Chokyi Kalzang, 67, wanted to go back to school.

Ms. Kalzang had an acceptance letter in hand, a grant to pay for her tuition and all the motivation in the world to complete her credits. But she was missing one thing necessary for a modern college education: a computer.

One day, at her local senior center in Boulder, Colo., Ms. Kalzang saw a flier asking older people for essays about their one greatest wish. Figuring she had nothing to lose, Ms. Kalzang wrote about her dream of finishing the college degree she began 50 years ago and about how something as simple as a computer and printer stood in the way of her goal.

That essay went to Jeremy Bloom’s Wish of a Lifetime, a charity named for Mr. Bloom, an Olympic skier and former professional football player, that grants wishes to low-income older people. The organization used donations totaling $1,000 to provide Ms. Kalzang with a new laptop and printer. After some computer lessons from her grandson, Ms. Kalzang enrolled at Metropolitan State College last fall.

While there are large organizations that grant wishes to chronically ill children and to the poor, Wish of a Lifetime is among just a handful of small charities that focus on underprivileged older people. Their wishes range from the fanciful (a trip skydiving, for instance) to the basic (a visit with a new granddaughter in another state) to the essential (the installation of an accessible shower).

Simply put, these organizations tell older people that it’s O.K. to keep dreaming and working toward larger goals.

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Seniors aren’t breaking out the champagne for President Barack Obama’s health care law, and for good reason.

While Democrats hail the overhaul as their greatest health care achievement since Medicare, seniors fear it’s a raid on that same giant health care program-a bedrock of retirement security-in order to pay for covering younger, uninsured workers and their families.

There’s no doubt that broad cuts in projected Medicare payments to insurance plans, hospitals, nursing homes and other service providers will sting. What hasn’t sunk in yet is that the new law also improves the lot of many Medicare beneficiaries. Obama is hoping that most will eventually conclude the plusses outweigh the minuses.

Keenly aware that this is a congressional election year, Democrats structured the law so virtually all the cuts start next year and take effect only gradually. For this year, the law provides a sweetener. More than 3 million seniors who have been falling into a Medicare prescription coverage gap will get a $250 rebate, a down payment on closing the “doughnut hole.”

Nonetheless, seniors are anxious.

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U.S. Rep. Paul E. Kanjorski delivered a message about the health care reform bill Tuesday, one senior citizen to a roomful of them.

His message: Despite attempts to scare seniors into thinking the bill threatens Medicare, it does not.

“Medicare will not in any way be injured,” said Mr. Kanjorski, who will turn 73 this week. “Take it to the bank.”

Nine days after voting for the reform bill, Mr. Kanjorski, D-11, Nanticoke, tried to reassure a skeptical audience of about 30 seniors at the South Side Senior Center.

“I was worried more or less about Medicare, that something would happen to that, that we would lose Medicare,” Irene Prazych, 84, of Scranton, said. “I’m hoping that what he says will come to fruition, that they don’t cut back or take away from us on Medicare.”

At times, the meeting grew testy, especially when Joe Gasdik, 74, an Old Forge Republican, questioned why the state no longer ran hospitals where the poor could get medical care.

“Why couldn’t you people just fix what we had?” Mr. Gasdik asked.

“Who paid for that?” Mr. Kanjorski asked, referring to the taxpayer-paid state hospitals.

“This Obamacare is no good,” Mr. Gasdik shot back.

Republicans have criticized the $940 billion legislation for diverting $132 billion over 10 years from private Medicare Advantage plans to help pay for it. The private plans often offer extra benefits that seniors in traditional Medicare do not receive. Critics of Medicare Advantage say it amounts to a subsidy for private health insurers. More than a fifth of Medicare’s 45 million beneficiaries are in the plans, and the fear is private insurers will drop the plans or cut extra benefits without subsidies.

“Nothing in this bill takes anything away from anyone who is on Medicare,” Mr. Kanjorski said. “There just isn’t any change to Medicare. … What we are doing is not allowing the insurance companies to get money for Medicare Advantage that was being paid to them.”

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Norma Clark, 80, slipped on the ice out by the horse corral one afternoon and broke her hip in four places. Alone, it took her three hours to drag herself the 40 yards back to the house through snow and mud, after she had tied her legs together with rope to stabilize the injury.

A dutiful farm wife, Ms. Clark somehow even got to her feet to latch the gate. And her first call when she got to the house was not to 911, but to a daughter 30 miles away.

“I told her she’d better come feed the horses,” said Ms. Clark, telling the story from her living room overlooking her 900-acre wheat farm.

