Inside The Senior Alliance: 2023 Congressional Outlook with Amy Gotwals (Ep 1.29)
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In this episode, Jason Maciejewski, CEO of The Senior Alliance, talks to Amy Gotwals, Chief, Public Policy and External Affairs of USAging. Jason and Amy discuss the upcoming Legislative sessions in Washington, DC, and how issues for seniors and older Americans are going to play out in the next two years. They also talk about the re-authorization of the Older Americans Act and what the funding goals are for Congress to approve services for seniors. You can also find out how you can become an advocate and take a role in helping to shape supports and help for seniors in your local community, as well as in Michigan and nationwide. Excellent information! www.thesenioralliance.org.
Produced by The Senior Alliance and Blazing Kiss Media
Transcription
Jason Maciejewski (00:00):
Welcome to Inside The Senior Alliance, a podcast exploring resources and issues in the field of aging. I’m Jason Maciejewski, CEO at the Senior Alliance, the Area Agency on Aging serving Western and Southern Wayne County. Joining me today is Amy Gotwals, Chief, Public Policy and External Affairs of USAging. She’s earned a bachelor’s degree from Mount Holyoke College and a Master’s of Legislative Affairs from George Washington University. Amy, welcome to the podcast.
Amy Gotwals (00:22):
Thanks, Jason. A pleasure to be here.
Jason Maciejewski (00:24):
So there are very slim majorities in Congress. Republicans hold the US House 222 to 212, and Democrats hold the US Senate 51 to 49. These margins would logically suggest a need for bipartisanship to get legislation passed and generally aging policy enjoys bipartisan for the most part once you get to those final votes. How would you describe the legislative climate in Washington DC right now?
Amy Gotwals (00:51):
So we’re here on the very final, second to last day of January, and I would have to say we’re off to a bit of a slow start, so it’s a little bit hard to tell. I think the nation watched the house leadership struggles and eventual success of Kevin McCarthy in the house to take the leadership role over there to become Speaker of the House. That certainly was a larger drama than I’m sure he preferred. And, people actually expected that burned through a lot of time that otherwise, and that had effects not just on getting to that point of making sure there was speaker of the house, but that delayed the convening and the swearing in of this new Congress. So that’s why I say it’s a bit of a slow start. And the same can be true of the Senate. They’re not exactly where you’d expect them at the end of January.
Amy Gotwals (01:38):
So I don’t know if everyone just needed a break after the elections and different reasons, but it’s still really ramping up. The Senate, as I mentioned, had taken a several week long break since they first came to town to help open up the new Congress and are just now getting back and starting to assign people to committees and what not. So we haven’t yet seen anything that we can use as a gamble. I think we’re all watching and waiting and seeing what those first few pieces of test legislation look like, especially within committees and seeing what newly appointed committee chairs and ranking members take on as their issues. I also think an issue that has been discussed about, and it might be our next big drama, is the debt ceiling issue and how that plays out over the next weeks. And then honestly, this could play out for months.
Amy Gotwals (02:27):
That’ll tell us a lot about how this Congress is going to work together across the two chambers, which are led by two different parties and with a president that is obviously a different party than leadership in the house. I think the closer we get to the next election, the more things will slow down. I know that seems like I’m skipping over all of 2023 and I am, but I’m mentioning that because that’s just a universal truth in DC sometimes it’s not the truth and a lot gets done. I would say that about this last midterm election year, a lot actually did get done by Congress, but as we get close to presidential, it gets more intense. And so both parties know that 2023 is really a big year of action for both parties in both chambers as well as for the White House wanting to get some wins.
Amy Gotwals (03:16):
So that could all lead to actually a lot of legislating and it could also given the differences in the split Congress lead to not much happening. That said, I still have faith in bipartisan legislation and the ability to do that if the issue is the right one. And as you know, Jason, the Older Americans Act is gonna be up for reauthorization 2024, which means that we start getting ready for it in 2023, and by the end of 2023, we start forming those relationships and talking to Congress. So that’s something that we are determined will remain a bipartisan process and are looking for it over the next two years, which is this Congress serves for two year the, it’s a two year Congress that just began. So I’m going to end that by saying I’m not really sure how fractured it’s going to be and how productive it’s going to be, but that doesn’t mean I don’t have faith that we will be able to make good progress on Older Americans Act because I do.
