Biden administration to target drugs for price negotiations to lower Medicare costs
President Joe Biden’s administration will announce on Tuesday the first prescription drugs being targeted by the U.S. government for price negotiations as part of an effort to lower Medicare costs. The announcement is a significant step under the Inflation Reduction Act, which was signed by Biden last year. The law requires the federal government for the first time to start negotiating directly with companies about the prices they charge for some of Medicare’s most expensive drugs. The process has drawn legal challenges from drugmakers and heavy criticism from Republicans in Congress. It’s also a centerpiece of Biden’s reelection pitch as he seeks a second term in office by touting his work to lower costs for Americans at a time when the country has struggled with inflation. Biden plans to deliver a speech on health care costs from the White House after the announcement. He’ll be joined by Vice President Kamala Harris. More than 52 million people who are either 65 or older or have certain severe disabilities or illnesses get prescription drug coverage through Medicare’s Part D program, according to the Centers for Medicare and Medicaid Services, or CMS. About 9% of Medicare beneficiaries age 65 and older said in 2021 that they did not fill a prescription or skipped a drug dose due to cost, according to research by the Commonwealth Fund, which studies healthcare issues. CMS aims to negotiate the lowest maximum fair price for drugs on the list released Tuesday. That could help some patients who have coverage but still face big bills like high deductible payments when they get a prescription. Currently, pharmacy benefit managers that run Medicare prescription plans negotiate rebates off a drug’s price. Those rebates sometimes help reduce premiums customers pay for coverage. But they may not change what a patient spends at the pharmacy counter. The new drug price negotiations aim “to basically make drugs more affordable while also still allowing for profits to be made,” said Gretchen Jacobson, who researches Medicare issues at Commonwealth. Drug companies that refuse to be a part of the new negotiation process will be heavily taxed. The pharmaceutical industry has been gearing up for months to fight these rules. Already, the plan faces several lawsuits, including complaints filed by drugmakers Merck and Bristol-Myers Squibb and a key lobbying group, the Pharmaceutical Research and Manufacturers of America, or PhRMA. PhRMA said in a federal court complaint filed earlier this year that the act forces drugmakers to agree to a “government-dictated price” under the threat of a heavy tax and gives too much price-setting authority to the U.S. Department of Health and Human Services. PhRMA representatives also have said pharmacy benefit managers can still restrict access to drugs with negotiated prices by moving the drugs to a tier of their formulary — a list of covered drugs — that would require higher out-of-pocket payments. Pharmacy benefit managers also could require patients to try other drugs first or seek approval before a prescription can be covered. Republican lawmakers also have blasted the Biden administration for its plan, saying companies might pull back on introducing new drugs that could be subjected to future haggling. They’ve also questioned whether the government knows enough to suggest prices for drugs. CMS will start its negotiations on drugs for which it spends the most money. The drugs also must be ones that don’t have generic competitors and are approved by the Food and Drug Administration. CMS plans to meet this fall with drugmakers that have a drug on its list, and government officials say they also plan to hold patient-focused listening sessions. By February 2024, the government will make its first offer on a maximum fair price and then give drugmakers time to respond. Any negotiated prices won’t take hold until 2026. More drugs could be added to the program in the coming years. Republished with the permission of The Associated Press.
Katie Britt joins letter supporting Medicare Advantage programs
On Tuesday, U.S. Senator Katie Britt joined a bipartisan group of 60 Senators in a letter urging the Biden administration to continue support for the Medicare Advantage (MA) program. Millions of seniors and individuals with disabilities use the corporate MA plans across the U.S. to get their Medicare benefits. Sen. Tommy Tuberville also signed the letter. “The number of Americans who choose Medicare Advantage continues to grow each year, with enrollment doubling over the last decade, resulting in Medicare Advantage serving nearly 50 percent of individuals eligible for Medicare,” the Senators wrote. “…In 2023, average Medicare Advantage premiums will fall to a 16-year low of $18 per month and beneficiaries will have access to vital financial protections, including out-of-pocket spending limits and often prescription drug coverage for no additional premium.” The Senators also urged “CMS to look at meaningful ways to continue to sustain and strengthen Medicare Advantage that protects beneficiaries’ affordability and access and builds on the unique attributes of Medicare Advantage.” “We are committed to our nearly 30 million constituents across the United States who rely on Medicare Advantage, and to maintaining access to the affordable, high-quality care they currently receive,” Britt and the other Senators wrote. “We ask that the Administration provide a stable rate and policy environment for Medicare Advantage that will strengthen and ensure the long-term sustainability of the program—protecting access to its important benefits on which our constituents have come to rely,” they concluded.” “It is crucial that we meet our obligations to the hardworking families and retirees who have paid into Social Security and Medicare their entire careers,” Sen. Britt said in a statement. “Over half of all Alabamians who are eligible for Medicare choose Medicare Advantage. I will continue to fight to ensure all Alabamians can live their American Dream and thrive in safe, strong communities.” Originally Medicare was a government program that provides seniors with healthcare benefits. The program includes Medicare Part A, which pays most of a senior’s hospital benefits with copays and deductibles paid by the senior. Seniors have to enroll in Medicare Part B, which provides almost everything else except for prescription drugs. Seniors pay premiums for their Part B benefits. Most pay $164.90 a month (in 2023), though for poor seniors, Medicaid picks up all or part of their Medicare premiums, and wealthy seniors pay more for their coverage– up to $395.60 per month. Seniors are also responsible for picking up roughly a third of the cost of their healthcare costs. A number of insurance companies offer Medigap coverage (often referred to as Medicare supplements) that pays all or part of the Part A and B copays and deductibles. Medicare Advantage (MA) is a Medicare plan offered by a private company that is contracted through Medicare to provide seniors with Part A and Part B benefits. These plans, often referred to as Medicare Part C plans, are usually HMOs or PPOs but can also be a Private Fee-for-Service Plan, Special Needs Plan, or Medicare Medical Savings Account Plan. Medicare Advantage is much more like the HMOs and PPOs that most people under age 65 use for their healthcare coverage. Each corporate MA plan has different copays and deductibles, and monthly premiums. MA plans became an alternative to original Medicare due to legislation in 1997 during the Clinton Administration. Medicare added a prescription drug benefit plan through Medicare’s corporate partners – often called Medicare Part D during the Bush Administration. Part D plans are means-tested and are often bundled within MA plans. Katie Britt is serving in her first term in office following her landslide election to the Senate in 2022. To connect with the author of this story or to comment, email brandonmreporter@gmail.com.
