare on par with Medicare Advantage plans including, dental, vision, hearing, pharmacy, and by ending copays, and the need for Medigap supplemental policies. Robby rounded off the discussion, speaking about the threats to Social Security. Closing of Social Security regional offices has left field offices without guidance and much needed support. Recent policy is to shift in-person support to phone support with agonizingly long wait times. Robby spoke about the long-desired effort to “Scrap the Cap” so that wealthy employees, who make more than the current wage cap of $176,100, would continue to pay the same tax rate on their multimillion dollar incomes as those of us with much less income. Robby reminded us that, last year, PSARA helped move Washington State Senate Joint Memorial 8002 (in support of Original Medicare), sponsored by Sen. Hasegawa, to the State House, where it died in the House Rules Committee. Given that there is no fiscal note or cost to this measure, we were encouraged to let House Speaker Jinkins know we want the measure approved by the House and sent to the US Congress as the will of the people of our state. Robby credited Connecticut Representative John Larson with introducing the “Social Security 2100 Act” in Congress. While no action will occur before the new Congress is sworn in in January, 2027, we can let our Washington Congress members know of our support to strengthen and preserve Social Security. Following questions and answers, Dan Grey, a PSARA Tacoma chapter member and volunteer for Radio Tacoma, interviewed Anne and Robby. Their 28-minute interview can be heard on the radiotacoma.org website click here for the direct link to the broadcast. Dan Grey is a member of PSARA in Pierce County. < Back to Table of Contents

The Retire Advocate < Back to Table of Contents November 2025 Stunning New Report From PNHP No Real Choices: How Medicare Advantage Fails Seniors of Color In a stunning new report, PNHP (Physicians for a National Health Program) reveals that Medicare Advantage (MA) plans fail to deliver on their promises of equity for seniors of color. According to the report, seniors of color continue to face all the disparities in health care that characterize the US health care system. the disparities MA plans still impose on seniors of color. The Medicare Advantage ('MA') program, through which health insurance corporations contract with the federal government to deliver Medicare benefits, offers enrollees few upfront costs, an out-of-pocket maximum, extra benefits, and a simple enrollment process. However, these advertised benefits show themselves to be hollow when carefully studied, revealing a program that compromises access, equity, and quality of care. Evidence from an exhaustive literature review and new research reveals that MA enrollees often encounter steep barriers to the physicians and hospitals people with complex conditions need for medically necessary care. Contrary to claims from the insurance industry that MA is a solution to inequity, racial and ethnic minorities enrolled in MA continue to face many of the longstanding disparities that are common in American healthcare. The financial model of MA does little to mitigate existing inequities – and often exacerbates them by disproportionately offering communities of color inferior insurance products. At the same time, MA places a heavier burden on federal spending than Traditional Medicare (TM), which raises doubts about whether the program truly provides worthwhile returns for the people it is meant to serve. Summary of PNHP Report How Medicare Advantage Fails Seniors of Color < Back to Table of Contents

The Retire Advocate < Back to Table of Contents August 2025 PSARA Letter to the Washington State Congressional Delegation PSARA Board 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 Table of Contents

The Retire Advocate < Back to Table of Contents August 2025 Social Security: A detailed behind-the-curtain look at what's going on, posted by a Social Security Administration worker Anonymous I have not posted about my federal agency in a while. Here is why: we lost 94% of the staff in my regional office in the last two and half months. An office of 550 is now less than 2 dozen. One group of folks retired or quit. Another group were given directed reassignments to headquarters components (but did not have to physically move). A third (largest) group was bullied and pressured into “volunteering” to take front-line, public-facing jobs. Many of these folks had never worked in direct service before, and others took significant downgrades to positions from which they were promoted years or even decades before. So basically we’ve been in an inadvertent devolution exercise for the past 3 months. It’s exhausting and traumatic. I’m simultaneously enraged and grieving all of the time. All of my energy is spent on – I don’t even know what. Survival? Putting out fires? Offloading work? Responding to emails that 550 staff used to respond to? Here is a long catch-up post. The Trump administration continues to assert that Social Security is not being touched and that there have been no field office closures. While it is true that there have not been field office closures recently, there are closures and these are completely destroying the infrastructure of the agency. In order to be invisible to the public, the cuts are happening at regional and national offices that provide support to our front line staff. The destruction at SSA is designed to be off the public radar. What is happening at SSA is happening to other agencies as well – like NPS, HUD, EPA, etc. Here is some granular info: SSA used to have 10 regional offices. We are now down to 4. The 4 remaining are in hospice care. We no longer have enough staff to even triage. In my newly consolidated region, we had 550 employees in March. We now have less than 24. The remaining two dozen staff are trying to support the operations of 10,000 employees in 20 states. The other three remaining regional offices are similarly gutted. What do employees in regional offices do? These mission critical employees support the front lines; we provide computer hardware and software support, provide policy advice and guidance, train new employees, train journey level