Jason Maciejewski (04:08):
It certainly looks like the debt ceiling discussion is kind of casting a shadow over everything at this point. So hopefully we can get a resolution to that and move on. But we’re really fortunate in our service area, which is noted as 1C here in Michigan, that we have a pretty strong congressional delegation for our AAA with Congressman Thanedar new to the US House, Congresswoman Rashida Tlaib. And our senators Gary Peters and Debbie Stabenow have all been really strong supporters of the work that we do over the last several years. And we’re really fortunate to have Congresswoman Debbie Dingell representing part of our service area as well as she’s been a strong advocate on Medicare issues. And she’s actually reintroduced the Medicare Hearing Aid Coverage Act, which is known as HR 244 in the current session. And she’s always been a strong supporter of home and community based servers and caregivers as well. But when you look nationally, who are the key members of Congress on Aging policy?
Amy Gotwals (05:06):
I’ll name a few. Some of these roles are still being sorted out here at the end of January, but we know we have some sense of who’s playing key roles on the committees that have jurisdiction over programs that we care about. Aging certainly broadly encompasses a whole bunch of different committees. I’m gonna focus on the ones that US Aging most often works with on our host of issues. But there are more than we really have time to name, if you start to drill down on all of the federal policy that could affect the lives of older adults and their ability to age well at home, if that’s their preference. So I would start with the committees that have jurisdiction over the Older Americans Act. So this means they’re not the ones who decide the funding every year, but they’re the ones who every three to five years, depending on how long they gave themselves before they wanted to look at the legislation again, they decide any changes that are made to how the older Americans Act work.
Amy Gotwals (05:59):
And in the Senate, that’s called the Health Committee, that’s short for health, education, labor and pensions. And we know for the Democratic Party, but himself an independent Bernie Sanders senator from Vermont will be newly taking the role of the entire senate Help Committee. He previously was a key OAA supporter in his subcommittee role, but now he’s moving into that top spot. And on the house side with the changeover in leadership on the house after the last election, longtime Congresswoman Virginia Fox, Republican of North Carolina will now be taking the lead on that committee, which is called the House Education and Workforce Committee. So as we do lead into the 2024 Older Americans Act authorization, for example, those are the folks and their subcommittee leadership that will be working with both Republicans and Democrats in both full committee and subcommittee. But for the major health programs important to older adults, you also have to look to the Senate Finance Committee in the Senate.
Amy Gotwals (07:00):
And then there’s two committees that align with the Senate finance’s jurisdiction with a bunch of exceptions. But to keep it simple, there’s a house ways and means and energy and commerce for those older Americans acts. So we also work with those people. So if you wanted to change Medicaid policy, you wanted to, for more specific example of Medicaid policy, make sure that money follows the person to help people transition back out of nursing homes in the community. You’d be working with these committees, not the ones I mentioned before. And then there’s an interesting committee that’s only in the Senate and it’s called the Aging Committee, and it is not supposed to write legislation and it can’t appropriate money, but it is there as an important spotlight committee, for lack of a better word, to shine a spotlight on the issues affecting older Americans. And in the last couple congresses thanks to the then leaders of originally Senator Susan Collins, Republican of Maine, and also now Bob Casey, Democrat from Pennsylvania.
Amy Gotwals (07:57):
They both are very passionate about this work and they really kind of upped the level of activity that that committee conducts. They still can’t be the ones who mark up legislation and refer it to the floor for votes. But the leadership have been very active in filling in any gaps and being definitely trying to advance policy, even if of course they’ll still work through the official committees. In fact, your Congresswoman Dingell that you were talking about just last week on Thursday, she and the Aging Committee chairman, the for mentioned Democrat Senator Casey from Pennsylvania reintroduced a bill of theirs that USAging strongly supports it’s the Better Care, Better Jobs Act. And that is the provisions that were unable to get into a major package in the last Congress that the president was pushing. That was his Build Back Better Bill that you will recall did not end up getting enough traction.
