Tag Archives: Medicare

FACT SHEET: Dozens of Pharma Companies Raised Prices Faster than Inflation, Triggering Medicare Rebates, While Republicans Work to Insure Giveaways to Big Pharma, Higher Costs for Seniors, Families

President Biden’s Inflation Reduction Act cracks down on Big Pharma price gouging, saving some seniors thousands of dollars per dose of medication. Meanwhile, Congressional Republicans push for giveaways to drug industry

President Biden’s Inflation Reduction Act cracks down on Big Pharma price gouging, saving some seniors thousands of dollars per dose of medication. Meanwhile, Congressional Republicans push for giveaways to drug industry © Karen Rubin/news-photos-features.com

President Biden visited the National Institutes of Health Clinical Center in Washington, D.C. to announce that dozens of pharmaceutical companies will be required to pay rebates to Medicare for outrageous price hikes on prescription drugs that over 750,000 seniors take per year. For the last quarter of 2023, 48 Medicare Part B drugs raised their prices faster than inflation, and some drug companies raised prices of certain medications faster than inflation for every quarter over the last year. President Biden’s Inflation Reduction Act cracks down on this exorbitant price gouging, requiring these companies to pay rebates back to Medicare, saving seniors who take these drugs between $1 and $2,786 per dose on their medication.

President Biden vowed to lower prescription drug costs for seniors and families – and he is delivering on that promise. His Inflation Reduction Act finally allows Medicare to directly negotiate lower prescription drug prices, capped the cost of insulin for Medicare beneficiaries at $35, made recommended adult vaccines free, requires drug companies to pay rebates if they raise prices faster than the rate of inflation, and locked in savings of $800 per year on health insurance for nearly 15 million Americans. While Republicans in Congress fight tooth and nail to repeal the Inflation Reduction Act and put money back in the pockets of Big Pharma, President Biden won’t back down from the fight to lower costs for hardworking Americans and make sure every family has access to affordable health care.

The Biden-Harris Administration announced:

  • The Department of Health and Human Services (HHS) announced a new list of 48 Medicare Part B drugs that raised their prices faster than inflation, and may be subject to inflation rebates in the first quarter of 2024 as a result of the Inflation Reduction Act. President Biden’s prescription drug law cracks down on price gouging from Big Pharma, requiring companies to pay back Medicare if they raise prices on seniors at a higher rate than inflation. Starting in January, some Medicare beneficiaries who take these 48 prescription drugs – including drugs used to treat cancer and fight infections – will have lower coinsurance than what they would have paid otherwise, and their out-of-pocket costs may decrease by $1 to as much as $2,786 per average dose.

Over the last four quarters, 64 drugs in total had prices that increased faster than inflation and may be subject to inflation rebates because of the Inflation Reduction Act. Some drugs, such as Signifor, used to treat an endocrine disorder, raised prices faster than inflation every quarter since the Inflation Reduction Act’s inflation rebate provision went into effect. Some Medicare beneficiaries who take Signifor could save $311 per monthly dose starting January because of the law.
 
The Administration is focused on making sure medications developed with taxpayer funds are available to Americans at reasonable prices. On average, Americans pay 2 to 3 times more than consumers in other developed countries for prescription drugs. Last week, the Administration announced a proposal to put drug companies on notice if products developed using federal funds are not made available to the public on reasonable terms, including based on price. The proposal would promote the federal government’s ability to license a patent — such as those used to create life-saving drugs — to a competitor with the goal of increasing competition and bringing costs down for families.
 
Building off last week’s announcement, today HHS announced that the Administration for Strategic Preparedness and Response (ASPR) is making fair pricing a standard part of contract negotiations for medical products developed or purchased as part of its commitment to obtain best value for the US taxpayer. In September 2023, ASPR finalized a Project NextGen contract agreement for a potentially life-saving COVID-19 treatment being developed by Regeneron stating if the product is commercialized, its list price in the United States will be equal to or less than its retail price in comparable global markets. Since then, ASPR has also included similar language in recent agreements with CastleVax, Codagenix and Gritstone Bio, developers of the first three vaccines selected for development within Project NextGen. These clauses will be in effect if and when a company’s candidate vaccine is selected to move into ASPR-supported Phase 2b trials to evaluate clinical safety and efficacy.These actions are the result of a successful and collaborative approach by ASPR and its industry partners and show HHS’s commitment to keep Americans from paying unfair prices for the care they need.

  • HHS is releasing new data on the ten drugs selected for Medicare Drug Price Negotiation. For Medicare enrollees who take these drugs, their out-of-pocket spending on the 10 drugs selected for negotiation represents, on average, over half of their total Part D out-of-pocket spending. The report shows that total Medicare spending on the 10 drugs more than doubled from 2018 to 2022 – a rate that was 3 times faster than all Part D drugs over the same period. The report also shows that 7 of the 10 drugs selected received direct at least one form of federal support towards their drug development or utilized a federal-funded invention for their development.

After decades and hundreds of billions of dollars spent by Big Pharma to block Medicare from directly negotiating lower prescription drug prices for people with Medicare, President Biden’s Inflation Reduction Act finally got it done. In total in 2022, Medicare Part D beneficiaries paid $3.4 billion in out of pocket costs for the 10 drugs selected for negotiation, and some paid over $6,000 per year for just one of the drugs on the list. Negotiated prices will go into effect for seniors in 2026.
Today’s announcements build off the actions the Administration has already taken to lower prescription drug costs for millions of seniors and families because of President Biden’s Inflation Reduction Act. In 2023 alone:

  • The Inflation Reduction Act saved nearly 15 million Americans an average of $800 in 2023 because of health insurance savings the law locked in.
    • The Inflation Reduction Act capped the cost of insulin at $35 per covered insulin product for Medicare beneficiaries, saving an estimated 1.5 million seniors on Medicare $500 on average in 2023 on insulin costs. 
       
    • The Inflation Reduction Act made recommended vaccines – like the shingles vaccine – free for the 50.5 million seniors with Medicare Part D, and made recommended, approved adult vaccines free for all adults in the Children’s Health Insurance Program, and nearly all full-benefit adults enrolled in traditional Medicaid. Seniors on Medicare who received a Part D vaccine saved an average of $70 on vaccines in 2023.
       
    • The Inflation Reduction Act saved many seniors on Medicare as much as $618 per average dose on 47 prescription drugs in 2023 because of the law’s provision requiring drug companies to pay rebates on certain drugs if they raise prices for those drugs faster than the rate of inflation. Starting in 2024, some seniors who take 48 prescription drugs could see savings of as much as $2,786 per average dose because those 48 drugs raised their prices faster than inflation in the last quarter of 2023.

In the coming months and years, the Inflation Reduction Act will continue to deliver cost-savings to millions of Americans, including:

  • In 2024, Part D enrollees will no longer pay 5% co-insurance when they reach the catastrophic phase of their benefit – meaning that some beneficiaries’ prescription drug costs will be capped at about $3,500 next year.
    • When the $2,000 out-of-pocket cap on prescription drugs applies in 2025, nearly 19 million seniors and other beneficiaries are projected to save $400 per year on prescription drugs. 1.9 million enrollees with the highest drug costs will save an average of $2,500 per year because of this provision of the Inflation Reduction Act.
       

Millions of seniors could save money when negotiated prices of the first group of drugs selected for the Inflation Reduction Act’s Medicare Price Negotiation program are scheduled to go into effect in 2026. In 2022, seniors spent $3.4 billion in out-of-pocket costs on the first ten drugs selected for negotiation – used to treat common conditions like diabetes, Crohn’s disease, arthritis, blood clots and more. A report released last week shows that had the Medicare price negotiation program been in effect in 2021, Part D out of pocket costs would have declined 23% for people taking the ten costliest drugs at the time.

The Congressional Republican Agenda on Prescription Drugs: Giveaways to Big Pharma and Higher Costs for Seniors and Families


While President Biden has taken historic action to reduce prescription drug costs for seniors and for working-age people who get health insurance through their jobs, Congressional Republicans are actively fighting to roll back the reforms the President signed into law and to keep Big Pharma’s taxes low.
 
Congressional Republicans’ agenda for Big Pharma giveaways includes:
 
Repealing prescription drug inflation rebates. The Inflation Reduction Act (IRA) cuts costs for Medicare and seniors by requiring pharmaceutical companies to pay a rebate to Medicare if they increase prices faster than inflation. Dozens of Republicans have signed onto legislation that would revoke the rebate requirement.
 
By 2031, repealing this provision would:

  • Cost seniors $5 billion per year.
  • Increase federal deficits by $7 billion per year.
  • Give away over $10 billion per year to pharmaceutical companies.

Taking away Medicare’s ability to negotiate prescription drug prices. The IRA finally gave Medicare the authority to directly negotiate with drug companies on the high prices they charge for prescription drugs. Republican Chairs and Ranking Members of the committees with jurisdiction over Medicare have publicly committed to repealing this authority, which would allow Big Pharma to go back to charging seniors exorbitant prices for life-saving drugs.
 
By 2031, repealing this provision would:

  • Cost seniors $7 billion per year.
  • Increase federal deficits by $14 billion per year.
  • Give away over $20 billion to pharmaceutical companies per year.

Opposing caps on insulin prices. Monthly insulin costs for Medicare beneficiaries are now capped at $35—providing certainty and critical cost savings for seniors who in some cases were paying as much as $400 for a month’s supply of insulin. The Republican Study Committee budget, as well as the House Budget Committee-passed budget plan, propose to repeal this and other IRA drug price reforms.  
 
Repealing this provision would mean the 1.5 million Medicare beneficiaries who use insulin could see their annual costs rise by an average of $500.
 
Protecting Big Pharma’s ability to avoid paying taxes. President Biden negotiated a historic agreement with over 130 countries that would enable the U.S. and its partners to ensure Big Pharma and other multinationals pay at least a minimum tax rate and has proposed that the U.S. implement that agreement with a 21% minimum tax rate on multinationals. Congressional Republicans are not only blocking the U.S. from implementing the global minimum tax agreement and vowing to never raise taxes on Big Pharma and other multinationals by implementing it, they also traveled to Europe this summer to try to persuade other countries to withdraw from the global agreement and keep taxes low for Big Pharma and other multinationals.
 
Blocking implementation of the President’s international tax reform proposals means:

  • Protecting a system in which Big Pharma can lower its taxes to under 12% by shifting profits offshore.

The U.S. would lose out on hundreds of billions in savings from adopting the President’s proposals to implement the international agreement. Based on a PhRMA-funded analysis, nearly $100 billion of the savings – or almost one-fifth of the total revenue – from implementing the President’s 21% minimum tax proposal would come from cracking down on pharmaceutical industry tax avoidance

Biden-Harris Administration Proposes Steps to Protect People with Medicare Advantage and Prescription Drug Coverage

The Biden-Harris Administration is proposing important steps to strengthen Medicare Advantage and the Medicare Prescription Drug Benefit Program (Part D). As part of his Bidenomics agenda, President Biden has worked to increase competition in the health care industry and other sectors, lower costs for families, and make sure every American has access to affordable, high-quality health care. © Karen Rubin/news-photos-features.com

The Biden-Harris Administration is proposing important steps to strengthen Medicare Advantage and the Medicare Prescription Drug Benefit Program (Part D). As part of his Bidenomics agenda, President Biden has worked to increase competition in the health care industry and other sectors, lower costs for families, and make sure every American has access to affordable, high-quality health care.

The Centers for Medicare & Medicaid Services’ (CMS’) proposed rule will help people with Medicare select and enroll in coverage options that best meet their health care needs by preventing plans from engaging in anti-competitive steering of prospective enrollees based on excessive compensation to agents and brokers, rather than the enrollee’s best interests. The proposed guardrails protect people with Medicare and promote a competitive marketplace in Medicare Advantage, consistent with the goals of President Biden’s historic Executive Order on Promoting Competition in the American Economy.

The proposed rule will also improve access to behavioral health care by adding a new facility type that includes several behavioral health provider types to Medicare Advantage network adequacy requirements. CMS is also proposing policies to increase the utilization and appropriateness of supplemental benefits to ensure taxpayer dollars actually provide meaningful benefits to enrollees. Additionally, the proposed rule would improve transparency on the effects of prior authorization on underserved communities and proposes more flexibility for Part D plans to more quickly substitute lower cost biosimilar biological products for their reference products.

“The Biden-Harris Administration remains committed to making health care more affordable and accessible for all Americans. By ensuring Medicare recipients have the information they need to make critical decisions about their health care coverage, we are doing just that,” said U.S. Department of Health and Human Services Secretary Xavier Becerra. “Promoting competition in the marketplace helps to lower costs and protect access to care while making the whole process more transparent and accountable.”

“CMS continues to improve the Medicare Advantage and Part D prescription drug programs and maintain high-quality health care coverage choices for all Medicare enrollees,” said CMS Administrator Chiquita Brooks-LaSure. “People with Medicare deserve to have accurate and unbiased information when they make important decisions about their health coverage. Today’s proposals further our efforts to curb predatory marketing and inappropriate steering that distorts healthy competition among plans.”

CMS has previously taken unprecedented steps to address predatory marketing of Medicare Advantage plans, such as banning misleading TV ads. Many people on Medicare rely on agents and brokers to help navigate Medicare choices. CMS is concerned that some Medicare Advantage plans are compensating agents and brokers in a way that may circumvent existing payment rules, inappropriately steer individuals to enroll in plans that do not best meet their health care needs, and lead to further consolidation in the Medicare Advantage market. To further protect people with Medicare through stronger marketing policies and to promote a competitive marketplace in Medicare Advantage, CMS is proposing added guardrails to plan compensation for agents and brokers, including standardization. These proposals are consistent with the statutory requirement that CMS develop guidelines to ensure that the use of compensation creates incentives for agents and brokers to enroll individuals in the Medicare Advantage plan that is intended to best meet their health care needs.

CMS also proposes to strengthen and improve access to behavioral health care by adding a new facility type, which includes marriage and family therapists, mental health counselors, addiction medicine clinicians, opioid treatment providers, and others, to CMS’ Medicare Advantage network adequacy requirements. This proposed addition builds on changes finalized last year to strengthen these requirements and would ensure people with Medicare Advantage can access vital mental health and substance use disorder treatment.

“The people we serve are at the center of the Medicare program, and we work each day to make sure the program works for them. Agents and brokers play an important role in guiding people with Medicare to the option that is tuned in to their medical needs. Our proposals on how plans compensate agents and brokers seek to support a competitive marketplace that best serves people with Medicare,” said Dr. Meena Seshamani, CMS Deputy Administrator and Director of the Center for Medicare.

Currently, 99% of Medicare Advantage plans offer at least one supplemental benefit. Over time, the benefits offered have become broader in scope and variety, with more rebate dollars directed toward these benefits. CMS is committed to ensuring these offerings are effectively reaching enrollees and actually meeting their needs, and not just used for attracting enrollees. In today’s rule, CMS proposes requiring Medicare Advantage plans to send a personalized notification to their enrollees mid-year of the unused supplemental benefits available to them to encourage higher utilization. Furthermore, CMS is proposing additional requirements designed to help ensure that benefits offered as special supplemental benefits for the chronically ill (SSBCI) are backed by evidence. CMS is also proposing new marketing and transparency guardrails around these benefits. These proposals will help ensure a robust and competitive Medicare Advantage marketplace made up of plan options with meaningful benefits.

