Cartoon – Modern Get Well Card
Monthly Archives: March 2018
Cartoon – Discussing Treatment Options
Cartoon – Committee Functions
Poll: Americans Aghast Over Drug Costs But Aren’t Holding Their Breath For A Fix
https://khn.org/news/poll-americans-aghast-over-drug-costs-but-arent-holding-their-breath-for-a-fix/
The recent school shootings in Florida and Maryland have focused attention on the National Rifle Association’s clout in state and federal lobbying activities.
Yet more than the NRA or even Wall Street, it’s the pharmaceutical industry that Americans think has the most muscle when it comes to policymaking.
A poll from the Kaiser Family Foundation found that 72 percent of people think the drug industry has too much influence in Washington —outweighing the 69 percent who feel that way about Wall Street or the 52 percent who think the NRA has too much power. Only the large-business community outranked drugmakers. (Kaiser Health News is an editorially independent program of the foundation.)
Drug prices are among the few areas of health policy where Americans seem to find consensus. Eighty percent of people said they think drug prices are too high, and both Democrats (65 percent) and Republicans (74 percent) agreed the industry has too much sway over lawmakers.
Democrats were far more likely than Republicans — 73 vs. 21 percent — to say the NRA had too much influence.
The monthly poll also looked at views about health care. Americans may be warming to the idea of a national health plan, such as the Medicare-for-all idea advocated by Sen. Bernie Sanders (I-Vt.). Overall, 59 percent said they supported it, and even more, 75 percent, said they would support it if it were one option among an array for Americans to choose.
Americans are far more concerned with lowering prescription drug prices, though they don’t trust the current administration to fix the problem. Fifty-two percent said lowering drug costs should be the top priority for President Donald Trump and Congress, but only 39 percent said they were confident that a solution would be delivered.
“There’s more action happening on the state level; what we are finding is they’re not seeing the same action on the federal level,” said Ashley Kirzinger, a senior survey analyst for KFF’s public opinion and survey research team. “They’re holding the president accountable as well as leaders of their own party.”
Overall, at least three-quarters of people don’t think Democrats and Republicans in Congress, as well as the Trump administration, are doing enough to bring costs down.
Twenty-one percent reported that they didn’t trust either party to lower prices, up from 12 percent in 2016. And, unlike other health-related policy questions such as repealing the Affordable Care Act or creating a national health plan, the poll does not find a partisan divide on this perception.
Passing legislation to lower drug prices was at the top of the list of the public’s priorities, making it more important than infrastructure, solving the opioid epidemic, immigration reform, repealing the ACA or building a border wall.
Looking ahead to the 2018 midterm elections, 7 percent reported that creating a national health plan was the “single most important factor” for how they would vote in 2018. However, 7 in 10 said it is an important consideration, and 22 percent said it is not an important factor at all.
The poll found that support for the federal health law fell this month, from February’s all-time high of 54 percent to 50 percent in March. Opposition moved up slightly from 42 to 43 percent.
Medical Research, Drug Treatment And Mental Health Are Winners In New Budget Bill
Sen. Susan Collins, R-Maine (center), is joined on Wednesday by Sen. Lindsey Graham (from left), R-S.C., Sen. Lisa Murkowski, R-Alaska, and Rep. Greg Walden, R-Ore. Collins was pushing for provisions in the budget bill aimed at lowering premiums for people purchasing health insurance in the Affordable Care Act’s marketplaces. That didn’t happen.
The big budget deal reached this week in the House doesn’t include a long-sought-after provision to stabilize the Affordable Care Act marketplaces. But the $1.3 billion plan, set to fund the government through September, has lots of new money for medical research, addiction treatment and mental health care.
Here’s the rundown of what’s included in the 2,232-page spending bill, now in the hands of a Senate vote, based on summaries released by the House and Senate appropriations committees.
- $78 billion in overall funding for the Department of Health and Human Services, a $10 billion increase
- $3.6 billion to fight the opioid addiction crisis
- This more than doubles the money allocated in fiscal 2017 and boosts funding for treatment and prevention, as well as helping to find alternatives for people suffering from pain.
- $3.2 billion for mental health care
- This is a 17 percent boost from last year and goes to treatment, prevention and research.
- $37 billion for the National Institutes of Health
- This is a $3 billion increase over fiscal 2017 and boosts spending on research into Alzheimer’s disease and a universal flu vaccine, among other things.
