Jenniffer González fights for equal Medicare funding in Puerto Rico

WASHINGTON, D.C. — Resident Commissioner Jenniffer González announced on Twitter that she presented a bill to increase Medicare funding in Puerto Rico to pay for medicine for senior citizens and people with disabilities.

House Bill 797 aims for Puerto Rico to receive equal health care fund assignments as the states, since the local government is expected to pay for half the cost of those distributions, whereas states aren’t expected to achieve fund parity. This, González said, is “discriminatory” against Puerto Ricans due to the island’s colonial condition.

“This bill is part of my plan to end second-class treatment given to Puerto Ricans due to our territorial condition, especially to our most vulnerable, such as people with low income who depend on Medicare Section D to acquire their medicine,” said González in written declarations. If approved, it would represent almost $35 million more in comparison to Fiscal Year 2015.

The resident commissioner explained that the U.S. government pays the total or near total amount of medicine costs for senior citizens or people with disabilities residing in the states, with incomes up to 150% the national poverty level, via Section D of the health care program.

Puerto Rico was eligible for health care funding of $43,580,880 to $51,701,315 annually between Fiscal Years 2010-2016, but it only had access to $9,240,022 to $28,332,152 annually, because the local government couldn’t achieve fund parity. From a potential assignment of $324,352,032, the island only received $166,740,677.

See also: Rosselló emphasizes historic importance of status referendum act

González took the opportunity to emphasize the importance of voting for statehood in the June 11 status plebiscite, option she deems essential not only to achieve equal treatment in fund assignments, but to overcome the island’s fiscal and social crises.

“The upcoming referendum is a clear opportunity to let the United States know that Puerto Rico wants full equality in all senses, and that health is imperative for progress and well-being. Until we can express ourselves as a people, I will fight so we can achieve the highest quantity of possible funds, starting with that which both House and Senate Republicans and Democrats have agreed upon,” she affirmed.

Trump Budget Pick Says Benefit Programs must be Changed

Budget Director-designate Rep. Mick Mulvaney, R-S.C., testifies on Capitol Hill in Washington, Tuesday, Jan. 24, 2017, at his confirmation hearing before the Senate Budget Committee. (AP Photo/Carolyn Kaster)

Budget Director-designate Rep. Mick Mulvaney, R-S.C., testifies on Capitol Hill in Washington, Tuesday, Jan. 24, 2017, at his confirmation hearing before the Senate Budget Committee. (AP Photo/Carolyn Kaster)

WASHINGTON — Social Security, Medicare and Medicaid need significant changes to be preserved for future generations, President Donald Trump’s pick to head the White House budget office told Congress Tuesday.

Rep. Mick Mulvaney’s comments at his confirmation hearing stand in sharp contrast to Trump’s campaign pledges not to cut the programs.

Mulvaney, a South Carolina Republican, said he would not propose cutting Social Security or Medicare benefits for people already receiving them.

“I’m not making my parents go back to work,” Mulvaney said.

But, he added, younger workers should expect to work longer than their parents. He also said Medicare should be means-tested, which means benefits would be limited for wealthy retirees. They already pay higher premiums.

“I think folks on Social Security and Medicare ought to be really worried,” said Sen. Debbie Stabenow, D-Mich. “The alarm bells should be going off right now.”

Sen. Bernie Sanders, an independent from Vermont, read quotes from Trump during the campaign saying he would not cut the benefit programs. Yet, as a member of Congress, Mulvaney has been outspoken on changing the programs.

“The only thing I know to do is to tell the president the truth,” Mulvaney said. He added later, “I have to imagine that the president knew who he was getting.”

Trump’s staunchly conservative choice to lead the White House budget office was elected in the 2010 tea party wave. He’s been a supporter of the House GOP’s plan to cut back Medicare by turning it into a voucher-like program for future retirees. Trump opposes the idea and has made it clear he doesn’t support dealing now with the program’s financial shortfalls.

Mulvaney said he will present Trump with many options to shore up Social Security, Medicare and Medicaid. As a member of Congress, Mulvaney has signed a pledge not to raise taxes.

He would no longer be bound by that pledge if he is confirmed by the Senate.

Mulvaney appeared before two Senate committees Tuesday as the Congressional Budget Office revealed new estimates showing that Trump has inherited a stable economy and a government that is on track to run a $559 billion budget deficit for the year.