Additionally, CMS is concerned that certain prior authorization policies may disproportionately inhibit access to needed care for underserved enrollees. To provide additional safeguards, CMS is proposing to require that Medicare Advantage plans include an expert in health equity on their utilization management committees and that the committees conduct an annual health equity analysis of the plans’ prior authorization policies and procedures. This analysis would examine the impact of prior authorization on enrollees with one or more of the following social risk factors—eligibility for Part D low-income subsidies, dual eligibility for Medicare and Medicaid, or having a disability—compared to enrollees without these risk factors. These analyses would have to be posted publicly to improve transparency into the effects of prior authorization on underserved populations. To further promote health equity, CMS is also proposing to streamline enrollment options for individuals with both Medicare and Medicaid, providing more opportunities for integrated care.

To support competition in the prescription drug marketplace, CMS is also proposing to provide more flexibility to substitute biosimilar biological products other than interchangeable biological products for their reference products to give people with Medicare more timely access to lower-cost biosimilar drugs. This proposal would permit Part D plans to treat such substitutions as maintenance changes so that the substitutions apply to all enrollees, not only those who begin the therapy after the effective date of the change, following a 30-day notice.

There will be a 60-day comment period for the notice of proposed rulemaking, and comments must be submitted at one of the addresses provided in the Federal Register no later than January 5, 2024. The proposed rule can be accessed at the Federal Register at https://www.federalregister.gov/public-inspection/current.

View a fact sheet on the proposed rule at cms.gov/newsroom.

View the CMS Blog Important New Changes to Improve Access to Behavioral Health in Medicare at https://www.cms.gov/blog.

Biden Administration Takes Historic Step to Lower Cost of Prescription Drugs for Medicare, Medicaid

For the first time, thanks to President Biden’s Inflation Reduction Act – the historic law lowering health care costs – Medicare is able to negotiate the prices of prescription drugs. HHS released the list of the first 10 drugs that it will negotiate prices for.When implemented, prices on negotiated drugs will decrease for up to 9 million seniors. These seniors currently pay up to $6,497 in out-of-pocket costs per year for these prescriptions. In addition, the nonpartisan Congressional Budget Office reports that this will save taxpayers $160 billion by reducing how much Medicare pays for drugs through negotiation and inflation rebates. © Karen Rubin/news-photos-features.com

In the immortal words of President Biden as VP when President Obama signed the Affordable Care Act (Obamacare) into law, this is a big f—kg deal.

For the first time, thanks to President Biden’s Inflation Reduction Act – the historic law lowering health care costs – Medicare is able to negotiate the prices of prescription drugs.

Today, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), announced the first 10 drugs covered under Medicare Part D selected for negotiation. The negotiations with participating drug companies will occur in 2023 and 2024, and any negotiated prices will become effective beginning in 2026. Medicare enrollees taking the 10 drugs covered under Part D selected for negotiation paid a total of $3.4 billion in out-of-pocket costs in 2022 for these drugs. 

“For far too long, pharmaceutical companies have made record profits while American families were saddled with record prices and unable to afford life-saving prescription drugs. But thanks to the landmark Inflation Reduction Act, we are closer to reaching President Biden’s goal of increasing availability and lowering prescription drug costs for all Americans,” said HHS Secretary Xavier Becerra. “Although drug companies are attempting to block Medicare from being able to negotiate for better drug prices, we will not be deterred. The Biden-Harris Administration will continue working to ensure that Americans with Medicare have access to innovative, life-saving treatments at lower costs.”

The Biden-Harris Administration has made lowering prescription drug costs and improving access to innovative therapies a key priority. Alongside other provisions in the new law that increase the affordability of health care and prescription drugs, allowing Medicare to negotiate prescription drug prices will strengthen the program’s ability to serve people with Medicare now and for generations to come. The negotiation process will consider the selected drug’s clinical benefit, the extent to which it fulfills an unmet medical need, and its impact on people who rely on Medicare, among other considerations, such as costs associated with research and development as well as production and distribution for selected drugs. As a result of negotiations, people with Medicare will have access to innovative, life-saving treatments at lower costs to Medicare.

The selected drug list for the first round of negotiation is:

  • Eliquis
    • Jardiance
    • Xarelto
    • Januvia
    • Farxiga
    • Entresto
    • Enbrel
    • Imbruvica
    • Stelara
    • Fiasp; Fiasp FlexTouch; Fiasp PenFill; NovoLog; NovoLog FlexPen; NovoLog PenFill

These selected drugs accounted for $50.5 billion in total Part D gross covered prescription drug costs, or about 20%, of total Part D gross covered prescription drug costs between June 1, 2022 and May 31, 2023, which is the time period used to determine which drugs were eligible for negotiation. CMS will publish any agreed-upon negotiated prices for the selected drugs by September 1, 2024; those prices will come into effect starting January 1, 2026. In future years, CMS will select for negotiation up to 15 more drugs covered under Part D for 2027, up to 15 more drugs for 2028 (including drugs covered under Part B and Part D), and up to 20 more drugs for each year after that, as outlined in the Inflation Reduction Act.

“We’ve reached this milestone because of the Inflation Reduction Act– one of the most significant laws ever enacted, and one that passed with the leadership of Democrats in Congress,” President Biden stated. “We took on Big Pharma and special interests, overcoming opposition from every Republican in Congress, and the American people won.”

When implemented, prices on negotiated drugs will decrease for up to 9 million seniors. These seniors currently pay up to $6,497 in out-of-pocket costs per year for these prescriptions. In addition, the nonpartisan Congressional Budget Office reports that this will save taxpayers $160 billion by reducing how much Medicare pays for drugs through negotiation and inflation rebates.

“This plan is a key part of Bidenomics, my economic vision for growing the economy from the middle out and the bottom up – not the top down. And it’s working.,” Biden stated. “That’s why Big Pharma has already filed eight lawsuits against my Administration, and spent nearly $400 million last year to try to stop our progress. Let me be clear: I am not backing down. There is no reason why Americans should be forced to pay more than any developed nation for life-saving prescriptions just to pad Big Pharma’s pockets. For many Americans, the cost of one drug is the difference between life and death, dignity and dependence, hope and fear. That is why we will continue the fight to lower healthcare costs – and we will not stop until we finish the job.”

HHS Announces First Set of Drugs Selected for Medicare Price Negotiation

For the first time ever, HHS announced ten drugs selected for Medicare drug price negotiation:
 

Drug NameCommonly Treated ConditionsTotal Part D Gross Covered Prescription Drug Costs from June 2022-May 2023Number of Medicare Part D Enrollees Who Used the Drug from June 2022-May 2023Average Part D Covered Prescription Drug Costs Per Enrollee
EliquisPrevention and treatment of blood clots$16,482,621,0003,706,000$4,448
JardianceDiabetes; Heart failure$7,057,707,0001,573,000$4,487
XareltoPrevention and treatment of blood clots; Reduction of risk for patients with coronary or peripheral artery disease$6,031,393,0001,337,000$4,511
JanuviaDiabetes$4,087,081,000869,000$4,703
FarxigaDiabetes; Heart failure; Chronic kidney disease$3,268,329,000799,000$4,091
EntrestoHeart failure$2,884,877,000587,000$4,915
EnbrelRheumatoid arthritis; Psoriasis; Psoriatic arthritis$2,791,105,00048,000$58,148
ImbruvicaBlood cancers$2,663,560,00020,000$133,178
StelaraPsoriasis; Psoriatic arthritis; Crohn’s disease; Ulcerative colitis$2,638,929,00022,000$119,951
Fiasp; Fiasp FlexTouch; Fiasp PenFill;
NovoLog; NovoLog FlexPen; NovoLog PenFill
Diabetes$2,576,586,000777,000$3,316

 
[Source: CMS, https://www.cms.gov/files/document/fact-sheet-medicare-selected-drug-negotiation-list-ipay-2026.pdf]

These ten drugs are among those with highest total spending in Medicare Part D – $50 billion in total part D gross covered drug cost s- or 20% of total part D gross covered drug costs june 1, 2022, may 31, 2023. More than 8 million Part D enrollees depend on these vital treatments to treat life-threatening conditions including diabetes, heart failure, and cancer, but many struggle to access their medications because of prohibitive costs.

Medicare drug price negotiation will result in lower out-of-pocket costs for seniors and will save money for American taxpayers. Negotiations for the first group of selected drugs will begin in 2023, with negotiated prices going into effect in 2026.

Out-of-Pocket Costs for Drugs Covered Under Part D Selected for Drug Price Negotiation, by State

Today HHS also released a report showing that 9 million Medicare Part D enrollees took the drugs covered under Part D selected for negotiation and paid a total of $3.4 billion in out-of-pocket costs for these drugs in 2022.  For enrollees without additional financial assistance, average annual out-of-pocket costs for these drugs were as high as $6,497 per enrollee in 2022.

To view a state-by-state breakdown of the number of Medicare enrollees who use the prescription drugs selected for negotiation and their out-of-pocket costs, visit HHS’s website.

Continuing to Lower Prescription Drug Costs

Every day, millions of seniors are saving money on prescription drug costs because of the Biden Administration’s actions. People with Medicare are saving an average of $70 in out-of-pocket costs on vaccines like shingles and Tdap because President Biden’s Inflation Reduction Act made recommended vaccines free for beneficiaries starting this past January. Nearly four million seniors and others on Medicare with diabetes started to see their insulin costs capped at $35 per month this past January, saving some seniors hundreds of dollars for a month’s supply. And some seniors taking drugs covered under Part B for which manufacturers have hiked prices faster than inflation are saving up to $449 in lower coinsurance this quarter thanks to the new Medicare inflation rebates.

People with Medicare will continue to see their prescription drug costs go down as more provisions of the Inflation Reduction Act go into effect in the coming years. Part D enrollees will no longer pay 5% co-insurance when they reach the catastrophic phase of their benefit starting in 2024. Nearly 19 million seniors and other Part D beneficiaries are projected to save $400 per year on prescription drugs when the out-of-pocket cap drops to $2,000 in 2025, and 1.9 million enrollees with the highest drug costs will save an average of $2,500 per year. And the lower prices negotiated for the high-spend drugs selected today will go into effect in 2026.

The President’s Budget for Fiscal Year 2024 builds upon the Inflation Reduction Act to continue lowering the cost of prescription drugs. For Medicare, this includes further expanding the newly established negotiation authority by extending it to more drugs and bringing drugs into negotiation sooner after they launch. The Budget also includes proposals to curb inflation in prescription drug prices and cap the prices of insulin products at $35 for a monthly prescription in the commercial market to lower drug costs for all Americans.

The ability to negotiate drug prices is historic. For decades, Big Pharma lobbyists (three for every one member of Congress) and Congressional Republicans stopped Medicare from saving taxpaying, hardworking families money by negotiating lower drug costs.

The result of that blockade was that Americans were forced to pay the highest prices for medicines in the world, despite the fact that taxpayers subsidize Big Pharma’s research and development.

“This is a game-changer for Americans who are being overcharged for medicines they need and a game-changer for Medicare because it will spend less taxpayer money to deliver the same benefits,” stated Deputy Press Secretary and Senior Communications Adviser Andrew Bates.

“This comes after President Biden also beat Big Pharma by capping the price of insulin at $35 per month for Medicare recipients. Big Pharma has spent nearly $400 million lobbying to stop these reforms.”

However, as the Biden Administration takes these newest historic actions to lower drug costs for Americans and strengthen Medicare, Congressional Republicans continue to side with Big Pharma’s price gouging and cuts to Medicare benefits instead.

Not only do congressional Republicans want to take the new benefits being announced today away from Americans with repeal legislation (just as they spent years trying to repeal the Affordable Care Act – Obamacare) – they are even siding with Big Pharma’s lawsuits to stop them in their tracks, Bates said.

Congressman Morgan Griffith endorsed their suits, saying, “every drug manufacturer probably ought to sue because it is, on its face, an unconstitutional taking.”

And reporters have frequently noted that in their opposition to this breakthrough for seniors, congressional Republicans are parroting Big Pharma’s talking points and “echoing arguments the pharmaceutical industry has made for years.”  

After unsuccessfully voting to block President Biden’s plan to let Medicare negotiate lower drug costs, Congressional Republicans have sought to repeal it, in alignment with Big Pharma. In the midterms, they campaigned on repealing Medicare’s new power but shut their ears to voters’ message back to them.

This summer alone, the Republican Study Committee, which represents over three quarters of House Republicans, unveiled yet another repeal plan.

The handouts Congressional Republicans are pursuing for Big Pharma would explode our deficit, weaken Medicare, and subject more American seniors and families to price gouging for life-saving medicines, Bates said. 

“Across the board, the hallmark of congressional Republicans’ trickle-down economic agenda is to increase costs and financial burdens shouldered by hardworking Americans in exchange for welfare payoffs to the super rich and multinational corporations. In this case, Big Pharma.

“Their philosophy is the polar opposite of Bidenomics, which is based on rewarding hard work and growing our economy by growing the middle class. Not leaching off the middle class for an extreme rightwing scheme to redistribute income upward.   

“We should be bolstering Medicare’s ability to lower drug costs for families, instead of trying to erase them.

“This fight is far from over. President Biden is pushing to expand Medicare’s capacity to negotiate lower drug costs, which he released a concrete plan for in his budget,” Bates said.

FACT SHEET: By The Numbers: Millions of Americans Would Lose Health Care Coverage, Benefits, and Protections Under Congressional Republicans’ Plans

This fact sheet on the impact on health care coverage, benefits and protections under the Congressional Republicans’ plans was provided by the White House:

While President Biden has secured a cap on insulin costs at $35/month, a cap on out-of-pocket prescription drug costs to $2000, enabled Medicare for the first time to negotiate drug prices, and lowered the cost of health care premiums, Congressional Republicans have promised to strip Medicare of the right to negotiate drug prices and remove the $2,000 cap on out-of-pocket pharmacy expenses and would  put Medicare, Medicaid, and Social Security on the chopping block every five years. © Karen Rubin/news-photos-features.com

President Biden’s top priority is to lower costs for the American people. He was proud to sign the Inflation Reduction Act into law, taking on Big Pharma to allow Medicare to negotiate prescription drug costs for the first time, capping seniors’ drug costs at the pharmacy and the cost of insulin, and lowering health insurance premiums for people who get coverage through the Affordable Care Act. President Biden and Congressional Democrats are committed to protecting and strengthening Social Security and Medicare.
 
Congressional Republicans have a very different vision. They have promised to strip Medicare of the right to negotiate drug prices and remove the $2,000 cap on out-of-pocket pharmacy expenses. Florida’s Republican Senator and Chair of the National Republican Senatorial Committee Rick Scott has championed a plan to put Medicare, Medicaid, and Social Security on the chopping block every five years. Further, Congressional Republicans have repeatedly pledged to hold the American economy hostage by refusing to raise the debt limit unless they can cut Social Security and Medicare benefits that tens of millions of Americans have already paid into. 
 
Here’s what Congressional Republicans’ plan would mean:

Part I: Putting Bedrock Programs like Social Security and Medicare on the Chopping Block and Threatening the Global Economy Unless Those Programs Are Cut

All Medicare, Medicaid, and Social Security beneficiaries would see their benefits threatened under Sen. Rick Scott’s plan to put those programs on the chopping block every five years. Sen. Ron Johnson’s vision of putting them up for a vote every year would make that even worse. 
 
