Rural Americans who face unique challenges would also experience unique struggles under a one-size-fits-all healthcare plan. For years, the farmers, ranchers, and everyone living in our nation's breadbasket have endured inequitable access to quality care and medical services compared to their urban and suburban counterparts. .By Representative Mike Kelly (PA-3) .In a January 2017 survey of The Senior Citizens League's members and supporters, 34 percent said they itemize deductions for out-of-pocket healthcare costs most years. One member of The Senior Citizens League – William P. from California – recently contacted us to share his concerns about the elimination of the medical expense deduction. William is home-bound due to several medical conditions, and he relies on home health aides to provide him with lifesaving care on a daily basis. At the age of 61, William is not yet eligible for Medicare and he expects the out-of-pocket cost of his care to total ,000 by the end of this year. The elimination of the medical expense deduction would be a major financial loss for him. .In 2016 there was no COLA at all, and in 2017 the COLA was just 0.3 percent. During that time a special provision of law known as "hold harmless" protected about 70 percent of Social Security recipients from reductions to their Social Security benefits due to increasing Medicare Part B premiums. .We recently moved my mom from another part of the state to live with us. She's starting to have memory problems and it's too risky for her to live on her own. Recently when we went for a visit to her new doctor, I discovered that her Medicare health plan isn't accepted in our area. Can she enroll in a new plan now that Open Enrollment is over? .You might better be able to help your brother by reminding him of doctor visits and seeing that he gets to appointments. You can also help by monitoring his care plan, and making sure he understands how and when to take prescriptions and any other forms of therapy. .The Notch is closely connected to problems that arose the last time Congress overhauled the Social Security benefit formula in 197A transitional benefit formula was provided to phase in the changes, and protect those closest to retirement from abrupt benefit reductions. The transitional formula was flawed however, and failed to provide the promised protection. .Other countries, such as Britain, take a more head-on approach: a national body does a cost-benefit analysis regarding the price at which a new drug is worth being made available to its citizens. Health authorities then use that information to negotiate with a drug maker on price and to develop a national reimbursement plan. .This week, one Member of Congress introduced legislation that could make the Social Security cost-of-living adjustment (COLA) a more accurate measure of inflation. In addition, The Senior Citizens League (TSCL) saw support grow for two key bills.