Tag Archives: High Deductible Health Plans

Healthcare Is The No. 1 Issue For Voters; A New Poll Reveals Which Healthcare Issue Matters Most

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https://www.forbes.com/sites/robertpearl/2018/08/13/midterms/#5b6ac3453667

Depending on which news outlet, politician or pundit you ask, American voters will soon participate in the most important midterm election “in many years,” “in our lifetime” or even “in our country’s history.”

The stakes of the November 2018 elections are high for many reasons, but no issue is more important to voters than healthcare. In fact, NBC News and The Wall Street Journal found that healthcare was the No. 1 issue in a poll of potential voters.

What’s curious about that survey, however, is that the pollsters didn’t ask the next, most-logical question.

What Healthcare Issue, Specifically, Matters Most To Voters?

To answer this question, I surveyed readers of my monthly newsletter. Will the opioid crisis sway voters at the polls? What about abortion rights? The price of drugs? The cost of insurance?

To understand the significance of these results, look closely at the top four:

  1. Prescription drug pricing (58%)
  2. Universal/single-payer coverage (57%)
  3. Medicare funding (50%)
  4. Medicaid funding (40%)

Notice a pattern here? All of these healthcare issues come down to one thing: money.

Healthcare Affordability: The New American Anxiety

Because the majority of my newsletter readers operate in the field of healthcare, they’re well informed about the industry’s macroeconomics. They understand healthcare consumes 18% of the gross domestic product (GDP) and that national healthcare spending now exceeds $3.4 trillion annually. The readers also know that Americans aren’t getting what they pay for. The United States has the lowest life expectancy and highest childhood mortality rate among the 11 wealthiest nations, according to the Commonwealth Fund Report. But these macroeconomic issues and global metrics are not what keeps healthcare professionals or their patients up at night.

Eight in 10 Americans live paycheck to paycheck. Most don’t have the savings to cover out-of-pocket expenses should they experience a serious or prolonged illness. In fact, half of U.S. adults say that one large medical bill would force them to borrow money. The reality is that a cancer diagnosis or an expensive, lifelong prescription could spell financial disaster for the majority of Americans. Today, 62% of bankruptcy filings are due to medical bills.

To understand how we’ve arrived at this healthcare affordability crisis, we need to examine the evolution of healthcare financing and accountability over the past decade.

The Recent History Of Healthcare’s Money Problems

Until the 21st century, the only Americans who worried about whether they could afford medical care were classified as poor or uninsured. Today, the middle class and insured are worried, too.

How we got here is a story of evolving policies, poor financial planning and, ultimately, buck passing.

A big part of the problem was the rate of healthcare cost inflation, which has averaged nearly twice the annual rate of GDP growth. But there are other contributing factors, as well.

Take the evolution of Medicare, for example, the federal insurance program for seniors. For most of the program’s history, the government reimbursed doctors and hospitals at (approximately) the same rate as commercial insurers. That started to change after a series of federal budget cuts (1997, 2011) and sequestration (2013) reduced provider payments. Today, Medicare reimburses only 90% of the costs its enrollees incur and commercial insurers are forced to make up the difference. As a result, businesses see their premiums rise each year, not only to offset the growth in their employee’s medical expenses, but also to compensate hospitals and physicians for the unreimbursed portion of the cost of caring for Medicare patients.

Combine two high-cost factors: general health care inflation and price constraints imposed by Medicare and what you get are insurance premiums rising much faster than business revenues.

To compensate, companies are shifting much of the added expense to their employees. The most effective way to do so: Raise deductibles. By increasing the maximum deductible annually, the company reduces the magnitude of its expenses the following year, at least until that limit is reached. A decade ago, only 5% of workers were enrolled in a high-deductible health plan. That number soared to 39.4% by 2016, and jumped again to 43.2% the following year.

High-deductible coverage holds individual patients and their families responsible for a major portion of annual healthcare costs, anywhere from $1,350 to $6,650 per person or $2,700 to $13,3000 per family. This exceeds what the average available savings for most American families and helps to explain the growing financial angst in this country.