Congressional Republican leaders have also repeatedly said they will use the debt limit as leverage to cut these bedrock programs. Congressional Republicans have supported Medicare and Social Security cuts including:

  • Gradually increasing the Medicare eligibility age to 67 and the Social Security eligibility age to 70. (Republican Study Committee FY 2023 Budget)
     
  • Transforming Medicare benefits into a voucher where seniors would get a fixed amount of money to purchase a private health plan (Better Way Plan) or offering beneficiaries the option to transition to a premium support system (Republican Study Committee FY 2023 Budget) – which could lead to hundreds or thousands of dollars in additional out of pocket costs for seniors throughout the country.


Part II: Repealing the Prescription Drug and Health Care Provisions in the Inflation Reduction Act
 

President Biden has worked for decades to let Medicare negotiate drug prices, and that is finally happening thanks to the Inflation Reduction Act.  This will save billions of dollars for both Medicare beneficiaries, who will see reduced premiums and out-of-pocket costs, and the federal government. Kaiser Family Foundation estimates suggest that some 5 to 7 million beneficiaries each year use the types of high-cost drugs that could be subject to negotiation and will directly face higher cost sharing if these provisions are repealed.

The Inflation Reduction Act also requires prescription drug companies to pay rebates if they increase drug prices faster than inflation. According to an analysis by the Department of Health and Human Services, the cost of 1,200 prescription drugs rose faster than inflation in the last year alone – some prescription drugs increasing by $1000 in just one year. If Congressional Republicans repeal the Inflation Reduction Act, drug companies will be able to continue raising prices without paying a rebate, rather than putting that money back into Americans’ pockets.
 

Before the Inflation Reduction Act, Medicare beneficiaries with conditions like cancer, multiple sclerosis, and lung disease could face thousands of dollars in out-of-pocket prescription drug costs per year. Thanks to President Biden and Congressional Democrats’ Inflation Reduction Act, those costs will be capped at $2,000 per year, saving over 1 million beneficiaries an average of over $1,300 per year. If Congressional Republicans get their way and repeal the law, over 1.4 million Medicare beneficiaries will pay more each year – thousands of dollars more in some cases – for drugs at the pharmacy.
 

Drug manufacturers have raised insulin prices so rapidly over the last few decades that some Medicare beneficiaries struggle to afford this life-saving drug that costs less than $10 a vial to manufacture. Today, Medicare beneficiaries are enrolling in plans that must cap the out-of-pocket cost of insulin at no more than $35 per month per prescription, a protection they will lose if the law is repealed.
 

The Inflation Reduction Act saves 13 million Americans an average of about $800 per year on their health care premiums, by continuing the improvements to Affordable Care Act (ACA) premium tax credits enacted in the American Rescue Plan. By making health care more affordable, these improvements have expanded coverage to millions of people, helping bring the uninsured rate to an all-time low. Starting today, during Open Enrollment season, Americans can choose health insurance plans that lock in the Inflation Reduction Act’s cost savings for 2023. But Congressional Republicans would repeal this assistance, drive premiums higher, and jeopardize the progress the Biden Administration has made in driving the uninsured rate to a historic low. Older Americans would see especially large premium spikes; in most states, annual premiums for a 60-year old making $60,000 would more than double to over $10,000.

Biden Acts to Lower Health Care and Prescription Drug Costs for Americans

This is a fact sheet from the White House on actions President Biden has taken to lower health care and prescription drug costs:

To mark the start of Medicare Open Enrollment season, President Biden highlighted how seniors can take advantage of the Inflation Reduction Act’s cost-saving provisions as they shop for new health insurance plans. The President also signed an Executive Order directing the Department of Health and Human Services to explore additional actions it can take to lower prescription drug costs to build on his Administration’s work lowering costs for working and middle-class families © Karen Rubin/news-photos-features.com

To mark the start of Medicare Open Enrollment season, President Biden highlighted how seniors can take advantage of the Inflation Reduction Act’s cost-saving provisions as they shop for new health insurance plans. The President also signed an Executive Order directing the Department of Health and Human Services to explore additional actions it can take to lower prescription drug costs to build on his Administration’s work lowering costs for working and middle-class families.
 
Americans are squeezed by the cost of living – that’s been true for years and is a key reason the President ran. Health care costs in particular are driving inflation. Too many Americans face challenges paying for prescription drugs. On average, Americans pay two to three times as much as people in other countries for prescription drugs, and one in four Americans who take prescription drugs struggle to afford their medications. Nearly three in ten American adults who take prescription drugs say that they have skipped doses, cut pills in half, or not filled prescriptions due to cost.
 
The Inflation Reduction Act – which President Biden and Congressional Democrats delivered – tackles that problem and locks in on average $800 per year lower health care premiums for 13 million families, lowers seniors’ prescription drug prices, and caps their out of pocket expenses for prescription drugs at $2,000 per year. The Inflation Reduction Act protects Medicare beneficiaries from catastrophic drug costs by phasing in a cap for out-of-pocket costs at the pharmacy, establishing a $35 monthly cap per prescription of insulin, requiring companies who raise prices faster than inflation to pay Medicare a rebate, and allowing Medicare to negotiate prices for high-cost prescription drugs for the first time ever. Republicans in Congress, meanwhile, have said their top priority is to repeal the Inflation Reduction Act, ending these cost-saving provisions and raising prices for tens of millions of Americans.
 
To further lower health care costs, earlier this week, the Treasury Department took action to fix the so-called “family glitch” rule that was making it harder for families to afford health care coverage for their spouse or child. About 1 million Americans will either gain coverage or see their insurance become more affordable as a result of the new rule.
 
Lowering Medicare Costs This Open Enrollment Season
 
Starting this January, seniors and other Medicare beneficiaries will begin to see the benefits of these cost-saving measures. Because of the Inflation Reduction Act:

  • A month’s supply of insulin will be capped at $35 starting on January 1, 2023.
  • Medicare beneficiaries will pay $0 out of pocket for recommended adult vaccines covered by their Part D plan, including the shingles vaccine – which costs seniors up to $200.
  • Prescription drug companies that try to raise their prices faster than inflation will be required to pay Medicare a rebate. 

Earlier this year, HHS released a report showing that the price of 1,200 prescription drugs rose faster than inflation in just the last year. For example, one manufacturer of a drug used to treat high blood pressure and heart failure, used by millions of Medicare beneficiaries, increased the drug’s price by nearly 540 percent in 2022. Another drug used to treat autoimmune conditions increased by $1000 just this year.
 
During Medicare Open Enrollment – running from October 15 to December 7 – seniors and other beneficiaries will be able to choose drug coverage that reflects these new cost-savings, putting money back into their pockets.
 
Medicare beneficiaries should visit Medicare.gov or call 1-800-MEDICARE to review their options for the coming year, and make sure their health and prescription drug coverage is right for them. 
 
Using HHS’ Innovation Center to Further Bring Down Costs
 
As the Biden-Harris Administration works to implement the Inflation Reduction Act, President Biden will sign an Executive Order today directing the Department of Health and Human Services to consider additional actions to further drive down prescription drug costs. That includes leveraging the “Innovation Center” at HHS, created by the Affordable Care Act, which has authority to test new ways of paying for Medicare services that improve the quality of care while lowering costs. 
 
Under the Executive Order, HHS will have 90 days to submit a formal report outlining any plans to use the Innovation Center’s authorities to lower drug costs and promote access to innovative drug therapies for Medicare beneficiaries. This action would build on the Inflation Reduction Act’s landmark drug pricing reforms and help provide additional breathing room for American families.

FACT SHEET: Biden Takes Action to Lower Health Care and Prescription Drug Costs for Americans

President Biden Signs Executive Order Directing HHS to Explore Additional Actions to Lower Prescription Drug Costs

Starting this January, seniors and other Medicare beneficiaries will begin to see the benefits of these cost-saving measures. Because of the Inflation Reduction Act: a month’s supply of insulin will be capped at $35; Medicare beneficiaries will pay $0 out of pocket for recommended adult vaccines covered by their Part D plan, including the shingles vaccine – which costs seniors up to $200; Prescription drug companies that try to raise their prices faster than inflation will be required to pay Medicare a rebate © Karen Rubin/news-photos-features.com

This fact sheet about actions that President Biden is taking to lower health care and prescription drug costs was provided by the White House:

To mark the start of Medicare Open Enrollment season, President Biden is highlighting how seniors can take advantage of the Inflation Reduction Act’s cost-saving provisions as they shop for new health insurance plans. The President  also signed an Executive Order directing the Department of Health and Human Services to explore additional actions it can take to lower prescription drug costs to build on his Administration’s work lowering costs for working and middle-class families.

Americans are squeezed by the cost of living – that’s been true for years and is a key reason the President ran. Health care costs in particular are driving inflation. Too many Americans face challenges paying for prescription drugs. On average, Americans pay two to three times as much as people in other countries for prescription drugs, and one in four Americans who take prescription drugs struggle to afford their medications. Nearly three in ten American adults who take prescription drugs say that they have skipped doses, cut pills in half, or not filled prescriptions due to cost. 

The Inflation Reduction Act – which President Biden and Congressional Democrats delivered – tackles that problem and locks in on average $800 per year lower health care premiums for 13 million families, lowers seniors’ prescription drug prices, and caps their out of pocket expenses for prescription drugs at $2,000 per year. The Inflation Reduction Act protects Medicare beneficiaries from catastrophic drug costs by phasing in a cap for out-of-pocket costs at the pharmacy, establishing a $35 monthly cap per prescription of insulin, requiring companies who raise prices faster than inflation to pay Medicare a rebate, and allowing Medicare to negotiate prices for high-cost prescription drugs for the first time ever. Republicans in Congress, meanwhile, have said their top priority is to repeal the Inflation Reduction Act, ending these cost-saving provisions and raising prices for tens of millions of Americans. 

To further lower health care costs, earlier this week, the Treasury Department took action to fix the so-called “family glitch” rule that was making it harder for families to afford health care coverage for their spouse or child. About 1 million Americans will either gain coverage or see their insurance become more affordable as a result of the new rule.

Lowering Medicare Costs This Open Enrollment Season

Starting this January, seniors and other Medicare beneficiaries will begin to see the benefits of these cost-saving measures. Because of the Inflation Reduction Act:

• A month’s supply of insulin will be capped at $35 starting on January 1, 2023. 

• Medicare beneficiaries will pay $0 out of pocket for recommended adult vaccines covered by their Part D plan, including the shingles vaccine – which costs seniors up to $200. 

• Prescription drug companies that try to raise their prices faster than inflation will be required to pay Medicare a rebate. 

Earlier this year, HHS released a report showing that the price of 1,200 prescription drugs rose faster than inflation in just the last year. For example, one manufacturer of a drug used to treat high blood pressure and heart failure, used by millions of Medicare beneficiaries, increased the drug’s price by nearly 540 percent in 2022. Another drug used to treat autoimmune conditions increased by $1000 just this year.

During Medicare Open Enrollment – running from October 15 to December 7 – seniors and other beneficiaries will be able to choose drug coverage that reflects these new cost-savings, putting money back into their pockets. 

Medicare beneficiaries should visit Medicare.gov or call 1-800-MEDICARE to review their options for the coming year, and make sure their health and prescription drug coverage is right for them.  

Using HHS’ Innovation Center to Further Bring Down Costs

As the Biden-Harris Administration works to implement the Inflation Reduction Act, President Biden signed an Executive Order directing the Department of Health and Human Services to consider additional actions to further drive down prescription drug costs. That includes leveraging the “Innovation Center” at HHS, created by the Affordable Care Act, which has authority to test new ways of paying for Medicare services thatimprove the quality of care while lowering costs.  

Under Executive Order XX, HHS will have 90 days to submit a formal report outlining any plans to use the Innovation Center’s authorities to lower drug costs and promote access to innovative drug therapies for Medicare beneficiaries. This action would build on the Inflation Reduction Act’s landmark drug pricing reforms and help provide additional breathing room for American families.

Democratic Candidates for 2020: Warren Details How She Would Finance Medicare for All

Sen. Elizabeth Warren, 2020 Democratic candidate for president detailed how she would finance her most controversial proposal, Medicare for All, without increasing taxes on middle class families. © Karen Rubin/news-photos-features.com

Senator Elizabeth Warren, Democratic candidate for President, has released details of her most controversial proposal, Medicare for All, promising that it will cover every person in America with health care, including long-term care, vision and dental, without increasing taxes on middle class families. Warren focuses on an overall restructuring taxes and spending – going after the loopholes and tax cheats and reining in military spending as well as drug costs and cutting healthcare costs by removing the for-profit insurance companies (gatekeepers) as middlemen. What her plan misses, though, is the obvious: collect the Medicare tax (1.45%, plus an extra 0.9% on income over $200,000) on all income, not just wages, and, if necessary raise the surcharge for incomes over $250,000. Interestingly, while employers would no longer pick and choose the private health insurance they subsidize, employers would still subsidize their employees’ Medicare cost. Health care is considered the leading issue for voters in 2020. Here is the detailed plan, from the Warren campaign: –Karen Rubin/news-photos-features.com.

Charlestown, MA – Today, Senator Elizabeth Warren, candidate for President, released her plan to finance Medicare for All. The coverage is identical to the coverage in the Medicare for All legislation in the Senate and it will cover every single person in America with excellent, high-quality health care, including long-term care and vision and dental. 

Elizabeth will pay for this plan without raising taxes one penny on middle class families. Instead, she will put about $11 trillion in the pockets of American families by eliminating what they would pay in premiums, deductibles, co-pays, and other out-of-pocket costs over the next ten years. 

Her numbers add up and are backed by experts including: 

Simon Johnson, the former Chief Economist at the International Monetary Fund and a professor at MIT

Dr. Donald Berwick, one of the nation’s top experts in health system management and improvement, who ran the Medicare and Medicaid programs under President Barack Obama

Mark Zandi, Chief Economist of Moody’s Analytics

Betsey Stevenson, former Chief Economist for the Obama Labor Department

Elizabeth’s plan to dramatically improve health care and cut family costs would cost the United States less than our current broken system. It would require $20.5 trillion in new revenue, nearly half of which comes simply from having employers pay Medicare instead of private insurance companies.

Elizabeth will finance the remainder of Medicare for All with targeted defense spending cuts, new taxes on financial firms, giant corporations, and the richest 1% of Americans, and by cracking down on tax evasion and fraud. The $11 trillion in household insurance and out-of-pocket expenses projected under our current system goes right back into the pockets of America’s working people — substantially larger than the largest tax cut in American history — and no middle class tax increases.

My daddy’s heart attack nearly sent our family skidding over a financial cliff. Today I think about all the kids this year who will face the double blow of nearly losing a parent and then watching their lives turn upside down as their families struggle to pay a growing stack of medical bills.  

I spent my career studying why so many hard-working middle class families were going broke. For years, my research partners and I traveled the country from bankruptcy courtroom to bankruptcy courtroom, talking directly to people who’d seen their lives turned upside down. We interviewed lawyers, judges, and families involved in bankruptcy cases. To save on printing costs, we lugged around a Xerox machine (I nicknamed him “R2-D2”) to save money on photocopying court records. 

Eventually, we built the largest and most comprehensive database of consumer bankruptcy data ever assembled. That first study surprised us: we found that 90% of families went bankrupt because of job loss, medical problems, and marital disruption. That finding was confirmed in 2007 by my later research, which found that the number one reason families were going broke was health care – and three quarters of those who declared bankruptcy after an illness were people who already had health insurance. 