Amy Gotwals (08:49):
Um, and the provisions in it got narrowed to just a few things. And this piece, this very important investment in Medicaid, home and community based services by investing in the workforce for Medicaid HCBS was left out. And so thankfully Senator Casey and with your congresswoman, they’ve taken up the charge again to advance it on the Aging Committee. We also have a newly, and I believe this is a final, it keeps not being in writing, but I’m hearing all the buzz is that Senator Mike Braun, republican of Indiana will newly take on the ranking role. So that’s a new opportunity. And any other new people in the committee, the Aging Committee is a great opportunity to also educate more senators, get them engaged in aging issues. And lastly, as far as Leaders on Aging, I did want to note that I was just reading the other day that Senator Peters, who you mentioned, one of your senators and a Democrat will be on the Appropriations Committee this year, that spending committee, I haven’t so much mentioned them, but they’re the ones who actually determine the spending and so not just oversee the program, but make sure every year there’s actual funding flowing.
Amy Gotwals (09:53):
And so that’s a key and critical role and a new opportunity for michigania and advocates. So you’ll definitely wanna make sure Senator Peters and all, any previous work you’ve done with him, you have a real opportunity to make sure that he’s able to show his support for programs like the Older Americans Act and many other key aging supports that are funded by the federal government through his new role. So I did wanna flag that for your listeners.
Jason Maciejewski (10:17):
Yeah, we’re really excited that Senator Peters is gonna have an appropriations role and I look forward to visiting him and other legislators in Washington in April when we make our trip there. But I want to turn our attention maybe to the administration at this point. And how would you characterize President Biden’s administration’s approach to aging policies so far, and have they had a different focus than perhaps the two previous administrations?
Amy Gotwals (10:41):
This is where you’re going to get me in hot water, Jason. I’ve worked across many, many administrations in my time at US Aging and a previous aging organization, so I don’t like to give them all different scorecards. I will say this within the Administration for Community Living, which is under HHS and is the oversight agency within the federal government that supports the work of the Older Americans Act and therefore our members, the area agencies on aging around the country, so that we shortcut them and call them ACL for Administration for Community Living. I think they’ve continued to do a great job, did a great job in the past and under the leadership of the Acting Assistant Secretary on Aging, Alison Barkoff, there’s not a permanent person, if you will. It’s never permanent, but there’s not a senate approved leader of that administration.
Amy Gotwals (11:31):
And we’re certainly hoping that Congress and the White House can come to agreement on a new nominee soon and try to get someone in that position. But meanwhile, the acting assistant secretary, Barkoff, she’s done a lot of tremendous work working with the staff there at ACL of supporting the Aging and Disability Networks through Covid, even as we also are still dealing with the effects of Covid and yet looking ahead to new challenges and opportunities. So I wanna praise her work in particular and give an example of that. Recently, ACL was able to secure through HHS 125 million dollars in funding to go out to the Aging and Disability Networks to be able to continue their work and in some cases reinvigorate their work around vaccination. And that’s for both Covid vaccines and boosters as well as influenza. So it’s an example of leadership within the Biden administration to secure the funding that the network needs in order to reach our common goal of reducing the harm of Covid on older adults and getting people vaccinated.
Amy Gotwals (12:33):
So again, that’s not saying past administrations also didn’t do amazing work. I just did wanna give a shout out to that current. We’re also very pleased at US Aging to be part of that effort and have formed an aging and disability vaccination collaborative. And we have about 75 of that 125 million dollars funding to help get that work out, excuse me, get that funding out into the Aging Disability Network. Organizations like AAA’s, like Centers for Independent Living. In some cases we’ll be funding Aging Disability Resource centers to be able to help achieve the President’s call, which has been set out for this to get 2 million shots in arms. So that’s just a recent leadership example from them that I wanted to call out. But I would say that over the years, the administration of community living in particular, which certainly only one agency that touches on aging issues, but it’s sort of our home agency <laugh>.