And it’s not just employees under the age of 65 who are anxious. Medicare enrollees also fear that the cost of care will drain their savings. As drug prices continue to soar, Medicare enrollees are hitting what has been labeled “the donut hole,” which means that once the cost of their “Part D” prescriptions reaches a certain threshold, patients are on the hook for a significant part of the cost. Now, more and more seniors find themselves having to pay thousands of dollars a year for essential medications.

When it comes to paying for healthcare, the United States is an anxious nation in search of relief. The fear of not being able to afford out-of-pocket requirements is the reason so many voters have made healthcare their No. 1 priority as they head to the polls this November. And it’s why both parties are scrambling to deliver the right campaign message.

On Healthcare, Each Party Is A House Divided

In the last presidential election, the Democratic Party chose a traditional candidate, Hilary Clinton, whose views on healthcare were closer to the center than her leading challenger, Bernie Sanders. Two years later, the party is divided by those who believe that (a) the only way to regain control of Congress is by fronting centrist candidates who support and want to strengthen the Affordable Care Act as the best way to attract undecided and independent voters, and (b) those who will accept nothing less than a government-run single payer system: Medicare for all. The primary election of New York congressional candidate Alexandria Ocasio-Cortez, a Sanders supporter, over long-time incumbent Joseph Crowley, represents this growing rift within the party.

The Republicans also face two competing ideologies on healthcare. Since his election in 2016, President Donald Trump has sought to dismantle the ACA. In addition, he and his political allies want to shift control of Medicaid (the insurance program for low-income Americans) from the federal government to the states—a move that would lower healthcare spending while eroding coverage protection. There are others in the Republican Party who worry that shrinking Medicaid or undermining the health exchanges will come back to bite them. Most of them live and campaign in states where voters support the ACA.

Do The Parties Agree On Anything?

Regardless of party, everyone, from the president to the most fervent single-payer advocate, understands that voters are angry about the cost of their medications and the associated out-of-pocket expenses. And, not surprisingly, each party blames the other for our current situation. Last week, the president gave the Medicare program greater ability to reign in costs for medications administered in a physician’s office. In addition, Trump has promised a major announcement this week to achieve other reductions in drug costs. Of course, generous campaign contributions may dim the enthusiasm either party has for change once the voting is over.

Playing “What If” With Healthcare’s Future

If both chambers remain Republican controlled, we can expect further erosion of the ACA with more exceptions to coverage mandates and progressively less enforcement of its provisions. For Republicans, a loss of either the Senate (a long-shot) or the House (more likely), would slow this process.

But regardless of what happens in the midterms, no one should expect Congress to solve healthcare’s cost challenge soon. Instead, patient anxiety will continue to escalate for three reasons.

First, none of the espoused legislative options will do much to address the inefficiencies in the current delivery system. Therefore, prices will continue to rise and businesses will have little choice but to shift more of the cost on to their workers.

Second, the Fed will persist in limiting Medicare reimbursement to doctors and hospitals, further aggravating the economic problems of American businesses. whose premium rates will rise faster than overall healthcare inflation.

Finally, compromise will prove even more elusive since so many leading candidates represent the extremes of the political spectrum.

Politics, the economy and healthcare will all be deeply entangled this November and for years to come. I believe the safest path, relative to improving the nation’s health, is toward the center. Amending the more problematic parts of the ACA is better than either of the two extreme positions. If our nation progressively undermines the current coverage provisions, millions of Americans will see their access to care erode. And on the other end, a Medicare-for-all healthcare system will produce large increases in utilization and cost.

It’s anyone’s guess what will happen in three months. But, whatever the outcome, I can guarantee that two years from now healthcare will remain top-of-mind for voters.

 

 

Short-term health plans: A junk solution to a real problem

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https://theconversation.com/short-term-health-plans-a-junk-solution-to-a-real-problem-101447

Serious illnesses like cancer often are not covered by short-term health insurance policies.

 

After failing to overturn most of the Affordable Care Act in a very public fight, President Donald Trump has been steadily working behind the scenes to further destabilize former President Barack Obama’s signature achievement. A major component in this effort has been an activity called rule-making, the administrative implementation of statutes by federal agencies like the Department of Health and Human Services.

Most recently, citing excessive consumer costs, the Trump administration issued regulations to vastly expand the availability of short-term, limited duration insurance plans.

