Font Size

From the category archives: healthcare

The Week Brings Good & Bad News for Medicaid


Let’s start with the good news. Yesterday, voters in Maine overwhelmingly approved the expansion of Medicaid in their state (59% to 41%), bucking the will of Republican Governor Paul LePage. The Governor had vetoed Medicaid expansion five times, but the people had the final say in yesterday’s referendum.  Now, some 70,000 Mainers should be newly eligible for Medicaid.  That includes thousands of older residents not yet eligible for Medicare who can’t afford private health coverage.  Forbes calls the outcome a “victory for Obamacare.” 

A spokesman for the group that sponsored the ballot initiative starkly defined the stakes.

“Too many Mainers have already waited too long for health care. They shouldn’t have to wait any longer. The governor cannot ignore the law or the Constitution of Maine. Simply put, the governor does not have veto power of citizen’s initiatives and he cannot ignore the law.” – David Farmer, Maine Medicaid expansion advocate

The federal government will cover 90% of the cost of expansion, injecting nearly $500 million into Maine’s economy in the next two fiscal years. A recent study says those federal funds will generate 6,000 new jobs (mostly in the health sector). 

Maine becomes the 33rd state (including D.C.) to expand Medicare.  But as Sarah Kliff writes in Vox, the way Maine did it provides a potential template for expanding the program in other states:

Maine is the first state to expand Medicaid during the Trump administration, and also the first to do so via a ballot initiative than legislation. This offers a possible playbook for health care advocates in other states looking to extend coverage but stymied by political opposition. – Sarah Kliff, Vox 11/7/17

Of the 17 holdout states, Utah, Idaho, and Kansas may see Medicaid expansion on the ballot in 2018.  Increased coverage, better access to care, and a huge economic boon should make this an obvious ‘yes’ vote – though outcomes are not guaranteed, especially without robust advocacy.

Advocates can expect the same kind of pushback from conservatives in these other states.  Governor LaPage peddled the falsehood that the expansion would put an unsustainable financial burden on the Maine government.  The Portland-Press Herald reports that the governor also perpetuated the myth that expanding Medicaid would give “free” healthcare to “able-bodied adults who can work and contribute to their own health insurance costs.”

And that leads us to some bad news, which is that the Trump administration is using that same canard to chip away at Medicaid in red states across the country.  Seema Verma, administrator of the Centers for Medicare and Medicaid Services (CMS), announced a rule change this week that will allow states to impose work requirements on Medicaid beneficiaries.  This supposes, of course, that there are legions of lazy Medicaid enrollees who could work, but just don’t want to – a total myth.

As Talking Points Memo reported, most adults on Medicaid suffer from some of disability and cannot work.  According to a 2017 study by the Kaiser Family Foundation, only 27% of Medicaid beneficiaries are adults without disabilities.  Of those, 60% are, in fact, working.  Most of the recipients not working have one of the following extenuating circumstances: 

  1. Caring for a family member full-time
  2. Lack of jobs in their area
  3. Criminal record prevents employment

The bottom line:  most of the Medicaid recipients who can work do work

These new conditions will especially onerous for some six million older Americans (age 45-64) currently on Medicaid.  This age group experiences more disability and chronic illness than younger recipients do.  If forced to go without care because of new restrictions, they will arrive at the doorstep of Medicare in worse health, which can drive up program costs. 

The Obama administration had it right, by allowing rule changes at the state level which “increase and strengthen overall coverage of low-income individuals” and “improve health outcomes for Medicaid and other low-income populations.” The Trump administration, under Verma’s leadership, is showing its contempt for the elderly and poor – and knee-jerk suspicion of federal programs that actually help society’s most vulnerable. What’s more, CMS’ new rules defy candidate Trump’s promises to “not touch your Medicaid.” But as we’ve seen with his pledges to protect Social Security and Medicare, the President’s promises are not worth the megabits they’re tweeted on. 