employees on new or changing policies and regulations, work with landlords and GSA, contract with guards, hire new staff, oversee labor and employee relations, allocate budget, overtime, and staffing, monitor spending, monitor for fraud, etc. We will not properly function without regional offices. We are being dismantled, physically and organizationally. Employees are psychologically gutted. Deep grief, anger, distrust. Russel Vought's plan to traumatize the workforce is working. Everyday there is an employee on the other end of the phone or video call that is crying, or telling me about their sky-rocketing blood pressure, about new anti-depressants and anti-anxiety prescriptions or increasing dosages, about their family begging them to quit or retire because it is not worth their health. It is frustrating that both the media and congressional staff keep asking only about how cuts are impacting the public. They are missing the bigger picture. It’s hard to explain what Social Security regional offices do as a lot of it is behind the scenes. We don’t interview the public or process claims, but here are some things we (used to) do that directly impacted payments and prevented fraud. As a result they are not getting done at all. Troubleshoot W2s and FICA tax issues with employers – these are both mom & pop small businesses as well as large employers like Boeing and Amazon. Interface with the state governments on Food Stamps, SNAP, WASHCAP, etc. Coordinate with state child support enforcement on garnishments. Field inquiries from state L&I on worker’s comp issues. Manage Section 218 agreements that state and local entities use to with- hold Social Security taxes from wages. Work with fisheries, farmers, and advocate groups on special Social Security number applications and non-work number cases. Liaison with state vocational rehabilitation. Work with states on Medicaid pass- along agreements. Interface with CMS and state healthcare entities on Medicare. Work with jails to support pre-release agreements as well as to obtain info when individuals are incarcerated and not entitled to benefits. Negotiate with state and local governments to obtain safe and protected data exchange agreements. Resolve attorney fee issues with disability attorneys. Ensure that Social Security over- payments are not discharged and are recouped in bankruptcy cases. Respond to FOIA requests. Headquarters components are also being hollowed out. Not only have they also lost employees to DRP, VSIP, and reassignments, they have been massively reorganized to the extent that there is no longer structural integrity. Staff have been scattered. Workloads are likewise scattered but have not always followed the staff that were scattered. We no longer know who “owns” what. Workload X used to be Department A’s responsibility but Department A is now Department Omega and the group who used to run it in Department A are no longer there. The work may still be in Department Omega or it could have moved to Department B except Department B is now gone too and maybe it’s in Department Beta? The regional offices are trying to move work to headquarters since there is no one left in regional offices but we don’t know who is left and where anything remains in headquarters either. All of this is invisible to the public because field offices continue to function at the moment. It is insidious. We are still in a freefall and haven’t hit bottom yet. There is no talk of rebuilding. We are not there. Elon may have left, but DOGE has not. < Back to Table of Contents

The Retire Advocate < Back to Table of Contents January 2025 History: “Neutralize Elderly Voters” Nancy Altman Social Security is the most popular and effective program in America, and Wall Street has spent decades on a campaign to undermine the people’s faith in the system. Think we’re exaggerating? A right- wing think tank called for a “Leninist Strategy on Social Security” back in 1983. Reading it today, much of that strategy looks just like reality. In 1983, Social Security was in a real crisis. But the system’s popularity protected it from destruction, much to Wall Street’s disappointment. Wall Street sees our Social Security system as a cash cow that they can’t access. They want to get their hands on Social Security’s $2.8 trillion trust fund, which is instead invested in US Treasury Bonds. So Wall Street–funded conservative think tanks got to work, outlining a long-term strategy to chip away at the public’s confidence in Social Security. And it was extraordinarily successful. The right-wing Cato Institute published a plan in 1983 called a Leninist Strategy1, designed to “neutralize” elderly voters while continuing to undermine confidence in Social Security among the young. The strategy had two main prongs: Make younger Americans lose faith that Social Security will keep its promise to them, and create an alternative in the form of private accounts that could be gambled on the stock market, similar to 401(k)s. The strategy took a decade to be mainstreamed by the Republicans. In 1988, a presidential candidate sharing his views about Social Security appeared on the scene. Former Delaware governor Pierre S. “Pete” du Pont IV, an heir to those who had thrown money at any FDR-hater they could find, sought the Republican nomination for president and ran on a platform of privatizing Social Security. But George H. W. Bush won the Republican nomination and the election that year. As president, he showed his understanding of the program when he said, “In my budget plan, I say we’ve got to control the growth of . . . mandatory programs but set Social Security aside. It’s not a welfare program. It’s sacrosanct.” In 1994, the House of Representatives returned to Republican control for the first time in over 40 years, the first time since Eisenhower was president. The Republicans had run in support of the “Contract with America,” drafted and promoted by Congressman Newt Gingrich (R-Ga.). Unfortunately for those opposing Social Security, the Contract with America expressed implicit support for the program by proposing only minor modifications. However, in 1994, as the law had required since 1956, the Secretary of Health and Human Services appointed 14 members to serve on Social Security’s