Medicare opens up access to free at-home COVID-19 tests
The Biden administration, seeking to fill a frustrating gap in coverage for COVID-19 tests, Thursday announced that people with Medicare will be able to get free over-the-counter tests much more easily in the coming weeks. The Centers for Medicare & Medicaid Services said Medicare will cover up to eight free tests per month, starting in early spring. The tests will be handed out at participating pharmacies and other locations. They’ll be available to people who have Medicare’s “Part B” outpatient benefit, which about 9 in 10 enrollees sign up for. Last month, the administration directed private insurers to cover up to eight at-home tests a month free of charge to people on their plans. Officials said at the time they were still trying to figure out what to do about Medicare, which covers more than 60 million people, most of them age 65 or older and more vulnerable to severe illness from coronavirus infection. Medicare benefits are governed by a host of arcane laws and regulations, and officials said Thursday they were able to arrange for coverage of over-the-counter COVID-19 tests by using the program’s legal authority to conduct demonstration programs on innovative ways to deliver health care. This is the first time Medicare has covered an over-the-counter test at no cost to recipients. People with Medicare Advantage, a private insurance option that covers about 4 in 10 Medicare enrollees, will also have access to free COVID-19 tests through their plans, officials said. Medicare Advantage plans can already cover over-the-counter COVID-19 tests as a supplemental benefit. AARP praised Medicare’s decision and said it will closely follow the rollout. “The cost of paying for tests and the time needed to find free testing options are barriers that could discourage Medicare beneficiaries from getting tested, leading to greater social isolation and continued spread of the virus,” Nancy LeaMond, a vice-president of the advocacy group for older people, said in a statement. The new policy focuses on so-called rapid tests, which provide at-home results in about 15 minutes. Many families use the tests before getting together for special occasions or when grandparents travel from out of state to see grandkids they haven’t been able to play with for months due to COVID-19 isolation. Some testmakers pitch older adults directly in their marketing. Medicare also will continue to cover the more precise lab-based PCR tests at no cost, but those must be ordered by a clinician or an authorized health care professional. Before Thursday’s announcement, Medicare enrollees did have options for getting free at-home tests, and those will remain available while the new policy is going into effect. Those options include requesting four free tests for home delivery through covidtests.gov or picking free tests up from community locations such as libraries or senior centers that distribute them. At-home tests were in vexingly short supply at pharmacies as the omicron wave gained momentum in December, and some consumers find that’s still the case. However, an all-out drive by the White House to provide 500 million free tests and greatly expand production capacity is starting to show results, although they can vary by community and by pharmacy location. Republished with the permission of the Associated Press.
Joe Biden touts savings on insulin and other drugs for Americans
President Joe Biden pledged Monday that his social agenda legislation would deliver tangible savings on prescription drugs for all Americans. Relief that consumers have clamored for is now in sight, he asserted. But first, the bill has to pass Congress, where plenty of obstacles remain in its path. Biden tried to shift the focus to pocketbook provisions overlooked in the political machinations over his $2 trillion legislation, which deals with issues from climate to family life and taxes. Even before concerns over rising inflation, polls consistently showed support from Americans across the political spectrum for government action to lower drug costs. “It’s safe to say that all of us can agree that prescription drugs are outrageously expensive in this country,” Biden said at the White House. “I’m committed to using every tool I have to lower prescription drug costs for Americans consistent with the drug companies getting a fair return on their investment,” he added. But even if Biden and his fellow Democrats succeed in their final push to pass the legislation, a major political difficulty awaits them: Dividends from their prescription drug provisions won’t show up right away, while the pain of rising costs is real and present. Democrats will have to point to promised, not actual, savings in next year’s midterm elections. The biggest policy change — a system for Medicare to negotiate prices for prescription drugs — won’t begin to deliver lower costs until 2025, and then only for a selected set of 10 medicines, as well as insulin products. The number of drugs subject to negotiations would build with time, reaching 100 in six years and continuing to grow by 20 a year. Other provisions would take effect earlier. — Copays for insulin would be limited to $35 a month, starting in 2023. Biden called the high cost of insulin “one of the most egregious examples” of overpriced medicines. He was introduced at the White House by a young woman, Iesha Meza, who couldn’t afford insulin for her Type 1 diabetes and was hospitalized in a coma. — Drugmakers would be required to pay rebates to Medicare if they raise prices faster than inflation, starting that same year. The provision would benefit people with private insurance as well. — Medicare recipients with high drug costs would finally get a cap on their annual financial exposure, $2,000 starting in 2024. — Shingles vaccines and other shots covered under Medicare’s “Part D” pharmacy benefit would be cost-free to consumers, starting in 2024. The social legislation has passed the House and is pending before the Senate, where the goal remains to pass it before Christmas. The powerful pharmaceutical industry is maneuvering to strip out as much as possible of the prescription drug provisions, even block the entire bill. They argue that limits on their ability to set prices would stifle investment that fuels innovation. In a statement following Biden’s speech, Stephen J. Ubl, head of the industry lobby Pharmaceutical Research and Manufacturers of America, said “a damaging bill jammed through a partisan process will not provide patients struggling to afford their medicines meaningful relief.” But a recent overview of the legislation from the nonpartisan Kaiser Family Foundation found that Medicare negotiations would “put downward pressure” on premiums and out-of-pocket costs for seniors, and other provisions of the legislation would also reduce out-of-pocket costs for those who are privately insured. A Kaiser Foundation poll from October found that more than 8 in 10 Americans favor allowing Medicare to negotiate prices, including 95% of Democrats, 82% of independents, and 71% of Republicans. Most in the poll agreed with a statement that “even if U.S. prices were lower, drug companies would still make enough money to invest in the research needed to develop new drugs.” Biden said the industry has lost the pricing debate with the American people. “Diabetes, Alzheimer’s, cancer — so many other diseases. They don’t care whether you are a Democrat or Republican,” said Biden. “We need Congress to finish the job,” he emphasized. Core provisions of the Biden bill draw from earlier legislation that was supported by then-President Donald Trump but failed to advance. Those include the cap on out-of-pocket costs for seniors and penalties on drug companies that raise prices faster than inflation. The $35 monthly copays were also introduced under Trump through regulation, and are now available in a limited though a growing number of Medicare prescription plans. Biden would greatly expand access and benefits. Meanwhile, Medicare recipients are about to get an unwelcome illustration of the impact of high drug costs. About half of next year’s $21.60 increase to Medicare’s “Part B” monthly outpatient premium is due to the program’s need to financially prepare for a pending coverage decision on a $56,000-a-year Alzheimer’s drug called Aduhelm. Notices have already gone out to millions of seniors telling them their cost in January will jump to $170.10. Republished with the permission of the Associated Press.