 

GOP Budget Resolution a "Lump of Coal" for Seniors, Middle Class

While the media have been largely consumed by the latest outrages from the White House, Republicans in Congress have been quietly working to radically redesign our tax code and cut trillions in spending that benefits ordinary Americans, including and especially seniors. With little fanfare, the Senate voted 51-49 last week to pass a cynical budget resolution that’s really a Trojan Horse for tax cuts for the wealthy and big corporations. Yesterday, the House followed suit by a vote of 216-212.  

Had a few votes gone the other way, these plans would have been stopped dead in their tracks, as we witnessed with Obamacare repeal.  But the public wasn’t paying much attention, and the pressure on Congress to vote in the public interest was nowhere near as intense.

Even if some of the more heinous budget cuts fall away, the resolution is an unsettling declaration of priorities that can only be described as mean-spirited and immoral.  As Dylan Scott keenly observes in Vox:

The budget stands as a vision of what the Republican majority wants to do, and perhaps would do if it had eight or nine more votes in the Senate. It suggests that basically every Republican in each chamber (the only senator opposed was Rand Paul, who wanted deeper cuts) is comfortable aligning himself or herself with an agenda that radically cuts the social safety net for… retirees and the middle class. – Dylan Scott in Vox, 10/26/17

The GOP budget and tax scheme, which leadership would like to pass before the holidays, has been rightly described as a “lump of coal for the middle class.”  Yes, the tax plan is a big, fat Christmas gift to the wealthy, wrapped in a package of distortions.  Despite President Trump’s disingenuous claim that it helps middle income earners, 80% of the tax savings goes to the wealthiest 1% of the American people.  The rest get only a trickle of tax relief.  

Tax policy that benefits the middle class, including deductions for state and local taxes, goes out the window in this plan.  So might existing exemptions for 401K contributions, currently set at $18,000 per year.  GOP leaders have talked about significantly reducing the amount of pre-tax contributions people can make, reportedly to $2,400 per year.  (The exact details are secret, of course, until the plan is unveiled on November 1st.)  The party of personal responsibility is actually proposing to penalize Americans for saving for retirement – as some 50 million of us now do to the tune of $67 billion in tax savings per year.

The GOP would pay for massive tax breaks for the rich by cutting essential safety net programs for seniors and other vulnerable Americans.  These are among the Scrooge-like proposals in the  budget plan:

*Cuts nearly $500 billion from Medicare by privatizing the program and raising the eligibility age.

*Cuts $1.3 trillion from Medicaid over ten years, jeopardizing long term care services and supports for the elderly.

*Cuts $653 in Supplemental Security Income (SSI) for some 8 million low-income seniors and people with disabilities.

*Will likely require cuts in in Older Americans Act programs (e.g., Meals on Wheels), home heating assistance for seniors, and research into diseases affecting the elderly, including Alzheimer’s and cancer.

Meanwhile, the supposedly budget-conscious GOP has voted to allow itself to deficit-fund $1.5 trillion of the tax cut package. As the hole in the deficit grows, Republicans will then be able to come after Americans’ earned benefits – Social Security and Medicare – to try to close the gap, even though Social Security and Medicare Part A are self-funded and don’t affect general revenues.  

Of course, the long-planned assault on Medicare has already begun – with new viability now that Republicans control all branches of government. The budget resolution contains oft-told prevarications about the program:

"Medicare spending is on an unsustainable course… Given this untenable situation, the budget resolution supports work by the authorizing committees to recommend legislative solutions extending Medicare's solvency in the near term, while pursuing policies that place the program on a sustainable long-term path." – GOP 2018 Budget Resolution

The way to strengthen Medicare now and for the future is to keep the Affordable Care Act in place (which is already saving Medicare hundreds of billions) and allow the government to negotiate prescription drug prices with drug companies, for starters. 

