Medicare, though, says that the automatic refill programs lead to waste when beneficiaries get prescriptions they don’t need and can’t return them.

In February, the Centers for Medicare & Medicare Services (CMS) proposed new regulations that say, in part: “Shipment of unwanted medications is not only wasteful, but also a source of significant beneficiary aggravation and a financial imposition that can negatively affect enrollee satisfaction with the plan.”

See also: Choosing a Part D Drug Plan That Is Right for You

In a letter to CMS, the employer organizations argue that “appropriately structured automatic refill programs can be developed that balance the need for therapeutic adherence and convenience, and do not result in unnecessary waste.”

The new rule, if approved, will go into effect in January 2014 and applies to the Medicare Part D program for prescription drugs. Beneficiaries could still get mail-order drugs but the company would have to contact them before sending a refill. Customers who have their prescriptions filled at a pharmacy would not be affected.

CMS is already advising beneficiaries about the likely change in rules. “Prescription drug plans should get your approval to deliver a prescription, new or refill, before each delivery, except when you yourself ask for the refill or request a new prescription,” the agency says. “Be sure to tell your drug plan the best way to reach you so you don’t miss the refill confirmation call or other communication.”

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Mistakes, inefficiencies and fraud in the two health care programs come at a steep price to both consumers and taxpayers, points out Joyce A. Rogers, senior vice president of government affairs for AARP, which has endorsed the bill.

“The PRIME Act is a strong first step toward reducing waste, fraud, and abuse in our public health programs,” she says. (PRIME is an acronym for “Preventing and Reducing Improper Medicare and Medicaid Expenditures.”)

While estimates of improper payments vary, Ariel Gonzales, director of health and family advocacy at AARP, says they may account for as much as 10 percent of Medicare spending. With Medicare expenditures at $600 billion a year (and Medicaid at $300 billion a year), that’s a lot of money down the drain.

Related: Medicaid’s Costly Revolving Door

Among other things, the PRIME Act would:

• Make it harder for criminals to steal the identities of physicians.

• Stiffen penalties for stealing the identification numbers of beneficiaries.

• More aggressively enlist older Americans in the fight against fraud, partly by offering better rewards for tips that lead to recoveries.

• Require the Centers for Medicare and Medicaid Services to focus on preventing improper payments in the first place instead of trying to collect money after the fact (as credit-card and other financial services companies do).

• Penalize bill-paying companies that make errors and overpay Medicare and Medicaid service providers.

• Improve information sharing between the federal and state governments, which jointly operate Medicaid.

Rep. Peter Roskam (R-Ill.) said the bill “can help stop fraudsters in their tracks and make Medicare and Medicaid more financially stable for the long term.” He offered the bill with Rep. John Carney (D-Del.); Sens. Tom Carper of (D-Del.) and Tom Coburn (R-Okla.) are co-sponsors of identical legislation in the Senate.

The legislation has been proposed before and not passed, but this year it could become part of a larger health care bill and win approval, Gonzalez said.

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Only a small percentage of legislation makes it to the Senate and House floors, where insomniacs can stay glued to the proceedings on C-SPAN.

But these days, it’s a lot easier than it used to be to track bills of interest through the legislative process.

The granddaddy of legislative access is named, fittingly, after the guy who created the Library of Congress. The library’s THOMAS system (as in Thomas Jefferson) allows users to research by topic or bill number and find a mostly readable summary of the legislation along with every step in the how-a-bill-becomes-law process, including final votes.

But the Library of Congress is now beta-testing a new website, Congress.gov, that aims to serve up a much more comprehensive platter of legislative information (including profiles of congressional lawmakers) in a format that’s considerably more user-friendly than its old standby. It will eventually incorporate all the information that’s now on THOMAS.gov.

Meanwhile, House Majority Leader Eric Cantor (R-Va.) has unveiled a new website that allows the public to follow legislation in the House of Representatives and even sign on as a “citizen cosponsor” of bills and resolutions. “Whether you want to support new legislation like the Kids First Research Act or show support for legislation that has already passed the House, like the Working Families Flexibility Act, you can do so here,” Cantor said.