It’s been nearly thirty years since we published that first groundbreaking study. And after all that time, here’s where we are: between 2013 and 2016, the number one reason families went broke was still because of health care – even though 91.2% of Americans had health insurance in 2016.

Families are getting crushed by health costs. Just look at the numbers. 

$12,378. That’s how much an average family of four with employer-sponsored insurance personally spent per year on employee premium contributions and out-of-pocket costs in 2018. And this figure has increased each year.

87 million. That’s how many American adults in 2018 were uninsured or “underinsured” – meaning either they have no insurance or their so-called health insurance is like a car with the engine missing. It looks fine sitting on the lot, but inadequate if they actually need to use it. Nearly one in every two adults not currently on Medicare has no insurance or unreliable insurance.

37 millionAmerican adults didn’t fill a prescription last year because of costs. 36 millionpeopleskipped a recommended test, treatment, or follow-up because of costs. 40 millionpeople didn’t go to a doctor to check out a health problem because of costs. 57 millionpeople had trouble covering their medical bills. 

Today, in 2019, in the United States of America, the wealthiest nation in the history of the world, inadequate health coverage is crushing the finances and ruining the lives of tens of millions of American families. 

I’m running for President based on a radical idea – calling out what’s broken and speaking plainly about how to fix it. 

All my plans start with our shared values. There are two absolute non-negotiables when it comes to health care:

One: No American should ever, ever die or go bankrupt because of health care costs. No more GoFundMe campaigns to pay for care. No more rationing insulin. No more choosing between medicine and groceries.

Two: Every American should be able to see the doctors they need and get their recommended treatments, without having to figure out who is in-network. No for-profit insurance company should be able to stop anyone from seeing the expert or getting the treatment they need.

Health care is a human right, and we need a system that reflects our values. That system is Medicare for All.

Let’s be clear: America’s medical professionals are among the best in the world. Health care in America is world-class. Medicare for All isn’t about changing any of that. 

It’s about fixing what is broken – how we pay for that care.

And when it comes to health care, what’s broken is obvious. A fractured system that allows private interests to profiteer off the health crises of the American people. A system that crushes our families with costs they can’t possibly bear, forcing tens of millions to go without coverage or to choose between basic necessities like food, rent, and health – or bankruptcy.

We must fix this system. And over the long-term, the best way to achieve that goal is to move from the system we have now to a system of Medicare for All. 

Medicare for All is about where doctors, hospitals, and care providers send the bill – to a collection of private insurance companies who make billions off denying people care or to the Medicare program for fair compensation. Under Medicare for All, everyone gets the care they need, when they need it, and nobody goes broke. 

A key step in winning the public debate over Medicare for All will be explaining what this plan costs – and how to pay for it. This task is made a hundred times harder by powerful health insurance and drug companies that make billions of dollars off the current bloated, inadequate system – and would be perfectly happy to leave things exactly the way they are. 

In 2017 alone, health industry players whose profiteering would end under Medicare for All unleashed more than 2,500 lobbyists on Washington. These industries will spend freely on shady TV ads and lobbying to convince people that a program that saves them massive sums of money will somehow cost them money. That being able to see the doctors and get the treatments they need regardless of what their employer or their insurance company thinks is somehow actually a loss of choice. That a program that covers more services, more people, and costs the American people less than what we currently spend on health care is somehow too expensive.

Meanwhile, where are the 2,500 lobbyists for the people who get sick and can’t pay their medical bills?  Where are the hundreds of millions being spent so that people who are trying to balance a budget around rising health care premiums and growing deductibles and copays can make their voices heard in Washington?  Washington hears plenty from the giant health insurance and giant drug industries, but not so much from families being squeezed to the breaking point.

So let’s focus on families’ expenses and families’ health care. 

Start with the Medicare for All Act – which I have cosponsored. The bill provides a detailed proposal for how to achieve our end goal. But as economists and advocates have noted, the legislation leaves open a number of key design decisions that will affect its overall cost, and the bill does not directly incorporate specific revenue measures. While much of this ambiguity results from the reasonable choice to delegate significant implementation discretion to the Executive Branch, it has also allowed opponents of Medicare for All to make up their own price tags and try to scare middle class families about the prospect of tax increases – despite the conclusions of expert after expert after expert that it is possible to eventually move to a Medicare for All system that gives both high quality coverage for everybody and dramatically lowers costs for middle class families.

The best way to fight misinformation is with facts. That’s why today, I’m filling in the details and releasing a plan that describes how I would implement the long-term policy prescriptions of the Medicare for All Act and how to pay for it. 

Under my plan, Medicare for All will cover the full list of benefits outlined in the Medicare for All Act, including long-term care, audio, vision, and dental benefits. My plan will cover every single person in the U.S., and includes common-sense payment reforms that make Medicare for All possible without spending any more money overall than we spend now. 

My plan reflects careful, detailed analyses from key national experts in health policy, tax policy, and economics. By filling in the details, we can strip away all the misleading political attacks and make plain the choice facing the American people: 

Option 1: Maintain our current system, which will cost the country $52 trillion over ten years. And under that current system – 

24 million people won’t have coverage, and millions can’t get long-term care.

63 million have coverage gaps or substandard coverage that could break down if they actually get sick. And millions who have health insurance will end up going broke at least in part from medical costs anyway. 

Together, the American people will pay $11 trillion of that bill themselves in the form of premiums, deductibles, copays, out-of-network, and other expensive medical equipment and care they pay for out-of-pocket – all while America’s wealthiest individuals and biggest companies pay far less in taxes than in other major countries.

Option 2: Switch to my approach to Medicare for All, which would cost the country just under $52 trillion over ten years. Under this new system –

Every person in America – all 331 million people – will have full health coverage, and coverage for long-term care.

Everybody gets the doctors and the treatments they need, when they need them. No more restrictive provider networks, no more insurance companies denying coverage for prescribed treatments, and no more going broke over medical bills.

The $11 trillion in household insurance and out-of-pocket expenses projected under our current system goes right back into the pockets of America’s working people. And we make up the difference with targeted spending cuts, new taxes on giant corporations and the richest 1% of Americans, and by cracking down on tax evasion and fraud. Not one penny in middle-class tax increases. 

That’s it. That’s the choice. A broken system that leaves millions behind while costs keep going up and insurance companies keep sucking billions of dollars in profits out of the system – or, for about the same amount of money, a new system that drives down overall health costs and, on average, relieves the typical middle class families of $12,400 in insurance premiums and other related health care costs. 

No middle class tax increases. $11 trillion in household expenses back in the pockets of American families. That’s substantially larger than the largest tax cut in American history.

Not every candidate for president supports moving to a system of Medicare for All. Some who support Medicare for All will have different ideas about how to finance and structure it. And everybody knows that there must be a real transition. But you don’t get what you don’t fight for – and my view is clear.  

Every candidate who opposes my long-term goal of Medicare for All should explain why the “choice” of private insurance plans is more important than being able to choose the doctor that’s best for you without worrying about whether they are in-network or not. Why it’s more important than being able to choose the right prescription drug for you without worrying about massive differences in copays. Why it’s more important than being able to choose to start a small business or choose the job you want without worrying about where your health care coverage will be coming from and how much it will cost.

Every candidate who opposes my long-term goal of Medicare for All should put forward their own plan to cover everyone, without costing the country anything more in health care spending, and while putting $11 trillion back in the pockets of the American people by eliminating premiums and virtually eliminating out-of-pocket costs. Or, if they are unwilling to do that, they should concede that they think it’s more important to protect the eye-popping profits of private insurers and drug companies and the immense fortunes of the top 1% and giant corporations, rather than provide transformative financial relief for hundreds of millions of American families. 

And every candidate who opposes my long-term goal of Medicare for All should put forward their own plan to make sure every single person in America can get high-quality health care and won’t go broke – and fully explain how they intend to pay for it. Or, if they are unwilling to do that, concede that their half-measures will leave millions behind.  

And make no mistake – any candidate who opposes my long-term goal of Medicare for All and refuses to answer these questions directly should concede that they have no real strategy for helping the American people address the crushing costs of health care in this country. We need plans, not slogans. 

THE COST OF MEDICARE FOR ALL

A serious conversation about how to pay for Medicare for All requires, first, determining how much such a system would cost. 

In recent years, several economists and think tanks have attempted to estimate the cost of a single-payer system in the United States. Those estimates consider how much our nation’s health care spending will change over a ten year window, and range from a $12.5 trillion decrease to a $7 trillion increase. They also consider how much additional money the federal government would need to fund this system, and those estimates range from a low of $13.5 trillion to a high of $34 trillion over ten years. 

Because nobody can actually see the future, some of this variation results from different assumptions about how parts of our health care system might work differently under Medicare for All. But most of the difference comes from policy choices. And while the Medicare for All Act is clear about some of these choices – for example, generous benefits, long-term care coverage, and virtually no out-of-pocket expenses – it is silent on a number of really important ones. How much will we pay for medical care and for prescription drugs? What do we do with the existing money that states spend on Medicaid? How aggressively will we cut administrative costs? Aggressive choices mean a lower total cost. Less aggressive choices result in a higher total cost. 

Serious candidates for president should speak plainly about these issues and set out their plans for cost control – especially those who are skeptical of Medicare for All. Because whether or not we make modest or transformative changes to our health care system, cancer, diabetes, strokes, Alzheimer’s, and Parkinson’s aren’t going to simply disappear. And without leadership from the top, neither will the mushrooming cost of care in America that’s bankrupting our families. 

I’ve asked top experts to consider the long-term cost of my plan to implement Medicare for All over ten years – Dr. Donald Berwick, one of the nation’s top experts in health system improvement and who ran the Medicare and Medicaid programs under President Obama; and Simon Johnson, the former Chief Economist at the International Monetary Fund and a professor at MIT. Their analysis begins with the assumptions of a recent study by the Urban Institute and then examines how that cost estimate would change as certain new key policy choices are applied. These experts conclude that my plan would slightly reduce the projected amount of money that the United States would otherwise spend on health care over the next 10 years, while covering everyone and giving them vastly better coverage. 

REDUCING INSURER ADMINISTRATIVE COSTS 

The business model of private insurers is straightforward: pay out less for medical care than they take in as premiums. This model is located right in the center of our health care system, wasting huge amounts of time and money documenting and arguing over who is owed what. Incredibly, insurance companies spend a whopping $350 billion on administration costs annually—and then, in turn, push huge additional administrative costs onto hospitals, doctors, and millions of other health care professionals in the from of complex billing—and then, in turn, drive up costs incurred by employers as they attempt to navigate the complexity of providing their employees with insurance.

Medicare for All will save money by bringing down the staggering administrative costs for insurers in our current system. As the experts I asked to evaluate my plan noted, private insurers had administrative costs of 12% of premiums collected in 2017, while Medicare kept its administrative costs down to 2.3%. My plan will ensure that Medicare for All functions just as efficiently as traditional Medicare by setting net administrative spending at 2.3%.

COMPREHENSIVE PAYMENT REFORM 

In 2016, the United States spent nearly twice as much on health care as ten high-income countries, and these costs have been steadily rising for decades, growing from 5.2% of U.S. GDP in 1963 to 17.9% in 2017. But instead of resulting in better health outcomes, Americans have the lowest life expectancy of residents in high-income countries, the highest infant mortality rate, and the highest obesity rates. 

Why? As a group of health economists famously wrote, “It’s the prices, stupid.” 

Studies have continued to show that it’s not how much people use the health care system, often referred to as “utilization,” but rather how much people pay that drives our high spending. Compared to other high income countries, Americans simply pay more for health care. We pay more for physicians and nurses. We pay more in administrative costs. We pay more for prescription drugs. 

A heart bypass surgery that costs nearly $16,000 in the Netherlands costs an average of $75,000 in the United States. A CT scan that costs $97 in Canada costs an average of $896 here. And in the United States, hospitals can charge new parents for holding their newborn after delivery. 

Meanwhile, private equity firms fight bipartisan legislation in Washington that might undermine the profitability of their investments or prevent their hospitals from sending patients surprise bills. And health care CEO salaries continue to soar. Between 2005 and 2015, non-profit hospital CEO salaries increased by 93% to an average of over $3 million, and last year, 62 health care CEOs raked in a combined $1.1 billion – more than the CDC spent on chronic disease prevention. 

If we expect the American people to be able to afford health care, we need to rein in these costs. Comprehensive payment reform, as part of Medicare for All, will reduce this component of health care spending. Under my approach, Medicare for All will sharply reduce administrative spending and reimburse physicians and other non-hospital providers at current Medicare rates. My plan will also rebalance rates in a budget neutral way that increases reimbursements for primary care providers and lowers reimbursements for overpaid specialties. While private insurance companies pay higher rates, this system would be expected to continue compensating providers at roughly the same overall rate that they are currently receiving. Why? This is partially because providers will now get paid Medicare rates for their Medicaid patients – a substantial raise. But it’s also because providers spend an enormous amount of time on billing and interacting with insurance companies that reduces their efficiency and takes away from time with patients. Some estimate that hospitals will spend $210 billion on average annually on these costs. 

The nonpartisan Institute of Medicine estimates that these wasted expenses account for 13% of the revenue for physician practices, 8.5% for hospitals, and 10% for other providers. Together, the improved efficiency will save doctors time and money – helping significantly offset  the revenue they will lose from getting rid of higher private insurance rates.

Under my approach, Medicare for All will sharply reduce administrative spending and reimburse hospitals at an average of 110% of current Medicare rates, with appropriate adjustments for rural hospitals, teaching hospitals, and other care providers with challenging cost structures. In 2017, hospitals that treated Medicare patients were paid about 9.9% less than what it cost to care for that patient. The increase I am proposing under Medicare for All will cover hospitals’ current costs of care – but hospital costs will also substantially decrease as a result of simpler administrative processes, lower prescription drug prices, the end of bad debt from uncompensated care, and more patients with insurance seeking care. 

Of course, as Medicare currently recognizes, not every provider situation is the same, and my Medicare for All program maintains these base rate adjustments for geography and other factors. In my plan for Rural America, for example, I have committed to creating a new designation under Medicare for rural hospitals due to the unique challenges health systems face in rural communities. That’s why my plan allows for adjustments above the 110% average rate for certain hospitals, like rural and teaching hospitals, and below this amount for hospitals that are already doing fine with current Medicare rates.Universal coverage will also have a disproportionately positive effect on rural hospitals. Because people living in rural counties are more likely to be uninsured than people living in urban counties, these hospitals currently provide a lot of uncompensated care. Medicare for All fixes that problem. And I’ve previously laid out additional investments to increase the number of Community Health Centers and grow our health care workforce in rural and Native American communities, while cracking down on anti-competitive mergers that lead to worse outcomes and higher costs for rural communities. 

We can also apply a number of common-sense, bipartisan reforms that have been proposed for Medicare. Today, for example, insurers can charge dramatically different prices for the exact same service based on where the service was performed. Under Medicare for All, providers will receive the same amount for the same procedure, saving hundreds of billions of dollars. We can also make adjustments to things that we know Medicare currently pays too much for – like post-acute care – by adjusting those payments down slightly while accounting for the patient’s health status, bringing health care costs down even more.  

We will also shift payment rates so that we are paying for better outcomes, instead of simply reimbursing for more services. We build on the success of value-based reforms enabled by the Affordable Care Act, including by instituting bundled payments for inpatient care and for 90 days of post-acute care. Instead of paying providers for each individual service, bundled payments reimburse providers for an entire “episode” of care and have been shown to both improve outcomes and control costs. These bundles help ensure that a patient’s different providers all communicate because they are all tied to the same payment.

