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The Retire Advocate < Back to Table of Contents March 2025 Mexico: Unequal Trade and Trump’s Nonsense Michael Righi What is Trump thinking with all this back-and-forthing on tariffs? Is it really linked to fentanyl labs and immigrants? Is there a hidden agenda? The idea of Trump “thinking,” rather than just blustering and bullying, may be a bit of a stretch. But let’s try to figure some things out. Trump has, of course, threatened 25% tariffs on imports from Mexico and Canada. As he often does, he claimed victory whenMexico moved some troops toward the border, which they were always planning to do. So the tariffs are on pause. Trump backed off. Trump’s justifications for higher tariffs wander all over the place. Besides using them to supposedly stop the flow of drugsand migrants, he claims countries are selling us too much stuff, stuff that could be made in the US. The US does have a trade deficit with Mexico, which has resulted from the signing of the North American Free TradeAgreement in 1994. This allowed US corporations, ever in search of cheaper resources, less regulation, and cheaper labor in particular, to produce in Mexico and export back to the US with minimal tariffs. We know the effects of NAFTA on jobs in US manufacturing towns. What is perhaps less discussed are the effects in Mexico. US agri corporations, subsidized by the US government, dumped tons of corn and wheat into Mexican markets at prices 15% to 30% below the cost of production. This drives down prices and drives millions of small Mexican farmers into poverty and off their land. Mexico now imports 40% of its grain, whereas before NAFTA it was 7%. Folks went north, to the maquiladoras, low-wage component and parts factories supplying US corporations. Or across theborder. Sin Maiz No Hay Paiz Trade and trade rules reflect relative economic and military power. NAFTA and the World Trade Organization (WTO) are agreements that privilege the free movement of goods and capital and profit. Under existing trade rules, workers and small farmers lose. For the last three decades, the global 1% captured over half of all increases in income. That’s not only because of trade, ofcourse, but trade played a part. Neoliberalism and its promise of “all boats rising” has failed. The WTO has a “trade court” that interprets trade rules. Over the last several years, Mexico, under President Lopez Obradorand now Claudia Sheinbaum, has adopted policies to support Mexican farmers, and move to healthier food. Corn is themain grain: “Without corn there is no country.” Part of agricultural policy has been to restrict and eventually phase out the import of US genetically-engineered corn. GM corn in the US is grown with the chemical glyphosate, a known carcinogen. Any trade restriction, no matter how reasonable,according to WTO rules, is banned. Mexico produced a brilliant synthesis of the evidence on the harms caused by glyphosate. They argued they have a right toprotect their people, their farm- ers, their indigenous food practices. The WTO trade court ruled for the US, and this was under the Biden administration. Might makes right. Bringing Jobs Back? Trump claims to want to bring back jobs to the US and punish Mexico for the trade imbalance. But it is not about Mexico and the US. Workers here and in Mexico have similar interests in not being thrown in competition with each other, and having wages driven down. Food producers (not Big Ag) and consumers in both countries need high quality standards and climate-sustain- ing production. Does Trump really think 25% tariffs will bring manufacturers back to the US? Does he care? Car manufacturers bring parts and components across the border several times per car in their supply chain strategies. Are they willing to refashion supply chains? Mainly what Trump is doing is introducing a whole lot of uncertainty into corporate decision making. Would some strategic tariffs and an industrial policy that fostered research and development and targeted loans to clean energy firms, and training for skilled workers make sense? Absolutely. But if you think that’s the path Trump is on, I have a bridge I could sell you. Trump’s tariffs and threats of tariffs are going to cause problems. They are a tax, so they will raise prices. Costs will go up, so firms might respond by cutting jobs. Trading partners will retaliate with their own tariffs. If prices rise, the Fed will keep interest rates high. As usual, all that hurts working families. So, what is Trump going on about? Part of it is a show of dominance, playing to his base. But perhaps the main point? Republicans want more tax cuts for the wealthy, and they are going to have to find some ways to fund those cuts. Tariffs do raise some revenue, so that may be the point. The 1% need more. 