Amy Gotwals (13:26):
So we talk to them a lot and we talk about them a lot. I would say really between administrations, they’ve been remarkably consistent over the years. Sure, political appointees might have different approaches to things, but I think they’ve been good stewards of the important role they have in administering the Older Americans Act and in trying to support the aging network throughout. But I’ll say this, I’m trying to stay on the line of safety in that answer, but I do want to also say that in my personal opinion, I think all White houses and their, you know, high level parts of their administration could definitely pay more attention to aging issues. We are undergoing a massive demographic change. We are not prepared for it, and now we are in it. And so I wish that aging issues and all the ways that it becomes about all of us, our aging country, not just about, oh, it’s older adults, the where the issue is, no, it affects all of us. And I wish that was a higher priority right now for both administrative officials, the White House and Congress.
Jason Maciejewski (14:27):
Yeah, we certainly spend a lot of time in our advocacy educating our state legislators and members of Congress as well about those demographic changes and how they’re going impact so many different policies that they deal with. But I want to think about Covid that, as you mentioned, you know, some of those new dollars related to vaccinations coming out, but Covid is really a routine part of our public health consciousness at this point. And do you think there are lasting impacts on how Congress approaches older adult issues after our experience with Covid?
Amy Gotwals (14:56):
Well, I hope so, but we need as advocates to make sure they do that in the right way. And what I mean by that is the attention paid to older adults and the issues that were particularly affecting them in Covid and the higher risks that they faced in Covid and the realities of those risks while trying to mitigate those risks. The social isolation for just one example of what the negative outcome of doing something that from a physical safety perspective was the right thing to remain at home and stay away from others. So it’s complex as we all saw, but I think we got a lot of attention on the population that we all want to support in effective ways. But I, I think we’re going to have to keep up the drum beat to keep that as a priority. Even when Covid gets under control or it, it’s not center stage anymore.
Amy Gotwals (15:44):
And I worry that we won’t be focusing on the right things, that we will end up focusing on one aspect of aging or one and not recognizing, as you just said Jason, it’s so true that this just ripples through society at all levels, economically within families, et cetera. So I would really like to see us not only keep the drumbeat alive of talking about older adults and given their numbers, not just becuase we want to support people who are at that stage of life in general, but it’s also about the numbers and impact on the country. I want to make sure we’re putting home and community-based services front and center. We have got to address the safety issues in nursing homes and other congregate housing that Covid just shown an incredibly strong spotlight on but was to some degree there before and was just exacerbated by the challenges posed by Covid.
Amy Gotwals (16:35):
But policymakers don’t need to not think that if they clear that up. Not an easy thing to do, but definitely worth trying that that’s there. We fixed it for older adults because you and I know that the vast majority of older adults don’t live in institutions like that. They live at their homes, which are in communities. And so we really have to keep up the momentum and the pressure on policy makers at all levels to pay attention to this population, to understand why investing in home and community-based services is the way to go. And then, and a stronger home and community-based services system not only gives back to that community, it’s an economic driver. People are staying in their homes, they’re paying taxes in their homes or as through sales tax, they’re still involved in the community. But lastly, if another major public health challenge, or probably more likely in many parts of this country, some sort of emergency or disaster comes into effect, the stronger our home and community services systems are, the better we’ll be able to support older adults and have smart ways that we’re dealing with this massive demographic change that give people the options that they really want.
Jason Maciejewski (17:42):
Thank you for that. I appreciate the response to that question. I want to talk for a minute about the older Americans Act reauthorization and give our listeners a little preview to that in our March, 2023 episode. You’re gonna join us to talk about the Older Americans Act in more specificity, but we know that it’s authorization is going to expire at the end of 2024. And as the Older Americans Act that goes through this process, what are the big issues that are gonna be debated in reauthorization and do you anticipate a push to quote modernize it?
Amy Gotwals (18:16):
That’s a good question and thank you for asking me about Older Americans Act. You can tell I talk about it a lot. I’ve already mentioned it a couple times. It’s only one of the many issues that US Aging works on on behalf of our members, but it’s, it’s our foundation, it’s our core. So it’s sort of at the, it’s always centered in the work we do, even as we are also engaging in policy and advocacy across many other issue areas including healthcare. But yes, our Landmark Act will be up for reauthorization in 2024, which means we start working on it this year and every time somebody will use the word modernize, it’s certainly not out of date. We only did it about, uh, it was finalized, the last update to the act, which had been previously updated only three years before that was done.