Social Security and Medicare have long-term financial problems that will get harder to fix the longer Congress waits to act.

Unless Congress acts, Social Security’s trust funds will be depleted in 2034 and Medicare’s trust fund for inpatient care will be exhausted in 2028, according to the trustees who oversee the programs.

If Congress allows either fund to run dry, millions of Americans living on fixed incomes would face steep cuts in benefits.

“If we do nothing then by the time I retire there will be an across-the-board 22 percent cut in my Social Security benefits,” Mulvaney said. “We do have a chance to fix these programs.”

Mulvaney also faced questions on his failure to pay more than $15,000 in payroll taxes for a household worker more than a decade ago.

Sanders said the lapse should disqualify Mulvaney from being confirmed, though most Democrats didn’t raise the issue. Sanders noted that Mulvaney voted for a bill in 2015 that would disqualify people with serious tax delinquencies from being federal employees.

Mulvaney said he failed to pay the taxes for a babysitter because he did not consider her a household employee.

“We made a mistake,” Mulvaney said.

Mulvaney said his wife had triplets in 2000 and they hired a babysitter. She worked for the family for four years but, Mulvaney said, she did not live with them.

Mulvaney said he didn’t realize that he should have paid the taxes until he was preparing for the nominating process. He said he has since paid the taxes.

Rosselló Creates Group to Tackle Healthcare Funding Parity

SAN JUAN — Gov. Ricardo Rosselló signed an executive order Monday to create a multisectoral team to achieve parity in Medicaid and Medicare funds.

“Health is non-negotiable, and with this executive order we establish as a priority to work toward achieving the necessary resources for a healthy population,” the governor said when signing E.O. 2017-12.

Gov. Ricardo Rosselló

Gov. Ricardo Rosselló

Secretary of State Luis Rivera Marín will head his new team and work alongside the island’s governor to coordinate public policy and present alternatives to comply with requisites established by federal agencies that are necessary to achieve equal benefits and budgetary allocations. Resident Commissioner Jenniffer González will also coordinate efforts from the U.S. Congress to ensure that Puerto Rico receives equal treatment in disbursement and fund management for Medicaid and Medicare.

According to the executive order, the team must present a report, to be approved by Rosselló, within the next 30 days on strategies for public policy to achieve funding parity. Subsequently, it must present periodical reports to outline their progress.

See also: Puerto Rico’s ‘healthcare crisis’ Prompts Investigation

Th eteam is composed of Health Secretary Rafael Rodríguez; Health Insurance Administration (ASES by its Spanish acronym) President Ricardo Rivera Cardona; the president of the Puerto Rico Hospitals Association, Jaime Plá; Federal Affairs Administration (PRFAA) President Carlos Mercader;  the president of the Puerto Rico Association of Physicians & Surgeons, Víctor Ramos Otero; Medicare Advantage Products Association (MMAPA) President Jim O’Drobinak; Puerto Rico Community Pharmacies Association (AFCPR) President Idalia Bonilla; and three additional members designated by the governor.

Congress Ushers in New Era of All-Republican Rule

FILE - In this Nov. 15, 2016 file photo, House Speaker Paul Ryan of Wis. speaks during a news conference on Capitol Hill in Washington. Congress ushers in a new era of all-Republican rule, with a tight GOP grip on the House, a slim majority in the Senate and a newfound ally in the White House in Donald Trump. (AP Photo/Cliff Owen)

In this Nov. 15, 2016 photo, House Speaker Paul Ryan of Wis. speaks during a news conference on Capitol Hill in Washington. (AP Photo/Cliff Owen)

WASHINGTON – Congress ushers in a new era of all-Republican rule.

On Tuesday at noon, with plenty of pomp and pageantry, members of the 115th Congress will be sworn in, with an emboldened GOP intent on unraveling eight years of President Barack Obama’s Democratic agenda and targeting massive legacy programs from Franklin D. Roosevelt and Lyndon B. Johnson such as Social Security and Medicare.

In the election, Republicans kept their tight grip on the House and outmaneuvered the Democrats for a slim majority in the Senate. In less than three weeks, on the West Front of the Capitol, Chief Justice John Roberts will administer the presidential oath to Donald Trump, the GOP’s newfound ally.

First up for Republicans is repeal and delay of the health care law, expediting the process for scrapping Obama’s major overhaul but holding off on some changes for up to four years. The tax code is in the cross-hairs. Conservatives want to scuttle rules on the environment and undo financial regulations created in the aftermath of the 2008 economic meltdown, arguing they are too onerous for businesses to thrive.