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 October 2025 DECLINE TO SIGN Don’t Be Fooled! Pam Crone He’s at it again. Multimillionaire Brian Heywood isn’t done yet messing with our rights and values. He's paying to circulate petitions for three new initiatives: 1L 26-001 Restoring the "Parents' Bill of Rights" 1L 26-638 Defending equity in interscholastic sports 1L 26-126 Requiring verification of citizenship for voter registration The first one would allow parents to opt their children out of school classes and activities the parents deem objectionable, prevent their children from seeing books and other educational materials, and violate the privacy rights of their children and potentially interfere with needed medical care and mental health counseling by requiring the parents be notified of such activity. The second would bar students from participating in sports that match their gender identity. Students would have to undergo intrusive tests to "prove" they were "biologically" male or female, whatever that means, in order to play their favorite sport. The third initiative is a voter suppression effort. This one is from the Republican Party Chair Jim Walsh who teamed up with Heywood in 2024. We will do everything in our power in Washington State to ensure that everyone eligible to vote can do so. We weren’t fooled in 2024 so let’s not be fooled this time. PSARA mounted a full on assault on initiatives that would have rolled back the Climate Commitment Act, WA Cares, and our progressive revenue source, the Capital Gains tax. And we won! Voters soundly defeated those initiatives at the ballot box. Once again, these new initiatives would hurt Washingtonians, especially our young people. We are not fooled by these blatant attacks on our transgender community, our teachers, and the privacy rights of our young people. So when you head out shopping this weekend or go to a sporting event, DECLINE TO SIGN . We can nip these harmful initiatives in the bud before they even go to the Legislature. Pam Crone is a retired PSARA lobbyist and the Chair of PSARA's Government Relations Committee. < 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 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

The Retire Advocate < Back to Table of Contents February 2025 Make Crypto Great Again Michael Righi Who bought the 2024 election? We all know about Elon Musk. But there was another huge source of election cash – cryptocurrency (it’s not really currency) firms and their wealthy owners. Crypto Political Action Committees (PACs) spent $265 million on the elec- tion, the most of any “industry.” What did they get for their money? FairShake, a crypto PAC, helped defeat critic Katie Porter in the California Democratic primary. FairShake, along with AIPAC, helped defeat progressives Cori Bush and Jamaal Bowman in their primaries. Crypto money’s biggest win was taking down Ohio’s Sherrod Brown, the Democratic leader on the Senate Banking Committee. They also helped Trump, who, back in the day, derided crypto as “thin air,” But recognizing a good scam, Trump and family are now all in. Besides Musk, Trump is surrounding himself with crypto parasites, from J.D. Vance to Paul Atkins (SEC appointee) and Howard Lutnick (Commerce). And who knew we needed an AI and Crypto Czar (David Sacks)? Rug Pulls and Wash Trading If it’s not currency, what is it? Currency, or money, is a social construct we have developed to buy and sell things and services. This may sound weird, but money is based on trust – trust that the bank where you deposited your pay will make payments when you write a check (old school) or use a card or a digital payment system. Or trust that the government will accept payment in the currency it prints and make depositors whole if a bank goes belly-up. In addition, the central bank will rescue the financial system as a whole if private banks or finance institutions threaten a collapse or depression. That’s what happened in 2008. Neo- liberal deregulation allowed bankers to create and speculate (“innovate,” they call it) on a whole slew of risky financial derivatives. These crashed in value, and the private banks were bailed out by central banks buying their bad assets. Financial fraud was revealed, but no one went to jail. Banks and bankers were bailed out, and homeowners were not. So in 2008, a private group created Bitcoin, a digital currency that was supposed to bypass the corrupt top-down financial institutions and allow users to make payments directly to each other. Did that work? Well, not really. Extremely complicated computer verification of transactions makes it impossible to use crypto to buy a cup of coffee or your groceries. It is not money. But hundreds and thousands of companies now issue cryptocurrency and crypto