RESTORING HEALTH CARE COMPETITION

Health care consolidation has also contributed to rising health care costs. One analysis found that over 90% of metropolitan areas had health care provider markets that were either highly concentrated or super concentrated in 2016. And despite the same kinds of empty promises we see every time there’s industry consolidation – in this case, that bigger hospitals would lead to better care – the data have not borne this out. In fact, it’s the opposite: more competition between providers creates incentives to improve care, and that incentive will only increase under a Medicare for All system where quality, not price, is the main differentiator in the system.

Under Medicare for All, hospitals won’t be able to force some patients to pay more because the hospital can’t agree with their insurance company. Instead, because everyone has good insurance, providers will have to compete on better care and reduced wait times in order to attract more patients. 

That’s why I will appoint aggressive antitrust enforcers to the Department of Justice and Federal Trade Commission and allow hospitals to voluntarily divest holdings to restore competition to hospital markets. I’ve also previously committed to strengthening FTC oversight over health care organizations, including non-profit hospitals, to crack down on anti-competitive behavior. And I will direct my FTC to block all future hospital mergers unless the merging companies can prove that the newly-merged entity will maintain or improve care. 

REINING IN OUT-OF-CONTROL PRESCRIPTION DRUG COSTS

Americans pay more for prescription drugs than anyone in the world – $333 billion in 2017 alone. Americans spent $1,220 per person on average for prescription drugs, while the next highest spending country, Switzerland, spent $963 per person. That’s not because Americans use more prescription medication – it’s because lax laws have allowed pharmaceutical companies to charge insurance companies and patients exorbitant rates. In a now-infamous example, when Turing Pharmaceuticals purchased the rights to the HIV medication Daraprim, the company raised the price of this life-saving drug from $13.50 per pill to a stunning $750 per tablet overnight. The price of insulin has skyrocketed, forcing people to risk their lives by rationing. And as prices continue to rise, more Americans are turning to Canada in search of affordable prices. 

Reining in prescription drug costs should be a top priority for any President – and there’s no better way to do it than through Medicare for All. My administration will use a suite of aggressive policy tools to set a net savings target that will bring down Medicare prices for brand name prescription drugs by 70% and prices for generics by 30%, with an initial focus on more expensive drugs. 

Under Medicare for All, the federal government would have real bargaining power to negotiate lower prices for patients. I will adopt an altered version of the mechanism outlined in the Lower Prescription Drug Costs Now Act which leverages excise taxes to bring manufacturers to the table to negotiate prices for both branded and generic drugs, with no drug exceeding 110% of the average international market price, but removes the limit of the number of drugs Medicare can negotiate for and eliminates the “target price” so Medicare could potentially negotiate prices lower than other countries. 

If negotiations fail, I will use two tools – compulsory licensing and public manufacturing – to allow my administration to ensure patient access to medicines by either overriding the patent, as modeled in the Medicare Negotiation and Competitive Licensing Act, or by providing public funds to support manufacturing of these drugs, as modeled in my Affordable Drug Manufacturing Act. Medicare for All will also incentivize pharmaceutical companies to develop the drugs we need – like antibiotics, cancer cures, and vaccines. And it’s not just about driving down drug prices. Making sure patients get important drug therapies up front that keep them healthy and cost a fraction compared to more severe treatment down the line can save money overall. Insurers, who may only cover individuals for a few years of their lives, see those investments in long-term health as a cost they’ll never recoup – so they have a financial incentive to deny patients these treatments. But Medicare for All covers each patient for their entire lifespan. There’s no perverse incentive to deny the prescriptions they need today because the long-term benefits to their health won’t benefit their current private insurance company. 

STEMMING THE GROWTH OF MEDICAL COSTS

Year after year, U.S. health spending has grown at rates above GDP growth, reaching a whopping 17.9% of GDP in 2017. Experts believe the changes to prescription drug spending and value-based payment systems that I’ve already outlined will bring growth rates in line with U.S. GDP, which CBO projects to be an average of 3.9% for the next decade. And if growth rates exceed this rate, I will use available policy tools, which include global budgets, population-based budgets, and automatic rate reductions, to bring it back into line.   

REDIRECTING TAXPAYER-FUNDED HEALTH SPENDING

Through Medicaid and public health plans for state employees, state and local governments play a significant role in financing health care coverage in America. Under my approach to Medicare for All, we will redirect $6 trillion in existing state and local government insurance spending into the Medicare for All system. This is similar to the mechanism that the George W. Bush Administration used to redirect Medicaid spending to the federal government under the Medicare prescription drug program.Under this maintenance-of-effort requirement, state and local governments will redirect $3.3 trillion of what they currently spend to support Medicaid and the Children’s Health Insurance Program and $2.7 trillion of what they currently spend on employer contributions to private insurance premiums for their employees into Medicare for All. Because we bring down the growth rate of overall health spending, states will pay less than they would have without Medicare for All. They’ll also have far more predictable budgets, resulting in improved long-term planning for state and community priorities. 

Together, these policy choices represent significant reductions in health care spending over current levels. Compared to the estimate by the Urban Institute, they will save over $7 trillion over ten years, bringing the expected share of additional federal revenue to just over $26 trillion for that period. After incorporating the $6 trillion we will redirect from states to help fund Medicare, the experts conclude that total new federal spending required to enact Medicare for All will be $20.5 trillion.

PAYING FOR MEDICARE FOR ALL

Medicare for All puts all health care spending on the government’s books. But Medicare for All is about the same price as our current path – and cheaper over time. That means the debate isn’t really about whether the United States should pay more or less. It’s about who should pay. 

Right now, America’s total bill for health care is projected to be $52 trillion for the next ten years. That money will come from four places: the federal government, state governments, employers, and individuals who need care. Under my approach to Medicare for All, most of these funding sources will remain the same, too. 

Existing federal spending on Medicare and Medicaid will help fund Medicare for All.

Existing state spending on health insurance will continue in the form of payments to Medicare – but states would be better off because they’d have more long-term predictability, and they’d pay less over time because these costs will grow more slowly than they do today.

Existing total private sector employer contributions to health insurance will continue in the form of contributions to Medicare – but employers would be better off because under the design of my plan, they’d pay less than they would have otherwise. 

Here’s the main difference: Individual health care spending. 

Over the next ten years, individuals will spend $11 trillion on health care in the form of premiums, deductibles, copays, and out-of-pocket costs. Under my Medicare for All plan, that amount will drop from $11 trillion to practically zero. 

I asked top experts – Mark Zandi, the Chief Economist of Moody’s Analytics; Betsey Stevenson, the former Chief Economist for the Obama Labor Department; and Simon Johnson – to examine options for how we can make up that $11 trillion difference. They conclude that it can be done largely with new taxes on financial firms, giant corporations, and the top 1% – and making sure the rich stop evading the taxes we already have.

That’s right: We don’t need to raise taxes on the middle class by one penny to finance Medicare for All. 

Here’s how it would work.

REPLACING EMPLOYER HEALTH SPENDING WITH A NEW EMPLOYER MEDICARE CONTRIBUTION 

Let’s start with a basic fact: American companies are already paying a lot for health care for their employees. They are projected to pay nearly $9 trillion over the next ten years, mostly on employer contributions for employee health insurance and on health-related expenses for employees under workers’ compensation and long-term disability. My idea is that instead of these companies sending those payments to private insurance companies, they would send payments to the federal government for Medicare in the form of an Employer Medicare Contribution. 

In fact, it’ll be a better deal than what they have now: companies will pay less than they otherwise would have, saving $200 billion over the next ten years. 

To calculate their new Employer Medicare Contribution, employers would determine what they spent on health care over the last few years and divide that by the number of employees of the company in those years to arrive at an average health care cost per employee at the company. (Companies would count part-time employees towards the total based on the number of hours they worked during a year.) Under the first year of Medicare for All, employers would then take that average cost, adjust it upwards to account for the overall increase in national health care spending, and multiply it by their total number of employees that year. Their Employer Medicare Contribution would be 98% of that amount – ensuring that every company paying for health care today will pay less than they would have if they were still offering their employees comparable private insurance. 

A similar calculation would apply to pass-through entities, like law firms or private equity funds, even though many of the people that work there technically aren’t employees. People who are self-employed would be exempt from making Employer Medicare Contributions unless they exceed an income threshold. 

Small businesses – companies with under 50 employees – would be exempt from this requirement too if they aren’t paying for employee health care today. When either new or existing firms exceed this employee threshold, we would phase in a requirement that companies make Employer Medicare Contributions equal to the national average cost of health care per employee for every employee at that company. Merging firms would pay the weighted average cost of health care per employee of the two firms that are merging.  

Employers currently offering health benefits under a collective bargaining agreement will be able to reduce their Employer Medicare Contribution if they pass along those savings to workers in the form of increased wages, pensions, or other collectively-bargained benefits. New companies or existing companies who enter into a collective bargaining agreement with their employees after the enactment of Medicare for All will be able to reduce their Employer Medicare Contributions in the same way. Employers can reduce their contribution requirements all the way down to the national average health care cost per employee. 

That way, my plan helps unions that have bargained for good health care already, and creates a significant new incentive for unionization generally by making collective bargaining appealing for both workers and employers as a way of potentially reducing the employer’s Employer Medicare Contributions.

Over time, an employer’s health care cost-per-employee would be gradually shifted to converge at the average health care cost-per-employee nationally. That helps make sure the system is fair but also gives employers and employees time to adapt to the new system.  

If we’re falling short of the $8.8 trillion revenue target for the next ten years, we will make up lost revenue with a Supplemental Employer Medicare Contribution requirement for big companies with extremely high executive compensation and stock buyback rates.    

There are a variety of ways to structure an employer contribution to Medicare for All. This particular approach has the benefit of helping American employers in a few ways:

Employers would collectively save $200 billion over the next ten years.

Employers receive far more certainty about how their health care costs will vary over time and affect their finances.

Small businesses – who often suffer when competing for employees because they can’t afford to offer health care coverage – would no longer be at a competitive disadvantage against bigger businesses.

Employers can reduce their Employer Medicare Contribution by supporting unionization efforts and negotiating with workers to provide better wages and benefits – reducing costs and promoting collective bargaining at the same time.

Because my plan holds health care cost growth to GDP levels, businesses will have stable balance sheets that grow with the economy instead of crowding out other priorities.

By asking employers to pay a little less than what they are already projected to pay for health care, we can get almost halfway to where we need to go to cover the cost of my Medicare for All plan. 

Automatic Increases in Take-Home Pay 

Medicare for All puts a whole lot of money back in the American people’s pockets. One way it does that is by taking the share of premiums employees are responsible for paying through employer-sponsored insurance – that line on pay stubs each week or month that says “health insurance” – and returning it to working people. Congratulations on the raise! 

And higher take-home pay for workers also means additional tax revenue just from applying our existing taxes – approximately $1.15 trillion if we apply average effective tax rates.  

Medicare for All saves people money in other ways too. With Medicare for All, nobody would need to put money in Health Savings Accounts or medical savings accounts to try and protect themselves against the unthinkable. And because individual spending on premiums, deductibles, copays, and out-of-pocket costs will basically disappear, the tax break for medical expenses in excess of 10% of Adjusted Gross Income becomes irrelevant. Together, those changes would generate another $250 billion in revenue.

All told, another $1.4 trillion in funding for Medicare for All is generated automatically through existing taxes on the enormous amount of money that will now be returned to individuals’ pockets from moving to a Medicare for All system with virtually no individual spending on health care. 

Here’s what that means: we can generate almost half of what we need to cover Medicare for All just by asking employers to pay slightly less than what they are projected to pay today, and through existing taxes.  

So where does the rest of the money come from that allows us to eliminate premiums, deductibles, copays, and most out-of-pocket spending for every American? Four sources: (1) better enforcement of our existing tax laws so we stop letting people evade their tax obligations; (2) targeted taxes on the financial sector, large corporations, and the top 1% of individuals; (3) my approach to immigration; and (4) shutting down a slush fund for defense spending. 

CRACKING DOWN ON TAX EVASION AND FRAUD

The federal government has a nearly 15% “tax gap” between what it collects in taxes what is actually owed because of systematic under-enforcement of our tax laws, tax evasion, and fraud. If that 15% gap persists for the next ten years, we will collect a whopping $7.7 trillion less in federal taxes than the law requires. By investing in stronger enforcement and adopting best practices on tax reporting, withholding, and filing, experts predict that we can close the tax gap by a third – generating about $2.3 trillion in additional federal revenue without a single new tax. 

A big part of our current tax gap problem is that we’re letting wealthier taxpayers get away with paying less than what they owe. Studies show that the wealthiest 5% of taxpayers misrepresent their income more frequently than the bottom 90%. 

The wealthy and their allies in Washington have worked to slash the IRS budget, leaving it without the resources it needs. The agency today has about the same number of revenue agents as it did when the economy was one-seventh its current size in the 1950s. And the IRS insists on targeting low-income taxpayers rather than wealthy ones, even though the amount of revenue we can recover from wealthy taxpayers is far more. 

We know how to fix this problem. We can draw lessons from what works in other countries with much lower tax gaps and rely on the recommendations of tax experts. Here’s a game plan:

Substantially increase funding for the IRS, including the Criminal Investigation Division. The Treasury Department estimated in its Fiscal Year 2017 budget request that every $1 invested in IRS enforcement brings in nearly $6 in additional revenue – not even including an indirect deterrence effect three times that amount.

Expand third-party reporting and withholding requirements. Research shows that third-party reporting and withholding cuts down on the tax misreporting rate substantially.

Strengthen enforcement of the Foreign Account Tax Compliance Act (FATCA). FATCA requires foreign financial institutions to report the holdings and income of U.S. taxpayers, but the IRS is generally not systematically matching these reports to individual tax returns. We also don’t hold foreign financial firms truly accountable for ignoring their reporting obligations. Automatically matching FATCA reports to tax returns and instituting sanctions for non-compliant foreign financial institutions would help narrow the tax gap.

Simplify tax filing obligations in line with other comparable countries with lower tax gaps, including by adopting my Tax Filing Simplification Act and using “smart returns” to improve honest reporting.

Redirect enforcement resources away from low-income taxpayers towards high-income taxpayers. 

Increase the nonfiler compliance program, strengthen reporting requirements for international income, use existing currency transaction reports to enforce cash income compliance, and increase reporting requirements for virtual- or crypto-currencies, as suggested by the Treasury Department’s Inspector General.

Allow employees who disclose tax evasion and abuse to use the protections of the False Claims Act and other whistleblower protections. 

The experts who reviewed these ideas estimated that if we implemented them, we could close the tax gap by one-third from 15% to 10%, bringing us closer to the tax gap in countries like the United Kingdom (5.6%). That will produce another $2.3 trillion in net federal revenue – without imposing a single new tax. 

TARGETED TAXES ON THE FINANCIAL SECTOR, LARGE CORPORATIONS, AND THE TOP 1% 

We can generate a whole lot of the remaining revenue we need for Medicare for All just by eliminating bad incentives in our current tax system and asking those who have done really well in the last few decades to pay their fair share.

Let’s start with the financial sector. It’s been more than ten years since the 2008 financial crisis, and while a lot of families are still dealing with the aftereffects, the financial sector is making record, eye-popping profits. Meanwhile, the risk of another financial crisis remains unacceptably high. By imposing targeted taxes and fees on financial firms, we can generate needed revenue and also make our financial system safer and more secure.