quadrennial advisory council. The trustees had begun to project a long term deficit in Social Security’s financing occurring somewhere more than 35 years in the future. Included in the report was an appendix, entitled “Developments Since 1983,” which addressed the causes of the projected shortfall. The appendix began by debunking the myth that the inexorable tide of aging baby boomers had anything to do with the projected deficit. The report clarified: “the fundamental ratio of beneficiaries to workers was fully taken into account in the 1983 financing provisions and, as a matter of fact, was known and taken into account well before that.” The report then explained that the shortfall resulted from a variety of factors. By the time the advisory council reported, almost 31 million workers participated in 401(k) plans, which contained assets of over $1 trillion. As the stock market went up and up in the 1990s, these arrangements became more and more popular. This was the opportunity the Leninist Strategy envisioned. More and more Americans were becoming used to private accounts for retirement income. The Cato Institute formed the Project on Social Security Privatization on August 14, 1995. A co-chairman of the project was José Pinero, the Pinochet Minister of Labor who had designed the Chilean system of private accounts. Just as supporters of private accounts had been doing since almost the moment Chile had privatized its Social Security program, Cato touted the Chilean system as a model for the United States, despite its decidedly mixed results. The new right-wing project fueled privatization talk with publications and conferences. In less than a decade, the project could proudly boast that it had “published more than forty books, articles, and reports” criticizing Social Security and advocating private accounts. During these years, Social Security produced large surpluses, as it had been projected to do when the 1977 and 1983 amendments had been enacted—but the federal deficit grew to record deficits. On March 7, 1999, the wealthy governor of Texas announced that he was forming a committee to explore a run for the presidency. Despite his limited political experience and his weaknesses as a speaker, he had one huge asset. He happened to be the son of a former president, and the two men shared the same first and last names, George Bush. Well before Bush formed his exploratory committee, he had been thinking about the presidency and had been thinking about Social Security as well. He had a long history of hostility to the program. As a student at the Harvard Business School in the early 1970s, he had railed against Social Security and other New Deal programs. In his losing bid for a congressional seat in 1978, he had ventured that “people [should] be given the chance to invest [Social Security] the way they feel.” The patience of the anti-Social Security forces seemed to have paid off. They finally had a president who seemed to see the world their way. Despite Social Security’s absence from the campaign, President Bush established a presidential commission, on May 2, 2001, to study and make recommendations about Social Security. The members consisted only of people who were dedicated to destroying Social Security’s universal promise, and it resulted in Bush’s privatization scheme. Unlike most presidential commissions, which are given broad guidelines within which to work, this commission was to be tightly constrained. Among the stipulations dictated by Bush was that the commission’s recommendations “must include individually controlled voluntary personal accounts.” It was not a commission to consider what should be done; rather, it was a commission to advise the president how to do what he had already made up his mind to do. At the same time, Bush used the ad- ministration of government to sow distrust in Social Security. Though Trustees Reports between 2001 and 2004 grew slightly more optimistic, with the projected year of exhaustion of the trust funds slightly further into the future, Social Security Administration publications became more alarmist. No longer confirming that Social Security faced “no immediate crisis,” the publications now warned that the program was “unsustainable,” and “under financed.” Most disturbing was the change in the annual statement sent to all of the 125 million workers aged 25 and over who pay into the trust funds. This statement, completely unsolicited, simply arrives in each worker’s mailbox. The 2001 statement proclaimed, “Will Social Security be there when you retire? Of course it will.” This reassurance was gone by 2002. And in 2005, the unsettling remark “Congress has made changes to the law in the past and can do so at any time” was now in the mailing, just in case workers were feeling too secure. The same tactics are being used today. Republicans in Congress are systematically underfunding the Social Security Administration, forcing office closings and longer wait times to receive the world class service Americans are promised. George W. Bush set the agenda for Trump and Elon Musk: Pass a massive tax cut, then try to cut Social Security in the name of fiscal discipline. Of course, Bush’s gamble failed. But privatizers learned a lesson from that. Instead of hashing it out in public, where Social Security’s overwhelm- ing popularity protects it, Wall Street learned to sharpen their axes behind closed doors – just like Elon Musk and Vivek Ramaswamy are doing right now. This isn’t a new fight – it is the same thing we have been fighting for almost a century. With our voices together, we beat Bush’s privatization scheme, we beat the neo-liberal drumbeat of President Obama’s fiscal commissions, and we’re going to beat Trump and Elon Musk. The way we win is to go on the offense. We need to EXPAND Social Security and never cut it. Nancy Altman is President of Social Security Works, Chair of the Board of Directors of the Pension Rights Center, a member of the Boards of Directors of the Alliance for Retired Americans Educational Fund, Latinos for a Secure Retirement, and the Institute for America’s Future. < Back to Table of Contents