tokens. So what are they? They are “investments” of a very peculiar kind. They are not shares of stock in a company that produces or owns some thing. They are just pieces of digital code that are being traded back and forth in what is a gambling economy. Crypto shills said it would go up in value forever. Influencers pushed it. This became a perfect opportunity for fraudsters to create a token, get inter- net posters to push it, then pull the rug out by selling at the top, leaving small investors to take the loss. Or buy and sell tokens back and forth from one account to another, driving up values, then getting out. Casino Capitalism Covid meant too many folks were isolated in front of their computer screens, trying to make the big score. This culminated in the Super Bowl ads of 2022, with Matt Damon and Kim Kardashian helping to push crypto to $3 trillion. Then, the inevitable crash came in May of that year and wiped out $2 trillion of that value. Of course, the “whales” were not wiped out; smaller investors were. From 2015 to 2022, 75 percent of crypto investors lost money. Speculative investments enrich only the already wealthy. We do have to recognize what crypto actually is good for. Because crypto holdings are pseudo-anonymous, trans- actions are hidden. So it is useful to opioid traffickers, tax avoiders, money launderers, ransomware hackers, gun runners, and anyone trying to avoid international sanctions. We have plenty of reasons to want to limit crypto and its scammers and criminals. But crypto businesses want more, and the incoming administration is poised to give it to them. They want “light-touch” regulation that would mainstream them. They do not want to be prosecuted for fraud, as many of them should be. They want crypto to be designated as a special asset, not a security with all the investor protections that implies. With very light legitimizing regulation, they could draw in millions from our pension funds and other traditional investment funds. That would mean their booms and crashes and fraud would have a more significant impact on the traditional financial system, the one we use. Yes, we need to reform that system with stricter regulation and new initiatives like postal accounts and public banks. But we also have to protect it from fraudsters and casino capitalists. 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 June 2025 PSARA Position Paper on Immigration PSARA Board The US has failed to articulate a coherent and just immigration policy. Now, under the current administration, even the meager protections we have for those who come from outside US boundaries are being stripped away. The Trump administration has engaged in new levels of cruelty against immigrants – terrorizing people, shackling them in chains, deporting them to countries other than their own, and undertaking these acts regard- less of the person’s citizenship or paperwork status. The administration is threatening sanctuary cities and states with funding cuts, mobilizing the military and national guard to engage in the apprehension of migrants, and seeking millions more in funding for this war on immigrants. They have allies in our state among many county sheriffs who are flouting our “Keep Washington Working” law and using their local law enforcement officers to assist ICE. Everything else being equal, people don’t choose to migrate. Most of us prefer to remain with our families, on the land in which we’ve been raised, and in the culture with which we’re familiar. Yet, huge numbers are migrating for a number of reasons. They are forced to migrate because of brutal conflicts, rampant lawlessness and criminal violence in their home countries, a lack of safe, well-paying jobs, crop failures and food scarcity, and increasingly severe climate disasters. In our country we now have more than 200 jails and prisons for immigrants. Approximately 90% of detained immigrants are held in private detention centers. The current Trump regime has announced plans to build many more. PSARA, takes the following position on the attack on immigrants: We will follow the lead of immigrant rights groups locally, working to support their efforts toward defending and strengthening rights, protecting those being targeted, and securing sanctuary. We welcome all migrants and fight alongside them for housing, healthcare, living wage jobs, and public education, among other things. We emphatically oppose repression, detention, deportation, and the racist attacks to which migrants are being subjected. We act from a commitment to joining hands in respect and solidarity to build a new – and more just – Beloved Community. < Back to Table of Contents