Sweeping new vaccine mandates for 100 million Americans
In his most forceful pandemic actions and words, President Joe Biden on Thursday announced sweeping new federal vaccine requirements affecting as many as 100 million Americans in an all-out effort to increase COVID-19 vaccinations and curb the surging delta variant. Speaking at the White House, Biden sharply criticized the roughly 80 million Americans who are not yet vaccinated, despite months of availability and incentives. “We’ve been patient. But our patience is wearing thin, and your refusal has cost all of us,” he said, all but biting off his words. The unvaccinated minority “can cause a lot of damage, and they are.” The expansive rules mandate that all employers with more than 100 workers require them to be vaccinated or test for the virus weekly, affecting about 80 million Americans. And the roughly 17 million workers at health facilities that receive federal Medicare or Medicaid also will have to be fully vaccinated. Biden is also signing an executive order to require vaccination for employees of the executive branch and contractors who do business with the federal government — with no option to test out. That covers several million more workers. Biden announced the new requirements in a Thursday afternoon address from the White House as part of a new “action plan” to address the latest rise in coronavirus cases and the stagnating pace of COVID-19 shots that has raised doubts among the public over his handling of the pandemic. Just two months ago, Biden prematurely declared the nation’s “independence” from the virus. Now, despite more than 208 million Americans having at least one dose of the vaccines, the U.S. is seeing about 300% more new COVID-19 infections a day, about two-and-a-half times more hospitalizations, and nearly twice the number of deaths compared to the same time last year. “We are in the tough stretch, and it could last for a while,” Biden said of the current state of the pandemic. After months of using promotions to drive the vaccination rate, Biden is taking a much firmer hand, as his aides blamed people who have not yet received shots for the sharp rise in cases that is killing more than 1,000 people per day and imperiling a fragile economic rebound. In addition to the vaccination requirements, Biden moved to double federal fines for airline passengers who refuse to wear masks on flights or to maintain face-covering requirements on federal property in accordance with Centers for Disease Control and Prevention guidelines. Biden announced that the federal government will work to increase the supply of virus tests and that the White House has secured concessions from retailers including Walmart, Amazon, and Kroger to sell at-home testing kits at cost beginning this week. The administration was also sending additional federal support to assist schools in safely operating, including additional funding for testing. And Biden will call for large entertainment venues and arenas to require vaccinations or proof of a negative test for entry. The requirement for large companies to mandate vaccinations or weekly testing for employees will be enacted through a forthcoming rule from the Occupational Safety and Health Administration that carries penalties of $14,000 per violation, an administration official said. The White House did not immediately say when it would take effect but said workers would have sufficient time to get vaccinated. The rule would also require that large companies provide paid time off for vaccination. Meanwhile, the Centers for Medicare & Medicaid Services will extend a vaccination requirement issued earlier this summer — for nursing home staff — to other healthcare settings, including hospitals, home health agencies, and dialysis centers. Separately, the Department of Health and Human Services will require vaccinations in Head Start Programs, as well as schools run by the Department of Defense and Bureau of Indian Education, affecting about 300,000 employees. Biden’s order for executive branch workers and contractors includes exceptions for workers seeking religious or medical exemptions from vaccination, according to Jen Psaki. Federal workers and contractors will have 75 days to get fully vaccinated. Workers who don’t comply will be referred to their agencies’ human resources departments for counseling and discipline, including potential termination. “We would like to be a model” to other organizations and businesses around the country, Psaki said of the federal workforce. An AP-NORC poll conducted in August found 55% of Americans in favor of requiring government workers to be fully vaccinated, compared with 21% opposed. Similar majorities also backed vaccine mandates for health care workers, teachers working at K-12 schools, and workers who interact with the public, as at restaurants and stores. Biden has encouraged COVID-19 vaccine requirements in settings like schools, workplaces, and university campuses, and the White House hopes the strengthened federal mandate will inspire more businesses to follow suit. On Thursday, the Los Angeles Board of Education was expected to vote on requiring all students 12 and older to be fully vaccinated in the nation’s second-largest school district. Walmart, the nation’s largest private employer, said in late July it was requiring that all workers at its headquarters in Bentonville, Arkansas, as well as its managers who travel within the U.S., be vaccinated against COVID-19 by Oct. 4. But the company stopped short of requiring shots for its frontline workers. CVS Health said in late August it would require certain employees who interact with patients to be fully vaccinated by the end of October. That includes nurses, care managers, and pharmacists. In the government, several federal agencies have previously announced vaccine requirements for much of their staff, particularly those in healthcare roles like the Department of Veterans Affairs, and the Pentagon moved last month to require all service members to get vaccinated. Combined, the White House estimates those requirements cover 2.5 million Americans. Thursday’s order is expected to impact nearly 2 million more federal workers and potentially millions of contractors. Biden’s measures should help, but what’s really needed is a change in mindset for many people, said Dr. Joshua Sharfstein, vice dean at the Johns Hopkins Bloomberg School of Public Health