Because Congressional leadership is forcing reckless tax cuts through the reconciliation process (where measures can pass the Senate with a simple majority), Democrats will be unable to impede this cruel juggernaut.  As we saw in the Obamacare repeal battle, it will once again fall to a handful of Republicans of conscience to put the brakes on unfair tax and budget cuts.  But they will do so only if they hear loudly and clearly from all of us.


Here's One Way You May be Overpaying for Prescription Drugs - And How to Avoid It

Did you know that when you lay down $10, $20, or $30 for a copay at the pharmacy that you may be overpaying for the prescription itself --- and a third party may be pocketing the difference?  Or that you might save money by not going through insurance at all and paying a reduced cash price for the medication?  Such is the head-spinning – and sometimes unethical – world of prescription drug benefits in the second decade of the 21st century.

Middlemen called Pharmacy Benefit Managers (PBMs) can skim extra profit by overcharging for medications.  The PBMs’ ostensible purpose is to negotiate favorable pricing with pharmaceutical companies on behalf of insurers, including Medicare.  But sometimes, especially with cheaper generic medicines, PBMs excessively mark up those prices and keep the remainder for themselves –  causing consumers to pay more than they should. Unfortunately, this practice is especially costly for older Americans living on fixed incomes. 

Unsuspecting customers are particularly vulnerable when paying co-pays at their local pharmacy, where PBMs can “claw back” excess profits.  Here’s how it works:

 A patient goes to a pharmacy and pays a co-pay amount -- perhaps $10 -- agreed to by the pharmacy benefits manager, or PBM, and the insurers who hire it. The pharmacist gets reimbursed for the price of the drug, say $2, and possibly a small profit. Then the benefits manager “claws back” the remainder. – Bloomberg, 2/24/17

(See also the graphic at the bottom of this post for a more detailed explanation of clawbacks.)

Though most customers are unaware of this practice, Bloomberg news reports that it is disturbingly common.  More than 80% of independent pharmacists surveyed said that they have experienced clawbacks from PBMs at least 10 times a month. 

In some cases, there is a simple way for customers to protect themselves from clawbacks. They can simply ask the pharmacist for the cash price of the prescription.  If the cash price is lower than the co-pay, the customer can elect to pay it and bypass the insurance coverage for that medication.  Consumers can also use prescription drug apps to determine the cash price (and available discounts) for various medications.

Unfortunately, PBMs do what they can to keep customers ignorant of this option.  In fact, many PBMs (including one called OptumRx) contractually forbid pharmacists from educating customers about potential alternatives.  

 Pharmacists who contract with OptumRx in 2017 could be terminated for “actions detrimental to the provider network,” doing anything that “disparages” it or trying to “steer” customers to other coverage or discounted plans… - Bloomberg, 2/24/17

Some PBMs further restrict customers’ rights by mandating that enrollees in certain insurance plans use mail order and specialty pharmacies that they own, creating a conflict of interest.

Up to now, PBMs have operated with little transparency, so that no one really knows the inner workings of their deals with the drug companies or the details of their pricing structures.  But pressure has been building on Capitol Hill.  After all, the federal government is the largest health care provider in the country and is motivated to keep prescription drug costs under control.  Hence, a bipartisan bill called the Prescription Drug Price Transparency Act (H.R. 1316) seeks to strengthen oversight of PBMs in the Medicare, Medicaid, and Federal Employee Health Benefit programs.  

Three other bills – one in House and two in the Senate – have been introduced requiring greater transparency and accountability for PBMs. Meanwhile, New York State (under the leadership of Governor Andrew Cuomo) has unveiled new regulations for PBMs, and other states may do the same.

PBMs have also become the target of lawsuits (16 of them since October of last year) and have invited scrutiny from the U.S. Justice Department, which has alleged that the industry “is rife with conflicts of interests and undisclosed arrangements entered into at customers’ expense.”

Of course, the nascent clampdown on PBMs has to be seen in the context of soaring prescription drug prices overall, which are the main driver of rising medical costs.  President Trump pledged to bring down drug prices, but so far has not delivered.  Incremental measures to crack down on pricing abuses by PBMs are a good start. But until consumers receive actual deliverance from prescription price gouging, they will have to try their best to protect themselves.  