The only obstacle to the far-reaching conservative agenda will be Senate Democrats who hold the power to filibuster legislation, but even that has its political limitations. Twenty-three Democrats are up for re-election in 2018, including 10 from states Trump won, and they could break ranks and side with the GOP.

Here are a few things to know about Congress:


Vice President Joe Biden, in one of his final official acts, will administer the oath to 27 returning senators and seven new ones. Republicans will have a 52-48 advantage in the Senate, which remains predominantly a bastion of white men.

There will be 21 women, of whom 16 are Democrats and five, Republicans; three African Americans, including California’s new Democratic senator Kamala Harris, and four Hispanics, including Nevada’s new Democratic senator Catherine Cortez Masto.

Across the Capitol, the House is expected to re-elect Rep. Paul Ryan as Speaker, with all the campaign-season recriminations involving the Wisconsin Republican and Trump largely erased by GOP wins. Once sworn in, Ryan will then administer the oath to the House members.

The GOP will hold a hefty 241-194 majority in the House, including 52 freshmen – 27 Republicans, including Wyoming’s Liz Cheney, daughter of former Vice President Dick Cheney, and 25 Democrats.


The Senate will exercise its advice and consent role and consider nominations of 15 department secretaries and six people tapped by Trump to lead agencies or serve in roles with Cabinet-level status, such as the EPA and U.N. ambassador.

Democrats won’t make it easy.

Several in the party have been highly critical of several of Trump’s choices, from Rick Perry, who forgot during the 2012 presidential campaign that the Energy Department was the one he wanted to eliminate, to Treasury pick Steve Mnuchin, the former Goldman Sachs executive whom Democrats have dubbed the “foreclosure king” for his stake in OneWest Bank that profited from the foreclosure crisis.

Others nominees, such as retired Marine Corps Gen. James Mattis for defense secretary, should easily win confirmation. First, though, Congress must pass a law allowing the former military man to serve in a civilian post.

There is a limit to what Democrats can do. Rules changes in 2013 allow some nominees, including Cabinet picks, to be confirmed with a simple majority, preventing Democrats from demanding 60 votes to move forward.


Adding to the drama of the new Congress will be high-profile confirmation hearings for Trump’s nominee for the Supreme Court.

Justice Antonin Scalia died last February and Republicans refused to consider Obama’s nominee, Merrick Garland, insisting that the next president should fill the high court vacancy that’s now lasted more than 10 months.

Trump released a list of potential choices during the campaign that included Utah Sen. Mike Lee, who clerked for Justice Samuel Alito. Since the election, the president-elect also has met with Texas Sen. Ted Cruz, who clerked for former Chief Justice William Rehnquist, prompting talk about a possible nomination for the onetime presidential rival.

Trump has said he wants to nominate a justice who would help overturn Roe v. Wade, the 1973 decision that legalized abortion. Cruz and Lee would fulfill that pledge.


The point man for Senate Democrats is Brooklyn-born Chuck Schumer, who will be a chief antagonist to fellow New Yorker Trump.

Schumer succeeds Nevada’s Harry Reid, who retired after five terms, and joins Congress’ top leaders – Majority Leader Mitch McConnell, R-Ky., House Minority Leader Nancy Pelosi, D-Calif., and Speaker Ryan – in what is certain to be tough negotiations next year on spending and policies.


The first public hearing on the intelligence community’s assessment that Russia interfered in the U.S. election is Thursday in the Senate Armed Services Committee, with James Clapper, the director of national intelligence, set to testify. Expect individual panels to investigate, but not a special, high-profile select committee. McConnell has rejected that bipartisan call.

Senate to Probe Alleged Misuse of Obamacare Funds

SAN JUAN — Sen. Ángel “Chayanne” Martínez Santiago said Wednesday that, as the recently designated chairman in the Senate’s Health Committee, he will carry out a thorough investigation regarding supposed fund misuse by the exiting administration through the Patient Protection and Affordable Care Act, commonly known as Obamacare.

The New Progressive Party (NPP) senator lashed against Gov. Alejandro García Padilla’s administration for supposedly spending most of Obamacare funds in only four years, and ensured the committee he will preside as of January will put the responsibility on those officials who “failed the people.”