While the cost of health care is one of the overwhelming problems in the American health care system, short-term health plans do nothing to alter the underlying causes. Indeed, these plans may cause great harm to individual consumers while simultaneously threatening the viability of many states’ insurance markets. Having studied the U.S. health care market for years, here is why I think states can and should take quick action to protect consumers.

Comparing crab apples and oranges

Short-term, limited duration insurance plans, by definition, provide insurance coverage for a short, limited period. Since being regulated by the Health Insurance Portability Act of 1996 (HIPAA), this has meant for less than one year. Sold at least since the 1970s, they were offered as an alternative to major medical insurance intended for individuals with temporary and transitional insurance needs such as recent college graduates or those in between jobs.

However, after passage of the Affordable Care Act further concerns emerged over the misuse and mismarketing of these kinds of plans. As a result, the Obama administration restricted their duration to three months.

In addition to being shorter in duration, these policies’ benefits tend to also be much skimpier than for those plans sold on the Affordable Care Act’s marketplaces. For example, plans often do not cover crucial services such as prescription drugs, maternity care, or major emergencies like cancer. Equally problematic, even those benefits covered come with high deductibles, strict limitations, and annual and lifetime coverage limits.

It is important to note that short-term health plans are also not subject to any of the consumer protections established by the Affordable Care Act. This means, for example, that insurers can set premiums, or even refuse to sell to an individual, based on a person’s medical history. Moreover, consumers must update their health status every time they seek to purchase coverage.

Crucially, short-term health plans have shown to be particularly discriminatory against women. For one, women are charged higher premiums. Moreover, they are likely to be disproportionately affected by medical underwriting for pre-existing conditions like domestic and sexual abuse and pre- and postnatal treatment.

Because plans are so limited in benefits, and because insurers are able to deny coverage to sicker individuals, short-term health plans come with much lower premiums than standard insurance plans with their more expansive benefits and vastly superior consumer protections. Indeed on average, premiums amount to only one-fourth of ACA-compliant plans.

Too good to be true

While short-term insurance plans are more affordable in terms of premiums, they come with a slew of problems for consumers.

For one, consumers have a tremendously hard time understanding the American health care system and health insurance. Predatory insurance companies have been known to take advantage of this shortcoming by camouflaging covered benefits, something the Affordable Care Act sought to ameliorate. Mis- and underinformed consumers often find themselves surprised when they actually try to use their insurance.

Even for those who are aware of the limitations, problems may arise. Unable to predict major medical emergencies, consumers may be confronted with tens of thousands of dollars of medical bills if they fall sick or face injury.

Moreover, insurers are also able to rescind policies after major medical expenses have been incurred if consumers failed to fully disclose any underlying health conditions. This even applies to health conditions that consumers had not been aware of prior to getting sick.

While some may argue that this is the fault of the those who purchase short-term insurance, it causes problems for all of us.

For one, these individuals may refuse to seek care. This could result in severe consequence for their and their family’s well-being and ability to earn a living.

At the same time, medical providers will shift the costs of the resulting bad debts to other individuals with insurance or the general taxpayer.

Bad for the individual, worse for all of us

Short-term insurance plans are perhaps even more problematic for the health of the overall insurance market than they are for individual consumers.

With a very short implementation time frame, insurance regulators in the states only have until October to prepare for the potentially significant disruptions to their markets. This leaves little time for analysis and regulatory preparation.

Yet long-term consequences are even more concerning. Healthier and younger consumers are naturally drawn to the low premiums offered by these plans. At the same time, older and sicker individuals will value the comprehensive benefits and protections offered by the Affordable Care Act. The result is the continuing segregation of insurance markets and risk pools into a cheaper, healthier one and a sicker, more expensive one. As premiums rise in the latter, its healthiest individuals will begin to drop their coverage, leading to ever more premium increases and larger coverage losses. If left unchecked, eventually the entire insurance market may collapse in this process.

This could be particularly problematic in states with relatively small insurance markets like Wyoming or West Virginia where even one truly sick individual can drive up premiums tremendously.

States have options

The expansion of short-term health plans is one action by the Trump administration that states can counteract relatively simply. Currently, states serve as the primary regulator of their insurance markets. As such, they have the power to make decisions about what insurance products can be sold within their boundaries.

Action can be taken by insurance regulators and legislature to create relatively simple solutions. While the vast majority of states have failed to create consumer and market protections, a small number of states have done just that.

