Tag Archives: health care

“For too long, Americans paid for health insurance that did not recognize that treatment for mental health and substance use disorders is as essential as other medical treatment,” the White House stated in a Fact Sheet describing steps the Federal Parity Task Force is taking to strengthen indusrance coverage for mental health and substance use disorders. “Untreated mental health and substance use disorders can be debilitating and life-threatening. These consequences are apparent in the prescription opioid and heroin epidemic, as well as the troubling rates of suicide and severe mental illness in this country.

“One of the many important provisions of the Affordable Care Act and the Mental Health Parity and Addiction Equity Act is to ensure that health insurance plans treat mental health and substance use disorders the same way that they treat other health conditions. In March of this year, President Obama established the Mental Health and Substance Use Disorder Parity Task Force and charged Federal Departments and Agencies to work together to ensure that Americans are benefiting from the mental health and substance use disorder parity protections under the law. Parity aims to eliminate restrictions on mental health and substance use coverage – like annual visit limits, higher copayments, or different rules on how care is managed such as frequent pre-authorization requirements or medical necessity reviews – if comparable restrictions are not placed on medical and surgical benefits.”

In its final report, the Task Force announced a series of actions and recommendations to help ensure better implementation of parity; to help consumers, providers, and plans understand how parity works; and to ensure appropriate oversight and enforcement of parity protections.

These steps are based on input the Task Force received through a series of listening sessions between March and October held with consumers, providers, employers, health plans, and State regulators, and through the more than 1,100 public comments the Task Force received from individuals with mental health and substance use disorders, families, their providers, advocates, and other stakeholders.

“These recommendations are subject to future budget and policy deliberation,” The White House noted. “Together, today’s steps build on the ongoing work of the Administration to make the treatment of mental health and substance use disorders a priority. The Affordable Care Act ended insurance discrimination based on pre-existing conditions, including mental health and substance use disorders; required coverage of mental health and substance use disorder services in non-grandfathered plans in the individual and small group insurance markets; ensured that recommended preventive screenings, including for depression and alcohol misuse, are available with no co-pays; and expanded Medicaid to millions of additional Americans, significantly improving coverage for mental health care and substance use disorder treatment. In addition, the Administration has issued final regulations providing parity protections to individuals covered through the employer and individual insurance markets, people covered through Medicaid managed care organizations and the Children’s Health Insurance Program, and service members and their families covered through TRICARE.

“Through these steps, the country has made significant progress in expanding mental health and substance use disorder coverage and parity protections for millions of Americans. The Task Force report focuses on parity-related actions and recommendations and does not include the provisions in the President’s Budget that would further expand access to care, including new investments in treatment capacity. The actions and recommendations announced today will continue to advance the Administration’s progress on parity implementation.”

The full report is available here: http://www.hhs.gov/parity

Here are the actions announced by the Task Force:

· The Centers for Medicare & Medicaid Services (CMS) is awarding $9.3 million to States to help enforce parity protections. CMS funding will help State insurance regulators work to ensure issuer compliance with the mental health and substance use disorder parity protections.

· The Department of Health and Human Services (HHS), in partnership with the Department of Labor (DOL) and other Task Force agencies, is releasing the beta version of a new parity website to help consumers find the appropriate Federal or State agency to assist with their parity complaints, appeals, and other actions. The Task Force received many comments about the challenges consumers face in identifying the appropriate agency that regulates their insurance coverage. The beta site is being released today for public comment. In the future, the Task Force Departments intend to work together to build out additional functionality on the website related to complaint and data tracking.

· The Substance Abuse and Mental Health Services Administration (SAMHSA) and DOL are releasing a Consumer Guide to Disclosure Rights: Making the Most of Your Mental Health and Substance Use Disorder Benefits to help consumers, their representatives, and providers understand what type of information to ask for when inquiring about a plan’s compliance with parity and to explain the various Federal disclosure laws that also require disclosure of information related to parity. The Guide includes 11 scenarios, each with specific suggestions for information consumers have a right to that can help, as well as timing requirements for plans and issuers providing these documents.

· DOL is announcing that it will release annual data on closed Federal parity investigations and will report on the findings, including the violations cited to ensure parity compliance and inform future policymaking efforts. This effort builds on the 1,515 investigations related to the Mental Health Parity and Addiction Equity Act and 171 violations cited by DOL since October of 2010.

· To ensure parity compliance in plans required to offer essential health benefits, CMS has added Mental Health Parity and Addiction Equity Act compliance to its review of plans subject to the essential health benefits requirement under the Affordable Care Act, and it expects State regulators to do so as well.