Sen. Ángel "Chayanne" Martínez Santiago, designated chairman of the P.R. Senate's Health Committee. (Agustín Criollo/CB)

Sen. Ángel “Chayanne” Martínez Santiago, designated chairman of the P.R. Senate’s Health Committee. (Agustín Criollo/CB)

“The health reform is largely financed by Obamacare funds. Section 2005 of the Affordable Healthcare for America Act assigned Puerto Rico $5.4 [billion] to ‘Mi Salud’ from July 2011 until September 30, 2019. We are in December 2016 and the vast majority of those funds were spent by this exiting administration,” said Martínez Santiago.

“This excessive waste of funds is unjustified. This committee will perform a thorough and responsible investigation about this affair and we will make referrals to pertinent authorities, both in Puerto Rico as well as to a federal level,” he added.

According to official data from Medicaid and Medicare Service Center, in addition to those $5.4 billion, the U.S. government assigned $925 million for Medicaid and Medicare. From these resources, which ascended to $6.4 billion in May 2015, only $3.4 billion remain.

Martínez Santiago reminded that federal input to ‘Mi Salud’ increased from 55% to 57.2% from Jan. 2014 until Dec. 31, 2015, which would have represented additional savings to the local government, thus extending those resources.

However, the senator said that as recently as late 2015, Dennis González, regional director of the Eastern U.S. Department of Health and Human Services (HHS), confirmed that García Padilla’s administration had spent disproportionately the Obamacare funds. He added it was imperative to demand Congress to declare Puerto Rico in health emergency.

“We had already addressed a letter to U.S. House Speaker Paul Ryan so he would give us the opportunity to discuss this issue in an emergency meeting, so he would declare Puerto Rico in a health emergency zone to look for the way to get federal funds,” explained Martínez Santiago.

“The grave problem Mi salud will have next year will be the lack of Advantage funds, which will be reduced by 11%. With this, thousands of people from the platinum programs -around 250,000 lives- could lose their medical plan and will be forced to emigrate toward reform because they aren’t guaranteed services via Medicare Advantage the moment they enter reform. This would represent the [local] government an annual blow of $400 to $500 million,” he said.

Alas, the senator was optimistic of the bill to be submitted by Resident Commissioner-elect Jenniffer González, to request additional funds through a mechanism known as Quick Fix, which he said would represent $3.5 billion for local health services while Congress works on new public policy regarding Obamacare.

However, when questioned what would be González’s course of action if her request were unsuccessful, Martínez Santiago said Plan B would be to look for recurrent funds from other means.

“I am developing measures that we will see in January of some areas that are being nourished by some funds that weren’t really given much importance. Funds are used for minuscule things from which we could take a percentage and not leave those organizations without funds, and they can be used for a special fund to manage Mi Salud,” he explained, although he didn’t specify which are those areas.

Sen. Rossana López demands explanation from Rosselló, warns of health crisis

SAN JUAN – Popular Democratic Party (PDP) Sen. Rossana López León called on Gov.-elect Ricardo Rosselló and the Financial Oversight & Management Board to present what she called their fiscal plan, including additional cuts “to important areas, like healthcare.”

She stated that “the fiscal oversight board and the incoming governor, Ricardo Rosselló Nevares, must be clear and show their budget cuts in essential services at once.”

PDP Sen. Rossana López León./ Inter News Service

PDP Sen. Rossana López León./ Inter News Service

She went on, saying, that regarding healthcare, “for example, they must be responsible and specify how many cancer patients won’t receive treatment, how many will die because organ transplants weren’t performed, and how many will be at the mercy of the pain caused by their sickness.”

López León said that when the fiscal oversight board emphasized there won’t be additional funds and referred to Medicare and Medicaid from the Affordable Care Act, “it isn’t talking about the island losing $865 million” nor that the local government has been carrying deficits for the past years.

“What that means is that more than 100,000 people will be left out of the government’s healthcare system. This includes those who are already facing illnesses and those who are about to face these terrible physical challenges,” she explained.

She stressed that cutting healthcare funds would be “a catastrophic infringement on civil rights for thousands of Puerto Rican families, because a human being’s dignity is inviolable and letting them die without treatment is an infringement on their right to healthcare.”

The PDP senator also added that Medicare funds are paid for by the working class, which is why “a $3 billion cut would be unfair and reproachable.”