The Retire Advocate < Back to Table of Contents October 2025 How WISeR Will Enable Companies to Profit from Pain – A Retired Physician’s Story Jaisri Lingappa, MD PhD As a retired and otherwise healthy physician, I recently endured weeks of intense pain this summer due to a herniated disk, which developed out of the blue without an obvious cause. This pain was beyond anything I had previously experienced – I am generally quite stoic, but these episodes reduced me to tears in the middle of the night. Disk herniation is a common spine condition that causes intense back pain and sciatica. The herniated (bulging) disk impinges on a spinal nerve causing inflammation that in turn increases pressure on the nerve leading to worse pain and inflammation in a vicious cycle. Epidural steroid injections are simple outpatient procedures that are performed in a few minutes without general anesthesia but must be done by a specialist using fluoroscopy (real- time X-ray imaging) to guide the injection to the site of the herniation. By delivering anti-inflammatory steroids to the exact site of the herniation, the epidural injection reduces the inflammation, thereby breaking the vicious cycle of pain and providing short term relief, often to a dramatic extent. In the long term, the patient’s immune system can trim the bulging disc, leading to a full recovery, but it is difficult for that healing process to begin when a patient is struggling with the vicious cycle of painful inflammation worsened by daily activity or impaired sleep. Thus, epidural steroid injection is a straightforward and minimally invasive procedure that can play a critical role in management of a common form of back pain. Pain specialists spend years learning when and how to use this important tool. Shockingly, “epidural steroid injection for pain management” is one of the 17 procedures that will soon require prior authorization for patients in Original (Traditional) Medicare in Washington State, thanks to a new program called WISeR(1) about to be instituted by Dr. Oz, the new Director of the Center for Medicare and Medicaid Services (CMMS). My herniated disk prevented me from sleeping for more than 90 minutes at a time without severe pain for much of this past summer. Because my Washington State town lacks practitioners who offer epidural injection, I tried other approaches for pain relief, including nonsteroidal anti-inflammatory medications, oral steroids, and intra- muscular steroid injections. But after seven weeks of repeated setbacks and severe sleep deprivation, I searched outside our area for the procedure. Because I am on Original Medicare, I was able to choose the best physician for this purpose regardless of location or network affiliation. A highly regarded pain specialist an hour away was able to schedule the initial visit in two weeks and the procedure, which included a diagnostic and therapeutic component, a week later. Within days after the procedure, I was sleeping pain-free for the first time in 10 weeks, and a couple days later I resumed my previous level of exercise. A month out from the procedure, I continue to be pain-free and my spine appears to be well on its way to healing. Under the new WISeR program, Washington State residents on Original Medicare will need prior authorization (PA) to obtain epidural steroid injections for pain management in the future, along with 16 other procedures - a list that could grow over time. Authorization will be decided by companies that use AI to make decisions and will gain profit through denying authorizations. This approach will be modeled on the current use of PA by Medicare Advantage (MA). MA, which is offered by for-profit insurers as an alternative to Original Medicare, has gained attention for the use of PA as a mechanism for enhancing corporate profits(2,3). “Data submitted by MA insurers show that 81.7% of prior authorization denials were overturned in 2023” upon appeal according to a recent article from Healthcare Uncovered (4). The success of most appeals shows that prior authorization denials are often medically inappropriate – in which case why is CMMS replicating MA programs already proven to be problematic (5) and imposing them on Original Medicare? I cannot begin to imagine how much worse it would have made my life to endure weeks or even months of additional excruciating pain and sleep deprivation while awaiting prior authorization and perhaps even an appeal. Is this what our country has come to? Will seniors now be forced to endure pain and illness, while knowing that relief used to be easily available if their physician deemed it necessary? Important procedures will soon be out of reach because our government allows corporations to reap huge profits by denying necessary healthcare. Citations: 1. WISeR Model RFA. Center for Medicare and Medicaid Services. P. 20. https://www.cms.gov/files/document/wiser-model-rfa.pdf 2. Medicare Advantage Plans Often Deny Needed Care, Federal Report Finds. Reed Abelson, The New York Times, April 28, 2022. https://www.nytimes.com/2022/04/28/ health/medicare-advantage-plans- report.html 3. Insurers Pledge to Ease Controversial Prior Approvals for Medical Care. Reed Abelson, The New York Times, June 20, 2025. https://www.nytimes.com/2025/06/20/ health/health-insurance-prior-authori- zation.html 4. CMS is Trying to Expand Prior Authorization in Traditional Medicare Even Though All Data Points Say That’s a Bad Idea. Rachel Madley, Healthcare Uncovered, July 7, 2025. https://healthcareuncovered.substack . com/p/cms-is-trying-to-expand-prior- authorization 5. About the Current Prior Authorization System. AMA Website FixPrior- Auth. https://fixpriorauth.org/issue Jaisri Lingappa is a retired physician and professor of global health, and a member of PSARA's Level the Playing Field task force. < Back to Table of Contents