· DOL, HHS, and the Department of Treasury (Treasury) are issuing guidance on parity and opioid use disorder treatment to address specific questions the Departments have received related to issues such as the application of parity to opioid treatment access and coverage of court-ordered treatment.

· HHS, DOL and Treasury are soliciting feedback on how the disclosure document request process can be improved (input is being sought through the FAQ process), while continuing to ensure consumers’ rights to access all appropriate information and documentation. The request solicits input on the option of developing model forms for parity-related disclosure requests.

· SAMHSA is announcing that it will host two State Policy Academies on Parity Implementation for State Officials in Fiscal Year 2017, including one focused on the commercial market and one on parity in Medicaid and the Children’s Health Insurance Program. These policy academies will bring together national experts to provide technical assistance to teams of State officials on strategies to advance parity compliance and lessons learned from other States’ implementation efforts.

· CMS will undertake a review of mental health and substance use disorder benefits in Medicare Advantage plans and identify any necessary improvements to advance parity protections.

· DOL, HHS, and Treasury are issuing a Parity Compliance Assistance Materials Index. The Departments have issued a total of 44 Frequently Asked Questions (FAQs) over the past six years related to parity, generally as part of larger guidance documents, as well as other parity materials. Several commenters suggested to the Task Force that putting all the parity-related FAQs and guidance together in one place would make the information easier to find and use for States, plans consumers, and other stakeholders.

In addition, the Task Force made the following recommendations:

• Create a one-stop consumer web portal to help consumers navigate parity, which will build out the functionality of the beta parity website released today. The Task Force recommends that the website should help consumers solve coverage issues, file a complaint, or submit an appeal, and also be used to better inform parity oversight and enforcement efforts.

• Increase Federal agencies’ capacity to audit health plans for parity compliance. The Task Force recommends that agencies’ future budgets include funding to expand audit capacity. Given current resources, Federal parity enforcement efforts to date have generally focused on investigating consumer, provider and other parity complaints. Agencies’ capacity to expand enforcement activities, including conducting random audits, is limited by their staffing resources.

• Undertake a detailed review of the non-quantitative treatment limits applicable to substance use disorder benefits in the Federal Employees Health Benefits (FEHB) Program. The Task Force received comments suggesting that non-quantitative treatment limits in FEHB plans may need examination and modification to ensure full compliance, as well as comments suggesting that consistent definitions of terms relating to residential treatment would provide greater transparency for consumers. The U.S. Office of Personnel Management has agreed to conduct this review over the coming year, and take corrective action as indicated by the findings.

• Allow the Department of Labor to assess civil monetary penalties for parity violations. Civil monetary penalty authority would lead to more meaningful penalties for non-compliance with parity. The Task Force recommends that Congress provide the Department of Labor with this authority.

• Develop examples of parity compliance best practices and of potential warning signs of non-compliance. Building on the 2016 DOL/HHS “Warning Signs” document identifying non-quantitative treatment limitations that require additional analysis to determine if they are in compliance with parity, the Task Force recommends a Warning Signs 2.0 document and encourages the inclusion of network adequacy issues in the document. The Task Force also recommends developing further examples of parity compliance best practices to illustrate appropriate application of non-quantitative treatment limitations that are comparable between mental health/substance use disorder benefits and medical/surgical benefits.

• Provide Federal support for State efforts to enforce parity through trainings, resources, and new implementation tools, including model compliance templates. The Task Force recommends continued Federal efforts to provide training and other resources to States to support compliance efforts including partnerships between State mental health/substance use, Medicaid, and State insurance agencies. Further, the Task Force recommends that Federal regulators work with the National Association of Insurance Commissioners and the States to develop a standardized template that States might use to help assess parity compliance. The Task Force also encourages Federal regulators, the National Association of Insurance Commissioners, and other stakeholders to consider a joint effort to develop a model prior authorization form and other model forms.

• Provide simplified disclosure tools to provide consistent information for consumers, plans and issuers. To facilitate disclosure, the Task Force recommends that, in coordination with the National Association of Insurance Commissioners, templates and other sample standardized tools be developed to improve consumer access to plan information.

• Expand consumer education about parity protections. The Task Force recommends continuing and expanding the work to educate consumers about parity and partnering with consumer groups to increase consumer awareness and understanding of parity protections.

• Clarify that health plan disclosure requirements include medical and surgical benefits. The Task Force heard from commenters that it can be challenging to ensure parity compliance when information on medical and surgical benefits is not readily available to allow for comparison to mental health and substance use disorder benefits. Disclosure of the relevant information used to apply coverage limitations to medical and surgical services is currently required for plans covered under the Employee Retirement Income Security Act (ERISA). The Task Force recommends that Congress extend this requirement to non-ERISA plans.