- $8.3 billion for the Centers for Disease Control and Prevention
- This is an increase of $1.1 billion over last year.
- The bill also allows more CDC research to look at causes and prevention of gun violence.
Lawmakers could not agree on language designed to stabilize the Affordable Care Act insurance markets and lower insurance premiums that Sens. Lamar Alexander, R-Tenn., and Susan Collins, R-Maine, have been fighting for since last fall. That bill would have reinstated the cost-sharing reduction payments, by which the government reimburses insurance companies that give the lowest-income customers a break on their copayments and deductibles.
Last year President Trump announced that the government would stop making the payments, a decision that drove the unsubsidized premiums on insurance policies higher.
Alexander says his proposal would restore those payments and cut premiums as much as 40 percent.
“Nothing is more important to Americans than health care, and nothing is more frightening than the prospect of not being able to afford health insurance, which is the case for a growing number of Americans,” he said at a news conference Wednesday.
But Democrats refused to support the provision because it also included language that would have barred any insurance policy sold on the ACA marketplaces from covering abortion.
Ascension could shift away from hospital focus, Modern Healthcare finds
https://www.healthcaredive.com/news/ascension-restructuring-modern/519850/
Dive Brief:
- Ascension is restructuring to adapt a new strategic direction. President and CEO Anthony Tersigni hinted that direction would put a larger emphasis on outpatient access points and telemedicine, according to a video obtained by Modern Healthcare. The effort could move Ascension away from being a hospital-focused business.
- The board of directors has endorsed the new direction and the company expects to save $57 million a year by streamlining its pay practices, Tersigni reportedly said in the video.
- The 151-hospital system has realigned leadership and organizational efforts, including limiting business travel and holding virtual meetings as Tersigni and his direct reports take pay cuts. Such efforts are expected to save $61 million in fiscal 2019, Modern Healthcare’s Alex Kacik reported.
Dive Insight:
The news comes as the industry is questioning whether the days of large hospital-based health systems are numbered.
Tenet Healthcare and Community Health Systems are both shedding hospitals as they seek to reduce debt loads that were $15 billion at their peaks. Tenet, also in restructuring mode, raised its number of layoffs to 2,000 to help reduce its debt.
Ascension recently laid off 500 workers in Michigan and more could be on the way. It’s restructuring shouldn’t be a surprise. The company’s operating income dropped 93% in Q1 2018 to $11.5 million, compared to $172.6 million the previous year. The operating revenue dropped $122.1 million over the last half of 2017.
Admissions for many health systems have been trending downward as expenses have risen. In efforts to make numbers work, health systems are exploring outpatient access points while focusing on geographic areas they believe they can become market leaders in and where higher-revenue-yield services are more in demand.
This has led to large systems questioning whether they want to still be large.
However, no one is waving the white flag just yet and pivoting away from a “strength by numbers” system approach. The restructuring news comes as Ascension and Presence Health signed a definitive agreement for Presence to join Ascension and become part of AMITA Health, a joint venture between Ascension’s Alexian Brothers Health System and Adventist Midwest Health.
The system is also rumored to be in merger talks with Providence St. Joseph Health that surfaced in December.
HCA, which is bullish on inpatient facilities and saw rising admissions last year, is exploring a possible acquisition of Mission Health.
The industry is in a state of change, and it’s yet to be seen how the multiple restructurings shake out. But smaller, regional-focused systems look to be one option as the large systems sell parts of themselves off.
What to watch for in the individual health insurance market
On Tuesday, March 6, the Brookings Institution’s Hutchins Center on Fiscal and Monetary Policy and the USC-Brookings Schaeffer Initiative for Health Policy co-hosted an event examining where the individual health insurance market is today and where it is heading. The event featured an opening presentation followed by a panel discussion featuring speakers from a variety of perspectives. The discussion examined how the individual market has evolved since the implementation of the main Affordable Care Act (ACA) reforms in 2014, the likely impact of recent policy changes implemented by the Trump Administration and Congress, and how federal policy toward the market might evolve in years to come.
Here are highlights from each of the participants.
Fiedler’s opening presentation: An overview of recent individual market trends and policy changes
The event opened with a presentation by Matthew Fiedler, a fellow at the Brookings Institution’s Center for Health Policy (slides available here). Fiedler started by showing that individual market enrollment grew significantly after implementation of the ACA’s reforms in 2014, but that individual market insurers also incurred significant losses. Those losses set the stage for a pricing correction in 2017, which he estimated returned premiums to a roughly sustainable position.