The Retire Advocate < Back to Table of Contents April 2025 It’s a Stew Midway Legislative Report Pam Crone Every legislative session has a distinctive flavor. The 2025 session is no different. What is the flavor of the 2025 session? It’s a stew. Brand new Governor Ferguson bringing his own style of governing and priorities. Huge budget deficit projected over the next four years. Loads of new senators and house members. Uncertainty at the federal level and potential impacts on the state, both policy-wise and fiscally. How this will all come together is a mystery at this time. As of the writing of this article, we are a little over halfway through the session. More will be revealed as the session progresses. We haven’t seen a budget deficit like the one we are facing this year since the lean years of the great recession beginning in 2008. Most of today’s legislators have never had to reckon with the prospect of massive cuts to essential public services. These days there may be more appetite for progressiverevenue, but we shall see. We still have a number of priority bills from our original 2025 legislative agenda moving, as well as some casualties of the first chamber cut-off in March. Do note that everything that passed its house of origin must go through the same process in the other house. If the bill passes both chambers, its final form must be the same before it can go to the Governor for signature. Still Alive and Kicking SJM 8002 Protecting Original Medicare and Leveling the Playing Field passed the Senate 30-19. SJM 8004 Supporting efforts to advance Universal Healthcare passed the Senate 30-19. SB 5291 Strengthening and Protecting WA Cares passed the Senate 38-11. HB 1217 Ensuring reasonable and more predictable rent increases passed the House 53-42. HB 1491 Creating affordable housing close to transit passed the House 58-39. HB 1213 Extending job protection in the Family and Medical Leave Program passed the House 55-41. SB 5041 Extending unemployment benefits to striking workers passed the Senate 28-21. SB 5284 Improving solid waste management by reducing the use of plastic wrap and containers passed the Senate 27-22. Casualties SB 5344/HB 1523 Ensuring quality affordable healthcare for nursing home workers. SB 5626/HB 1773 Providing wage replacement (unemployment benefits) to undocumented workers. SB 5541/HB 1661 Building eco- nomic security through WA Future Fund Pilot Program. SB 5768/HB 1214 Expanding the Working Families Tax Credit. SB 5439 Divesting WA State In- vestment Board funds from fossil fuels (No Coal Act) SB 5380/HB 1303 Increasing environmental justice by improving government decisions (Curb Act) The 2025 session is the first session of the two-year biennium. Bills that die in 2025 spring to life again in 2026, so there is still hope. Yet to heat up will be budget discussions around creating a balanced budget with revenue rather than making cuts to essential services. PSARA will be part of the advocacy effort around progressive revenue. The May Retiree Advocate will carry a review of the wins and losses of the 2025 legislative session. As always, stay well, active, and engaged. Democracy is not a spectator sport. Pam Crone is a retired lobbyist and the Chair of PSARA's Government Relations Committee. < Back to Table of Contents

The Retire Advocate < Back to Table of Contents April 2025 Protecting our Assets and Protecting Our Asses -Part 2 Jeff Johnson If all mankind were to disappear, the world would regenerate back to the rich state of equilibrium that existed 10 thousand years ago. If insects were to vanish, the environment would collapse into chaos.” E.O. Wilson Naturalist Edward Wilson recognizes a fundamental truth. Humankind’s pen- chant for hubris, our seemingly eternal quest to one up the natural world, has created the conditions for our own demise. As we continue to spew carbon into the atmosphere, we create climate chaos and species decline. To put a point on it, this is not good. And of course, while all of us will be impacted, not all of us will be impacted equally. Those countries, communities, and individuals that did the least to cause climate disaster will be disproportionately impacted by the climate chaos as well as by the inability to recover from its effects. I remember listening to a college lecture in 1971 from an analyst from either the Pentagon or the Department of State. She laid out a scenario of future climatic shifts that would reduce the amount of arable land and potable water, causing massive human migration, species decline, and geo-political unrest. It is no longer hyperbole to recognize that we have crossed over the climate chaos threshold. While the ignorance of climate deniers and their disastrous policies make those pushing for carbon neutrality by 2050 seem reasonable, our hubris prevents us from recognizing the urgency of the moment, even as insects and birds vanish exponentially. We can’t wait for 2050 to act. We need to dramatically reduce carbon pollution and rapidly increase renew- able clean energy now. Our planet is seriously out of balance, egregiously out of equilibrium. I was struck by something I read from the Dalai Lama, that while humans “have the capacity to destroy the earth, so, too, do we have the capacity to protect it.” I believe that we can help the earth rebalance itself. But to do so we must act thoughtfully, equitably, and with a great sense of urgency and purpose. Financial Rebalancing There is an analogous concept of rebalancing in the financial world. Diversified financial portfolios are made up of a variety of assets in different risk classes, i.e., equities, bonds, real estate, hedge funds, government securities, etc. The overall goal for the long-term health of your portfolio is to establish a range of asset allocations that provide the best return for the least risk. You develop a target asset allocation range for different asset classifications and then track how your portfolio values match up to your asset allocations. If you can keep your portfolio in this preferred range over time, your portfolio will be in balance, providing the best returns for the least risk. Of course, as economic activity goes up and down and investment decisions change, asset values rise and fall on a daily, weekly, and quarterly basis. As a consequence, the values of your asset classes change from the targeted allocation you chose. Some will have grown higher than the target range and others fallen below the preferred range. So now what do you do? Well, it’s not rocket science. To rebalance your port- folio, to bring it back into equilibrium, you make strategic decisions to sell off certain assets from one classification and buy assets from another classification. [Note: It doesn’t work quite the same way for private-equity type investments. Often it