The Retire Advocate < Back to Table of Contents November 2025 A Formidable First Foursome and Tacoma’s Dirty Dozen Richard Burton On October 1, four PSARA members joined with two activists from Communities for a Healthy Bay (CHB) to patrol Commencement Bay in Tacoma for pollution and learn about environmental issues in this historic port. Carol Conley, Tim Burns, Ron Stone, and Richard Burton met and learned from Stefani Stockwell and Audrey Holloway from CHB. The PSARA crew ready to embark on their cruise We did this after learning about a recent report written by Communities for a Healthy Bay: South Sound’s Dirty Dozen. As its name implies, this incisive report details the environmentally irresponsible record of the 12 worst offending companies on or near Tacoma’s Commencement Bay. You can read it here: South Sound's Dirty Dozen - Communities for a Healthy Bay. The hard working staff at Communities for a Healthy Bay acknowledge some good actors, i.e., South Sound industrial facilities that are doing the right thing, “proving that with investment, oversight, and a commitment to environmental health it is possible to operate responsibly, even within the same legal and regulatory frameworks that others exploit.” These good actors are: • Auto Warehousing Company • Georgia Pacific Gypsum • MK Fibers • Globe Machine Manufacturing Additionally, both University of Washington Tacoma and Point Defiance Zoo & Aquarium are congratulated for their commitments to green infrastructure, transparent emissions tracking, climate responsive design, and a detailed “Climate Action Plan” to reduce greenhouse gas emissions. But then the following “Dirty Dozen” companies are named. These are facilities that repeatedly exceed stormwater discharge limits, contribute to toxic air emissions, mishandle hazardous waste, and operate atop Superfund sites with little regard for ongoing risks. The Dirty Dozen: Carlile Transportation Systems, LLC Concrete Technology Corporation Emerald Services, Inc. Kleenblast Division Manke Lumber Company, Inc., Sumner Simon Metals Tacoma Wheel Shop Tacoma Export Marketing Company (TEMCO) Tru Grit Abrasives, Inc Quality Transport & Truck Rail Handling Superlon Plastics, Inc. Occidental Chemical Corporation (OxyChem) The neighborhoods surrounding these various facilities rank among the highest in the state for pollution expo- sure, health risks, and socioeconomic vulnerability. The people in these communities experience disproportionate rates of asthma, heart disease, limited access to healthcare and fewer political resources. Moreover, many of these bad actors operate on or adjacent to lands protected under the Medicine Creek Treaty and stewarded by the Puyallup Tribe of Indians, violating treaty rights and undercutting tribal sovereignty. PSARA activists look forward to joining with Communities for a Healthy Bay and other allied groups to fight against this dirty dozen, but also against the current system in the South Sound of noncompliance, weak enforcement and accountability, and preventable harm to the health of the ecosystem. Richard Burton is PSARA's Co-VP for Outreach and a leader of PSARA's Pierce County Organizing Committee < Back to Table of Contents

The Retire Advocate < Back to Table of Contents December 2025 AARP, United Health Group, and WISeR Robby Stern On October 21, Wendell Potter, a former high ranking health insurance executive and whistle blower, wrote the following in Healthcare Uncovered , the newsletter of the Center for Health and Democracy. "In 2024, United Health Group (UNH) -- the nation’s largest health insurer -- paid AARP a one-time upfront royalty payment of just over $9 billion for the rights to use AARP’s name in marketing Medicare Advantage-type plans and Medicare supplement policies. According to financial statements for AARP, this windfall came as part of a restructured deal with UNH’s insurance unit, United Healthcare, extending their partnership for an additional 12 years and recording a balance of about $8.72 billion in deferred revenue as of December 31. "What makes a deal like this so troubling is its implication: the organization that millions of older Americans consider their trusted advocate -- AARP, with its packed magazines and covers featuring Bon Jovi, Samuel L. Jackson, and Sally Field -- is in fact functioning as a multimillion-dollar marketing arm for an insurer whose business model increasingly depends on enrolling seniors in private Medicare plans." A recent Kaiser Family Foundation study found that Medicare Advantage (MA) enrollees will have access to approximately 50% of the healthcare providers that Original Medicare (OM) enrollees can access in regions across the country. In addition, the study found that OM enrollees were more likely to receive care in the highest-rated hospitals and skilled nursing facilities. In 2023, the number of prior authorization requests to MA insurers was approximately 50 million and