Moving off of Capitol Hill, there are lots of choices when it comes to figuring out what Congress is up to.

If Vegas is your style, for example, you can get a bill’s odds of passage from GovTrack. The site is run by “civic hacker” Joshua Tauberer, who started it as a hobby and has since written a book called Open Government Data. GovTrack points out that only about 4 percent of the 10,000 measures introduced in each session of Congress make it into law. The odds of passage, based on things like whether a bill’s sponsor chairs a powerful committee, are designed to help people focus on the bills most likely to succeed. With Govtrack you can choose a bill to follow and be emailed updates on its progress.

OpenCongress, funded by the Sunlight Foundation, has the bill information along with news coverage and public comments.

Want to dive even deeper? Here’s a WikiHow primer on how to track legislation and keep tabs on what Congress is doing.

So if you want to know whether the Older Americans Act is headed toward renewal, whether Social Security’s cost-of-living formula is likely to be changed or what resolution is being offered to honor the obscure organization of your choice, it’s all only a few keystrokes away. Thomas Jefferson would love it.

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This from a recent CNN/ORC survey that shows 43 percent of all Americans in favor of Obamacare — a figure that, for all the politicking on both sides, hasn’t really changed in a year. Opposition from the “too liberal” camp has softened a bit (down from 37 percent in March 2012), while opposition from the “not liberal enough” camp is significantly stronger (up from 10 percent in March 2012).

More than half (52 percent) of those in the youngest age bracket (18 to 34) favor the law, which may have something to do with the fact that many of them were among the its first beneficiaries: one provision requires insurance companies to offer coverage to young adults up to age 26 on their parents’ policies.

See also: Age Divide Narrows on Hot-Button Social Issues

On the other hand, less than a third (31 percent) of Americans 65 and older favor the law. A lot of their opposition may be rooted in the misperception that Obamacare “cut” Medicare. And, of course, there’s the fact that people in the 65+ age group have access to Medicare and don’t face many of the problems the law was designed to solve — like being turned away by insurers because of pre-existing health conditions or paying sky-high premiums because of age.

What about the rest of us? The CNN/ORC poll shows that, overall, adults between the ages of 35 and 49 and those between the ages of 50 and 64 have pretty much the same view of Obamacare, with 43 percent of the younger group and 40 percent of the older group saying that they favor the law. (The difference is well within the poll’s margin of error.)

Kevin Drum of Mother Jones magazine calls the CNN breakdown — which has 54 percent of respondents categorized as opposing the law — “wildly misleading”:

If you oppose Obamacare solely because you think it should be more generous, then you’re not part of the group that’s commonly thought of as the opposition: tea partiers, conservatives, Republicans, and so forth. These are the folks who want to repeal Obamacare completely and leave it a smoking husk, and they’re the ones most of us think of as the “opposition.”

What do you think? You can add your comments in the box below.

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Dingell (left) 1955

Rep. John D. Dingell Jr. (D-Mich.) now owns the record for holding a seat in Congress longer than anyone else – 57 years, 5 months and 26 days. As the Washington Post’s Paul Kane writes:

“That eclipses the late Robert C. Byrd (D-W. Va.), who served in both the House and Senate.

“Elected in 1955 — the year Rosa Parks refused to sit in the back of a bus, when a stamp cost three cents and the Brooklyn Dodgers won the World Series — Dingell has become synonymous with the House of Representatives in the way that Byrd became synonymous with the Senate after more than 50 years in the so-called upper chamber.”

To steal a joke from Stephen Colbert of Comedy Central, Dingell has been in Congress longer than Hawaii or Alaska.

Fifty-seven years of dashing up the Capitol’s marble stairs, late night vote-a-thons and early morning meet-and-greets on the campaign trail is a lot of energy. And in Dingell’s case a lot of Energy. Dingell, 86, chaired the Energy and Commerce Committee, building a reputation as powerful and sometimes cranky during nearly 30 years as the top Democrat there.