*******************************************************************************************************************

GOP Tax Cuts Could Cost Seniors in the Long Run

The GOP had scarcely emerged from the defeat of their latest Obamacare repeal legislation when they pivoted lightning-quick from healthcare to taxes.  The tax reform plan the party unveiled last week may ultimately endanger the well-being of older Americans more than the vanquished healthcare bill.  Here’s why:  The nonprofit Tax Policy Center estimates that the GOP tax plan will reduce federal revenues by a net $2.4 trillion in the next 10 years.  As the deficit grows, Congress will look to cut spending.  Republicans have already called for deep cuts to Social Security and Medicare, and would no doubt come after those programs looking for massive savings. Seniors’ earned benefits could be used as piggy banks to pay for reckless tax cuts that largely benefit the wealthy.

Americans for Tax Fairness put it his way:

"[The tax plan’s] eye-popping cost will lead to deep cuts in Social Security, Medicaid, Medicare, and public education that will leave working families in the cold."- Americans for Tax Fairness

… while House Democratic leader Nancy Pelosi predicted:

“Make no mistake: after Republicans’ tax plan blows a multi-trillion dollar hole in the deficit, they will sharpen their knives for Social Security, Medicare, Medicaid.” – House Minority Leader Nancy Pelosi 

Budget hawks (including President Trump’s budget director Mick Mulvaney and House Speaker Paul Ryan) have long dreamed of cutting Social Security and Medicare.  Once their tax plan balloons the deficit, they will have the perfect excuse for gutting those programs – even though Social Security and Medicare Part A are completely self-funded by workers’ payroll contributions; they contribute not a penny to the deficit.

In fact, the budget cutters’ knives are already sharpened. The 2018 House Budget resolution calls for nearly $500 billion in cuts to Medicaid over the next decade.  That would be devastating for the 1.4 million seniors who rely on Medicaid for long-term care, and millions of others who are dually eligible for Medicaid and Medicare.  The House budget resolution also includes nearly $500 billion in cuts to Medicare over the next ten years.  Under the House budget plan, Medicare would be privatized and the eligibility age raised from 65 to 67 (an effective benefit cut). If these changes are enacted, seniors will be left to fend for themselves in the private insurance market with vouchers that may not keep up with rising costs. 

Despite President Trump’s protestations that the GOP tax plan won’t benefit the rich, that’s precisely who would reap the biggest gains.  (Trump himself could save an estimated $1 billion in taxes!)  According to the Tax Policy Center’s analysis:

"Taxpayers in the top 1 percent would receive about 50 percent of the total tax benefit from the tax overhaul, with their after-tax income forecast to increase an average of 8.5 percent." – Tax Policy Center 

On the other hand, some in the middle class would see their taxes go up.  One in seven households earning between $48,000 and $86,000 per year would pay more in taxes next year; the proportion would double during the next decade.  For households earning $150,000-217,000 a year, one third would immediately pay more in taxes. 

Republicans claim that the tax cuts will pay for themselves through intense economic growth.  They have tried this before (Most recently, with the Bush tax cuts in the early 2000s), and it didn’t work out.  Instead, deficits swelled, reinforcing budget hawks’ instincts to cut programs for the most vulnerable members of our society, including and especially seniors.  One of the (repentant) architects of the failed trickle-down economics of the 1980s, Bruce Bartlett, put it best in a recent column for USA Today: 

"Tax cuts and tax rate reductions will not pay for themselves; they never have. Republicans don’t even believe they will, they are just excuses to slash spending for the poor when revenues collapse and deficits rise." – Bruce Bartlett, former Congressional economist

 

 

Throwing More Money at Wavering Senators’ States Doesn’t Improve Graham-Cassidy

To paraphrase W.C. Fields, it seems as if news of the death of the Graham-Cassidy bill is greatly exaggerated.  As veteran Kaiser Health News correspondent Julie Rovner tweeted this morning:

FWIW I will not believe health bill is really dead until I see it with an actual stake through it.