“It is unfortunate that a nation that promotes social justice and democracy would run over an ally that has always been willing to contribute with its blood and lives in their wars, as well as the best talent for their territory’s industrial development,” she concluded, regarding the United States and its historical relation with Puerto Rico.

Policy Prescriptions: Clinton and Trump on health care

FILE - In this Oct. 6, 2015, file photo, the website, where people can buy health insurance, is displayed on a laptop screen in Washington. About 9 in 10 Americans now have health insurance, more than at any time in history. But progress is incomplete, and the future far from certain. Rising costs could bedevil the next occupant of the White House. Millions of people previously shut out have been covered by President Barack Obama’s health care law. No one can be denied coverage anymore because of a pre-existing condition. But “Obamacare” remains divisive, and premiums for next year are rising sharply in many communities. (AP Photo/Andrew Harnik, File)

In this Oct. 6, 2015, file photo, the website, where people can buy health insurance, is displayed on a laptop screen in Washington. (AP Photo/Andrew Harnik, File)

WASHINGTON (AP) — Hillary Clinton has been involved in the nation’s health care debate for more than 20 years and, as her campaign likes to say, she has the scars to prove it.

The Democratic presidential candidate failed in her 1990s effort to steer her husband’s universal coverage program through Congress, as the complex plan collapsed for lack of political support. Since then, she has tacked sometimes to the right on health care, and sometimes to the left.

Clinton is campaigning as the candidate of continuity and would leave all major health care programs in place. She has a long list of tweaks and adjustments that reflect her familiarity with policy and would expand the government’s role in health care.

Donald Trump calls President Barack Obama’s health care law “a disaster,” and vows to seek its repeal. He’d provide a new tax deduction for health insurance premiums, but also limit federal support for Medicaid, which covers low-income people. An independent analysis recently estimated his seven-point plan would cause 20 million people to lose coverage.

Trump’s ideas on health care have shifted over time, and his latest plan hews to basic GOP talking points. He’s expressed a belief that an economically advanced country like the United States can’t have people “dying in the street” for lack of medical care.

Here is a summary of their proposals:



The government’s premier health insurance program covers about 57 million people, including 48 million seniors and 9 million disabled people under age 65. It enjoys strong support from voters across the political spectrum, although its long-term financial outlook is uncertain.

CLINTON: She would authorize Medicare to negotiate drug prices with pharmaceutical companies, and she supports allowing patients to import lower-cost prescriptions from abroad. Medicare beneficiaries represent a big share of the market for medications.

Clinton would also allow people ages 55-64 to buy into Medicare, although her campaign has not released much detail on how that would work.

TRUMP: He promises not to cut Medicare, and has suggested that other Republicans like House Speaker Paul Ryan made a political mistake by calling for major changes. But it remains unclear how Trump’s proposed repeal of “Obamacare” would affect its improvements to Medicare benefits, including closing the prescription drug coverage gap known as the “doughnut hole.”

Earlier, Trump spoke approvingly of giving Medicare legal authority to negotiate prescription drug prices, but that idea currently is not mentioned in his health care plan. Instead, he also supports allowing drug importation.



The federal-state program for low-income individuals covers more than 70 million people, from pregnant women and children to elderly nursing home residents. Under Obama’s health care law, states can expand the program to include more low-income adults. Medicaid has sometimes carried a social stigma, but polls show the program has a solid base of public support.

CLINTON: She’d work to expand Medicaid in the 19 states that have yet to take advantage of the health law. She’s proposing three years of full federal funding for those states, the same deal given to states that embraced the law right away.

TRUMP: In 2015 Trump told an interviewer: “I’m not going to cut Social Security like every other Republican. And I’m not going to cut Medicare or Medicaid. Every other Republican’s going to cut.”

But his campaign plan would convert Medicaid into a block grant, ending the open-ended federal entitlement and capping funding from Washington. Over time, such an approach is likely to result in a big cut.



About 177 million people under age 65 have private health insurance, with nearly 9 in 10 getting their coverage through an employer. Rising out-of-pocket costs such as insurance deductibles and copayments are a sore point with consumers.

CLINTON: She has proposed a new tax credit of up to $5,000 per family, or $2,500 for an individual, for households that face “excessive” out-of-pocket costs. The credit would be refundable, meaning that people who don’t owe income tax could still get money back. An independent analysis of her plan defined “excessive” costs as exceeding 5 percent of household income.