So maybe he wouldn’t mind a cranky response to his new record from Bloomberg’s Jeffrey Goldberg, who called him the Queen Elizabeth of Congress:

“Like the queen, Dingell essentially inherited his job from his father. John D. Dingell Sr. served in Congress from 1933 until his death in 1955.”

“Unlike the queen, who is the symbolic leader of a constitutional monarchy, Dingell has wielded real power for many decades. And unlike Queen Elizabeth – who this week is celebrating her 60th year on the throne – Dingell is a member of an elected legislature that requires new blood and fresh ideas to stay relevant and vital.”

The New York Times’ Ashley Parker asked Dingell about succeeding his father:

“He made his first appearance on the House floor at the age of 6, when his father was elected in 1933; he went on to become a Congressional page; and after his father died in 1955 he successfully ran for his seat at the age of 29. “

“ ‘I gave Dad about a week to get comfortable and then I went and ran,’ he said, sitting in his office in the Rayburn Building this week as he reflected on a career and role in major battles over health care, civil rights and energy policy to name but a few. ‘It turned out to be a great thing. I’ve loved the job.’ ”

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“Americans’ fundamental views on several issues that define the nation’s culture have changed in important ways since the start of the last decade,” Joy Wilke and Lydia Saad of Gallup write. “Gallup trends by age show that (in every case) increasing acceptance of several matters relating to sexual relations, as well as divorce and stem cell research, have moved closer to the views held by the youngest generation of Americans. In some cases, this has resulted in transformative change, with majority acceptance emerging in the past decade, and in others, it has resulted in expanded majority acceptance.”

Americans 55 and older still lag 23 percentage points behind adults 34 and younger in supporting gay relations. But the 56 percent approval among older Americans is now majority support and a remarkable 25 percent jump since 2001. The public shift has changed the political landscape. Lawmakers have followed suit with same-sex marriage laws in 11 states and the District of Columbia, and U.S. Supreme Court decisions about marriage equality are imminent.

Older Americans also changed their views in large numbers on whether human embryos should be allowed to be used for stem cell research, which looks for cures for diseases like Parkinson’s and Alzheimer’s. Gallup says the national increase in support for stem cell research is largely due to growing acceptance by people 55 and older, which has increased 20 percent in 11 years. The issue has been at the center of numerous battles in Congress over the years.

Only on three issues – stem cell research, divorce, and medical testing on animals – do a greater share of older Americans place themselves in the “morally acceptable” column than younger Americans.

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Older Americans, who generally relocate less often than younger adults, followed the trend. Less than 14 percent of people 65 and older moved — compared with more than 18 percent from 2000 until 2005. For the 45- to 64-year-old group, 23.5 percent moved — compared with 26.5 percent last time.

Though relocation has consistently dropped after hitting a high of 46.7 percent from 1985 to 1990, the lingering effects of the recession might be adding molasses to moving patterns, according to Carl Haub, senior demographer with Population Reference Bureau.

“Slow sales in the housing market have certainly kept some people in place. It may also be because people are having more difficulty finding a different or better-paying job, one of the main causes of moving. My guess is that those two things have played a significant role,” Haub says.

Join the discussion: Share Your Most Memorable Vacation Spots

Older Americans who did move provided some interesting anomalies:

• Among all movers, 21 percent of the 65- to 74-year-old group headed to a new state, the highest of any age group.
• The South had the biggest net gain of residents, and the biggest bloc, 253,000, was in the 45- to 65-year-old age group.
• While younger adults left the Midwest, people age 75 and up moved in, perhaps to be closer to family.

Photo: Farm Service Agency via Wikimedia

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1. The IRS targeting conservative political groups
2. The Obama administration response to the attack on the U.S. consulate in Benghazi, Libya
3. The Justice Department seizure of records from the Associated Press

Forty-four percent of voters choose the IRS scandal, a new Quinnipiac University poll finds.

Older voters agree. Of those 65 and older, 43 percent rate it tops, as do 41 percent in the 45-64 group. Benghazi is second, with 19 percent of the oldest age group and 29 percent of the 45-64 group saying it’s most important. The seizure of phone records comes in third.