• Implement the Medicaid and Children’s Health Insurance Program (CHIP) parity final rule in a robust manner. The Task Force recommends that implementation include the development of a parity analysis toolkit to help States assess compliance with the final rules on parity for Medicaid managed care organizations and CHIP programs. The toolkit will review key considerations for defining and classifying mental health and substance use disorder benefits (including intermediate and long term supports and services), conducting claims-based analyses for quantitative treatment limits, identifying and analyzing non-quantitative treatment limits, and considerations for Alternative Benefit Plans and CHIP.

• Expand access to mental health and substance use disorder services in TRICARE. The Task Force recommends the Department of Defense’s continued implementation of the TRICARE final rule on mental health and substance use disorders and parity through contract modifications and DOD’s monitoring of access to mental health and substance use disorder care to ensure parity with medical/surgical care.

• Eliminate the lifetime day limit on Medicare Part A treatment in psychiatric hospitals. In Medicare Part A (hospital coverage), there is a 190-day lifetime limit on inpatient treatment in psychiatric hospitals while there is no such limit on inpatient medical/surgical hospital treatment. The Task Force recommends that Congress eliminate the psychiatric hospital lifetime day limit, consistent with the President’s 2017 budget request.

• Update guidance to address the applicability of parity to opioid use disorder services. The Task Force recommends issuing guidance clarifying the application of parity to opioid use disorder treatment benefits in response to specific scenarios associated with these benefits raised by consumers and other stakeholders and updating this guidance regularly, as warranted.

• Eliminate the parity opt-out process for self-funded non-Federal governmental plans. Currently, self-funded non-Federal governmental plans have the ability to elect to not comply with certain Federal provisions including the Mental Health Parity and Addiction Equity Act, which deprives thousands of employees of State and local governments of the mental health and substance use disorder parity protections. The Task Force recommends that Congress eliminate the ability of these plans to opt out of these protections.

Health Care, Presidential Campaign 2016, Presidential Politics

Dueling Candidates on Health Care: Hillary Clinton Would Improve Upon Obamacare, Donald Trump Would Repeal, Restore Control to Insurance Companies

October 14, 2016 krubin

Donald Trump and Hillary Clinton, during presidential debate, have very different health care proposals © 2016 Karen Rubin/news-photos-features.com

Before the Affordable Care Act (ACA, better known as Obamacare), more than 50 million Americans were without any health insurance and 20,000 people were losing their health insurance each month as the Bush Great Recession hemorrhaged 850,000 jobs a month. Though employers for more than a decade have been cutting back on health benefits (making it a Hobson’s choice to leave a terrible job or an abusive marriage), 170 million people get their insurance through their employment, and insurance companies were raising premiums annually at rates five times the rate of inflation, refusing to provide insurance based on pre-existing conditions, charging women higher rates (because they have babies, don’t you know), arbitrarily denying services, capping lifetime claims, throwing people off insurance, and pocketing 25-30% of the premium, with only 70-75% going to patient care.

The Affordable Care Act, designed to make health insurance accessible to everyone, made improvements that have benefited everyone (as Hillary said), but meant the difference between life and death for the 50 million who could not afford health care at all. But to get it passed Obama had to make compromises, including giving up a public option. Then, chiefly Republican-dominated states rejected ACA, casting millions of their residents into a limbo where they could not qualify for the federally-provided exchange and didn’t have access through an employer.

Significantly, ACA (Obamacare) was a Hail Mary to get universal access to health care, with some benefits in terms of containing health care costs. But the next round of health care reform would need to address costs. Here, in the words of their own campaigns, are the candidates’ health plans – in essence, Donald Trump pledges to repeal Obamacare and replace it by returning to “market” (that is, for-profit insurance companies) control, while Hillary Clinton is vowing to make necessary improvements to Obamacare to continue the goal of universal health care, correcting the inequities between states which refused Obamacare and possibly with a public option – Karen Rubin, News & Photo Features.

Trump: Obamacare is a Disaster and Needs to be Repealed

“Obamacare Is A Disaster. You Know It We All Know It.”