Fiedler then examined the implications of three significant policy changes under the Trump Administration: the end of cost-sharing reduction payments, the pending repeal of the individual mandate, and the proposed expansion of short-term, limited-duration plans. Fiedler argued that “the market will survive and will find a new equilibrium” because many enrollees in the ACA-compliant individual market are eligible for large subsidies that will make remaining in the market attractive.
Nevertheless, he concluded that repeal of the individual mandate and the expansion of short-term plans, will reduce the number of people covered, increase the number of people with lower-quality coverage, and reduce pooling of risk between healthier and sicker individuals. On the other hand, he argued that the Trump Administration’s decision to end cost-sharing reduction payments will have the unintended consequence of lowering premiums after subsidies for many enrollees and increasing federal spending.
Corlette: Short-term plans pose risks to consumers
A major topic for the panel discussion was the Trump Administration’s proposal to expand the definition of “short-term, limited duration” plans from a plan lasting less than 3 months (with no renewals permitted) to a plan lasting less than 12 months (with renewals permitted). Short-term plans are exempt from a broad range of federal regulatory requirements, including the ban on varying premiums based on health status and the ACA requirement to cover the so-called essential health benefits package.
Panelists noted that broader availability of short-term plans is likely to weaken the market for ACA-compliant plans since many healthier enrollees will migrate into the short-term market. Sabrina Corlette, a research professor at Georgetown University, argued that short-term plans pose significant risks not only to the market for ACA-compliant plans but also to consumers who buy them. These short-term plans are potentially harmful, she argued, because they “walk and talk a lot like traditional comprehensive health insurance” but many consumers will find themselves liable for “thousands of dollars of medical bills because these things simply don’t cover anything.”
Capretta: Recent policy changes are expanding state flexibility in beneficial ways
In discussing various policy changes implemented by the Trump Administration, James C. Capretta, a fellow at the American Enterprise Institute, noted that many of these policy changes have the effect of increasing state flexibility. He argued that state flexibility could help illuminate the path forward for federal policy. “Given the stalemate at the national level, maybe we need a two or three-year period where a lot of states try a couple of different things,” he said. “If some states want to re-impose the individual mandate they can do so. If they want to impose continuous coverage penalties they can do so. They can restrict which plans are sold on the insurance market,” he said.
Patterson: What is the next national goal for health policy?
Panelists discussed their views on next steps for federal policymakers. Kevin Patterson, CEO of Connect for Health Colorado, said that policymakers need “to think about what we are going to challenge ourselves to actually deal with.” Patterson noted that the Affordable Care Act had a national goal of improving access to care. “But what’s the next national goal? Is there one?,” Patterson asked. Patterson identified reducing the underlying cost of care as a potential priority. Patterson noted that the “big bad insurance company” often gets blamed for high premiums, “but a lot of what they have to do is just reflect the cost that they’re seeing in what the provider networks are charging.”
Geraghty: Increasing competition among providers can reduce the cost of care
Following on Patterson’s comment, Geraghty highlighted the importance of increasing competition among health care providers if the goal is to reduce costs. “We as a country have not looked at competition on the delivery side,” he said. Geraghty noted that there were particular challenges in many rural markets. “If you’re in a rural area and you’ve got one hospital and they bought up the physician groups around them, they now set the market and they set the price,” he explained. Geraghty argued that improvements in communications technology might make it possible to deliver more care remotely, which could facilitate increased competition in many markets with a small number of providers.
The ACA at Eight: Resilient but Still at Risk
It’s Obamacare’s birthday. After eight years of relentless pounding, the Affordable Care Act (ACA) is still the law of the land. Its resilience reflects the fundamental decency of the American people who — when faced with the reality of taking coverage away from millions of their neighbors — refused to let that happen. They filled town hall meetings, they flooded the corridors of Congress, and support for the law surged to its current 54 percent.
That is not to say that the law’s future is assured. As part of its recent tax reform legislation, Congress eliminated financial penalties for not having health insurance — the teeth of the so-called individual mandate. The Congressional Budget Office (CBO) predicts that this will raise health insurance premiums in individual private markets by an average of 10 percent, and 13 million Americans could lose their health insurance. If Congress fails to enact recent bipartisan market stabilization proposals, these numbers could go even higher.