COVID recession pushed Social Security insolvency up a year
The sharp shock of the coronavirus recession pushed Social Security a year closer to insolvency but left Medicare’s exhaustion date unchanged, the government reported Tuesday in a counterintuitive assessment that deepens the uncertainty around the nation’s bedrock retirement programs. The new projections in the annual Social Security and Medicare trustees reports indicate that Social Security’s massive trust fund will be unable to pay full benefits in 2034 instead of last year’s estimated exhaustion date of 2035. For the first time in 39 years, the cost of delivering benefits will exceed the program’s total income from payroll tax collections and interest during this year. From here on, Social Security will be tapping its savings to pay full benefits. The depletion date for Medicare’s trust fund for inpatient care remained unchanged from last year, estimated in 2026. In the 1980s, financial warnings about Social Security prompted then-President Ronald Reagan and lawmakers of both parties in Congress to collaborate on a long-term solvency plan, but such action is unlikely in today’s bitter political climate. Democrats who control the White House and Congress offered assurances they would protect both programs. “The Biden-Harris administration is committed to safeguarding these programs and ensuring they continue to deliver economic security and health care to older Americans,” Treasury Secretary Janet Yellen said in a statement. The latest estimates reflected the push and pull of many factors flowing from the pandemic, and the full impact may take years to sort out. The deep but relatively short recession slashed revenue from payroll taxes. But the death toll from COVID-19, concentrated among older people, reduced future Social Security benefit payouts. Hospitals were stressed by the influx of COVID patients, but Medicare didn’t have to pay for as many knee surgeries, colonoscopies, and other more routine procedures. Birth rates and immigration, which tend to bolster the two programs, both fell. For Social Security, the loss of payroll tax revenue outweighed any savings from what the program would have paid out to people whose lives were lost in the pandemic. The report noted that employment, earnings, interest rates, and economic growth plummeted in the second quarter of 2020 after the pandemic hit the United States. “The finances of both programs have been significantly affected by the pandemic and the recession of 2020,” the trustees said. But “given the unprecedented level of uncertainty,” there was no consensus on what the long-lasting effects of the pandemic would be. A looming question for Medicare: Will the population of beneficiaries who survived the pandemic be healthier on the whole, or will a high number suffer from new conditions like long COVID? Social Security pays benefits to more than 65 million Americans, mainly retirees but also disabled people and survivors of deceased workers. Medicare covers more than 60 million older and disabled people. Together, both programs account for more than 40% of the federal budget and act as stabilizers not only for families but for the national economy. While long-term projections are sobering, in the short run, there was some good news for Social Security recipients. Government economic experts who prepared the Social Security report estimated recent increases in inflation mean the cost-of-living adjustment for 2022 will approach 6%, a whopping jump from the 1.3% COLA awarded for this year. Some of that may go for higher Medicare costs. The Medicare “Part B” premium for outpatient coverage was projected to rise by $10 a month in 2022, to $158.50 under the report’s intermediate assumptions. The official number won’t be released until later this year. Social Security and Medicare remain under intense financial pressure with the retirement of millions of baby boomers, who are living longer than previous generations. When the Social Security trust fund is depleted, the government will be able to pay 78% of scheduled benefits, the report said. When Medicare’s trust fund for inpatient care runs short, it will be able to pay only 91% of expected costs, mainly hospital bills. Because reductions of that magnitude would cause a political uproar, it is likely that a future Congress would find ways to recover the lost benefits, either by hiking the payroll taxes paid by current workers or by increasing government borrowing to cover the shortfall. With Medicare, lawmakers could also raise premiums paid by beneficiaries. It’s unclear how the Medicare projections will affect the debate on Capitol Hill about authorizing the program to negotiate prescription drug prices and then using projected savings to provide new Medicare coverage for dental, vision, and hearing services. Republicans have argued that any savings should go to shore up the underlying program, not expand benefits. The Medicare report steered clear of making any projections about the new Alzheimer’s drug, Aduhelm, which has a list price of $55,000. Most of the 6 million Americans dealing with Alzheimer’s are covered by the program, though not all would-be candidates for the medication. The trustees’ reports, which have been delayed for months, represent the government’s effort to assess the impact of last year’s pandemic and recession on Social Security and Medicare. The U.S. economy lost a staggering 22.4 million jobs in March and April 2020 as the pandemic forced businesses to close or cut their hours, and the economy went into recession. But the recession turned out to be brief, and hiring has bounced back as economic growth has resumed. Employers have brought back 16.7 million jobs since April 2020, but that gain still leaves the labor force 5.7 million jobs below where it was before the pandemic hit. The trustees of Social Security and Medicare include the secretaries of Treasury, Health and Human Services, and Labor, as well as the Social Security commissioner. They are supposed to be joined by two “public trustees,” knowledgeable private citizens who act as the eyes and ears of taxpayers and beneficiaries. But those posts have been vacant since July 2015 — before the end of the Obama administration. And this year, there’s no Social Security commissioner either since President Joe Biden fired Andrew Saul, a holdover appointee
Chad Mathis: Believe it or not, America’s healthcare system is the best in the world
