Congressional Impasse Results in Shut-Down .Although it's illegal for immigrants to work in this country without a valid Social Security number, millions of illegal workers readily obtain forged or invalid Social Security numbers and show them to employers to get jobs. Employers use the invalid Social Security numbers for reporting earnings to the Social Security Administration. .However, it is possible that some doctors and hospitals may opt not to accept Medicare due to lower cost reimbursements or providers may also try to pass extra costs to consumers. .The House recently passed legislation the FAIR Act (H.R. 1423, S.610) that would prohibit mandatory arbitration agreements in employment, consumer, and other contracts. Legal advocates who work on behalf of older adults estimate that as many as 90% of large nursing homes in the U.S. use arbitration agreements in their admission contracts. The federal government has been considering plans to expand the use of mandatory arbitration clauses to be included in contracts for every long - term care facility that accepts federal money as a condition of admission. Nursing homes receive funding from both Medicaid and Medicare for all residents. .This week, one new cosponsor – Rep. Elijah Cummings (MD-7) – signed on to the Consumer Price Index for Elderly Consumers (CPI-E) Act (H.R. 1030), bringing the bill's total up to twenty-five. If signed into law, the CPI-E Act would base the Social Security cost-of-living adjustment (COLA) upon the spending patterns of seniors. Currently, it is based upon the way that young, urban workers spend their money – a method that underestimates the spending inflation that seniors experience. A study conducted by TSCL this year found that seniors have lost 31 percent of their purchasing power since 2000 – a clear sign that the current COLA is growing too slowly. .A number of vaccines, including those for flu and pneumonia, might be capable of improving immunity overall, according to one researcher. Scientists are looking at several other potential candidates, including vaccines against herpes viruses and tuberculosis. .What does this new "pay for performance" mean for patients? Not much is known yet, but I got a first - hand experience of the new system recently. One of my doctors, a specialist, told me that due to a "quality initiative reorganization," he wouldn't be seeing me as a patient anymore. I'll have to find a new doctor. .The Finance Committee members spent much of Tuesday's hearing debating the primary motivators of rising healthcare costs, especially growing premiums in the individual market. Many on the committee seemed convinced that the ACA is to blame, while others said the Trump Administration is responsible. .Your total earnings, including your earnings now until you stop working.