frequently were determined using Artificial Intelligence (AI). Prior authorization is rarely used in OM. The corporate MA insurance system poses significant risks for beneficiaries because of delays and denials of care resulting from prior authorizations. Corporate Medicare Advantage also threatens the viability of the entire Medicare system. MA costs the Medicare Trust Fund approximately 35% more per beneficiary than OM. According to MedPAC, a nonpartisan congressional agency that provides Congress with analysis of the Medicare program, MA overcharged the Medicare Trust Fund in 2024 an estimated $84 billion dollars. AARP is being paid to promote United Healthcare’s Medicare insurance which threatens, along with the other MA plans, the financial future of the Medicare system. United Healthcare is by far the largest corporate for-profit MA insurer. In March, 2025, United Health was estimated to have nearly $10 million MA enrollees. The insurer was compensated an average of $5,000 per enrollee. AARP provides a significant customer base and credibility to United Healthcare. No wonder AARP has been paid just over $9 billion for a 12-year agreement. How does this financial relationship impact AARP’s decision making? We can only speculate, but WISeR presents an interesting case study. The Centers for Medicare & Medicaid Services (CMS) and an agency within CMS, the Center for Medicare & Medicaid Innovation (CMMI), have initiated the WISeR program to expand artificial intelligence (AI) prior authorization to 16, and maybe more, medical procedures in Original Medicare (OM). This unwelcome expansion in the number of prior authorizations in OM will still be a small fraction of the number in MA. Despite the fact that healthcare providers and patients have expressed strong dislike for practices that intervene between the provider-patient relationship, CMS plans to proceed with the WISeR pilot program beginning January, 2026. Private companies who will determine the required prior authorizations in OM must have AI capability to be eligible to engage in reviews for the WISeR program. These companies will be paid based on the amount they save the Medicare system, i.e. higher compensation for denials. What is AARP’s position on WISeR? According to an AARP spokesperson, they are “watching carefully." The organization states it supports efforts to address Medicare fraud and abuse, which is the public justification for WISeR by CMS. AARP also states it prioritizes the health care of older Americans and that nobody should be denied legitimate, medically necessary treatment. Nice words, but we know that AI prior authorization does deny medically necessary treatment frequently in MA and that one of the most consistent users of AI prior authorization is United Healthcare. Regarding fraud and abuse, MedPAC noted there is approximately $5.8 billion in treatments that may be unnecessary. Compare this to the MedPAC estimate of $84 billion in overcharges by corporate MA insurers. On the AARP website WISeR is listed as one of the changes to Medicare in 2026. They acknowledge that “If successful, the pilot project could lead to wider uses of prior authorization in original Medicare...” They state the experiment in six states, including Washington, could involve up to 6.4 million beneficiaries. AARP goes on to provide CMS’s justification for the program. They then state “Technology companies that participate will be paid based on savings from denied medical claims, which has drawn the ire of the American Medical Association and consumer organizations.” Note, it has not drawn the ire of AARP, which one might think is a consumer organization. The final paragraphs in the posting state: “The pilot project comes amid concerns from lawmakers, government watchdogs, and others that Medicare Advantage plans’ prior authorization procedures can create burdens for caregivers, who have to figure out how to appeal, and risk the health of patients by delaying or denying care that would otherwise be covered under original Medicare.” If we believe the concerns of caregivers and consumer organizations to an expansion of AI prior authorization in OM are legitimate (and PSARA emphatically does), we question the failure of AARP to support those of us in this fight. To quote Wendell Potter in his discussion of the relationship between United Health and AARP: “All this being said, AARP taking money from a giant corporation is not the least bit unusual in Washington. And advocacy on behalf of consumers and patients requires resources. But when an organization is simultaneously lobbying Congress on Medicare and cashing billion-dollar checks from the largest Medicare Advantage insurer, it’s no longer just an advocate for consumers and patients.” Robby Stern is President of the PSARA Education