We have the best healthcare system in the world. That is a statement you won’t often hear, but it’s true. For years we have listened to calls for Medicare for all and that the federal government should scrap our broken system. The list goes on and on. Yet these calls have been strangely silent of recent. We are better at treating chronic diseases such as hypertension and diabetes, but we don’t hear that very often. One glaring example against socialized medicine is the vaccine production and rollout efforts. Because of Operation Warp Speed, the United States successfully facilitated and accelerated the development and distribution of the Covid-19 vaccine and other diagnostics and therapeutics. Operation Warp Speed was the simultaneous development with large clinical trials and manufacturing ramp-up of the COVID-19 vaccine. The United States produced and distributed the vaccine precisely because of our highly fragmented, highly customizable healthcare system. While not perfect, it can hold its own on the world stage. The European Union cannot boast the same successes. The EU’s vaccination rollout efforts have failed. Only five countries have met their first vaccination threshold of having 80% of people over the age of 80 vaccinated. Even fewer countries have vaccinated 80% of their healthcare workers. The EU is still working out how to roll out vaccines for the entirety of their adult population months after the United States began to offer vaccines for anyone who wanted one. The EU vaccine rollout has been a massive failure. The EU has failed because their system sets them up for failure. While the United States still values a limited government approach, the EU relies on a centralized government. Because of our fragmentation and customizability, the American healthcare system succeeds in a large disparate country with high variability throughout, which ultimately allows it to be customizable to any situation. Thus, the success of Operation Warp Speed. A centralized system will set up our system to fail, just like the failures within the EU. Rising costs and delays in care are a natural consequence of a centralized system. The stagnation of care will become the norm as questions will always have to be referred back to a bureau in Washington for the answer in this system. It will always require more funding to tinker a little bit more to make it better, “if we could only …” will always be the answer. Operation Warp Speed has proven that the American approach to healthcare is what works for such a large nation. It is good to be back home in Birmingham. Last year, the opportunity to serve our country during this difficult time as a Senior Policy Advisor at Health and Human Services was a blessing. It was the honor of a lifetime to go to our nation’s capital and aid in the work to combat Covid-19. I look forward to writing about and advocating for policies that preserve free markets, limited government, and strong families both here in the state of Alabama and nationally. These values have proven to work repeatedly, and Alabamians must continue to advocate for these kinds of policies. Dr. Chad Mathis is a former senior policy advisor in the Trump Administration, a board-certified orthopedic surgeon, and a distinguished fellow at the Alabama Policy Institute.
Donald Trump touts support for medicare, slams “medicare for all”
President Donald Trump intends to tout his support for Medicare and slam left-leaning Democrats on their “Medicare for All” proposal when he visits Florida on Thursday. Administration officials say Trump plans to sign an executive order that calls for a series of changes, including a broader role for Medicare’s private insurance option, as he visits The Villages, a bustling community for adults in Central Florida. That part of the state overwhelmingly supported Trump in 2016. The trip is political messaging combined with a dose of health care policy, and it comes as the Republican president angrily defends himself against House Democrats’ impeachment inquiry. Trump is calling the Medicare for All plan from Vermont Sen. Bernie Sanders a “socialist” idea that would destroy Medicare. Sanders’ “single-payer” approach would cover people of any age under a new government plan for all. Medicare administrator Seema Verma said on Thursday that Trump is a “great protector of the Medicare program” and that Sanders’ plan would “eviscerate” it. She called Sanders’ idea not just impractical but “morally wrong,” saying it would “demote American seniors to little more than second-class status.” The Sanders plan would incorporate the Medicare program, but private health insurance _ including the Medicare Advantage option used by about one-third of seniors _ would no longer have a role. Sanders, who unexpectedly underwent a heart procedure this week, says Medicare for All would offer seniors broader benefits and lower costs. Sanders’ style of single-payer health care has long been popular among liberals, but polling lately has shown that a majority of Democrats and independents who lean Democratic prefer expanding coverage by building on the Affordable Care Act, or “Obamacare.” Trump is asking federal courts to overturn that law as unconstitutional, after a Republican-controlled Congress failed to repeal it his first year in office. Trump’s executive order does not involve a major overhaul of Medicare, which would require congressional approval. Instead, it pulls together a series of technical changes and administration priorities. The subject of prescription drug costs also is sure to come up. Trump enthusiastically endorsed a plan by Florida’s Republican Gov. Ron DeSantis to allow patients to import lower-cost medicines from abroad and is pursuing a federal version. But the impeachment inquiry has cast a cloud on prospects for major legislation to reduce drug prices. Trump’s executive order is basically a to-do list for the Department of Health and Human Services. It will require months of follow-up. Among the priorities are an expansion of telemedicine and changes to avoid overpaying for procedures just because they get done in a hospital instead of a doctor’s office. Much of the order focuses on Medicare Advantage, the private insurance option under Medicare. Medicare Advantage plans offer savings on premiums and an annual limit on out-of-pocket costs. They provide one-stop shopping, eliminating the need for separate supplemental insurance. Offered by major insurers, the plans also cover prescription drugs in most cases. But there are trade-offs. Seniors joining a Medicare Advantage plan generally must accept limits on their choice of hospitals and doctors as well as prior insurer approval for certain procedures. If they change their minds and decide to return to traditional Medicare, they’re not always guaranteed supplemental “Medigap” coverage, which is also private. Health and Human Services Secretary Alex Azar said Trump’s order directs his department to examine whether its current policies and practices put traditional Medicare ahead of the private Medicare Advantage option. Some advocates for older people say that it’s the other way around and that the administration is trying to put private plans ahead. The order also would seek to expand the range of additional services that can be offered by the private plans and would direct regulators to find more ways for seniors to financially benefit from plans that provide cost-efficient service. Many Medicare Advantage insurers offer some dental and vision coverage, along with basics like transportation to medical appointments. But the industry lately has started to experiment with in-home assistance, including nutritious meals, and financial help with safety-related home improvements. As a presidential candidate, Trump promised not to cut Medicare. As president, he has avoided calling for privatization of the program or raising the eligibility age beyond 65 or rolling back benefits. However, Trump’s latest budget proposed steep cuts in Medicare payments to hospitals and other service providers, prompting protests from the industry and accusations by Democrats that he was going back on his promises to seniors. The Medicare cuts have gone nowhere in Congress, as Republicans backed away from the president’s budget. By Kevin Freking and Ricardo Alonso-Zaldivar Associated Press. Republished with the permission of the Associated Press.