New York, for example, has banned the sale of these plans.

Others, like Maryland, have strictly limited their sale and renewability.

Treating the symptoms, not the cause

Many Americans struggle to access insurance and services despite the Affordable Care Act. While the Affordable Care Act has unquestionably improved access to insurance for Americans, cost control and affordability are truly its Achilles heels. Indeed, some Americans lost their limited benefits, lower cost plans when the Affordable Care Act did not recognize them as viable coverage.

The Trump administration has rightfully highlighted to high costs of the American health care system. However, offering consumers the opportunity to purchase bare-bones insurance at lower costs does nothing to solve America’s health care cost problems.

If access to insurance is truly a concern for the Trump administration, I believe it should seek to convince the remaining hold-outs to expand their Medicaid programs. Also, I think discontinuing its actions to destabilize insurance markets would also go a long way to reducing premiums.

Yet when it comes to altering the underlying cost calculus, there are no simple solutions. Administrative costs are too high. Medical quality is too low. Resources constantly get wasted. Consumers could do more to be healthier.

Ultimately, I see it coming down to one crucial problem: Providers, pharmaceutical companies, device makers and insurers are making too much money. And it is these vested interests that make structural reform of the U.S. health care system a truly herculean endeavor.

But unless Americans and policymakers of both parties are willing to address this root cause, any reform effort amounts to nothing more than rearranging the deck chairs on the Titanic.

 

2018 Mid-Term Healthcare Issues

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https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2018/08/15/the-health-202-senate-democrats-stay-focused-on-health-care-even-during-short-august-recess/5b72f0901b326b4f9e90a72c/?utm_term=.2403975557c2

Senate Democrats used their truncated August recess to talk to their constituents about one key issue: Health care. 

And though they are returning to Washington tonight, they have no plans to stop talking about it. 

That’s a remarkable turnaround for Democrats who have been on the defensive about health care for the better part of a decade. Obamacare played a major role in their loss of control of the House in the first midterm election of President Obama’s presidency in 2010. But now, they’re hoping to take back the House and retain their seats in the Senate largely by running on the merits of the Affordable Care Act.

Over their 10-day mini break, Sen. Joe Donnelly (D-Ind.) held a roundtable discussion with voters about health care, as did Sen. Joe Manchin (D-W.Va.), who held his third roundtable this year focused specifically on pre-existing conditions. And Sen. Claire McCaskill (D-Mo.) also met with voters with pre-existing conditions on Tuesday.

“Cutting people off from insurance and making it harder for people to get insurance, we’re all still gonna pay the bill because in America we’re not going to stop people at the door at the emergency room and I’m sorry you don’t have health insurance, we’re gonna let you die,” she said, according to Missourinet.

In Nevada, Democratic Rep. Jacky Rosen, who is hoping to unseat GOP Sen. Dean Heller, also held a public meeting with voters with pre-existing conditions.  Sen. Bob Casey (D-Pa.) met with health care providers and patients to talk pre-existing conditions, and Rep. Kyrsten Sinema (D-Ariz.), who is vying for the open Senate seat there, also met with constituent groups to discuss health care.

“It doesn’t matter which community you are in, health care is the number-one issue that Arizonans are talking about,” Sinema told the Arizona Daily Star. “It is not just Arizonans who don’t have health-care coverage, many of those who are expressing concerns and fear are Arizonans who do have coverage but cannot afford it.”

As campaign cycles go, it’s still early in this one. And the deluge of ads will really heat up come fall. Republicans still see an opening to talk about rising costs of health care and President Trump continues to declare that the ACA is dead. But unlike years past when the GOP could run on an anti-Obamacare message, this year the party is more likely to focus on other issues like tax cuts and job creation. 

It’s harder for GOP candidates to make their case that health care policy is failing in the first election where they are in control of both houses in Congress and the White House. And recent scuttlebutt that Republicans would consider another repeal effort if they held Congress may not be helpful this cycle.

And so Democrats, if August activity is the precursor to the fall campaign, are going all in on health care. 

Earlier this month, the New York Times’ Margot Sanger-Katz had a great anecdote from an event with McCaskill. The senator, who may be in the toughest fight of her career, asked voters to stand if they have a pre-existing condition. There were reportedly few people left in their seats.