Growing old has never been easy. But in isolated, rural spots like this, it is harder still, especially as the battering ram of recession and budget cuts to programs for the elderly sweep through many local and state governments.

Ms. Clark has been able to get help since her fall two winters ago because Wyoming, thanks to its energy boom, continues to finance programs for the elderly. But at least 24 states have cut back on such programs, according to a recent report by the Center on Budget and Policy Priorities, a Washington research group, and hundreds of millions of dollars in further cuts are on the table next year.

The difficulties are especially pronounced in rural America because, census data shows, the country’s most rapidly aging places are not the ones that people flock to in retirement, but rather the withering, remote places many of them flee. Young people, for decades now, have been an export commodity in towns like Lingle, shipped out for education and jobs, most never to return. The elderly who remain — increasingly isolated and stranded — face an existence that is distinctively harder by virtue, or curse, of geography than life in cities and suburbs. Public transportation is almost unheard of. Medical care is accessible in some places, absent in others, and cellphone service can be unreliable.

Read more at the NYT.

The federal government pays private insurers to administer advantage plans, but it’s paying them 14 percent more, on average, than it does for Medicare. Those subsidies could be cut in congressional health care reform legislation to help fund a historic expansion of health insurance coverage.

But bringing advantage spending back in line with traditional Medicare could mean increases in premiums or a decrease in services — and given the popularity of the programs, that’s perilous political territory.

…

Medicare Advantage began in the 1970s, when seniors gained the option to enroll in a private health maintenance organization plan rather than the traditional Medicare fee-for-service model. HMO plans offer more in terms of health management, but only within a preselected “network” of physicians, while fee-for-service plans provide comprehensive acute care.

The federal government funded the private plans at 95 percent, on average, of what it was paying for Medicare.

The system allowed people who enjoyed their current health insurance company to stick with it in retirement. Medicare Advantage tends to be used by middle-class seniors, as those with the highest incomes often have health benefits included in their pensions and low-income seniors are covered by Medicaid. Premiums are comparable among Medicare and Medicare Advantage plans.

Medicare Advantage hit a turning point in 1997 when Congress passed the Balanced Budget Act, which increased the private-plan options. Over the next several years, Congress increased payments and expanded the range of advantage plans — which now include fee-for-service plans and hybrid plans called Preferred Provider Organizations.

…

The result has been an explosion of seniors using advantage plans. According to Kaiser, the number of Medicare beneficiaries in private plans nearly doubled from 2003 to 2009. As of March, 10.2 million people — 22 percent of all Medicare recipients — were enrolled in advantage plans.

As enrollment has grown, so have government reimbursements for the private plans. Instead of saving money for Medicare, advantage plans now are more expensive for the government.

“The broader policy question is whether or not Medicare can afford to sustain a program that loses money, erodes the hospital insurance trust fund and increases premiums for all beneficiaries in the current fiscal environment,” Ms. Neuman said.

Find out more at the Post-Gazette.

Even as House Democrats yesterday revealed their version of a major overhaul to the nation’s health-care system, activists on both sides of the debate were marshaling a potent force to push their viewpoints.

The force? Senior citizens.

Polls have indicated that concerns about the overhaul are strongest among senior citizens, an influential bloc because people 65 and older are the most reliable voters. Their power is magnified in midterm elections because turnout is usually much lower than in presidential years.

That is why America’s Health Insurance Plans, a trade group, is spending millions to run these advertisements in 10 states, including Pennsylvania, which has one of the largest populations of senior citizens in the nation.

And it is why a tiny band of elderly activists, marshaled by two statewide organizations promoting President Obama’s plan, rallied briefly outside the headquarters of Cigna Corp. in Philadelphia yesterday.

“I get so angry I see red,” said one of them, Clara Jellinek, 83, of Center City. She said the advertisements were confusing and intended to scare senior citizens. “They are very effective.”

She said senior citizens would be helped when more people were covered and when their choices included a government option, which insurers such as Cigna oppose.

Read more at the Inquirer.

By RICARDO ALONSO-ZALDIVAR (AP) – 16 hours ago

WASHINGTON — House health care legislation expected within days is likely to include a new long-term care insurance program to help seniors and disabled people stay out of nursing homes, senior Democrats say.

The voluntary program would begin to close a gap in the social safety net overlooked in the broader health care debate, but it must overcome objections from insurance companies that sell long-term care coverage and from fiscal conservatives.

“I’m pretty confident that it will be in there,” Rep. Frank Pallone, D-N.J., a leading sponsor, said of the provision.

More than 10 million people currently need long-term care services, a number that’s only expected to grow as the baby boom generation ages. But most families whose elders can no longer care for themselves have to scrape to find a solution.

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