Clinton would also require insurers to cover three sick visits to the doctor each year without patients needing first to meet their plan’s deductible, the annual amount patients pay before their insurance kicks in.

TRUMP: He has no similar proposals on out-of-pocket expenses but has called for requiring hospitals, clinics and doctors to disclose prices so patients can shop around to reduce costs. And he would expand the use of tax-sheltered health savings accounts, used to pay for medical expenses not covered by insurance.



More than half of U.S. adults take prescription drugs, and according to a recent Kaiser Family Foundation poll most of those patients report no major problems affording their own medications.

But consumers have been alarmed by the introduction of breakthrough drugs costing tens of thousands of dollars a year, along with a spate of seemingly random price hikes for older medications. More than 3 out of 4 say the cost of prescription drugs is unreasonable. A majority favors government action to curb costs.

CLINTON: She has several proposals, including a new government board with the power to penalize drug companies for “unjustified, outlier price increases,” a monthly limit of $250 on patients’ copayments for prescription drugs, lowering the period of protection from generic competition for biologic drugs from 12 years to 7 years, and requiring drug companies to provide rebates for medications used by low-income Medicare recipients.

Those ideas are on top of Medicare negotiations and allowing patients to import lower-cost prescription drugs from abroad.

TRUMP: In addition to backing drug importation, he also has called on Congress to remove barriers to competition from lower-price, equally effective medications.



The 2010 Affordable Care Act expanded coverage for the uninsured and made carrying health insurance a legal obligation for most people. It offers subsidized private insurance for people who don’t have access to a job-based plan, along with a state option to expand Medicaid.

About 11 million people are covered through the law’s private insurance markets, while the Medicaid expansion has added at least 9 million to that program. It’s unclear if all those people were previously uninsured, but experts say the law deserves most of the credit for 21 million gaining coverage since its passage. Americans, however, remain deeply divided over “Obamacare.”

CLINTON: She wants to strengthen Obama’s signature law. Clinton would resolve a “family glitch” that denies health insurance subsidies to some dependents, sweeten subsidies for people buying coverage on the health law’s markets, and offer a new government-sponsored insurance plan to compete with private companies.

Her proposals would expand coverage to about 9 million more uninsured people, according to a recent study by the Commonwealth Fund and the RAND Corporation.

But Clinton would repeal the law’s tax on high-cost insurance, known as the “Cadillac Tax.” Many economists are critical, saying repeal of the tax would eliminate a brake on costs.

TRUMP: He would completely repeal the 2010 law and start over again. Trump has proposed a tax deduction for health insurance premiums, and also allowing insurers to sell policies across state lines, a longstanding GOP idea.

Critics say a deduction, usually claimed after the end of the tax year, wouldn’t do much to help lower-income people squeezed to pay premiums.

And the idea of selling across state lines has been opposed in the past by state insurance commissioners and attorneys general, who warned that it would undercut consumer protections. The insurance industry is divided, with smaller companies fearing it would favor major insurers.

Social Security Recipients to Get Tiny Increase in Benefits

In this Jan. 11, 2013 file photo, the Social Security Administration's main campus is seen in Woodlawn, Md. Millions of Social Security recipients and federal retirees will get only tiny increases in benefits next year, the fifth year in a row that older Americans will have to settle for historically low raises.  (AP Photo/Patrick Semansky, File)

In this Jan. 11, 2013 file photo, the Social Security Administration’s main campus is seen in Woodlawn, Md. (AP Photo/Patrick Semansky, File)

WASHINGTON — Millions of Social Security recipients and federal retirees will get a 0.3 percent increase in monthly benefits next year, the fifth year in a row that older Americans will have to settle for historically low raises.

There was no increase this year. Next year’s benefit hike will be small because inflation is low, driven in part by lower fuel prices.

The federal government announced the cost-of-living adjustment, or COLA, Tuesday morning. By law, the COLA is based on a government measure of consumer prices.

The COLA affects more than 70 million people – about 1 in 5 Americans.

The average monthly Social Security payment is $1,238. That translates into a monthly increase of less than $4 a month.

More bad news for seniors: Medicare Part B premiums, which are usually deducted from Social Security payments, are expected to increase next year to the point in which they will probably wipe out the entire COLA.

By law, the dollar increase in Medicare’s Part B premium cannot exceed a beneficiary’s cost-of-living raise. That’s known as the “hold harmless” provision, and it protects the majority of Medicare recipients.