Amy Gotwals (19:02):
The last update was in 2020, so not that long ago. Even if it, it feels given what’s happened in the intervening years, it might feel like a long time ago, to all of us from our exhaustion of dealing with Covid, I will say it’s not really that long. However, the fact that the period here was dominated in the first two years and continuing into this third year since Covid a lot changed. States and area agencies on aging administered the act at the state and then local level were given more flexibility. States waived a lot of their rules because they got the clear direction from the feds that anything they could do to make the act easier to administer and to reach more older adults. When we were in those crisis years, there was obviously federal authority through emergency disaster declarations that also made it a lot easier, particularly for AAA’s to administer these programs.
Amy Gotwals (19:54):
And that was absolutely the right thing to do. It was incredibly important to being able to take the Philosophy Act, which is person-centered and meeting people where they are. But now, hey, people had needs in a very different way. They might have previously gone out in the community to receive regular meals through a congregate meal program at their local community center. And now that wasn’t safe to do, but they not only still may need their nutritional supports, but now they are at risk of isolation if their engagement at that community center and the programs that offers such as the meals program and other things was the main way that they were getting social engagement. And so the flexibility to not have to quite so much as usual worry about where a particular funding stream came from in the delivery of that service to get creative and change up services and how they were delivered was vital to the incredible work that the Aging Network did to not only serve those they already had on as clients to be able to actually reach out and serve hosts more people. <laugh>.
Amy Gotwals (20:59):
We don’t really have a number on this, but in many cases, thanks to additional funding from Congress, the network was able to essentially double some of their service roles in particular programs. And so getting back to reauthorization and looking ahead and we’re hearing loud and clear from our represenatives since those flexibilities were introduced, how much they appreciated that. And so I think that can we make the act even more flexible will be a key conversation. There’s checks and balances here that we’ll want to talk about, but I think that flexibility that was experienced under disaster declarations and other authorities that were loosened during Covid will be something that is definitely going to come up from the field. I also think that as more and more populations who may feel that they’ve been overlooked by society in one way or another or are underserved, will want to see, be seen and heard by the act.
Amy Gotwals (21:54):
So I think you’ll see attention well from Congress and from advocates on diverse elders and how the act responds to their needs, literally to tell what other issues are coming up. But we are starting our punch list on what we’d like to talk to Congress about. And we’re going to be working with our members to come up with our proposals for 2024. We’ll start working on what those look like in 2023, get a read of our members, make sure we’ve got what they would like to see updated or otherwise changed in the Older Americans Act. And then it’s really not just that we talked to Congress, we also negotiate, talk and advocate among other aging groups. If they put out proposals we really don’t love if we want to talk them into supporting our proposal. All that’s also going on later on this year and into 2024. So that, that as much as possible, those who support this act at any level are singing enough off the same song sheet. Even if we’re in harmony, that Congress, it makes it easy for Congress to do as much good many good things as possible, not do any harm first and get something passed on a bipartisan basis.
Jason Maciejewski (23:00):
When we go out and advocate, we typically find ourselves in a situation where we only have the time to talk about a couple of our priorities with a legislator at any given time. And so at US Aging, I know you have an extensive policy platform, but what is the top two things in that platform that US Aging really focuses on?
Amy Gotwals (23:20):
Oh, I’m going, two is too small. You’re right, we have an extensive policy platform and we’re actually going to make it smaller in our policy priorities for this year. Not that we still don’t care about all the issues that we typically weigh in on, but in producing our annual booklet of policy thoughts and recommendations for Congress and the administration this year our board, which helps guide this work suggested we might like to zero in zoom in on the issues that were tippy top. It’s very hard for AAA directors to prioritize these types of policy issues because their work is so broad sweeping and touching so many aspects of the aging experience that they’d love us to weigh in on just about everything. And so this time it’s not soup to nuts, it’s zeroing in on four top priorities, which wasn’t easy to do.