Fund and a member of PSARA's Executive Board. < 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 May 2025 GiveBig Challenge 2025 Karen Richter The Board members of PSARA and the PSARA Education Fund have issued a challenge to our membership for the 2025GiveBIG campaign. This is our most important and biggest fundraiser of the year. Our 2025 goal is $35,000. Our Board members have generously pledged $27,700 so we are asking our membership to donate $8,000 to reach ourgoal. If our members can donate more, we will be most grateful. Together, we can expand and finance our progressive work that is needed now as never before. Your donations support our educational and advocacy work on halting and pushing back the privatization of Medicare and SocialSecurity and devastating cuts to Medicaid. As a result of our work in 2024, PSARA expanded the geographic reach of oureducational and advocacy work, bringing in new members locally and nationally. PSARA is very active in the legislative process. This year we are the lead organization for legislation in the 2025 WashingtonState Legislature. Working with the support of Senator Bob Hasagawa, PSARA helped draft and is advocating for SenateJoint Memo- rial (SJM) 8002, which calls for leveling the playing field between Traditional Medicare and MedicareAdvantage to give retirees a financially viable choice. Right now, many low-income people are forced into MedicareAdvantage (MA) plans because they are cheaper to purchase up front. But delays and denials in MA plans are costly andin some cases have been deadly. Profit- driven corporate insurers stand in the way of doctor/patient healthcare decisions. SJM 8002 passed the Senate but it failed to get a House vote before the cut off. We will advocate for itspassage in the 2026 session. PSARA has been joined by large national organizations that have embraced the “level the playing field” strategy.You can read more about this and other issues PSARA is undertaking in past issues of The Retiree Advocate as well as innumerous national publications. And you can view many of our webinars on our YouTube station, www.youtube.com/@psaraWA . Additional advocacy and education continue on racial and climate justice issues, including support for reparations toAfrican Americans and a coalition campaign to influence the Washington State Investment Board to divest from fossilfuel corporations. Your donations will also assist in covering the costs of creating and distributing The Retiree Advocate. Every year,PSARA takes on the challenge to sustain a one-staff-person, volunteer- driven organization. With your support, PSARAhelps build a progressive movement with our partners while publishing a quality newsletter, which we’ve done for over40 years. Our Education Fund also supports cultural events. We are planning a Juneteenth, in-person celebration this year withthe theme With Hope We Unite, Resist, and Overcome. We are also planning a concert, a book release event,continuing our oral history project of PSARA members, and much more. GiveBIG days are May 6 and May 7. Early online giving for GiveBIG starts on April 22. Donations can be made from April22 through May 7 by going to https/ www.wagives.org/donate/ PSARA-Education-Fund. Or you can go to wagives.org/donate/ and enter the PSARA Education Fund in the search function. Once there you can donate beginning April 22. If you prefer not to donate online, or if you want the Education Fund to receive the full amount of your donation, you cansend a check to PSARA Education Fund anytime between now and May 7. Please mail your check to PSARA EducationFund, 321 16th Avenue South, Seattle, WA 98144 and write GiveBIG in the memo line. If you choose this option, the creditcard fee we pay for online processing is eliminated. Thank you for your generous donations. Continuing our work requires more revenue than our $20 membership dues. Wehope you can help to continue the production and distribution of the newsletter and our educational programs andadvocacy work. Thank you for being a PSARA member. Karen Richter is Co-President of PSARA and Vice President of the PSARA Education Fund. < Back to Table of Contents