For example, a small tax on financial transactions – one-tenth of one percent on the sale of bonds, stocks, or derivatives – would generate about $800 billion in revenue over the next ten years. The tax would be assessed on and collected from financial firms, and would likely have little to no effect on most investors. Instead, according to experts, the tax could help decrease what Americans pay in fees for their investments and reduce the size of relatively unproductive parts of the financial sector. 

We can also impose a fee on big banks that encourages them to take on fewer liabilities and reduce the risk they pose to the financial system. A small fee that applies only to the forty or so largest banks in the country would generate an additional $100 billion over the next ten years – while making our financial system more safe and resilient. 

Next, we can make some basic changes to ensure that large corporations pay their fair share and to fix some fundamental problems with our current approach that actually encourage companies to shift jobs and investment overseas. These changes will generate an estimated $2.9 trillion over the next ten years. 

For instance, our current tax system lets companies deduct the cost of certain investments they make in assets faster than those assets actually lose value. That means that if a company buys a machine for a million dollars, it gets to deduct a million dollars from its taxes that same year – even if the machine only loses $100,000 in value a year. Letting the company write off the extra $900,000 all at once is like giving them an interest-free loan from the government. 

That might be worth it if the company responded to this tax break by investing more and building out their businesses. But the data suggest this isn’t happening because companies don’t actually value these tax deferrals as much as policymakers assume. Companies are mostly making the same investments they would’ve made anyways – sometimes with small changes in timing – and getting a write-off in exchange. Some experts even suggest that accelerated expensing could induce less domestic investment, not more. 

That’s why I’m proposing to get rid of this loophole. Under my plan, businesses will still write off the depreciation of their assets – they’ll just do it in a way that more accurately reflects the actual loss in value. This would generate $1.25 trillion over ten years.

We can also stop giant multinational corporations from calling themselves American companies while sheltering their profits in foreign tax havens to avoid paying their share for American investments. 

Currently, a U.S. multinational corporation can make billions in profits and attribute it to a company it set up in a tax haven like the Cayman Islands, which has no corporate taxes. The Trump tax bill claimed to address that problem by creating a global minimum tax rate for corporations, but that minimum tax – the result of heavy lobbying by multinationals – is too low and easily gamed. While Trump and congressional Republicans claimed their minimum tax would keep companies from shifting profits to tax havens and limit offshoring, the opposite is happening. The current approach both encourages companies to shift their profits to tax havens and actually incentivizes American companies to outsource their operations overseas. 

That’s why I’m proposing to institute a country-by-country minimum tax on foreign earnings of 35% – equal to a restored top corporate tax rate for U.S. firms – without permitting corporations to defer those payments. Under my plan, corporations would have to pay the difference between the minimum tax and the rate in the countries where they book their profits. For example, an American corporation booking a billion dollars in profits in the Cayman Islands, taxed at 0% there, would need to pay the federal government a 35% tax rate – the difference between the new minimum rate (35%) and the foreign rate (0%) – on the billion dollars in profits. 

My plan would also collect America’s fair share of profits that foreign companies make by selling their products to Americans. Today, we have a “global tax deficit”: companies that sell their goods abroad don’t have to pay the extra taxes that they would have to pay if they were subject to a minimum effective tax rate in each country they operated in. Making U.S. firms pay a country-by-country minimum tax effectively collects their whole global tax deficit – but foreign companies should have to pay their fair share, too. That’s why I’m proposing that the U.S. collect the fraction of this global tax deficit that corresponds to the percentage of that company’s sales in the U.S. In other words, if a foreign company should owe an additional $1 billion in taxes if it were subject to a country-by-country minimum tax, the U.S. would collect a fraction of that $1 billion based on the amount of sales that company made in the United States. 

Together, the country-by-country minimum tax and the taxation of foreign firms based on their domestic sales would result in an additional $1.65 trillion in revenue. 

Finally, we can raise another $3 trillion over ten years by asking the top 1% of households in America to pay a little more. 

The tax burden on ultra-millionaires and billionaires is less than half that of working families in the United States. In 2019, the bottom 99% of families will pay 7.2% of their wealth in taxes, while the top 0.1% of households will pay just 3.2%. My Ultra-Millionaire Tax, a 2-cent tax on the wealth of fortunes above $50 million, tackles this head on. Under this tax, the top 0.1% – the wealthiest 75,000 Americans – would have to pitch in two cents for every dollar of net worth above $50 million and three cents for every dollar on net worth over $1 billion. With this version of the Ultra-Millionaire Tax in place, the tax burden on the wealthiest households would increase from 3.2% to 4.3% of total wealth – better, but still below the 7.2% that the bottom 99% are projected to pay.

Today, I’m going one step further. By asking billionaires to pitch in six cents on each dollar of net worth above $1 billion, we can raise an additional $1 trillion in revenue and further close the gap between what middle-class families pay as a percentage of their wealth and what the top one-tenth of one percent pay. 

Yes, billionaires will have to pay a little more, but they will still likely pay less than what they would earn just from putting their assets into an index fund and doing nothing. The average annual rate of return of the S&P 500 has regularly topped 10%. And billionaires have access to the kinds of fancy investment opportunities that can generate even higher returns on average. Put it this way – should we ask billionaires to pitch in an extra three cents on every dollar above $1 billion, or force middle-class families to bear another $1 trillion in health care costs?

We can also change the way the government taxes investment income for the top 1%. Today, taxes are only assessed on capital gains when securities are sold. That means wealthy investors can put their money in the stock market, see it grow, and not pay a dime in taxes on those earnings unless or until it is taken out of the market. Under the current system, they can then pass along those shares to their heirs when they die and their heirs will be able to pay even less when they choose to sell.

I’ve already proposed closing that loophole for how capital gains are treated when shares are passed on to heirs. But we can go a step further. Under “mark-to-market” system for the wealthiest 1% of households, we will tax capital gains income (excluding retirement accounts) annually, rather than at the time of sale, and raise the rates on capital gains to match the tax rates for labor income. Individuals would still only pay taxes on gains and could use current losses to offset future taxes.

Under this system, investment income will no longer be treated differently than labor income for the top 1% of households. Ultra-millionaires and billionaires won’t be able to earn income on giant fortunes year after year without paying a penny in taxes. And we can raise another $2 trillion over ten years to pay for my Medicare for All plan.

IMMIGRATION REFORM 

I support immigration reform that’s consistent with our values, including a pathway to citizenship for undocumented immigrants and expanded legal immigration consistent with my principles. That’s not only the right thing to do – it also increases federal revenue we can dedicate to Medicare for All as new people come into the system and pay taxes. Based on CBO’s analysis of the 2013 comprehensive immigration reform bill, experts project that immigration reform would generate an additional $400 billion in direct federal revenue. 

REINING IN DEFENSE SPENDING 

Since the attacks of 9/11, the United States has appropriated $2 trillion to fund combat and counterterrorism operations around the world via the Overseas Contingency Operations fund, or OCO. On average this spending has amounted to $116 billion per year – and in total, an amount equivalent to nearly 10 percent of all federal discretionary spending over that same time period. 

Republicans – including the President’s current Chief of Staff – and Democrats alike agree that OCO is a budget gimmick that masks the true impact of war spending. The emergency supplemental funding mechanism was never intended to fund the costs of long-scale, long-term operations outside of the normal appropriations process. And in recent years, OCO has also been used to fund so-called “base” requirements unrelated to the wars, outside of the Budget Control Act caps – in effect acting as a slush fund for increased Pentagon spending. And as everything from more F-35s to massive bombs never used in combat have migrated into the OCO account, the Department of Defense has been spared from having to prioritize or live within its means. It’s not just bad budgetary practice – it’s wasteful spending. 

I’ve called out this slush fund for what it is. I’ve also called for an end to endless combat engagements in places like Afghanistan, Iraq, and Syria, and to responsibly bring our combat troops home from these nations. These open-ended commitments are not necessary to advance American foreign policy or counterterrorism interests, their human cost has been staggering, and their financial cost has created a drag on our economy by diverting money better invested in critical domestic priorities. 

I’ve also called to reduce defense spending overall. The Pentagon budget will cost more this year than everything else in the discretionary budget put together. That’s wrong, and it’s unsustainable. We need to identify which programs actually benefit American security in the 21st century, and which programs merely line the pockets of defense contractors – then pull out a sharp knife and make some cuts. 

We can start by shutting down this slush fund and balancing with our overall defense priorities in the context of the actual defense budget. And as we end these wars, eliminating the Overseas Contingency Operations fund and forcing the Pentagon to fund any such priorities through its regular budgetary process will provide $798 billion over the ten-year period relative to current spending levels. 

As I have said repeatedly, under my Medicare for All plan, costs will go up for the very wealthy and big corporations, and costs will go down for middle-class families. I will not sign a bill that violates these commitments. And as my plan to pay for Medicare for All makes clear, we can meet these commitments without a tax increase on the middle class – and, in fact, without any increase in income taxes at all. 

America’s middle class is facing a crisis. For a generation, wages have remained largely flat while family costs have exploded. I’ve spent decades sounding the alarm about it. I’m running for President to fix it. That means doing whatever we can to reduce the overall strain on family budgets. 

Medicare for All can be a huge part of the solution. When fully implemented, my approach to Medicare for All would mark one of the greatest federal expansions of middle class wealth in our history. And if Medicare for All can be financed without any new taxes on the middle class, and instead by asking giant corporations, the wealthy, and the well-connected to pay their fair share, that’s exactly what we should do.

ACHIEVING MEDICARE FOR ALL

Of course, moving to this kind of system will not be easy and will not happen overnight. This is why every serious proposal for Medicare for All contemplates a significant transition period. 

In the weeks ahead, I will propose a transition plan that will specifically address how I would use this time to begin providing immediate financial relief to struggling families, rein in out-of-control health care costs, increase coverage, and save lives. My transition plan will take seriously and address substantively the concerns of unions, individuals with private insurance, hospitals, people who work for private health insurers, and medical professionals who worry about what a new system will mean for them. It will also grapple directly with the entrenched political and economic interests that would spend freely, as they have throughout modern American history, to influence politicians and try to frighten the American people into rejecting a plan that would save them thousands of dollars a year on premiums and deductibles while making sure they can always see the health care providers they need with false claims and scare tactics.  

But there’s a reason former President Barack Obama has called Medicare for All a good idea. There’s a reason the American people support it. It’s because when it comes to the cost of health care, we are in the middle of a full-blown crisis. 

We are paying twice as much as any other major nation for care – even as tens of millions lack coverage, and even as family after family sees its finances destroyed by a health issue. And the American people know that in the long-term, a simple system that covers everybody, provides the care they need when they need it, puts $11 trillion back in their pockets and uses all of the public’s leverage to keep costs as low as possible is the best option for their family budgets and for the health of their loved ones.

As President, I’ll fight to get it done.

Read the plan here
Read expert letter on cost estimate of Medicare for All here 
Read expert letter on financing Medicare for All here
Calculator here

Democratic Candidates for 2020: The Biden Plan for Older Americans

Vice President Joe Biden, campaigning to be the 2020 Democratic nominee for president, released his plan for seniors to have secure retirement © Karen Rubin/news-photos-features.com

The vigorous contest of Democrats seeking the 2020 presidential nomination has produced excellent policy proposals to address major issues. This is from the Biden 2020 campaign:

THE BIDEN PLAN FOR OLDER AMERICANS

The moral obligation of our time is rebuilding the middle class. The middle class isn’t a number, it’s a value set. And, a key component of that value set is having a steady, secure income as you age so your kids won’t have to take care of you in retirement. This means not only protecting and strengthening Social Security, but also helping more middle-class families grow their savings. 

A dignified retirement also means having access to affordable health care and support. Too many Americans – and too many older Americans – cannot afford their prescriptions or their long-term care. Their families are faced with saving for their own retirement or taking care of their aging parents. It’s not right. 
 
Working- and middle-class Americans built this country. And, they deserve to retire with dignity – able to pay for their prescriptions and with access to quality, affordable long-term care. 

I. STAND UP TO THE ABUSE OF POWER BY PRESCRIPTION DRUG CORPORATIONS

Too many Americans cannot afford their prescription drugs, and prescription drug corporations are profiteering off of the pocketbooks of sick individuals. The Biden Plan will put a stop to runaway drug prices and the profiteering of the drug industry by:

  • Repealing the outrageous exception allowing drug corporations to avoid negotiating with Medicare over drug prices. Because Medicare covers so many Americans, it has significant leverage to negotiate lower prices for its beneficiaries. And it does so for hospitals and other providers participating in the program but not drug manufacturers. Drug manufacturers not facing any competition, therefore, can charge whatever price they choose to set. There’s no justification for this except the power of prescription drug lobbying. The Biden Plan will repeal the existing law explicitly barring Medicare from negotiating lower prices with drug corporations.
  • Limiting launch prices for drugs that face no competition and are being abusively priced by manufacturers. Through his work on the Cancer Moonshot, Biden understands that the future of pharmacological interventions is not traditional chemical drugs, but specialized biotech drugs that will have little to no competition to keep prices in check. Without competition, we need a new approach for keeping the prices of these drugs down. For these cases where new specialty drugs without competition are being launched, under the Biden Plan the Secretary of Health and Human Services will establish an independent review board to assess their value. The board will recommend a reasonable price, based on the average price in other countries (a process called external reference pricing) or, if the drug is entering the U.S. market first, based on an evaluation by the independent board members. This reasonable price will be the rate Medicare and the public option will pay. In addition, the Biden Plan will allow private plans participating in the individual marketplace to access a similar rate.
  • Limiting price increases for all brand, biotech and abusively priced generic drugs to inflation. As a condition of participation in the Medicare program and public option, all brand, biotech and abusively priced generic drugs will be prohibited from increasing their prices more than the general inflation rate. The Biden plan will also impose a tax penalty on drug manufacturers that increase the costs of their brand, biotech or abusively priced generic over the general inflation rate.
  • Allowing consumers to buy prescription drugs from other countries. To create more competition for U.S. drug corporations, the Biden Plan will allow consumers to import prescription drugs from other countries, as long as the U.S. Department of Health and Human Services has certified that those drugs are safe.
  • Terminating pharmaceutical corporations’ tax break for advertisement spending.Drug corporations spent an estimated $6 billion in 2016 alone on prescription drug advertisements to increase their sales, a more than four-fold increase from just $1.3 billion in 1997. The American Medical Association has even expressed “concerns among physicians about the negative impact of commercially driven promotions, and the role that marketing costs play in fueling escalating drug prices.” Currently, drug corporations may count spending on these ads as a deduction to reduce the amount of taxes they owe. But taxpayers should not have to foot the bill for these ads. As president, Biden will end this tax deduction for all prescription drug ads, as proposed by Senator Jeanne Shaheen.
  • Improving the supply of quality generics. Generics help reduce health care spending, but brand drug corporations have succeeded in preserving a number of strategies to help them delay the entrance of a generic into the market even after the patent has expired. The Biden Plan supports numerous proposals to accelerate the development of safe generics, such as Senator Patrick Leahy’s proposal to make sure generic manufacturers have access to a sample.