During the second presidential debate, the question was asked, “What will you do to bring down the cost of health care? This is the rambling, nonsensical reply to the question, and the Trump campaign is so proud of it, they emailed it out:

TRUMP: “It is such a great question, and it’s maybe the question I get almost more than anything else. Outside of defense. Obamacare is a disaster. You know it we all know it. It is going up at numbers that nobody has ever seen worldwide. No One has ever seen numbers like this for healthcare. It is only getting worse. In seventeen, implodes by itself. Their methods of fixing it is to go and ask Congress for more money. More and more money. We right now have almost twenty trillion dollars in debt. Obama care with mother work. It is very bad, very bad health insurance. Far too expensive, and not only expensive for the person that has it, unbelievably expensive for our country. It’s got to be one of the biggest line items very shortly. We have to repeal it, and replace it with something absolutely much less expensive. And something that works. Where your plan can actually be tailored. We have to get rid of the lines around the state, and official lines. Where we stop insurance companies from coming in and competing because they wanted President Obama and whoever is working on it. They want to leave those lines because that gives the insurance companies, essentially, monopolies. We want competition. You will have the finest healthcare plan there is, she wants to go to a single-payer pan. Which would be a disaster. Somewhat similar to Canada. And if you haven’t noticed the Kitty Indians, when they need a big operations they come into the United States in many cases. Because they are system is so slow, it is catastrophic in certain ways. But she wants to go to single-payer. Which means the government basically rules everything. Hillary Clinton has been after this for years. Obamacare was the first step. Obamacare is a total disaster. And not only are your rates going up by numbers that no one has ever believed, but your deductibles are going up. So that unless you get hit by a truck, you are never going to be able to use it. It is a disastrous plan and it has to be repealed.” (Click To Watch)

Clinton’s Plan To Improve Our Health Care And Build On The Affordable Care Act

“Hillary Clinton will defend and expand on the progress made under Obama Administration toward universal coverage through the Affordable Care Act. The fact is, Hillary has never given up on the fight for universal coverage—and she won’t stop now. As First Lady, she refused to give up when the insurance industry and special interests attacked her and defeated healthcare reform. Instead, she worked with Republicans and Democrats to help create and implement the Children’s Health Insurance Program, which now provides health coverage to more than 8 million children,” Hillary for America campaign stated.

Hillary Clinton, Democratic candidate for President, advocates improving upon Obamacare toward the goal of universal health care © 2016 Karen Rubin/news-photos-features.com

As president, Hillary will build on the Affordable Care Act to expand coverage for millions of Americans.

She will lower-out-of-pocket expenses for consumers purchasing health insurance on the Obamacare exchanges. Hillary believes that in order to expand coverage for families, we need to reduce the cost of purchasing health insurance on the Affordable Care Act exchanges. Her plan will provide enhanced relief for people on the exchanges, and provide a tax credit of up to $5,000 per family to offset a portion of excessive out-of-pocket and premium costs above 5% of their income. She will enhance the premium tax credits now available through the exchanges so that those now eligible will pay less of a percentage of their income than under current law and ensure that all families purchasing on the exchange will not spend more than 8.5 percent of their income for premiums. Finally, she will fix the “family glitch” so that families can access coverage when their employer’s family plan premium is too expensive.

She will support new incentives to encourage all states to expand Medicaid. Hillary will fight for health insurance for our lowest income residents living in every state across the nation. Hillary will follow President Obama’s proposal to allow any state that signs up for the Medicaid expansion to receive a 100 percent match for the first three years, and she will continue to look for other ways to incentivize states to expand Medicaid to meet the health needs of their most vulnerable residents.

She will invest in navigators, advertising and other outreach activities to make enrollment easier. Today, as many as 16 million people or half of all those uninsured are eligible but not enrolled in virtually free Medicaid coverage or exchange coverage for as little as $100 a month or less. Hillary will ensure anyone who wants to enroll can understand their options and do so easily, by dedicating more funding for outreach and enrollment efforts. She will invest $500 million per year in an aggressive enrollment campaign to ensure more people enroll in these extremely affordable options.

She will expand access to affordable health care to families regardless of immigration status. Hillary sponsored the Immigrant Children’s Health Improvement Act in the Senate, which later became law and allows immigrant children and pregnant women to obtain Medicaid and CHIP. She believes we should let families—regardless of immigration status—buy into the Affordable Care Act exchanges. Families who want to purchase health insurance should be able to do so.

She will continue to support a “public option”—and work to build on the Affordable Care Act to make it possible. As she did in her 2008 campaign health plan, and consistently since then, Hillary supports a “public option” to reduce costs and broaden the choices of insurance coverage for every American. To make immediate progress toward that goal, Hillary will work with interested governors, using current flexibility under the Affordable Care Act, to empower states to establish a public option choice.

Going forward, Hillary will build on these efforts and fight to ensure that the savings from these reforms benefits families—not just insurance companies, drug companies, and large corporations. She will expand coverage for Americans living in rural areas and continue a lifelong commitment to protecting women’s reproductive rights.