The Retire Advocate < Back to Table of Contents April 2025 PSARA to Olympia Lawmakers: “No Cutbacks! Tax the Rich!" Tim Wheeler Beaming with delight, GRC Committee Chair Pam Crone greeted a crowd of grassroots lobbyists gathered in a conference roomof the Washing- ton State Labor Council in Olympia, on Mar. 18. The African American, Asian American, Latino, and white activists were reporting back on their meetings with Washington State legislators to press their demands for increased funding for healthcare, public schools, rent stabilization for people who live in manufactured homes, and a wealth tax. They were all participants in PSARA Lobby Day, including activists from Seattle, Tacoma, Gig Harbor, and other cities andtowns. A delegation of five PSARA members drove down from Port Angeles, Sequim, and Port Townsend. “We had meetings with38 legislators and their staff,” Crone exclaimed. “One staffer told me, ‘You guys are everywhere!’” Crone, PSARA’s former lobbyist, urged the crowd to keep the pressure on. She warned against Republican schemes to bury legislation with crippling amendments proposed to stall passage until the 90-day legislative session ends. She hailed Senateapproval by a landslide vote of 30 to 19 Senate Joint Measure 8002. SJM 8002, now pending in the House, urges the WashingtonCongressional delegation, President Trump, the House, and the Senate, calling on them and CMS to halt privatization ofMedicare, and to enact measures to “level the playing field” between so-called Medicare Advantage (MA) and traditional Medicare. The measure urges Congress to cap out- of-pocket costs. It would eliminate the need for supplemental insurance that traditionalMedicare recipients must purchase. SJM 8002 also calls for adding to traditional Medicare dental, vision, and hearing benefitsoffered by MA. David Loud, a member of the PSARA Board and a leader of Health Care Is a Human Right, said SJM 8004, which urges theCongress to sup- port universal health care, was approved by the State Senate, 30 to19. Advocates of Medicare for All will rally on the steps of the Capitol in Olympia on April 2 to urge approval of universal health care in Washington State, Loud said. Rep.Pra- mila Jayapal, Democrat from Washington’s 7th Congressional District, is the author of Expanded and Improved Medicarefor All, which will be introduced in the US Congress. Bobby Righi of Seattle, Co-Chair of PSARA’s Climate & Environmental Justice Committee, told the debriefing that lawmakers in her legislative district support PSARA’s legislative agenda. And one legislator was clearly distressed about Gov. Bob Ferguson’sstate budget with $4 billion in cuts. Coupled with the enormous cuts to health, education, and welfare programs inflicted by theTrump-Musk Administration, it adds up to disaster for the poor, the sick, children, and the elderly. “ It is going to take hard work to come up with a budget compromise,” she said. “We have to put pressure on Ferguson.” Michael Righi warned that an atmosphere of doom is hanging over the legislature. He pointed out that there is no economicrecession, no lack of wealth that could be taxed to pay for these life and death programs. “We should have the position: NO CUTS!” he said. The crowd erupted in applause. These warnings were on display in earlier sessions. A lawmaker from LD 24 told the delegation from the Olympic Peninsula that “Ferguson is strangely silent on the (Wealth) Tax bill,” which the LD-24 legislator promised to support. He spoke atlength about the worsening budget crisis with cutbacks in vital programs that serve children, the elderly, and the poor, and the Ferguson conundrum: He ran as a progressive yet now governs as a “fiscal conservative,” proposing budget cutbacks cheered by the MAGA Republicans. Insurance Commissioner Patty Kuderer, a former legislator, told the PSARA delegation, “Our health care system is morally bankrupt.” She spoke of her being born prematurely with many life-threatening problems. She became “a proponent of universal health care where everyone has access.” Health care, sheadded, should not be a field for “making profits…This should be a country that cares about people.” When she was a legislator, she told her constituents, “Out of 400,000 people I represent, only 400 were impacted by thecapital gains tax...I want taxes to go to health care, education.” It will mean, she added, “A robust economy, poverty plummeting, crime in decline.” Her aide, Bryon Welch, said a delegation from the Insurance Commission is headed to the nation’s capital to meet with theWashington State congressional delegation to urge them to take action against the “relentless, misleading ads for MedicareAdvantage. We are going to Washington D.C. to make sure that Medicare is not completely privatized.” Robby Stern, President of the PSARA Education Fund, presented him with Give Us a Real Choice, a 63-page PSARA primer onthe urgent need to “level the playing field” between traditional Medicare and MA. Stern said the book “lays out very clearly ourmembers who have had problems with Medicare Advantage. We’re not saying eliminate Medicare Advantage, but what we are saying is that senior citizens should have a real choice.” Later, the delegation gathered in the Capitol building to hear House Speaker Laurie Jinkins. “We prefer progressive taxes ratherthan budget cuts,” she said. “Start building on the taxes we already have, the Capital Gains Tax.” The crowd erupted in applause.“When you build support for programs that people want, they are willing to pay taxes to pay for them.” PSARA Co-President Karen Richter urged Jinkins to push SJM 8002. It is necessary, Richter said. “We really need the backing ofthe State Legislature to exert pressure on Washington D.C. to take action to level the playing field.” Tim Wheeler is a veteran activist and journalist, a member of PSARA's Executive Board, and a leader of PSARA organizing in Clallam County. < Back to Table of Contents