II. PROTECT AND STRENGTHEN MEDICARE AS WE KNOW IT AND ENSURE QUALITY, AFFORDABLE HEALTH CARE FOR ALL OLDER AMERICANS 

On March 23, 2010, President Obama signed the Affordable Care Act into law, with Vice President Biden standing by his side, and made history. It was a victory 100 years in the making. It was the conclusion of a tough fight that required taking on Republicans, special interests, and the status quo to do what’s right. But the Obama-Biden Administration got it done.
 
Today, the Affordable Care Act is still a big deal – especially for older Americans. Because of Obamacare, over 100 million people no longer have to worry that an insurance company will deny coverage or charge higher premiums just because they have a pre-existing condition – whether cancer or diabetes or heart disease or a mental health challenge. Insurance companies can no longer set annual or lifetime limits on coverage. The law limited the extent to which insurance companies may charge you higher premiums just because of your age. And, the Affordable Care Act strengthened Medicare by extending the life of the Medicare Trust Fund; giving Medicare beneficiaries access to free recommended preventive services, such as an annual wellness visit; and closing the prescription drug coverage gap, often referred to as the “donut hole.”
 
But, every day over the past nine years, the Affordable Care Act has been under relentless attack.

Immediately after its passage, Congressional Republicans began trying again and again to repeal it. Following the lead of President Trump, Republicans in Congress have only doubled down on this approach since January 2017. And, since repeal through Congress has not been working, President Trump has been unilaterally doing everything he can to sabotage the Affordable Care Act. Now, the Trump Administration is trying to get the entire law – including protections for people with pre-existing conditions – struck down in court.
 
As president, Biden will protect the Affordable Care Act from these continued attacks. He opposes every effort to get rid of this historic law – including efforts by Republicans, and efforts by Democrats. Instead of starting from scratch and getting rid of private insurance, he has a plan to build on the Affordable Care Act by giving Americans more choicereducing health care costs, and making our health care system less complex to navigate. You can read Biden’s full health care plan [here]. In addition, to improve older Americans’ access to affordable, quality health care, Biden will:

  • Protect Medicare as we know it. Today, Medicare provides health insurance coverage to over 60 million older Americans and people with disabilities.  As president, Biden will continue to defend our nation’s commitment to older Americans and people with disabilities through Medicare, and he will keep Medicare as a separate and distinct program, and ensure there is no disruption to the current Medicare system.
  • Protect Medicaid and ensure its beneficiaries can access home and community-based long-term care when they want it. Medicaid pays for more long-term care than any other insurer in the country. In fact, roughly 6 in 10 individuals residing in nursing homes are enrolled in Medicaid, including many older Americans. Yet, the Trump Administration is reportedly considering a plan to cut Medicaid funding by turning it into a block grant. And Republican leadership in states like Iowa, where Medicaid has been privatized with devastating results for some of its most vulnerable residents, are not fulfilling their obligations under the program. The Biden Plan will protect Medicaid funding and make sure the program gives those on Medicaid who need long-term care the flexibility to choose home- and community-based care. In addition, the Biden Administration won’t let states skirt their duties under Medicaid and will take enforcement action against any state that allows profiteering to get in the way of Medicaid beneficiaries’ health.
  • Provide tax relief to help solve the long-term care challenge. The Biden Plan will also help Americans pay for long-term care by providing relief for Americans needing long-term care by creating a $5,000 tax credit for informal caregivers, modeled off of legislation supported by AARP. These informal caregivers – whether family members or other loved ones – have for too long been doing tireless work without any financial support. In addition, Biden will increase the generosity of tax benefitsfor older Americans who choose to buy long-term care insurance and pay for it using their savings for retirement.
  • Care for our caregivers. The physical, emotional, and financial challenges of caring for a loved one is enormous. As president, Biden will work to enact at the federal level the AARP-endorsed Caregiver Advise, Record, Enable (CARE) Act, which has already been passed in 39 states. This legislation will help our caregivers by ensuring hospitals equip them with instructions and information when their loved ones are discharged. Biden also supports additional proposals to support caregivers, such as funding to give them access to respite care.

III. PRESERVE AND STRENGTHEN SOCIAL SECURITY

Social Security is the bedrock of American retirement. Roughly 90% of retirement-age Americans receive Social Security benefits, and one-in-four rely on Social Security for all, or almost all, of their income. The program has not only ensured that middle-class workers can enjoy the sound and secure retirement they worked so hard for, it also lifted over 17 million older Americans out of poverty in 2017 alone.
 
The Biden Plan will protect Social Security for the millions of Americans who depend on the program. With Social Security’s Trust Fund already in deficit and expected to be exhausted in 2035, we urgently need action to make the program solvent and prevent cuts to American retirees.
 
But the Biden Plan doesn’t stop there. As president, Joe Biden will strengthen benefits for the most vulnerable older Americans – including widows and widowers, lifelong workers with low monthly benefits, and old-age beneficiaries who may have exhausted their other savings. Specifically, the Biden Plan will:

  • Put Social Security on a path to long-run solvency. The impending exhaustion of the Social Security Trust fund imperils American retirement as we know it. Waiting to act only jeopardizes the program further, and will make an eventual solution that much more difficult. The Biden Plan will put the program on a path to long-term solvency by asking Americans with especially high wages to pay the same taxes on those earnings that middle-class families pay.
  • Preserve the nature of Social Security. Social Security is one of our nation’s great public policy successes, in large part due to the fact that participation in the program is shared across almost all workers. Efforts to privatize the program – such as an approach suggested under the Bush Administration – will undermine the program’s solvency, while putting at risk individuals’ income in retirement. Similarly, proposals to make the program “means-tested” – so that only low-income retirees workers receive benefits – jeopardizes the program’s universal nature and key role as the bedrock of American retirement. Ultimately, the success of Social Security is largely due to the fact that almost all Americans can rely on the program to make their retirement more secure.
  • Provide a higher benefit for the oldest Americans. At advanced ages, Americans become more vulnerable to exhausting their savings, sometimes falling into poverty and living a life of hardship. The Biden Plan will provide the oldest beneficiaries – those who have been receiving retirement benefits for at least 20 years – with a higher monthly check to help protect retirees from the pain of dwindling retirement savings.
  • Implement a true minimum benefit for lifelong workers. No one who has worked for decades and paid into Social Security should have to spend their retirement in poverty. The Biden Plan will revolutionize the Social Security’s minimum benefit, which has deteriorated over time to the point of being entirely ineffective. Under the Biden Plan, workers who spent 30 years working will get a benefit of at least 125% of the poverty level.
  • Protect widows and widowers from steep cuts in benefits. For many couples, the death of a spouse means that Social Security benefits will be cut in half – putting pressure on the surviving spouse who still needs to make the mortgage payment and handle other bills. The Biden Plan will allow surviving spouse to keep a higher share of the benefits. This will make an appreciable difference in the finances of older Americans, especially women (who live longer on average than men), raising the monthly payment by about 20% for affected beneficiaries.
  • Eliminate penalties for teachers and other public-sector workers. Current rules penalize teachers and other public sector workers who either switch jobs or who have earned retirement benefits from various sources. The Biden Plan would eliminate these penalties by ensuring that teachers not eligible for Social Security will begin receiving benefits sooner – rather than the current ten-year period for many teachers. The Biden Plan will also get rid of the benefit cuts for workers and surviving beneficiaries who happen to be covered by both Social Security and another pension. These workers deserve the benefits they earned.

IV. EQUALIZE SAVING INCENTIVES FOR MIDDLE-CLASS WORKERS

In the modern retirement landscape, a sound retirement begins with years of diligent saving. While other aspects of the Biden Plan will help raise wages for workers and reduce costs for spending like child care and health insurance, the Biden Plan will also ensure that middle-class families get a leg up as they grow their nest egg.
 
Under current law, the tax code affords workers over $200 billion each year for various retirement benefits – including saving in 401(k)-type plans or IRAs. While these benefits help workers reach their retirement goals, many are poorly designed to help low- and middle-income savers – about two-thirds of the benefit goes to the wealthiest 20% of families. The Biden Plan will make these savings more equal so that middle class families can enter retirement with enough savings to support a healthy and secure retirement. President Biden will do so by:

  • Equalizing the tax benefits of defined contribution plans. The current tax benefits for retirement savings are based on the concept of deferral, whereby savers get to exclude their retirement contributions from tax, see their savings grow tax free, and then pay taxes when they withdraw money from their account. This system provides upper-income families with a much stronger tax break for saving and a limited benefit for middle-class and other workers with lower earnings. The Biden Plan will equalize benefits across the income scale, so that low- and middle-income workers will also get a tax break when they put money away for retirement. 
  • Removing penalties for caregivers who want to save for retirement. Under current law, people who work as caregivers without receiving wages are ineligible to get tax breaks for retirement saving. The Biden Plan will allow caregivers to make “catch-up” contributions to retirement accounts, even if they’re not earning income in the formal labor market, as has been proposed in bipartisan legislation by Representatives Jackie Walorski and Harley Rouda.
  • Giving small businesses a tax break for starting a retirement plan and giving workers the chance to save at work. As proposed by the Obama-Biden Administration, the Biden Plan will call for widespread adoption of workplace savings plans and offer tax credits to small businesses to offset much of the costs. Under Biden’s plan, almost all workers without a pension or 401(k)-type plan will have access to an “automatic 401(k),” which provides the opportunity to easily save for retirement at work – putting millions of middle-class families in the path to a secure retirement.

V. PROVIDE HELP FOR OLDER WORKERS WHO WANT TO KEEP WORKING

With longer lifespans and the changing nature of work, many Americans are choosing to stay in the workforce longer. Despite their valuable contributions, these workers often face illegal discrimination or steep tax penalties when they try to continue to earn a living. Joe Biden believes that all workers deserve an opportunity to earn a living and will fight to change the laws to allow all people – regardless of their age – to get the pay they deserve. The Biden Plan will:

  • Protect older Americans against harmful age discrimination. As president, Biden will back bipartisan legislation protecting older workers from being discriminated against in the workforce. According to an AARP survey, this practice is widespread – with more than 60% of older workers reporting discrimination because of their age. The Biden Plan will put in place workplace safeguards making it easier for older workers to prove that they were treated unfairly at work.
  • Expand the Earned Income Tax Credit (EITC) to older workers. The EITC is one of the most effective strategies for helping low-wage workers achieve a living wage. Unfortunately, the EITC is not available to workers once they turn 65, putting them at a distinct disadvantage relative to their younger peers. As president, Joe Biden will allow low-wage older workers to claim the tax credit they deserve.

Bernie Sanders Defends Medicare-for-All, Attacks Insurance Companies, Big Pharma for Dysfunctional, High-Cost Healthcare

Bernie Sanders, seen at a Brooklyn rally, is defending his signature plan, Medicare-for-All, and blaming the greed of the insurance and pharmaceutical industries as the reason for dysfunctional, high cost health care system that causes 30,000 premature deaths a year and bankrupts 530,000 Americans a year. © Karen Rubin/news-photos-features.com

WASHINGTON – U.S. Senator Bernie Sanders, running to be the Democratic nominee for president, on July 17 delivered a major address on Medicare for All, coinciding with the 54th anniversary of Medicare being signed into law. In his remarks, Sanders outlined his plan to make health care a human right for all Americans. Here is highlighted transcript of remarks as they were prepared for delivery: – Karen Rubin, News & Photo Features

Thank you all very much for being here to discuss one of the major crises facing our country.  Let me also thank the dozens of organizations throughout America who support Medicare for All and the tens of thousands of doctors, nurses and other health professionals who support my legislation.  Let me thank the 14 Senate co-sponsors that we have on this legislation and the 118 Members of the House who support similar legislation.  And mostly, let me thank the American people who by the millions understand, as I do, that health care is a human right, not a privilege.

Together, we will end the international embarrassment of the United States being the only major country on earth that does not guarantee health care to all of its citizens.  

It is not acceptable to me, nor to the American people, that some 87 million people today are either uninsured or underinsured.

It is not acceptable to me that we end up spending almost twice as much as any other major country on health care, while our life expectancy continues to decline and our healthcare outcomes lag behind many other countries.

Frankly, I am sick and tired of talking to doctors who tell me about the patients who died because they were uninsured or underinsured, and walked into the doctor’s office when it was too late.  And we are talking about over 30,000 Americans who die every year because they are uninsured or under-insured.  What a tragedy. 

I am sick and tired of seeing working class families and small businesses pay far more for healthcare than they can afford, and 530,000 Americans declare bankruptcy each year because they cannot pay off the outrageous cost of a medical emergency or a hospital stay.  Families should not be driven into financial ruin because someone in the family became seriously ill.  How insane is that?

I am sick and tired of hearing from Americans who lost loved ones because they could not afford the unbelievably high cost of prescription drugs, or hearing from constituents who are forced to cut their pills in half due to the cost. 

In fact, later this month, I will be travelling from Detroit, Michigan to Windsor, Ontario with a busload of Americans who have diabetes in order to purchase insulin in Canada at one-tenth of the price that they pay in America.

I am sick and tired of talking with people who are struggling with mental illness but cannot afford the mental health counseling they desperately need. 

I am tired of talking to people who have teeth that are rotting in their mouths, but cannot afford the high cost of dental care

Let me be very honest and tell you that, in my view, the current debate over Medicare for All really has nothing to do with healthcare.  It has everything to do with greed and the desire of the healthcare industry to maintain a system which fails the average American, but which makes the industry tens and tens of billions of dollars every year in profit. 

It is about whether we maintain a dysfunctional system which allows the big drug and health insurance companies to make over $100 billion in profits last year, while the top CEOs in that industry made $2.6 billion in total compensation – all the while 1 out of 5 Americans cannot afford the prescription drugs their doctors prescribe.

It’s about whether we maintain a system in which the CEO of the Aetna insurance company, Mr. Mark Bertolini, received a golden parachute worth nearly $500 million after his company merged with CVS Health, while elderly people lack the resources to purchase a hearing aid.

It’s about whether we maintain a system that allows the former CEO from Gilead (John Martin) to become a billionaire by charging $1,000 a pill for a hepatitis c drug called Sovaldi that costs a dollar to manufacture.

Let us make no mistake about it.  The struggle that we are now undertaking, to guarantee health care to all Americans as a right and to substantially lower the cost of prescription drugs, will be opposed by some of the most powerful forces in America – entities that have unlimited amounts of money.  We’re talking about the insurance companies, the drug companies, private hospitals, medical equipment suppliers, Wall Street and other powerful entities.  

Let me make a prediction. In order to defeat the Medicare for All movement, powerful special interests will be spending millions on 30 second television ads, full page magazine ads, and corporate-sponsored “studies” to frighten the American people about Medicare for All – which is exactly what happened before the passage of Medicare in the 1960s. They failed then and they’re going to fail now.

And let me give you an example of the kind of money and power we are talking about. 

Over the last 20 years, the insurance industry and pharmaceutical companies have spent more than $330 million in campaign contributions and over $4 billion in lobbying to get Congress to do its bidding. 

The pharmaceutical industry alone has hired some 1,200 lobbyists – including the former leadership of both political parties.

I find it quite interesting that Billy Tauzin, the Republican Congressman who wrote the bill to prevent Medicare from negotiating for lower drug prices and then went on to become the President and CEO of Pharma, received over $11.6 million in compensation in 2010.

That’s how business is done in Washington.  Well, I have a different vision of what a rational healthcare system is all about.  Instead of massive profits for the drug companies, the insurance companies and Wall Street, we must provide a healthcare system that provides quality healthcare to all in a cost effective way.

And that is exactly what Medicare for All does.