Hillary’s plan will reduce the cost of prescription drugs. Prescription drug spending accelerated from 2.5 percent in 2013 to 12.6 percent in 2014. It’s no wonder that almost three-quarters of Americans believe prescription drug costs are unreasonable. Hillary believes we need to demand lower drug costs for hardworking families and seniors and she will hold drug companies accountable for unjustified price hikes with new penalties.

Her plan will transform our healthcare system to reward value and quality. Hillary is committed to building on delivery system reforms in the Affordable Care Act that improve value and quality care for Americans.

Hillary will also work to expand access to rural Americans, who often have difficulty finding quality, affordable health care. She will explore cost-effective ways to broaden the scope of health care providers eligible for telehealth reimbursement under Medicare and other programs, including federally qualified health centers and rural health clinics. She will also call for states to support efforts to streamline licensing for telemedicine and examine ways to expand the types of services that qualify for reimbursement.

Hillary is continuing a lifelong fight to ensure women have access to reproductive health care. As senator, she championed access to emergency contraception and voted in favor of strengthening a woman’s right to make her own health decisions. As president, she will continue defending Planned Parenthood, which provides critical health services including breast exams and cancer screenings to 2.7 million patients a year. And she will work to ensure that all women have access to preventive care, affordable contraception, and safe, legal abortion—not just in principle, but in practice, by ending restrictions like the Hyde Amendment.

Hillary for America also challenged Trump’s proposals:

Trump Would Rip Away Health Coverage From 20 Million People And Let Insurers Write The Rules

Donald Trump would immediately work to repeal Obamacare–taking health insurance away from at least 20 million people and letting the insurance companies write the rules all over again. Trump even supported shutting down the government in order to defund Obamacare.

New York Times: “Millions of low-income people have gained coverage under the Affordable Care Act and could lost it if Congress repealed the law.”
Trump saidhe supported Republicans’ efforts to shut down the government over Obamacare and that they should have stuck together.

Trump’s “plan” would cost hundreds of billions more, and does not address people with pre-existing conditions.

CNBC: More $$$, More Uninsured: Donald Trump’s Health-Care Plan
VOX: Trump’s Plan Would Take Health Insurance Away From 21 Million People. Sad!
Bloomberg: “Trump’s proposal is silent on the subject of preventing insurers from dropping coverage for those with preexisting conditions, a feature of Obamacare that Trump has said he supports.”

Meanwhile, the Trump campaign is making hay, taking a statement that President Bill Clinton made out of context:

FACT CHECK: President Clinton And The Affordable Care Act

“Don’t believe Donald Trump when he distorts what President Clinton said about the Affordable Care Act. Bill Clinton, Hillary Clinton, Tim Kaine and President Obama all agree that we have made tremendous progress because of the Affordable Care Act, delivering coverage to 20 million people who were previously uninsured — but they agree there’s more we can do.”

Politifact: “In context, it’s also worth noting that Clinton’s actual comments never mentioned the Affordable Care Act or Obamacare. In fact, as we reviewed the transcript, we noticed that much of what Clinton said addressed issues that pre-dated the 2010 health care law, including concerns about high costs and a lack of guaranteed coverage.”

Huffington Post: “Calm Down – Bill Clinton didn’t Say Obamacare is Terrible.” “That quotation, while accurate, doesn’t fully portray Bill Clinton’s argument for keeping the Affordable Care Act ― which has extended health coverage to 20 million people and cut the uninsured rate to a historic low ― and enhancing it with policies proposed by Hillary Clinton’s campaign…Despite its characterization in the CNN report, Bill Clinton’s assessment of the health care system and the Affordable Care Act mirrors Hillary Clinton’s and Obama’s own.”

Thinkprogress: “No, Bill Clinton does not think Obamacare is ‘the craziest thing in the world.’” “in a statement sent to ThinkProgress, Angel Urena, press secretary for Bill Clinton, said the former president’s remarks are being taken out of context and emphasized that Clinton has consistently supported Obamacare.”

The bottom line is Hillary will defend and expand on the progress made under Obama Administration toward universal coverage through the Affordable Care Act, while Donald Trump would immediately work to repeal Obamacare, taking health insurance away from 20 million people – and letting the insurance companies write the rules all over again. Trump’s suggested healthcare plan would cost hundreds of billions more, and does not address people with pre-existing conditions.