Still, money matters rule. None of the scandals du jour measure up to the importance of dealing with the economy and unemployment, say voters by 73-22 percent. The older the voter, however, the higher investigating the scandals rank: Ages 45-64, 70-24 percent; ages 65 and older, 65-26.

So, who should investigate the IRS? In a nation polarized on so many issues, the call for a special prosecutor stands out in its unity – supported by overwhelming majorities of not just every age group, but both parties, all income levels, all races and both genders.

Some 76 percent of all voters polled favor a special prosecutor, including 78 percent of the 45-64 group and 70 percent of 65 and older.

Not surprisingly, the IRS isn’t making many friends. Two-thirds of voters think it’s doing a lousy job, and older voters are even more critical.

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“Even short gaps in coverage can lead to delay or avoidance of needed care,” says Leighton Ku, the director of the Center for Health Policy Research at George Washington University’s School of Public Health and Health Services. “This can result in significant increases in hospitalizations for chronic diseases like diabetes, asthma and mental disorders. These costly interruptions can arise from something as simple as a change of address.”

The study was sponsored by the Association of Community Affiliated Plans, which represents 58 nonprofit “safety net” health plans in 24 states. It’s lobbying for a guarantee that would allow Medicaid beneficiaries to stay in the program for 12 months or more. This, the oragnization says, would be a solution “to the phenomenon of ‘churn,’ where otherwise-eligible beneficiaries are disenrolled and reenrolled in the program owing to paperwork issues or small and often temporary changes in income.”

Related: Implications of Expanding Medicaid for Uninsured Low-Income Midlife Adults

As the Hill reports: “According to the study, a Medicaid beneficiary enrolled consistently for 12 months pays $333 in medical bills per month, on average. Patients enrolled for six months paid $469, and those enrolled for one month paid $625. “

Past research by Ku has described Medicaid as a “leaky sieve” that leaves seniors and other low-income beneficiaries without coverage because of bureaucratic snafus and often temporary changes in income, leading to expensive hospitalizations and other health consequences.

Want to know how much Medicaid “churn” there is your state? Look here.

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Factoring in health care costs changes poverty statistics

While 9 percent or so of all Americans 65 and older were below the official poverty threshold in 2011 ($10,788 for an individual), 15 percent were below an alternative threshold that takes into account spending on health care.

The alternative measure also takes into account variations in the cost of living, taxes, whether a person receives food stamps, and whether a person is a homeowner, for example.

Now comes a report from the Kaiser Family Foundation that takes a state-by-state look at the alternative threshold (formally known as the “supplemental poverty measure”).

It finds that the share of older Americans living in poverty is higher in every state under the alternative measure, and at least twice as high in 12 states: California, Colorado, Connecticut, Hawaii, Massachusetts, Maryland, Minnesota, New Hampshire, New Jersey, Nevada, Wisconsin and Wyoming. In five states (California, Hawaii, Louisiana, Nevada, Georgia and New York) and the District of Columbia, roughly one of every five residents 65 and older are living in poverty, the report says.

Politico notes that there’s a political context to the Kaiser report: “The Kaiser brief says it’s meant to provide context for the many spending proposals being tossed around — particularly those that focus on shifting costs in Medicare and paring down Social Security benefits. It also notes that adopting ‘chained CPI,’ which slows the growth of Social Security benefits, would most likely make for higher poverty rates for older seniors across both census measures.”

Max Richtman, the president of the National Committee to Preserve Social Security and Medicare, said it’s proof that the safety net needs strengthening. “The Kaiser study validates that — for a larger share of seniors — the death of a spouse or serious illness is all it takes to push many older Americans into the indignity of a poverty-ridden old age,” he says. “That’s why we continue to tell lawmakers that it is wrong to cut benefits for the oldest and most vulnerable Americans who would be least able to afford it.  In fact, the decline of employer-sponsored retirement, and the recession’s erosion of retirement savings, mean that the percentage of Americans who depend on Social Security for most of their income will only continue to grow.”

Photo by thinkpanama, via Flickr

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