The Democrats and the groups who support them have homed in specifically on the warning that if the ACA is struck down, people with pre-existing conditions would lose protection. Notably, McCaskill and Manchin, two of the Democrats’ most vulnerable members, are running against state attorneys general who joined a lawsuit arguing the ACA should be deemed unconstitutional. If the law were struck down, it would take with it protections for people with past and current health conditions.

Before the Senate left, Minority Leader Chuck Schumer (N.Y.)  pledged to keep health care front and center this month in Congress, which is in keeping with Democrats’ election strategy this year.  Schumer’s office declined to show its hand, but on the floor he detailed exactly what the Democrats would be pushing for, including votes to protect people with pre-existing conditions and a Medicare buy-in program. They’re unlikely to get those votes, but that’s all part of the game plan to keep the attention on health care.

“The number one thing Americans want is health care, and we Democrats will spend August recess focusing on that issue, and forcing Republicans to cast votes or deny votes on those important issues,” Schumer said. “It’s a great opportunity, not just for Democrats, not just for Republicans, but for America. We are going to do it.”

The first television ad the campaign arm for the Democrats released in 2017 was about health care. It showed a man selling his car and a woman pawning her engagement ring. Then it cuts to them sitting at the hospital bedside of a sick child.

Most of the heavy ad buys are still to come, but an independent analysis of political ads so far this cycle found pro-Democrat ads have been overwhelmingly about health care.  According to Kantar Media/CMAG data by the Wesleyan Media Project, “An astounding 63 percent of pro-Democratic ads for U.S. House discuss healthcare, and 16 percent contain an explicit statement about being in favor of the Affordable Care Act. U.S. Senate contests are less likely to feature health care, but it is still the top issue, appearing in over a quarter (28 percent) of all ad airings.”

Take Rosen, the congresswoman running against Heller. She has a television ad that shows her talking to voters about their anxieties over the ACA being repealed. She says in the ad that ACA has “real problems,” but repealing it isn’t the answer. 

It’s a strategy divergent from previous years when Democrats were defensive of their support for Obamacare. They’d make macro arguments about the millions of people who would lose coverage without it. But now, with the focus on pre-existing conditions, they’ve found a way to make it personal and accessible for voters. 

“What we’re seeing on the trail is that health care remaining the defining issue of the election and voters are aware and concerned that GOP policies will increase their costs and jeopardize their coverage and voters are preparing to hold GOP candidates accountable on this issue,” said David Bergstein, a spokesman for the Democratic Senatorial Campaign Committee.

When asked, most Republicans will say they support keeping protections for pre-existing conditions. For example, when asked, McCaskill’s opponent, Missouri Attorney General Josh Hawley, said he thinks“insurance companies should be forced to cover pre-existing conditions.”

For his part, Hawley’s first television ad of the campaign was about his work as a clerk on the Supreme Court and accused McCaskill of supporting “liberal activist judges.”

In a press release in response to the ad, McCaskill’s campaign said, “Josh Hawley is suing to strip protections for nearly 2.5 million Missourians with pre-existing conditions.”

 

 

 

Deductibles: They’re not going down

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http://files.kff.org/attachment/Report-Employer-Health-Benefits-Annual-Survey-2017?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosvitals&stream=top-stories

 

Data: Kaiser Family Foundation; Chart: Chris Canipe/Axios

The average insurance deductible keeps going up, as does the number of people covered by high-deductible plans. And only about half of those people get help from their employers to save up for potential medical bills, according to a new study in Health Affairs.

The details:

  • In 2006, just 11.4% of private-sector workers had a high-deductible plan. In 2016, that number was up to 46.5%.
  • Roughly half of those workers also get an employer contribution to a health savings account or health reimbursement arrangement.
  • High-deductible plans are most popular with smaller companies, where employer contributions to an HSA are least popular.
  • At the smallest companies, about two-thirds of workers didn’t have the option of a plan without a high deductible, and don’t get an employer contribution to an HSA or HRA.

Why it matters: Higher deductibles don’t just require people to pay more out of pocket each year. They also expose those consumers to the complexities of the health care system, including the way prices are set.

  • People with high deductibles are more likely to have to pay the full sticker price of a prescription drug, or for a hospital procedure.