Democrats take a look at a practical health care approach
Democratic voters appear to be reassessing their approach to health care, a pragmatic shift on their party’s top 2020 issue. While “Medicare for All” remains hugely popular, majorities say they’d prefer building on “Obamacare” to expand coverage instead of a new government program that replaces America’s mix of private and public insurance. Highlighted by a recent national poll, shifting views are echoed in interviews with voters and the evolving positions of Democratic presidential candidates on a proposal that months ago seemed to have growing momentum within their party. Several have endorsed an incremental approach rather than a government-run plan backed by Sens. Bernie Sanders of Vermont and Elizabeth Warren of Massachusetts. It could mean trouble for Sanders and his supporters, signaling a limit to how far Democratic voters are willing to move to the left and an underlying skepticism that Americans will back such a dramatic change to their health care. “We hear Medicare for All, but I’m not absolutely certain what that means and what that would then mean for me,” said Democrat Terrie Dietrich, who lives near Las Vegas. “Does it mean that private insurance is gone forever?” Dietrich, 74, has Medicare and supplements that with private insurance, an arrangement she said she’s pretty comfortable with. She thinks it’s important that everyone has health care, not just those who can afford it. She said she would support Medicare for All if it was the only way to achieve that. But “I don’t think we can ever get it passed,” Dietrich added. Erin Cross, her 54-year-old daughter and also a Democrat, said she’s not comfortable with switching to a system in which a government plan is the only choice. She said Democrats won’t be able to appeal to Republicans unless they strike a middle ground and allow people to keep their private insurance. “We’ve got to get some of these other people, these Republican voters, to come on over just to get rid of Trump,” she said. Democratic presidential candidates also have expressed skepticism. California Sen. Kamala Harris’ new plan would preserve a role for private insurance. New Jersey Sen. Cory Booker is open to step-by-step approaches. Meanwhile, health care moderates including former Vice President Joe Biden have been blunt in criticizing the government-run system envisioned by Sanders. In Nevada, the early voting swing state that tests presidential candidates’ appeal to labor and a diverse population, moderate Democrats have won statewide by focusing on health care affordability and preserving protections from President Barack Obama’s law. Nationwide, 55 percent of Democrats and independents who lean Democratic said in a poll last month they’d prefer building on Obama’s Affordable Care Act instead of replacing it with Medicare for All. The survey by the nonpartisan Kaiser Family Foundation found 39% would prefer Medicare for All. Majorities of liberals and moderates concurred. On a separate question, Democratic support for Medicare for All was a robust 72 percent in July, but that was down from 80 percent in April, a drop Kaiser says is statistically significant but not necessarily a definitive downward trend. That said, Kaiser pollster Liz Hamel said it wouldn’t be surprising if it turned into one. On big health care ideas, she said, “as the public starts seeing arguments for and against, we often see movement.” The Kaiser survey also found broad backing for the public-option alternative that moderates are touting, a government plan that would compete with but not replace private insurance. Eight-five percent of Democrats supported that idea, along with 68 percent of independents. Republicans were opposed, 62 percent to 36 percent. Large increases in federal spending and a significant expansion of government power are often cited as arguments against Medicare for All. However, the main criticism Democrats are hearing from some of their own candidates is that the Sanders plan would force people to give up their private health insurance. Under the Vermont senator’s legislation, it would be unlawful for insurers or employers to offer coverage for benefits provided by the new government plan. Ohio Rep. Tim Ryan argued during the last round of Democratic debates that that’s problematic for union members with hard-fought health care plans secured by sacrificing wage increases. However, Sanders has long asserted his plan will allow unions to obtain bigger wage increases by taking health care out of the equation. In interviews with The Associated Press, union workers in Nevada said they worried about how Medicare for All would affect their coverage. Chad Neanover, prep cook at the Margaritaville casino-restaurant on the Las Vegas Strip, said he would be reluctant to give up the comprehensive insurance that his union has fought to keep. He has asthma, and his wife is dealing with diabetes. The union’s plan has no monthly premium cost and no deductible. “I don’t want to give up my health insurance. I’ve personally been involved in the fight to keep it,” said Neanover, 44. “A lot of people have fought to have what we have today.”Savannah Palmira, a 34-year-old union construction worker in Las Vegas, said she’s open to supporting Medicare for All, but wants to know specifically what it would look like, how the country would transition and how it would affect her plan. “That’s one of the biggest things that I love about being in the union, is our quality health care,” Palmira said. Medicare for All backers say their plan has been unfairly portrayed. “The shift in polling on Medicare for All is a direct result of mischaracterizations by opponents,” said Rep. Ro Khanna, Democrat-California, a Sanders campaign co-chair. People are most interested in keeping their own doctors, Khanna added, and Medicare for All would not interfere with that. Longtime watchers of America’s health care debate see new energy among Democrats, along with a familiar pattern. “The long-standing history of health reform is that people want to hang on to what they have,” said Georgetown University public policy professor Judith Feder, who was a health policy adviser in the Clinton administration. Nonetheless, she noted a common interest