Her caution is well warranted.  Anti-repeal advocates breathed a sigh of relief last Friday when Senator John McCain (R-AZ) announced his opposition to the bill.  But opponents of Graham-Cassidy still need one more GOP vote to kill it before the September 30th deadline, and so far only McCain and Senator Rand Paul (R-KY) have announced as ‘No’s.  Some Hill-watchers are wary of Rand Paul’s position and predict he will flip to ‘Yes’ at the last minute, as he has done previously.  On the other hand, this weekend Sen. Ted Cruz (R-TX) threw cold water on Graham-Cassidy because he says it doesn’t go far enough in undoing Obamacare regulations:

"Right now they don't have my vote, and I don't think they have Mike Lee's either," Cruz said. "I want to be a yes."              –  Senator Ted Cruz

Seeing their Obamacare repeal bill appear to collapse before their eyes, Senators Lindsay Graham (R-SC) and Bill Cassidy (R-LA) have now sweetened the deal to try to buy off two wavering moderate Senators, Lisa Murkowski (R-AK) and Susan Collins (R-ME).   The Graham-Cassidy bill was changed over the weekend to give away tens of millions of dollars to two of America’s least populous states.  Alaska would net $3 million more in federal health spending than under current law from 2020-2026, and Maine $43 million.  Of course, when Graham-Cassidy’s block grants to states expire in 2026, both states will lose funding along with the other 48.   Steven Dennis of Bloomberg handicaps it this way:


These buy-offs may or may not bring Senators Murkowski and Collins over to the ‘Yes’ side.  Nor should they.  Both Senators have expressed deep concerns about other parts of the bill:  Sen. Murkowski for its elimination of protections for pre-existing conditions; Sen. Collins for its deep cuts to Medicaid.  And of course, these bribes for Alaska and Maine do not make the Graham-Cassidy bill any less egregious.  Every major group of stakeholders – insurers, doctors, hospitals, patients, and all 50 state Medicaid directors – have condemned this bill as a reckless assault on America’s health care system.  National Committee president Max Richtman lays out the case in testimony given to the Senate Finance Committee. 

The Republicans supporting Graham-Cassidy don’t seem to care as much about improving healthcare as they do about fulfilling a reckless campaign promise and scoring a legislative “win,” even though the vast majority of the American people would actually lose.  Premium subsidies would be eliminated, pre-existing conditions no longer protected, essential benefits gutted, and Medicaid decimated to the point where crucial services would be cut for seniors, children and the disabled.  One look at this chart from Kaiser Health News showing where most Medicaid spending goes makes it crystal clear who gets hurt if Graham-Cassidy becomes law.

Senators Graham and Cassidy, along with their enablers in the Trump administration, will continue to falsely claim that their bill protects people with pre-existing conditions, when by leaving it to the states to decide, there is no such protection at all.  If states seek waivers to pre-existing conditions, insurers can jack up rates for patients with diabetes, cancer, heart disease and other chronic illnesses to the point of unaffordability.

Instead of believing more pablum, or trusting that the Republican-led Senate will do the right thing, we must keep up the pressure on wavering Senators (especially Collins and Murkwoski) to vote ‘No’ when the bill comes to the floor later this week.  If we are to see a stake through Obamacare repeal, we must make sure to put it there ourselves. 

Pages: Prev1234567...34NextReturn Top



   

Questions?

Have a Social Security or Medicare question?




 

Archives
Media Contacts

Pamela Causey
Communications Director
causeyp@ncpssm.org
(202) 216-8378
(202) 236-2123 cell

Walter Gottlieb
Assistant Communications Director 
gottliebw@ncpssm.org
(202) 216-8414

Entitled to Know

            

 

Copyright © 2017 by NCPSSM
Login  |