 

How drug companies are beating Trump at his own game

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https://www.politico.com/story/2018/08/03/trump-drug-prices-companies-721145

People pass the Pfizer headquarters in New York. |Getty Images

 

Recent price freezes and rollbacks are symbolic measures with little lasting impact.

A July tweet from President Donald Trump sent panic through the C-suites of some of the world’s biggest drug companies, prompting Pfizer and nine other companies to roll back or freeze prices.

But there’s less to those announcements than meets the eye. The gestures turned out to be largely symbolic — efforts to beat Trump at his own game by giving him headlines he wants without making substantive changes in how they do business.

The token concessions are “a calculated risk,” said one drug lobbyist. “Take these nothing-burger steps and give the administration things they can take credit for.”

Of the few companies that actually cut prices, for instance, most targeted old products that no longer produce much revenue — such as Merck’s 60 percent discount to a hepatitis C medicine that had no U.S. revenues in the first quarter.

Others volunteered to halt price increases for six months — in some cases, just weeks after announcing what is normally their last price hike for the year.

“A lot of this shit is meaningless to satisfy Trump,” said another drug lobbyist.

The industry’s deft response to Trump’s tweet shaming has also become a test of whether his administration is serious about following up with an aggressive crackdown on the companies or will simply declare victory based on token measures and move on.

“I think right now it’s a lot of noise, not a lot of substantial impact to the companies,” said Les Funtleyder, a health care portfolio manager at E Squared Asset Management, which owns shares in Pfizer. The prospect for meaningful change “is out there … but that will take motivation on the part of regulators and policymakers.”

Analysts are in broad agreement that the spate of recent concessions won’t hurt bottom lines, or rein in drug prices beyond this six-month period, because many companies already increased prices this year — in some cases, just weeks before publicly pledging to freeze them for the rest of 2018.

“There’s the glass-half-full and glass-half-empty interpretation,” said Walid Gellad, director of the Center for Pharmaceutical Policy and Prescribing at the University of Pittsburgh. “Glass half full says we have never before seen pharma promise not to raise prices anymore. So this is a step forward — including for patients. Glass half empty is that these are token measures — either on drugs few people use, or drugs that just had their price raised, and that prices will just go up next year.”

Either way, Gellad said, “this is not the kind of structural change we want in the market so that prices go down.”

Drug prices are a fixation for Trump, who rants about them in conversations with aides and advisers, according to people close to the president. He sees the issue as a political winner, especially among his conservative — and largely older — base, which relies heavily on prescription drugs. And after facing huge hurdles moving his legislative priorities through Congress, he sees this as something he can win on by using his executive authority.

That has put huge pressure on Health and Human Services Secretary Alex Azar, a former top official of Eli Lilly and Co.

“They talk three times a week, and they never have a conversation where drug pricing isn’t a topic,” said one person briefed on the conversations, adding that Trump has also interrupted Cabinet meetings to encourage Azar to brief the group on the latest developments.

But even as Azar implements his 44-page blueprint aimed at lowering prices, Trump has grown impatient with the glacial pace of rulemaking and arcane details of drug policy.

His outlet is Twitter, where he can marshal the rage of his millions of followers in an instant. White House aides say he sees his Pfizer tweet as a warning shot to other drug companies — part of a public “shaming” campaign designed to pressure companies to take voluntary steps to lower prices.

That strategy diverges sharply from what Azar is saying publicly — raising doubts about how serious the administration is about cracking down on drugmakers.

The HHS secretary’s rhetoric often targets pharmacy benefits managers — the obscure middlemen who manage the drug side of patients’ health insurance benefits — not drug companies. And targeting the middlemen is a play directly out of pharma’s strategy book — drug companies have long sought to pin patients’ frustration with rising costs on PBMs. HHS has also signaled it wants to overhaul a drug discount program for hospitals that could put money back in pharma’s pocket.

Pfizer CEO Ian Read himself praised the president’s blueprint on the company’s recent second-quarter earnings call, just a few weeks after Trump’s Pfizer tweet.

“I don’t think the administration is gunning for [pharma],” said Ronny Gal, a financial analyst at Sanford Bernstein. Everything they are doing right now is “scratching around the problem,” he said.