The Retire Advocate < Back to Table of Contents August 2025 Vote Yes on Prop 1 to Keep Seattle’s Elections in the Hands of the People Alice Woldt For more than a quarter-century, PSARA has fought to protect the security and dignity of older Americans and the generations that follow. That mission is deeply tied to the health of our democracy. If billionaires and corporate interests drown out our voices, we all pay the price – whether it’s in lost retirement security, unaffordable healthcare, or neglect of our most vulnerable neighbors. That’s why I’m urging PSARA members to vote Yes on Proposition 1 this August to renew funding for Seattle’s groundbreaking Democracy Voucher Program. Since voters first approved it nearly a decade ago, this program has transformed how our city elections work by putting real power back in the hands of everyday people. Seattle’s Democracy Voucher Program gives every resident four $25 vouchers to contribute to local candidates of their choice. It’s a simple idea that has had extraordinary results. Instead of local campaigns relying on a handful of wealthy donors and corporate PACs, they’re fueled by small contributions from people like us – retirees, renters, working families. And the proof is overwhelming: Since the program began, small donor participation has increased fivefold, with more than 105,000 Seattle residents using Democracy Vouchers. The vast majority were first-time donors, many from lower-income house- holds and communities of color who previously had little voice in our local politics. The candidate pool is more diverse than ever. There’s been an 86% jump in the number of candidates per race, opening the door for more women, younger candidates, and people of color to run competitive campaigns. And it’s made our elections more fair. Contributions under $100 have surged by 156%, while large contributions over $250 have dropped by 93%. Big out-of-city money has plummeted by up to 84%, making local campaigns truly local again. This is precisely the kind of change many of us dreamed of when we first took up the fight to reduce the influence of big money in politics. And it’s working. A study even found that Seattle’s Democracy Voucher Program boosted voter turnout by nearly 5 percentage points – an enormous shift in local elections that typically struggle to bring people to the polls. Right now, we have a chance to protect all of this progress. Prop 1 would renew the small property tax levy that funds the Democracy Voucher Program for another 10 years. For the average Seattle homeowner, it’s a modest investment – about $13 a year – to keep our democracy strong, fair, and accountable. Without renewal, the program’s dedicated funding will disappear. Seattle would either have to drastically cut back or eliminate the program, or raid the city’s general fund – already under strain from other vital needs. Worse, letting it lapse would send a terrible message: that we’re willing to let billionaires and special interests reclaim their grip on our elections, right when so much is at stake. Our country is at a crossroads. Across the nation, we’re seeing voting rights rolled back, dark money unleashed, and attempts to silence the voices of working people. Here in Seattle, we can show there’s another way. We can stand up for a democracy that works for retirees on fixed incomes, young families starting out, and everyone in between – not just the wealthy few. So here’s what you can do: Mark your calendar and return your ballot by August 5th. Talk to your friends, family, and neighbors – especially younger voters – about why voting Yes on Prop 1 matters for the future of our city and our democracy. And if you have questions or want more resources, visit www.YesOn Prop1Seattle.org. As a long-time advocate for democracy reforms, I’ve seen countless efforts come and go. Seattle’s Democracy Voucher Program is different. It’s a proven success, built by voters, supported by voters, and now ready to be protected by voters once again. Let’s make sure we keep our elections of, by, and for the people. Vote Yes on Prop 1 this August. PSARA has endorsed a Yes vote on Prop 1. Alice Woldt is the former Executive Director of Fix Democracy First and Washington Public Campaigns and a member of PSARA. < Back to Table of Contents