Amy Gotwals (24:12):
And it doesn’t mean we will only work on these issues, but our priorities this year are going to be funding, specifically we want to raise funding for all older Americans Act programs. But what you’re going to hear us talk about and talk about and talk about again, is that Title Three B of the Older Americans Act, which is the most flexible pot of money. It pays for everything from case management, helping people, the hotlines that AAA’s operate to be able to help people find and access resources as well as in-home health, transportation, legal services, whole bunch of other things. That’s our top appropriations priority in Title Three. And then we will also, given our constituency of Title Six, native American aging programs, be fighting really hard to get more funding to those programs as well. Second priority is caregivers. There’s a real opportunity coming up now with the release of the national strategy for family caregivers that was released last fall to help try to implement some of those recommendations that came out of multiple advisory councils that were initially put in motion by Congress.
Amy Gotwals (25:16):
So we’re at a really interesting point in the national conversation about playing caregivers and really excited to go on that. And as part of that, we certainly want funding for our very own older Americans Act caregiver program. Title Three E. Third one is Medicaid, Home and Community-Based Services, which she probably would’ve guessed from what I was talking about before. We want to put this front and center and understand that when we spend these Medicaid dollars, we want to talk about investing in home and community-based services and to be successful in delivering those services. We also want to talk about the direct care workforce that supports those programs and which is facing challenges of the zone. And our last priority is a little more high level and it is that intersection between healthcare and the social care, social care being what our members and others in social services do. And we are standing on that line doing some more of that translation between the healthcare world and the aging network world and also our friends and allies in the disability community to be able to make sure that as healthcare wisely has realized that social drivers of health impact your acute health and that there are times when social care is actually the right prescription.
Amy Gotwals (26:26):
It is so important that then the social care professionals such as AAA’s and others are getting paid for that work. So lots of opportunity here as we bridge health and social care, whatever those conversations look like in Congress this year, we plan on being in them, so supportive services for both all older adults as well as Native American older adults. Supplemental, everybody’s eligible for Title Three B, but also the Title Six caregivers, Medicaid, HCBS. And this intersection of health and social care is what we’ll probably be talking about the most and really look forward to others engaging in conversations with others and us all trying to do more education and more promotion of these critical issues with Congress, the administration. And also a lot of this also has to happen at the state and local level, particularly around Medicaid. So we look forward to that.
Jason Maciejewski (27:17):
You know, AAA’s are charged with advocating on behalf of older adults to the older Americans Act and the strength of our effort really comes from our stakeholders and our program participants and their caregivers to really react to those advocacy action alerts. They get put out and make those phone calls and those emails happen. But how can the average person that wants to be an effective advocate for older adults what can they do to have an impact?
Amy Gotwals (27:44):
You’ve alluded to something, a mechanism that AAA’s deploy that I think is one key, particularly if you were wanting to zero in on the types of aging services that our network provides versus saying, I want to champion higher benefits in social security, which is also critically important, but I might have a different answer. So if you want to be able to advocate for older adults locally or state or national, I think finding who else is already engaged on that issue is your first step. You want to be part of that larger message or group in order to show you have a standing on that issue. You take advantage then of, I’ve used this word before, translation issues so you don’t have to know everything about Congress. You’ve got a trusted ally, whether it is your triple or a statewide advocacy group or US Aging, helping you figure out when’s the right time to take a position to send an email, make a call, whatever the action is around the advocacy. That kind of working as a group, working as a coalition, it you not only have the strength in numbers, but it really helps you be a more effective advocate.
Jason Maciejewski (28:47):
Amy, I want to thank you for joining us today and talking about the State of Aging policy in Washington, DC
Amy Gotwals (28:52):
Thank you so much for having me, and thank you for all your tremendous work.
Jason Maciejewski (28:56):
If you have any questions about services or programs The Senior Alliance offers, you can call us at 1-800-815-1112 or email us at info@thesenioralliance.org. Information about our agency or the programs and services we offer found on our website at www.thesenioralliance.org. On Facebook, we can be located by searching for the Senior Alliance. And finally, our Twitter handle is @AAA1C. I’m Jason Maciejewski. Thank you for listening to this episode of Inside the Senior Alliance.
Inside the Senior Alliance is a production of The Senior Alliance and Blazing Kiss Media.