2020 Democrats grapple with how to pay for “medicare for all”
Democratic presidential candidates trying to appeal to progressive voters with a call for “Medicare for All” are wrestling with the thorny question of how to pay for such a dramatic overhaul of the U.S. health care system. Bernie Sanders, the chief proponent of Medicare for All, says such a remodel could cost up to $40 trillion over a decade. He’s been the most direct in talking about how he’d cover that eye-popping amount, including considering a tax hike on the middle class in exchange for healthcare without co-payments or deductibles — which, he contends, would ultimately cost Americans less than the current healthcare system. His rivals who also support Medicare for All, however, have offered relatively few firm details so far about how they’d pay for a new government-run, single-payer system beyond raising taxes on top earners. As the health care debate dominates the early days of the Democratic primary, some experts say candidates won’t be able to duck the question for long. “It’s not just the rich” who would be hit with new cost burdens to help make single-payer health insurance a reality, said John Holahan, a health policy fellow at the nonpartisan Urban Institute thinktank. Democratic candidates campaigning on Medicare for All should offer more specificity about how they would finance it, Holahan added. Sanders himself has not thrown his weight behind a single strategy to pay for his plan, floating a list of options that include a 7.5% payroll tax on employers and higher taxes on the wealthy. But his list amounts to a more public explanation of how he would pay for Medicare for All than what other Democratic presidential candidates who also back his single-payer legislation have offered. Kamala Harris, who has repeatedly tried to clarify her position on Medicare for All, vowed this week she wouldn’t raise middle-class taxes to pay for a shift to single-payer coverage. The California senator told CNN that “part of it is going to have to be about Wall Street paying more.” Her contention prompted criticism that she wasn’t being realistic about what it would take to pay for Medicare for All. Colorado Sen. Michael Bennet, a rival Democratic presidential candidate, said Harris’ claim that Medicare for All would not involve higher taxes on the middle class was “impossible,” though he stopped short of calling her dishonest and said only that candidates “need to be clear” about their policies. A Harris aide later said she had suggested a tax on Wall Street transactions as only one potential way to finance Medicare for All, and that other options were available. The aide insisted on anonymity in order to speak candidly about the issue. Another Medicare for All supporter, New York Sen. Kirsten Gillibrand, would ask individuals to pay between 4% and 5% of their income toward the new system and ask their employers to match that level of spending. Gillibrand’s proposal, shared by an aide who requested anonymity to discuss the campaign’s thinking, could supplement the revenue generated by that change with options that hit wealthy individuals and businesses, including a new Wall Street tax. Gillibrand is a cosponsor of Sanders’ legislation adding a small tax to financial transactions, while Harris is not. New Jersey Sen. Cory Booker, who also has signed onto Medicare for All legislation but said on the campaign trail that he would pursue incremental steps as well, could seek to raise revenue for the proposal by raising some individual tax rates, changing capital gains taxes or expanding the estate tax, according to an aide who spoke candidly about the issue on condition of anonymity. The campaign of Massachusetts Sen. Elizabeth Warren, who used last month’s debate to affirm her support for Sanders’ single-payer health care plan, did not respond to a request for more details on potential financing options for Medicare for All. Meanwhile, Sanders argued during a high-profile Medicare for All speech this week that high private health insurance premiums, deductibles and copayments, all of which would be eliminated by his proposal, amount to “nothing less than taxes on the middle class.” Medicare for All opponents are also under pressure to explain how they’d pay for changes to the health insurance market. Former Vice President Joe Biden is advocating for a so-called “public option” that would allow people to decide between a government-financed plan or a private one. He would pay for his $750 billion proposal by repealing tax cuts for the wealthy that President Donald Trump and the GOP cut in 2017, and by raising capital gains taxes on the wealthy. By Elana Schor Associated Press Associated Press writers Juana Summers in Washington and Alexandra Jaffe in Cedar Rapids, Iowa, contributed to this report. Republished with permission of the Associated Press.