“You can tell by the way the stock has performed that investors aren’t too concerned,” Funtleyder said. “They figure, ‘OK, the pharma companies waved the white flag for now, so they’re out of the cross hairs.‘”

Meanwhile, HHS and drug industry officials have worked closely to show Trump they are getting results, administration and pharmaceutical industry sources tell POLITICO.

In private meetings with drug officials, HHS officials ask what steps they’ve taken that they might relay to Trump to keep the president satisfied, said drug company sources.

“They’re also like, ‘Hey, don’t be stupid. If you’re going to do something you feel like we can mutually take some credit for, let us know. … If you can get a good tweet out of it, don’t be an idiot. Let us know [ahead of time],’” said one person familiar with the conversations.

“They’ve said: ‘What would it take for you to lower prices?’” said another top drug industry official.

“There is a real fear that Trump only understands things very simplistically,” said a lobbyist for several drug companies. “So they want to keep tossing treats for him or he will go after blunt instruments,” like government drug price negotiations — steps neither the conservative leadership at HHS nor the drug industry want.

Observers both inside HHS and outside the administration see Azar’s drug pricing team as a buffer for the drug industry.

“To be candid, the secretary is pro-patient, pro-innovation and pro-competition and, quite frankly, really standing in between the industry and some faster ways to lower prices that some would say are not pro-competition,” said HHS’ John O’Brien, a senior adviser to Azar, at a drug cost event one day after Trump’s tweet attacking Pfizer.

Azar prefers the industry and HHS work to make change together, rather than it being adversarial, according to people familiar with HHS’ strategy.

He publicly touts industry price freezes and reversals “in part to show Trump they’re making progress, but also to show the industry that you get recognized for playing ball,” said a person familiar with the discussions.

The White House, meanwhile, was thrilled about the industry’s recent price freezes, even as officials acknowledged the companies’ announcements are only a first step — and promised what one official characterized as a “deluge” of drug price-related regulatory action in the coming months.

“Nothing about what they do or don’t do is going to really turn the tide in a major, major way on a voluntary basis,” the official said of the drug companies’ actions, promising that the administration will take aggressive action.

In the meantime, the White House isn’t ruling out more Twitter shaming.

“You’ll see continuing of the tweeting and announcing different actors doing good or bad things in the market,” the official said.

That will get particularly tricky for the industry come January, when drugmakers would typically take their biggest price increases of the coming year — and when their public concessions sunset.

“They can live with the changes that were made — but they can’t live with not raising prices forever,” Gal said. “It’s a noose they put their head into. In January, we will see what happens with that noose. Does it tighten or not?”

 

California Employer Health Benefits: Workers Shoulder More Costs

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https://www.chcf.org/publication/california-employer-health-benefits-workers-shoulder-more-costs/

Image result for California Employer Health Benefits: Workers Shoulder More Costs

From 2000 to 2017, the percentage of employers offering health insurance coverage has declined from 69% to 56%. At the same time, workers are shouldering more of the costs for their health care with increasing premiums and higher deductibles and copays.

California Employer Health Benefits: Workers Shoulder More Costs presents data compiled from the 2017 California Employer Health Benefits Survey.

Key findings include:

  • From 2016 to 2017, health insurance premiums for family coverage increased by 4.6%, slightly higher than the 3.0% inflation rate.
  • Average monthly premiums, including the employer portion, were significantly higher in California than the national average. In 2017, the average premium was $604 for single coverage and $1,643 for family coverage.
  • California workers paid an average of 17% of the total premium for single coverage and 27% for family coverage.
  • One in 4 workers had an annual deductible of at least $1,000 for single coverage. Large deductibles were more common among workers in small firms (3 to 199 workers) than larger firms. Nearly 60% of workers had no deductible.
  • In 2017, 25% of California firms reported increasing cost sharing for workers in the past year, and 37% reported that they are very or somewhat likely to increase their workers’ share of premiums in the next year.

The full report, all of the charts found in the report, and the data files are available under Related Materials. These materials are part of CHCF’s California Health Care Almanac, an online clearinghouse for key data and analyses describing the state’s health care landscape.

The California Employer Health Benefits Survey is a joint product of CHCF and the National Opinion Research Center (NORC) at the University of Chicago. The survey was designed and analyzed by researchers at NORC and administered by National Research.