The current administration is also using executive authority to weaken the law. The U.S. Department of Health and Human Services has encouraged states to impose a range of new restrictions on Medicaid recipients — work requirements, premiums, copays — that may reduce the number of poor and near-poor Americans who enroll in this program.
The administration has also proposed new rules that would allow health insurers to sell plans that evade the ACA’s standards regarding preexisting conditions and minimum benefits. For example, the administration would permit insurers to market short-term plans — coverage limited to a year in duration — without the requirement that they accept all comers, and with various restrictions on benefits. These cheaper, less generous plans would appeal to healthier individuals, who would then likely choose not to purchase the more expensive, comprehensive insurance sold in ACA marketplaces. Only sicker individuals would buy ACA plans, raising their costs and making them unaffordable to millions who have come to depend on them. The net effect is to add choices for healthy Americans, but reduce options for the sick.
Efforts to curtail the ACA will likely increase the number of Americans without insurance, now at a historic low of 14 percent of working-age adults, according to the Commonwealth Fund’s Affordable Care Act Tracking Survey. These efforts will also likely increase health disparities between states. A number of the restrictions sought by the administration will go into effect only if states embrace them. States must request waivers to limit Medicaid benefits. So far, only Republican-led states are doing so. Similarly, states have discretion about whether to permit the sale of short-term plans. Many blue states are considering banning or regulating them.
Despite these threats, however, fundamental elements of the ACA remain in effect. Federal financial assistance for purchase of health insurance in ACA marketplaces remains available for individuals with incomes below 400 percent of the federal poverty level. This is one reason why 11.8 million people had signed up for ACA plans through the marketplaces by the end of January. Federal support for states to expand Medicaid persists. Thirty-four states and the District of Columbia have done so, resulting in 15 million more beneficiaries of that program.
Recent legislative and executive restrictions on the ACA will not totally reverse these gains. Paradoxically, some states that refused previously to expand Medicaid may decide to do so now that they may be able to impose work requirements, premiums, and copays, and thus give expansion a conservative stamp. This could actually increase the total number of Americans with some Medicaid coverage.
In fact, the continuing struggle over the ACA fits a decades-old pattern of steady, if erratic, expansion of health insurance coverage in the United States. Since the creation of Medicare and Medicaid 53 years ago, the federal government has periodically extended insurance to new populations: the disabled, those with end-stage renal disease, children. The federal government also massively expanded Medicare benefits to cover drugs. Once provided, these benefits have proved politically difficult to peel back — in a recent poll, 92 percent of Americans said they felt all of us should have the right to health care.
What does this mean for the ACA? While it will not achieve all its supporters’ goals, it will survive, and provide a new foundation upon which Americans can build if they choose, as they have in the past, to help their vulnerable neighbors deal with the scourge of illness. To paraphrase Martin Luther King, one might even say that the arc of history is long, but it bends toward health coverage.
Cartoon – The Fourth Ape
Drug prices are still skyrocketing
https://www.axios.com/newsletters/axios-vitals-60130f85-58f2-499f-abf8-271cf0d1c225.html
The Trump administration — primarily the president himself — has talked a lot about cracking down on prescription drug prices. But the pharmaceutical industry hasn’t changed its ways since Trump took office: 20 drugs have seen price hikes of 200% or more since January 2017, my colleague Bob Herman reports this morning.
- The drugs to watch: High-cost, high-use prescriptions like Humira, Enbrel and Revlimid. AbbVie hiked the price of Humira, the highest-selling drug in the world, by 19% over the 14-month period, and Amgen did the same for Enbrel. Celgene raised the list price of Revlimid by 20%.
- The big one: SynerDerm, a prescription skin cream, had the largest price hike. Phlight Pharma, the maker of SynerDerm, raised the list price by 1,468% over the past 14 months.
- The runners-up: A total of 39 drugs saw price hikes of at least 100%, although many of them — like anti-venom extracts — are rarely used and don’t cost the health care system much overall.
The impact: These increases, which can be found in an analysis by Pharmacy Benefits Consultants, are in the drugs’ list prices, before rebates and discounts are applied. People with insurance don’t pay these full amounts, but price hikes still affect everyone.
- Copays and deductibles are often based on drugs’ list prices, and uninsured patients can find themselves on the hook for a drug’s entire list price.
HENRY KOTULA 