is more prudent to hold the private-equity type investments until their normal wind-down, but importantly to not invest more]. Financial rebalancing of portfolios is a usual and customary practice. It hap- pens all the time. Washington State Investment and Pension Funds The Washington State Investment Board (WSIB) manages nearly $200 billion of state funds and public employee pension dollars. The WSIB has been a good care-taker of these funds for decades and has earned a positive national reputation as one of the best- managed state funds. The WSIB has approximately $5.5 billion invested in fossil fuel assets. This represents about 2.5 percent of its total portfolio. Given that fossil fuel assets have been significantly underperforming the broad stock market for quite some time; that the concept of financial prudence defined narrowly or more broadly, as laid out in article two of this series, war- rants selling off fossil fuel assets; that financial rebalancing is standard practice in the financial industry; and given the continued decline in the value of fossil fuel assets, there is no good reason not to rebalance our state’s Investment portfolio by selling off fossil fuel assets over the next several years and replacing them with assets that provide a better return for a lower risk. So Now Where Are We? In the first three articles of this series, “Protecting Our Assets, Protecting Our Asses,” we laid out the moral, economic, fiscal, employment, and social needs bases for rebalancing our state funds out of fossil fuels. We made the argument that it is important for our state and our public employee unions to lead the way in countering the financial industry’s $7 trillion investment in fossil fuels since the signing of the Paris Climate Accords. Rebalancing of fossil fuel assets will send a strong message to institutional investors to do likewise. We have also shown that by any measure of financial prudence our state funds and pension funds are not being well served by fossil fuel investments. Finally, we have shown that financial rebalancing is done as a matter of course in the financial industry. And that rebalancing our Washington State funds out of fossil fuels is not only a smart and financially prudent thing to do, it is a step towards rebalancing our earth – protecting both our assets and our asses. Jeff Johnson is a former President of the Washington State Labor Council and the Co-President of PSARA. < Back to Table of Contents

The Retire Advocate < Back to Table of Contents May 2025 Autoworkers, the UAW, Trump, and Trade Tariffs and the Autoworkers Michael Righi Our orange king has put 25 percent tariffs on imported cars and trucks. Wait! They are suspended for a couple months, but not for all countries. Not for China, of course. And maybe special consideration for parts made in Canada and Mexico. By the time you read this, who knows what the situation will be? But a couple things are clear. While Trump and Miller and the rest of them blather on about bringing industry back to a bunkered USA, their broad and haphazard tariffs are leading straight to recession and job loss. Uncertainty will crash business investment. Intermediate goods that firms need will cost more, and they will cut back and lay workers off. Tariffs are a tax that falls most heavily on goods bought by working families. So they will feel both the inflation and the job loss. Trump says “we” will need to suffer a little pain in the short run. Except not Apple or purchasers of I- phones or computers, they are exempt. Blow Up Free Trade Fundamentalism We should not mourn the end of so- called “free trade." Neoliberal economists, corporate Democrats and many NY Times pundits are howling about the end of the postwar trading system. But we do not want the corporate trade model that is embodied in the North American Free Trade Agreement and the opening of trade with China. That has allowed multinational corporations to exploit foreign workers and environments, moving factories overseas and devastating working class communities in the US. NAFTA and trade with China have led to a loss of 70,000 manufacturing plants in the US and millions of jobs. To quote Shawn Fain, president of the United Auto Workers, “Our union is hell bent on ending the free trade disaster of the last 30 years.” It is workers who have borne the brunt of trade dislocations, not the auto companies. During the 1980’s the US Big Three – Ford, GM, and Chrysler (now Stellantis) – faced sharp competition from Japanese cars. Tariffs and quotas were enacted to stop imports and force foreign car companies to locate plants in the US. They built factories in non-union states. Then, with NAFTA in the 1990’s, the automobile corporations moved many parts and assembly factories to Mexico, and a little bit to Canada, setting up complex supply chains. A typical car sold in the US today has parts that have crossed borders several times. Most have 40 percent or more “foreign content.” The top 10 global automakers raked in $70 billion in profit in 2020. Now that has doubled, to $150 billion, as they raised prices 30 percent during the Covid crisis. Over the last 15 years, they have bought back $370 billion in stock from their wealthy investors. Meanwhile, workers’ wages were stagnating until the recent UAW con- tract made significant gains. But those wage increases apply only to union workers, and the majority are non-union. Now, 43 percent of car parts and assembly jobs are in Mexico, where workers average $3 an hour. That’s down from $6 an hour in 1993, before NAFTA. NAFTA opened up Mexican markets, especially corn, to US agribusiness, driving down prices and driving families off the land. Many headed north to maquiladora auto parts and assembly plants, pushing down wages. Moving jobs to Mexico, in this race to the bottom, is still going on. One example: Stellantis recently moved Ram truck production from Warren, Michigan, to Mexico. Instead of paying $37 an hour, the company pays $3. They don’t lower prices, they just send more profit to Wall Street. The UAW has calculated how much US factory capacity is sitting idle. Enough to build two million cars and hire 50,000 more workers. Every auto assembly job creates seven more in the supply chain. So Tariffs Would