Election 2016, Health Care, Presidential Politics

Hillary Clinton Announces Aggressive New Plan to Address Unjustified Price Hikes in Life-Saving Drugs

September 2, 2016 krubin

Hillary Clinton announced a new plan to protect Americans from unjustified price hikes of long-available prescription drugs with limited competition, like EpiPens and pyrimethamine, the drug for a disease related to AIDS that Turing Pharmaceuticals raised the price of by more than 5,000% © 2016 Karen Rubin/news-photos-features.com

Hillary Clinton has announced a new plan to protect Americans from unjustified price hikes of long-available prescription drugs with limited competition, like EpiPens and pyrimethamine, the drug for a disease related to AIDS that Turing Pharmaceuticals raised the price of by more than 5,000%. After speaking out against excessive prices for prescription drugs throughout the campaign and, last week, calling for Mylan to lower its EpiPen price, Clinton believes that Mylan’s recent actions have not gone far enough to remedy their outrageous price increase. So today, Clinton is proposing a new set of strong tools – including a consumer protection group – that will let the government take effective action in such cases where public health is put at risk by an unjustified, outlier price increase for a treatment long available on the market with limited competition.

“Over the past year, we’ve seen far too many examples of drug companies raising prices excessively for long-standing, life-saving treatments with little or no new innovation or R&D,” Clinton said. “It’s time to move beyond talking about these price hikes and start acting to address them. All Americans deserve full access to the medications they need — without being burdened by excessive, unjustified costs. Our pharmaceutical and biotech industries are an incredible source of American innovation and revolutionary treatments for debilitating diseases. But I’m ready to hold drug companies accountable when they try to put profits ahead of patients, instead of back into research and innovation.”

Today, building off the comprehensive plan she offered earlier in the campaign last year, Clinton is calling for action to protect consumers from unjustified prescription drug price increases by companies that are marketing long-standing, life-saving treatments and face little or no competition. She’ll start by convening representatives of Federal agencies charged with ensuring health and safety, as well as fair competition, to create a dedicated group charged with protecting consumers from outlier price increases. They will determine an unjustified, outlier price increase based on specific criteria including: 1) the trajectory of the price increase; 2) the cost of production; and 3) the relative value to patients,among other factors that give rise to threatening public health.

Should an excessive, outlier price increase be determined for a long-standing treatment, Clinton’s plan would make new enforcement tools available including:

Making alternatives available and increasing competition: Directly intervening to make treatments available, and supporting alternative manufacturers that enter the market and increase competition, to bring down prices and spur innovation in new treatments.

Emergency importation of safe treatments: Broadening access to safe, high-quality alternatives through emergency importation from developed countries with strong safety standards.

Penalties for unjustified price increase to hold drug companies accountable and fund expanded access: Holding drug makers accountable for unjustified price increases with new penalties, such as fines – and using the funds or savings to expand access and competition.

Her plan will establish dedicated consumer oversight at our public health and competition agencies. They will determine an unjustified, outlier price increase based on specific criteria including: 1) the trajectory of the price increase; 2) the cost of production; and 3) the relative value to patients, among other factors that give rise to threatening public health.

In combination with her broader plan – which addresses the costs facing consumers from both long-standing and patented drugs – these new tools to address price spikes for treatments available for many years will lower the burden of prescription drug costs for all Americans.

This plan would impact the many examples we’ve seen over the past year of drug companies raising prices excessively for drugs that have been available for years – from Turing raising the price of pyrimethamine for AIDS patients by over 5,500 percent, to Mylan raising the price of the EpiPen by more than 400 percent. This is not an isolated problem: Between 2008 and 2015, drug makers increased the prices of almost 400 generic drugs by over 1,000 percent. Many of these companies are an example of a troubling trend—manufacturers that do not even develop the drug themselves, but acquire it and raise the price.

The immediate protections she is offering today build on her broader plan to lower prescription drug costs for all Americans that she released last year.

The full fact sheet is available here.

Health Care, President Obama

The Affordable Care Act: Healthy Communities Six Years Later

March 3, 2016 krubin

The Affordable Care Act made it possible for young people, striking out on their own with their own entrepreneurial enterprises, to get affordable health insurance © 2016 Karen Rubin/news-photos-features.com

I’m so sick of Republicans, especially those who would be President and promise to repeal every word of the Affordable Care Act, lying about how Obamacare has harmed jobs creation, and destroyed American freedom. Such a crock. The White House has just issued a fact sheet appraising the Affordable Care Act six years after. Republicans are a fact-free zone, but here are the facts:

FACT SHEET: The Affordable Care Act: Healthy Communities Six Years Later

President Obama promised that he would make quality, affordable health care not a privilege, but a right. After nearly 100 years of talk and decades of trying by presidents of both parties, that’s exactly what he did.