But another federal law says that the Part B premium must raise enough money to cover one-fourth of expected spending on doctors’ services. That means that a minority of beneficiaries, including new enrollees and higher-income people, have to shoulder the full increase. Their premiums would jump.

Millicent Graves, a retired veterinary technician, says Medicare and supplemental insurance premiums eat up nearly a third of her $929 monthly Social Security payment. And don’t tell the 72-year-old from Williamsburg, Virginia, that consumer prices aren’t going up. She says her insurance premiums went up by $46.50 this year, and her cable TV, Internet and phone bill went up, too.

“I just lose and lose and lose and lose,” Graves said.

More than 60 million retirees, disabled workers, spouses and children get Social Security benefits. The COLA also affects benefits for about 4 million disabled veterans, 2.5 million federal retirees and their survivors, and more than 8 million people who get Supplemental Security Income, the disability program for the poor. Many people who get SSI also receive Social Security.

Since 2008, the COLA has been above 2 percent only once, in 2011. It’s been zero three times.

“This loss of anticipated retirement income compounds every year, causing people to spend through retirement savings far more quickly than planned,” said Mary Johnson of the Senior Citizens League. “Over the course of a 25- or 30-year retirement, it reduces anticipated Social Security income by tens of thousands of dollars.”

By law, the cost-of-living adjustment is based on the Consumer Price Index for Urban Wage Earners and Clerical Workers, or CPI-W, a broad measure of consumer prices generated by the Bureau of Labor Statistics. It measures price changes for food, housing, clothing, transportation, energy, medical care, recreation and education.

The COLA is calculated using the average CPI-W for July, August and September. If prices go up, benefits go up. If prices drop or stay flat, benefits stay the same.

The numbers for July and August suggest COLA of just 0.3 percent. The numbers for September are to be released Tuesday.

Some advocates complain that the government’s measure of inflation doesn’t reflect the costs many older Americans face.

For example, gasoline prices have fallen by nearly 18 percent over the past year, according to the August inflation report, while the cost of medical care has gone up by more than 5 percent.

For seniors who don’t drive much, they don’t get the full benefit of low gas prices, said Max Gulker, a senior research fellow at the American Institute for Economic Research. Many seniors, however, spend more of their income on health care.

Graves said she appreciates lower gas prices, but doesn’t drive much.

“I just have to rely more each month on cashing in investments,” Graves said. “I’m lucky I can do that.”

Medicare Unveils Far-Reaching Overhaul of Doctor’s Pay

FILE - In this July 30, 2015 file photo, a sign supporting Medicare is seen on Capitol Hill in Washington. Medicare on Friday, Oct. 14, 2016, unveiled a far-reaching overhaul of how it pays doctors and other clinicians. Compensation for medical professionals will start taking into account the quality of service, not just quantity.  (AP Photo/Jacquelyn Martin, File)

In this July 30, 2015 file photo, a sign supporting Medicare is seen on Capitol Hill in Washington. Medicare on Friday, Oct. 14, 2016, unveiled a far-reaching overhaul of how it pays doctors and other clinicians. (AP Photo/Jacquelyn Martin, File)

WASHINGTON– Medicare on Friday unveiled a far-reaching overhaul of how it pays doctors and other clinicians. Compensation for medical professionals will start taking into account the quality of service – not just quantity.

The massive regulation is known as MACRA. It’s meant to carry out bipartisan legislation passed by Congress and signed by President Barack Obama last year.

MACRA creates two new payment systems, or tracks, for clinicians. The majority of medical professionals billing Medicare – some 600,000 doctors, nurse practitioners, physician assistants and therapists – are affected. Medical practices must decide next year what track they will take.

Starting in 2019, clinicians can earn higher reimbursements if they learn new ways of doing business, joining a track that’s called Alternative Payment Models. That involves being willing to accept financial risk and reward for performance, reporting quality measures to the government, and using electronic medical records.

Advocates say the new system will improve quality and help check costs. But critics say the complicated requirements are overwhelming for solo practitioners.

It’s going to take time to assess the impact on Medicare’s 57 million beneficiaries.

The government’s premier health insurance program is in the midst of an overhaul in how it pays service providers, trying to shift to a new emphasis on rewarding quality. But it may take years to see whether the new approach can lead to major savings.

Medicare’s previous congressionally-mandated system for paying doctors proved unworkable. It called for automatic cuts when spending surpassed certain levels, and lawmakers routinely waived those reductions. MACRA was intended as a new beginning.