targeted tariffs on imported cars and trucks help bring autoworker jobs back? The UAW thinks so. (Just to be perfectly clear, Shawn Fain and the UAW, while in favor of auto tariffs, are opposed to 99 percent of the Trump agenda, including the detention of union members and protestors.). But tariffs are only a first step – the trade agreement with Mexico and Canada (formerly NAFTA) must be renegotiated. It must include provisions for a minimum manufacturing wage way above $3 an hour. It must have a labor board to enforce labor organizing and bargaining rights. In the long run, the UAW wants to be making the electric cars and batteries we need. That will require strong government action forbidding stock buybacks and excessive CEO compensation, and forcing the auto companies to invest and innovate. Trump wants trade chaos and scapegoats. Corporations want free trade and profit. We want fair trade, so that all workers can make a living on a living planet. Michael Righi is a retired economics professor and a member of the Retiree Advocate editorial board. < Back to Table of Contents

The Retire Advocate < Back to Table of Contents July 2025 Rural Protestors Urge Senate to Kill Trump Medicaid Cuts Tim Wheeler Senior citizens stood near Clallam County’s only full service public hospital, June 7, holding signs proclaiming “85% of OMC Patients on Medicaid, Medicare” and chanting “No Cuts to Medicaid or Medicare.” The vigil, initiated by PSARA, attracted 18 participants who lined First Street a couple of blocks south of the Olympic Medical Center (OMC), a public hospital that serves 111,000 on the isolated, rural Olympic Peninsula. The protesters held up their signs and waved as passing motorists honked and gave thumbs-up salutes. In the crowd were two candidates for the OMC Board of Commissioners constantly struggling with millions of dollars in debt due to the low reimbursement rates for Medicare and Medicaid. The vigil was in protest against President Trump’s “Big Beautiful” budget bill passed by the House and now pending in the US Senate. The bill would inflict $715 billion in cuts to Medicaid and $300 billion in cuts to the SNAP nutrition programs to defray the trillion dollar tax cut for billionaires and millionaires. Laurie Force, a retired nurse and a candidate in the August primary for the OMC Board, was holding a sign as was her husband, Larry, whose hand-lettered message was “Stop the Steal.” Her campaign slogan is “A Force For OMC.” The other candidate for the OMC Board, Dr. Gerry Stephanz, Medical Director of the Olympic Peninsula Community Clinic, pointed out that Trump’s budget bill is a grave risk to rural hospitals across the nation, including the OMC, that are totally dependent on Medicare and Medicaid payments to stay afloat financially. OMC, he said, should file to be designated a “Rural Health” provider, like the hospital in Port Townsend. If recognized as a rural hospital that provides life and death services to more than 100,000 people, OMC would enjoy far higher reimbursement rates for the 85% of its patients now covered by Medicaid and Medicare. The vigil took place one week after a “town hall” meeting, also organized by PSARA at the senior Shipley Center in nearby Sequim. Speaking at the Shipley Center in Sequim on May 24, PSARA leaders Robby Stern and Anne Watanabe urged fightback against President Trump’s so-called budget “reconciliation” bill that will inflict hundreds of billions in cutbacks to Medicaid, the SNAP food stamp program and other human needs benefits while handing trillions in tax cuts to themselves and their billionaire cronies. Said Watanabe, “The GOP ‘big, beautiful bill’ means that by 2034, 8.6 million lose health insurance because of cuts. Another 5.1 million lose health insurance through loss of tax credits….13.7 million total will lose healthcare insurance.” She cited the disastrous impact the cuts would inflict in Clallam County where 20,866 children, 38 percent of youngsters, are protected by Medicaid and 21 percent of those 55 years or older. In neighboring Jefferson County 7,641 people, over 29 percent of children and 27 percent of those 55 years are older are enrolled in Medicaid. Rural hospitals, she said, like the Olympic Medical Center (OMC) in Port Angeles that serves 111,000 people, are at grave risk of closing or losing their public status, being privatized through merger with private for-profit hospitals like Providence, a Catholic hospital chain that bans abortions and other reproductive health care. These hospitals, she charged, are being forced into bankruptcy due to ruinously low reimbursement rates for their Medicaid and Medicare patients. In the past twenty years, 200 rural hospitals across the nation have been forced to close due to this crisis in rural America. OMC is the only full service hospital in an isolated region two hours drive from Silverdale or Tacoma and a long ferry ride from Seattle. Treatment for a heart attack or delivery of a baby is care needed instantly not after a two hour drive. Enactment of the Trump-MAGA budget bill will be a death sentence for tens of thousands of low income people, children, immigrant and native-born alike. Already approved by the House, Stern and Watanabe urged the crowd to bombard the U.S. Senate with mes- sages demanding the Senators vote down the budget scam, the most sweeping attack on federal human needs programs ever. Both Stern and Watanabe addressed the issue of defending traditional Medi- care from privatization by so-called “Medicare Advantage.” Stern described in detail the life-threatening struggles by PSARA member Richard Timmins, of Whidbey Island, who was forced to undergo intense treatment for skin cancer because his so-called Medicare Advantage (MA) provider refused to approve in time treatment by a dermatologist despite his physician’s recommendation. By the time the MA provider reversed course and approved examination, the tumor had metastasized into cancer. Stern told of his own family forced to file multiple appeals against a Medicare Advantage provider to win skilled nursing coverage for a parent/ grandparent in a nursing home. Medicare Advantage was authorized in 1982 said Watanabe. “The intention was to lower the cost of Medicare and improve outcomes for patients. So