On March 23, 2010, President Obama signed the Affordable Care Act (ACA) into law, putting in place comprehensive reforms that improve access to affordable health coverage for everyone and protect consumers from abusive insurance company practices. Because of the ACA, 17.6 million previously uninsured people had gained coverage prior to this year’s open enrollment period, and the law has driven the uninsured rate below 10 percent for the first time since we started keeping records. The ability to buy portable and affordable plans on a competitive marketplace is giving Americans the freedom to move, leave an unsatisfying job and start businesses which is especially important as more consumers become entrepreneurs. And thanks in part to the law’s focus on reducing costs and inefficiencies, health care prices have risen at the slowest rate in 50 years since the law passed, which will benefit all of us for years to come.

These access gains are due in large part to the efforts of local and state elected officials, community organizations and leaders, and volunteers who have worked tirelessly to help their neighbors find access to quality, affordable coverage. During the most recent open enrollment period from November 1 through January 31, the Administration and its partners on the ground nationwide undertook an unprecedented local and regional effort to sign up the remaining uninsured who are eligible for Marketplace coverage.

As part of this effort, the White House launched its “Healthy Communities Challenge” to engage 20 key communities with large numbers or high percentages of uninsured in states across the country where strong federal, state, and community collaboration can have a meaningful impact on reaching the uninsured. Last month, the White House announced that the winner of the challenge is Milwaukee, Wisconsin. Under the leadership of Mayor Tom Barrett and County Executive Chris Abele, about 38,000 people in the Milwaukee area newly selected a plan through the Health Insurance Marketplace during this open enrollment period. Together with returning Marketplace consumers, about 89,000 people in the Milwaukee area selected a 2016 Marketplace plan. Nationwide, nearly 13 million Americans signed up for 2016 Marketplace coverage, including people who were previously uninsured, as well as Americans finding coverage as they go through changes in life such as being in between jobs or aging off their parents’ plans.

Because of the Affordable Care Act, This is What Health Care in America Looks Like Today:

17.6 million consumers have gained health insurance thanks to the ACA, prior to this year’s open enrollment period. From 2010 through the first nine months of 2015, the uninsured rate has fallen by more than 40 percent and, for the first time ever, more than 9 in 10 Americans now have health insurance. In Wisconsin, Gallup recently estimated that the adult uninsured rate in 2015 was 5.9 percent, down from 11.7 percent in 2013.
As many as 129 million Americans who have some type of pre-existing health condition, including up to 19 million children, are now protected from coverage denials and reduced benefits – practices that were routine before the law’s enactment.
105 million Americans, including 39.5 million women and nearly 28 million children, have benefited from annual limits on out-of-pocket spending on essential health benefits – and the elimination of lifetime and annual limits on insurance coverage. These are protections that did not exist before the ACA.
Americans now have access to critical preventive services at no cost, like flu shots, yearly check-ups, and birth control. These are benefits that did not exist before the ACA.
Over 14 million more Americans have received coverage through Medicaid since the ACA’s first open enrollment period in 2013. States have an option to expand Medicaid to all non-eligible adults with incomes under 133 percent of the federal poverty level, and to date, 31 states and the District of Columbia have chosen to expand the program. In these states that have already expanded Medicaid, 4.4 million uninsured people will gain coverage. If the remaining states expand Medicaid, over 4 million more uninsured people would gain coverage.
The ACA has provided new transparency in how health insurance plans disclose reasons for premium increases and requires simple, standardized summaries so over 170 million Americans can better understand their coverage information and compare plans. These consumer protections did not exist six years ago.
2.3 million young Americans gained coverage between 2010 and October 2013 because they could now stay covered on their parents’ health care plans until they turn 26 – a benefit that did not exist before the law.
The ACA created tax credits that, as of September 2015, have helped 7.8 million Americans who otherwise often could not afford it purchase health coverage through the Health Insurance Marketplaces.
Health insurers are now required to provide consumers with rebates if the amount they spend on health benefits and quality of care, as opposed to advertising and marketing, is too low. Last year, 5.5 million consumers received nearly $470 million in rebates. Since this requirement was put in place in 2011 through 2014, more than $2.4 billion in total refunds will have been paid to consumers.
Out-of-pocket costs have been eliminated for preventive services like immunizations, certain cancer screenings, contraception, reproductive counseling, obesity screening, and behavioral assessments for children. This coverage is guaranteed for more than 137 million Americans, including 55 million women.
Out-of-pocket costs have been eliminated for 39 million Medicare beneficiaries for preventive services like cancer screenings, bone-mass measurements, annual physicals, and smoking cessation.
The ACA expands mental health and substance use disorder benefits and parity protections to over 60 million Americans.
The ACA phases out the “donut hole” coverage gap for nearly10.7 million Medicare prescription drug beneficiaries, who have saved an average of $1,945 per beneficiary.
Accountable Care Organizations now exist, consisting of doctors and other health-care providers who come together to provide coordinated, high-quality care at lower costs to their Medicare patients. Over 477 ACOs are serving nearly 8.9 million Medicare beneficiaries nationwide.
Overpayments through the Medicare Advantage system have been phased out, while Medicare Advantage plans are required to spend at least 85 percent of Medicare revenue on patient care. Medicare Advantage enrollment has grown by 50 percent to over17.1 million while premiums have dropped by 10 percent since 2009.
Hospitals in Medicare now receive incentives to reduce hospital-acquired infections and avoidable readmissions. A collaborative health-safety learning network, the Partnership for Patients, includes more than 3,200 hospitals to promote best quality practices.