Medicare officials say the change will be gradual, and the agency is requesting additional public comment on Friday’s final rule.

Officials say they worked to address the concerns of smaller medical practices, by exempting more of them from the new system.

Hispanic Caucus Holds First Gathering of the Week at DNC

PHILADELPHIA — Puerto Rico came to the forefront during a gathering of the Democratic Hispanic Caucus held Monday at the Philadelphia Convention Center.

The island’s debt crisis, the Zika virus and the role Puerto Ricans on the U.S. mainland could play ahead of the presidential elections were some of the topics discussed during the caucus, along with immigration and discrimination issues. Victims of the recent Orlando shooting were also paid tribute, as speakers heavily criticized racism and discrimination against Latinos and the LGBTT community.  

“The big elephant in the room—and I don’t mean Republicans—is that we still have a colony,” said Rep. José Serrano, adding that as long as Puerto Rico continues to be a colony of the U.S., the island’s woes, particularly its fiscal problems, won’t be solved once and for all.

Along with Serrano, New York City Council Speaker Melissa Mark-Viverito; Liza Ortiz, campaign manager for Popular Democratic Party gubernatorial candidate David Bernier; and Manuel Ortiz, a lobbyist on K Street with ties to the Democratic Party and who advises New Progressive Party gubernatorial candidate Ricardo Rosselló’s campaign, took part in a panel that discussed various issues related to the island.

Serrano believes the U.S. is “just putting bandaids on” without solving Puerto Rico’s political status. He urged Congress to explicitly express which options are available, and says he supports three formulas: statehood, independence and free association.

Mark-Viverito stressed it is important for the Puerto Rican diaspora to take on an active role in finding solutions to the crisis. Moreover, she said the fiscal board to be established by the Puerto Rico Oversight, Management and Economic Stability Act, or Promesa, should concern everyone and urged once again for completing an audit of Puerto Rico’s debt.

As for the Bernier campaign manager Ortiz, she said economic development must be achieved first and foremost, adding that the island’s debt must be restructured. She added that Bernier “has been in talks with bondholders since Day 1,” and was confident a solution could be reached with the island’s creditors.

In his evaluation, lobbyist Manuel Ortiz insisted it is impossible to de-link status from Puerto Rico’s economic issues. On that front, he touted the NPP gubernatorial candidate’s plan to seek economic development by achieving parity in the Medicare and Medicaid federal programs.

“Economic development tools for Puerto Rico are clearly lacking,” Ortiz said during an exclusive interview with Caribbean Business after the panel discussion.

He added that Promesa lacks provisions for economic development. “The most important thing is that the board members be chosen from technocrats. People who are experienced, financial services people, people who know municipal debt—not ideologues and people who are going to bring their own agendas. I am inspired by conversations that I have had with the White House and with Speaker [Paul] Ryan,” Ortiz said.

“Once they get in there, I think it is important that the new administration produces audited financial statements; the data that is out there right now is not enough to get a clear picture,” he added, pointing to claims that Rosselló made that the debt was overblown to obtain the oversight board.

“[Promesa] is important to me and, yes, it is important to our constituents,” former Miami Mayor Manuel Díaz said for his part during an exclusive interview with Caribbean Business.

Hispanic caucusOn the Zika front, Serrano doesn’t think that “any American, including Puerto Ricans, understand the major threat posed by the virus,” adding that resources and funding must be provided to fight the virus in Puerto Rico.

Meanwhile, as expected, Republican presidential candidate Donald Trump was slammed during the event, particularly for his stance against immigrants.

“How have we allowed Trump’s language to be acceptable of this country’s political debate?” said DNC Vice Chairwoman María Elena Durazo, criticizing the GOP candidate for his continuous remarks against immigrants, particularly Hispanics, in the mainland U.S.

“Today, we are here to protect and defend immigrants in the U.S.,” added Rep. Luis Gutiérrez, who also took part in one of the event’s panels.

“We are all going back home…back to Puerto Rico to elect Hillary Clinton,” Durazo added. Yet, although Puerto Rico residents vote in U.S. primaries, they don’t have the right to vote in the presidential elections.

“Preach the good word; let’s make sure the Latino community puts Hillary in the White House,” said actress Rosie Pérez, who moderated the Puerto Rico panel during the Hispanic caucus.