what happened?” Corporate insurers paid a per patient capitation fee, seek to inflate their profits through massive overcharges, false claims, "upcoding" in which patients are over-diagnosed to allow MA providers to receive higher capitated payments from Centers for Medicare & Medicaid Services. The total overcharges by MA is estimated to be $80 billion to $140 billion annually. Much of this corrupt profiteering has been exposed by the MEDPAC, a commission that oversees Medicare and Medicaid. PSARA is part of a nationwide coalition seeking to preserve Medicare against privatization by “leveling the playing field,” enacting reforms that allow traditional Medicare to offer the same extra benefits offered by MA like dental, vision, and hearing, and capping out-of-pocket costs for traditional Medicare enrollees. PSARA also supports “Medicare For All” or universal publicly paid healthcare for every person in the U.S. native born and immigrant, said Watanabe. Ellen Menshew, a member of PSARA and also Chair of the Clallam County Democratic Party (CCD), and Lisa Dekker, an Outreach Vice President of PSARA from Clallam County, introduced the guest speakers from Seattle. Dekker told the crowd that PSARA members and other volunteers are standing in front of the Federal Building in Port Angeles every Friday at 1 p.m. to protest the Trump-Musk attacks on Social Security, Medicare, and Medicaid focused now on demanding that the U.S. Senate reject the MAGA-Trump budget bill. It was Memorial Day weekend and many in the crowd came directly from a “Hands Off Our Veterans” protest by hundreds at the main intersection in Sequim denouncing cuts by Trump and unelected Elon Musk to the Veterans Administration, and sharp reductions in healthcare and other benefits for war veterans and their families. In the audience were members of PSARA from Sequim, Port Angeles, Port Townsend, Gig Harbor, and Tacoma. US Army vets, and active union members were present. Tim Wheeler is a veteran activist, journalist, and a leader of PSARA's Clal- lam County organizing committee. < Back to Table of Contents

The Retire Advocate < Back to Table of Contents December 2025 No Real Choices – Diversity Is Not Equity Anne Watanabe In the November Retiree Advocate , readers learned about a recent study by Physicians for a National Health Program (PNHP) called “No Real Choices.” The study shows how the Medicare Advantage (MA) system, which claims to increase equity in healthcare, fails to do so and instead disproportionately harms seniors of color. Of course, all seniors are affected by the high prices of Medigap policies which lead many to turn to Medicare Advantage plans. MA plans frequently offer lower premiums and promise “extras,” like hearing, dental and vision benefits that are not covered by Original Medicare. But with for-profit MA plans, the costs, network of providers, and benefits can change suddenly, and beneficiaries may find they are unable to access the care they need because of limits on network providers or benefits. Meanwhile, the MA companies continue to overcharge the Medicare Trust Fund by billions each year. The MA industry claims that it is improving racial equity in healthcare by providing MA plans as an alternative to Original Medicare. It’s true that MA plans are purchased by a racially diverse group of seniors, and MA companies often tout this fact in their advertising. Black seniors in particular, and seniors of color generally, are disproportionately enrolling in MA plans, compared with their white counterparts. But as PNHP points out, this diversity does not bring about equity. Far from it. PNHP and Johns Hopkins University examined so-called “affinity plans,” MA plans which have a high enrollment of Black, Hispanic, and Asian beneficiaries. Those plans had lower “star” ratings from Medicare, indicating lower quality. The conclusion? “Taken together, the plans disproportionately serving Black, Hispanic, and Asian beneficiaries tend to be of lower quality and more restrictive, while plans disproportionately serving White beneficiaries tend to be of higher quality. Far from advancing equity, these patterns perpetuate disparities in access and outcomes.” PNHP notes that higher enrollment in lower-rated plans is affected by the geographic availability of plans; counties with higher unmet social needs were found to have a lower likelihood of access to higher-rated plans. And higher-rated plans are rewarded by “bonuses” from CMS, which funnels additional resources to healthier, wealthier communities. So lower-income communities with lower-rated plans are essentially stuck with lower quality MA plans, and the cycle perpetuates itself. Further, PNHP cites studies showing that MA enrollees of color experience worse outcomes than white MA enrollees in areas such as hospitalizations, mental health treatment, emergency department use, and outcomes in preventive care. The impacts on MA enrollees of color documented in this report – poorer outcomes, lack of access to care, closures of local hospitals in underserved communities, and yes, higher denial rates for prior authorizations – will not be a surprise to BIPOC (Black, Indigenous, People of Color) seniors. The problems associated with the MA system are amplified when it comes to marginalized communities. So what can we do? We can have real choices that create true equity in healthcare. We must return to Medicare’s original promise of universal, equitable healthcare. Solutions identified by PNHP include: ending the “gap trap” by creating a reasonable cap on uncovered costs in Original Medicare, so that no one is forced into an MA plan because of the cost of a Medigap plan; adding missing benefits to Original Medicare (e.g., hearing and vision); and ending the overpayments to MA plans. PNHP notes that if the estimated $84-140 billion per year in overpayments to MA plans were recovered, we could easily afford to put a reasonable cap on uncovered costs in Original Medicare and add missing benefits, all comparable to what the MA plans offer. PSARA continues to fight for real choices and true equity in healthcare. We thank all of you for being part of this effort. Anne Watanabe is Chair of PSARA's Race and Gender Equity (RaGE) Committee. < Back to Table of Contents