In addition, other legislation and executive actions build on this progress and advance the cause of effective, affordable and accountable health care. This includes:

Advancing innovative care delivery models and value-based payments in Medicare and Medicaid. The Administration set ambitious goals of tying 30 percent of traditional Medicare payments to alternative payment models by the end of 2016 and 50 percent by the end of 2018.
Proposals to invest in targeted research and technologies to advance the BRAIN Initiative, Precision Medicine Initiative, and cancer research.
A funding pool for Community Health Centers to build, expand and operate health-care facilities in underserved communities. Health Center grantees served 23 million patients in 2014 and received $11 billion under the health care law to offer a broader array of primary care services, extend their hours of operations, hire more providers, and renovate or build new clinical spaces.
Health provider training opportunities, with an emphasis on primary care, including a significant expansion of the National Health Service Corps. As of September 30, 2015, there were 9,600Corps clinicians providing primary care services, compared to 3,600 clinicians in 2008.

To learn more about the Healthy Communities challenges, visit: https://www.whitehouse.gov/the-press-office/2016/02/12/fact-sheet-announcing-winner-healthy-communities-challenge. For more on the President’s overall record on providing quality, affordable health care for Americans, visit: https://www.whitehouse.gov/the-record/health-care.

Health Care, Office of Management & Budget, US Congress

OMB: Obama Would Veto Latest Effort to Dismantle Obamacare, McConnell’s ‘Restoring Americans’ Healthcare Freedom Reconciliation Act’

December 2, 2015 krubin

They’re at it again! For like the 60th time, Republicans are pushing to dismantle Obamacare.

The latest is the sickly named “Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015” sponsored by none other than that Darth Vader of anything that actually helps people, the Senate Leader himself, Sen. Mitch McConnell.

The only thing standing in the way is President Obama’s veto, which the Office of Management & Budget (OMB) says he would.

Here’s how the OMB explains the Administration’s position:

The Administration strongly opposes Senate passage of the Senate amendment to H.R. 3762. By repealing numerous, key elements of current law, this legislation would take away critical benefits and health care coverage from hard-working middle‑class families. The bill also would remove policies that are expected to help slow the growth in health care costs and that have improved the quality of care patients receive. The Senate amendment to H.R. 3762 detracts from the work the Congress could be doing to foster job creation and economic growth.

The Affordable Care Act is working and is fully integrated into an improved American health care system. Discrimination based on pre-existing conditions is a thing of the past. And under the law, health care prices have grown at the slowest rate in 50 years, benefiting all Americans.

Repealing key elements of the Affordable Care Act would result in millions of individuals remaining uninsured or losing the insurance they have today. An estimated 17.6 million Americans gained coverage as several of the Affordable Care Act’s coverage provisions have taken effect – 15.3 million since the beginning of the first open enrollment in October 2013. The Senate amendment to H.R. 3762 would roll back coverage gains and would cost millions of hard-working middle-class families the security of affordable health coverage they deserve.

Repealing the health care law would have implications far beyond these Americans who have or will gain insurance. More than 150 million Americans with employer-based insurance would be at risk of higher premiums and lower wages, or losing their coverage altogether. It would raise taxes on certain middle‑class families. The Senate amendment to H.R. 3762 also would defund the Prevention and Public Health Fund, limit women’s health care choices, and disproportionately impact low-income individuals.

This legislation is being considered by the Senate just days ahead of the December 15 deadline for Marketplace coverage that starts on January 1, 2016. Rather than refighting old political battles by once again voting to repeal basic protections that provide security for the middle class, Members of Congress should be working together to grow the economy, strengthen middle‑class families, and create new jobs.

If the President were presented with H.R. 3762, as amended by the Senate amendment, he would veto the bill.