Marilyn Singleton: Thought police (oops, Medicare) for all
The new Medicare for All bill (H.R. 1384) has come and hopefully will go the way of the pet rock. Everybody now knows the basics: the government will take care of all medical, dental, vision, pharmacy, and long-term care services with no out-of-pocket expenses. The bill prohibits parallel private insurance, and has the glaring absence of a financing mechanism. But as usual, bills contain hidden gems. Section 104 of the bill tracks the Affordable Care Act’s “anti-discrimination” rule, making it clear that no person can be denied benefits, specifically including abortion and treatment of gender identity issues “by any participating provider.” The bill does not correspondingly reaffirm the federal laws protecting conscience and First Amendment religious freedom rights of medical personnel. Such protections relate to participation in abortion, sterilization, assisted suicide, and other ethical dilemmas. Most sane individuals agree that we do not want our government to control any aspect of our individual lives—particularly not our religious beliefs and moral codes. When the Department of Health and Human Services (HHS) sought to clarify such conscience protections, thousands of commenters offered evidence of discrimination and coercion to violate the tenets of the Oath of Hippocrates and their own ethics. Some left their jobs or left the medical profession entirely when their conscientious objections were not honored. Conscience protections are vital in this time of unabashed devaluing of life. Last year, the Palliative Care and Hospice Education Training Act (PCHETA), passed the House but died in the Senate. This bill would have dedicated $100 million in additional taxpayer dollars to persuade patients to forgo treatment that might prolong life in exchange for a steady stream of increasing doses of narcotics. Already some families feel they are not merely offered hospice as a choice but are steered toward it when their older relatives fall ill, even when the medical prognosis is uncertain. The focus on palliative care and lowering costs by reducing “aggressive” end-of-life treatment is one more incremental under-the-radar step along the road to government control over life and death. A culture of hastening death has gradually evolved, disguised as “death with dignity.” California, Colorado, Oregon, Washington, Montana, Vermont have legalized physician-assisted suicide with 20 other states considering implementing such laws. Subtly devaluing life primes the pump for rationing of medical care at all stages by a government-run program that is the exclusive purveyor of medical “benefits.” Our western counterparts with single payer have discovered that offering fewer benefits is the simplest way to control costs. The “Complete Lives System”—the brainchild of ObamaCare physician architect Ezekiel Emanuel—includes worrisome determinants of who should receive care. The system prioritizes adolescents and persons with “instrumental value,” i.e., individuals with “future usefulness.” This year, legislators were not so subtle. It is bad enough that our elderly are pushed into hospice, but now the compassionate legislators have set their sights on newborns. New York passed, and Virginia floated laws that permit the killing of babies after birth. The U.S. Senate garnered only 53 of the 60 votes needed to pass the Born Alive Survivors Protection Act which would mandate medical care and legal protections to infants born alive after an attempted abortion. Starting in the 1970s, the federal government clearly saw a need to protect medical personnel from the tyranny of the government mandates that could violate religious or moral convictions. Personal liberty is an integral part of our democratic republic. While a physician’s calling is to render treatment to all patients, this is balanced with an individual physician’s moral beliefs. This is no more apparent than in legislation permitting physician assisted suicide and post-delivery “abortions.” Sadly, under threat of discrimination lawsuits, some physicians have acquiesced to patients’ requests for medications and surgical procedures that conflict with their moral code. As anthropologist, Margaret Mead so brilliantly wrote, “One profession, the followers of [Hippocrates], were to be dedicated completely to life under all circumstances…This is a priceless possession which we cannot afford to tarnish, but society always is attempting to make the physician into a killer—to kill the defective child at birth, to leave the sleeping pills beside the bed of the cancer patient. … It is the duty of society to protect the physician from such requests.” We must not let the government bury our conscience and beliefs under layers of bureaucracy. Medicare for All may mean independent thought for none. Dr. Marilyn Singleton is a board-certified anesthesiologist. She is President of the Association of American Physicians and Surgeons (AAPS). She graduated from Stanford and earned her MD at UCSF Medical School. Dr. Singleton completed 2 years of Surgery residency at UCSF, then her Anesthesia residency at Harvard’s Beth Israel Hospital. While still working in the operating room, she attended UC Berkeley Law School, focusing on constitutional law and administrative law. She interned at the National Health Law Project and practiced insurance and health law. She teaches classes in the recognition of elder abuse and constitutional law for non-lawyers. She lives in Oakland, Ca.
Donald Trump trashes Democrats’ Medicare for All plan in op-ed
President Donald Trump is stepping up his attack on Democrats over a health care proposal called Medicare for All, claiming it “would end Medicare as we know it and take away benefits that seniors have paid for their entire lives.” Trump, omitting any mention of improved benefits for seniors that Democrats promise, writes in an op-ed published Wednesday in USA Today, “The Democrats’ plan means that after a life of hard work and sacrifice, seniors would no longer be able to depend on the benefits they were promised.” But Medicare for All means different things to different Democrats. The plan pushed by Sen. Bernie Sanders, the Vermont independent who challenged Hillary Clinton for the 2016 Democratic presidential nomination, would expand Medicare to cover almost everyone in the country, and current Medicare recipients would get improved benefits. Other Democratic plans would allow people to buy into a new government system modeled on Medicare, moving toward the goal of coverage for all while leaving private insurance in place. Trump’s column comes as he is looking to paint Democratic candidates as extreme ahead of next month’s midterm elections. A White House official speaking to The Associated Press on the condition of anonymity to describe internal plans said that Trump’s health care attack will be echoed by the Republican National Committee and other GOP groups and that the president will continue to raise the attack during his campaign rallies. Sanders responded Wednesday in a statement, saying Trump “is lying about the Medicare for All proposal” that he introduced. “No, Mr. President. Our proposal would not cut benefits for seniors on Medicare. In fact, we expand benefits,” Sanders said. As Trump escalates his efforts on behalf of fellow Republicans, he is casting health care as one of an expanding list of choices for the electorate this year while seeking to raise the alarm about the consequences of Democratic control of the House or the Senate. Medicare for All, also called single-payer over the years, was until fairly recently outside the mainstream of Democratic politics, but this year it has become a key litmus test in many party primaries and a rallying cry for progressive candidates. Under the plan by Sanders, all Americans would gain access to government insurance with no copays or deductibles for medical services. Republicans contend that the proposal would be cost-prohibitive and argue it marks government overreach. Trump has already sought to paint Democrats as extremists after the bitter confirmation battle over Supreme Court Justice Brett Kavanaugh, and internal GOP polling obtained last month by the AP shows that the party believes the message will help galvanize Republican voters to the polls. At a rally in Iowa on Tuesday, Trump argued that the only reason to vote for Democrats “is if you are tired of winning.” He will be holding a rally in Pennsylvania on Wednesday evening. Republished with permission from the Associated Press.