Under this legislation, every family in America would receive comprehensive coverage, and middle-class families would save thousands of dollars a year by eliminating their private insurance costs as we move to a publicly funded program.

The transition to the Medicare for All program would take place over four years. In the first year, benefits to older people would be expanded to include dental care, vision coverage and hearing aids, and the eligibility age for Medicare would be lowered to 55. All children under the age of 18 would also be covered. In the second year, the eligibility age would be lowered to 45 and in the third year to 35. By the fourth year, every man, woman and child in the country would be covered by Medicare for All.

Medicare for All will reduce – let me repeat, reduce — overall health care spending while lowering the number of uninsured and underinsured people in this country to zero.   

We accomplish this because Medicare for All creates a system of health care insurance that isn’t designed to generate profits for insurance and drug companies — it will be a system focused on delivering actual health care. It will save lives, save money, and end the frustration of endless paperwork, denials, and desperate fights with an insurance company to cover medically-necessary medications and procedures.

Medicare for All will fully eliminate health insurance premiums, deductibles and co-payments. Make no mistake about it: These are nothing less than taxes on the middle class. 

And when we do that, the average middle class family will save an estimated $3,000 each and every year.

Further, unlike the current dysfunctional system, Medicare for All allows people the freedom to choose any doctor, clinic, and hospital without worrying about whether their provider is in-network or not.  People will be able to make the health care choices that are best for themselves and their families without some insurance bureaucrat telling them which providers they can see or not see. Medicare for All is at the end of the day empowering patients and health care providers. 

In addition, a Medicare for All system will allow us to address the serious problem of medically underserved areas. 

Just to demonstrate how absurd our health care system is, I was in Philadelphia two days ago rallying with the people of that city to try to stop the closure of Hahnemann University Hospital, an important, safety net hospital in that community.  Why do the owners want to close this hospital? Because they can make more money redeveloping that property into condominiums and hotels.

Let me address some of the half-truths, misinformation, and, in some cases, outright lies that people may be hearing about Medicare for All.  

Medicare for All critics tell us that Americans just love their private health insurance companies. We heard this most recently from UnitedHealth CEO David Wichmann, who by the way, made $83 million in 2017 and who said Medicare for All would “destabilize the nation’s health system.” 

But let’s remember: the current system is already disrupting and destabilizing millions of people’s lives. In the current system, 50 million Americans every year lose their existing health insurance when their employer changes insurer, when they change jobs, or when they cannot afford their current plan. For many of them, they will no longer be able to see the doctor they have relied on for years.  For others, important treatments for long-term conditions or disabilities will be changed or stopped altogether.  

Here is the simple truth. The American people do not like their private health insurance companies. In fact private health insurance companies are quite unpopular.  What the American people do like are their doctors, nurses and other health care providers. 

While our opponents claim that Medicare for All is too expensive, the reality is that it is much more cost effective than our current system.

The Center for Medicare and Medicaid Services estimates that, if we do not change the system, this country will be spending $50 trillion over the next ten years –19.4 percent of our nation’s GDP.  This is unsustainable and will be incredibly harmful to the people of our country, to the business community, and to the entire economy.

And the reason why we spend so much is obvious.  It is not just the huge profits in the insurance industry and the pharmaceutical industry, but it is the incredible and wasteful bureaucratic maze developed by thousands of different healthcare plans.  Today, hospitals and doctors must deal with patients who have different deductibles, different co-payments, different networks of coverage, and different coverage for pharmaceuticals, or no insurance at all.  All of this is not only driving doctors and nurses and hospital administrators to distraction, but it is wasting up to $500 billion a year on unnecessary administrative costs.

Unlike our current system, there is broad consensus – from conservative to progressive economists – that Medicare for All would result in substantial savings to the American people.  Two of the most recent studies on this issue have estimated that Medicare for All would save the American people between $2 trillion and $5 trillion over a 10-year period.

Let us be clear, the fight against Medicare for All today is not a new development.  Powerful special interests have always opposed healthcare programs that work for the people and not for corporate interests.

Let us not forget that when President Harry Truman first proposed a program guaranteeing health care to seniors that idea was billed as radical, “un-American,” and an attack on basic freedom. And because of that assault, the idea stalled in Congress for years — until voters made their voices heard.

In 1960, America elected John F. Kennedy after he campaigned in support of Truman’s idea. That election prompted serious work on universal health care bill, and Kennedy at the time noted that “what we are now talking about doing, most of the countries of Europe did years ago.”

Finally, following the 1964 Democratic election landslide, the new Congress was able to pass what is now known as Medicare despite intense opposition from the health insurance industry and the pharmaceutical companies.

More than a half-century after that achievement, the time is now to go forward.  The time is now to expand Medicare to every man, woman and child in this country. 

Let us be very clear.  When it comes to health care, the insurance and drug industries have been able to control the political process.  

If we are going to break the stranglehold of corporate interests over the health care needs of the American people, we have got to confront a Washington culture that is corrupt, that puts profits before people.

That is why I am calling on every Democratic candidate in this election to join me in rejecting money from the insurance and drug industries. That means not accepting donations over $200 from health insurance or pharmaceutical company PACs, lobbyists or executives. Candidates who are not willing to take that pledge should explain to the American people why those corporate interests believe their campaigns are a good investment.

Of course, President Trump should do the same but I am not going to even waste my breath suggesting that he will.  His efforts to throw 32 million people off their health insurance to have it replaced with junk insurance shows exactly what side he is on.

Finally, let me say, eliminating health insurance and drug company money from the Democratic primary won’t solve all the problems, but it is an important step forward. Now is the time to tell the health care industry that your profits are not more important than the lives of the American people.

See also: Biden Plan for Universal Healthcare: Protect, Build on Obamacare

NY, CA, NJ Governors Assail Republican Tax Plan as ‘Evil in the Extreme,’ a Wrench to Nation’s Economic Engine

Blue State governors including New York’s Andrew Cuomo hope their Republican Congressmembers will do the right thing for their constituents; otherwise, they raise the specter of court challenges to Republican Tax Plan © 2017 Karen Rubin/news-photos-features.com

by Karen Rubin, News & Photo Features

Governors of New York and California and the Governor-Elect of New Jersey and California joined forces to condemn the Republican tax plan as a “stake in the heart” of the nation’s economic engine, a cynical ploy to punish Democratic-majority states, and only the first-step toward generating such an increase in the national debt to justify cuts in Medicare, Social Security, Medicaid, CHIP and other social programs, and threatened to challenge the legality of elements of the tax plan should it become law.

In a joint press call, New York Governor Andrew Cuomo, California Governor Jerry Brown and New Jersey Governor-Elect Phil Murphy and using phrases such as “evil,”  “nefarious” and “cynical,” raised issues of the legality of elements of the Republican tax plan, which shifts $1.5 trillion in wealth from middle class and working families to the wealthy  – indeed, 50% of the tax cuts go directly into the pocket of the top 1% – through lowered tax rates, elimination of the AMT (Alternative Minimum Tax), reductions if not elimination in the Estate Tax (which only impacts 2 out of 1000 families now), and new rules enabling the wealthiest to shelter tax through pass-throughs.

But the Republicans pay for the cuts by largely eliminating or significantly reducing the deductibility of state and local taxes, including property taxes, effectively double-taxing, something that has not existed since income taxes were first implemented in 1913, which disproportionately targets 12 states that happen to vote Democratic and also happen to be the donor states that account for 40% of the nation’s gross domestic product (GDP). A similar effort during the 1986 Reagan tax reform effort was defeated by both Republicans and Democrats. The governors say this may be challenged as unconstitutional double-taxation.

Other provisions, such as establishing a legal framework for “personhood” may also be challenged as unconstitutional.

The way the Republican tax plan is structured, it shifts wealth from the 12 “donor” (Democratic-majority) states, to the rest of the country, by eliminating or dramatically reducing the tax deductibility of state and local taxes, including property taxes. In effect, it makes those states structurally uncompetitive by effectively increasing taxes by 20-25 percent for homeowners, may reduce home values by that amount, as well as make it difficult for schools (which account for 60-65% of New Yorkers’ property taxes and 40% of California’s) to raise the revenue they need to property function. But while individuals lose the deductibility of SALT, corporations do not.

In a further blow to public education and stripping away of the separation of Church & State, the Republicans would allow the tax-exempt 529 funds, created to fund college, to be used for K-12 education for parochial and private schools, even homeschooling. (This is on top of repealing the Johnson Amendment, opening floodgates of “charitable” contributions to religious institutions to become political PACs; a particularly insidious breach of the Constitution’s Establishment clause because the religious leader preaching from the pulpit has a special ability to coerce.

The governors held at the hope that the wildly unpopular Congress (only 13% approval) and the most unpopular president in history (33% approval), will recognize the tax plan is similarly wildly unpopular, with barely 20% support, and that Republican Congressmen who have to stand for election in 2018, will do what is best for their constituents.

The Senate version, which eliminates the individual mandate from the Affordable Care Act (Obamacare), would result in 13 million more people without health insurance by 2025, and 10 percent annual increases in premiums on everyone else.

The bill also “pays” for the tax cuts to the richest Americans and corporations by eliminating the deductibility of student loan interest, tax credits for renewable energy, and opens the way for drilling in the Arctic National Refuge, and other provisions which help the upward mobility of working families and middle class striving to achieve the American Dream.

The governors held out a glimmer of hope that enough of the Republicans (the only ones who voted in favor of the tax plan) would vote for their constituents’ interests.

“The tax plan that passed Senate, the House, and is headed to reconciliation, is a long way from done. It is a fraud on the American people. They talk about tax cuts for middle class and working people, but what it is, is tax cut for the rich – 50% of the tax cuts go to the top 1%. That’s an inarguable fact. Their theory isn’t new or novel. It’s ‘trickle down’ on steroids.” He argued that instead of corporations taking their tax cuts to raise wages for workers or create more jobs  through investment, corporations in the past have pocketed the extra cash or used it to buy back stock (raising the share prices) or paying dividends.

“To add insult to injury,” Cuomo said. “the tax cut is then targeted at 12 states that happen to be Blue States where they target eliminating state and local deductions. People don’t understand what that will do, but it will be devastating for states. In essence, it is an increase in property taxes and state income tax only on those 12 states. It puts us at a structurally competitive disadvantage because structurally our taxes will be higher.” That gives residents additional complaint about their government (Republicans even now charge that New York’s taxes are high because of mismanagement, or lavish spending on services). Cuomo countered the claim by Republicans that the poorer states somehow subsidize the public services of the richer states.  New York, California and New Jersey are donor states, which means we put more into the [federal] till than we take out. This aggravates and enhances the injustice where we are subsidizing the other states, and now you’re using New York and New Jersey as a piggybank to finance tax cuts in other states.

“That amounts to political retaliation through the tax code. That’s why they passed it with only their own votes,” Cuomo charged.

California Governor Jerry Brown assailed the Republican tax plan saying, “the most immediate evil of this cynical maneuver called the tax bill is to further divide America when we are at one of our most divisive periods in history. The idea that a president and representatives only in the majority would use that power to penalize 12 states – most of which voted strongly against this president– is not going to bring country together. We are divided while some of our most important competitors are getting more unified, authoritarian. We need to come together. This will further divide blue states from red, Democrats from Republicans. It is evil in the extreme. It exacerbates inequality….It’s not right. It won’t stand.”

New Jersey Governor-Elect Philip Murphy further expounded on the devastating impact in terms of widening inequality and continuing down the awful path of us vs Washington leadership.

“It is based on the trickle down theory, which we have seen time and again doesn’t work. Executives get paid better, the gap between the top of corporate food chain and bottom widens; shareholders benefit from buybacks while working people are neglected. It is a scam at the ultimate extreme. On more than one occasion we all heard, when asked for the rationale, the awful answer [from Republicans] was ‘it is our donors, our donor base will dry up if we don’t.’ We saw the chaos Friday night, literally lobbyists hand-writing in pen, amending the bill. This is as bad as it gets.

“But in a ‘glass half full’ sense, as Governor Cuomo stated,  It’s not over yet. This is the ninth inning. Each of our states have Republican House members. This is beyond Republican, Democrat; it is a clear question of whether you are representing the constituents who elected you. Black & white.”

“The changes in the SALT deduction, are particularly problematic, Murphy said. “That’s been part of the tax code since income tax became legal in 1913. For over 100 years, Congress realized taxing people twice is unfair. We are the biggest odnor states in terms of the federal money we give. This will only make it worse.

“The stronger we are together, the more numbers, the more locked arms, we fight together as a team. There is a lot to be said for that. I am honored to be with you.”

Asked what actions, beyond political pressure on Republican members of Congress, the governors might take, they said that just as the Republicans, the day after Obamacare was signed into law, pledged to repeal and replace, they would also take whatever means – even court challenges– to repeal and replace this tax law.

“We’re looking at the legality now. [SALT deductions] has been in the tax code since it started over 100 years ago. This is double taxation – they are taxing taxes, this from the party that’s against taxation, redistribution [or what Republicans used to condemn as “class warfare”]. This is redistribution in an exponential form –taking from richer states and subsidizing a tax cut in less wealthy states. Hypocritical. Everything they said were against: double-taxation, taxing tax for first time, redistribution state to state, so may well be illegal, unconstitutional. We’re looking at it.”

“There may be some legal action but this is a quintessentially political challenge,” Governor Brown stated. “Our job is to communicate the fraudulent and nefarious character of this tax bill – the way it proceeded, which John McCain said follows no normal pathway. We want to make sure our members of Congress know they are hurting New York, California, New Jersey but also hurting America. We are the key elements of America’s engine of prosperity, and when Trump and his allies attack New York, New Jersey, California, they are attacking the vital seams of the American economy. That’s stupid. They will regret it, and we will do everything we can to convince our Republican representatives that the right thing to do is defeat.

Murphy said they are working with state Attorneys General “to tear up all the floor boards, to the fullest extent of law, and challenge this. There are 500 pages of amendments, a lot handwritten. I am betting there are flaws, holes. If we don’t succeed in the next few days, we will have to take this to the limit.

“This is double taxation and I’m not sure it’s legal,” said Cuomo. “We will find out if it is. But Governor Brown’s point is that it is counterproductive. These 12 states are 40% of GDP. If you say this will help the American economy, how do you do that by assaulting 12 states that are 40% of GDP: this will be negative for our states and regional economies. No doubt about that.”

“Attacking the innovation of NY, CA, NJ and others is just a dumb move, only explained by the desperate situation the Republican leadership find themselves,” Governor Brown added. “This president is the most unpopular is history. They are riding a dead horse in this tax bill, acting irrationally, not in interest of country, throwing a wrench into engine of economy.”

“The more people understand, the more people understand how unfair, divisive and harmful it is to them individually,” Cuomo commented. “The problem is, there is so much news, so much happening. This is so complicated – elimination of state and local taxes but the more people understand it, the more they are against it. Congresspeople and Senators ultimately have to go home, and if they vote for this, they are voting against the interests of their constituents, and they have election next year. Ultimately democracy works. A congressperson who votes for this, there’s no going home again.

“I’m an optimist for the simple reason that we all believe in a different America than this bill articulates,” Murphy said. “The more people understand what’s in this thing, the more actively they push back. What it will do for higher education by repealing tax deduction for student loans, stripping credits for renewable energy, opening Arctic to drilling, on and on –repealing the individual mandate in ACA – the more people realize what’s at stake, the more collectively they say this can’t go forward.

Largely eliminating the SALT deductions, Cuomo said, contradicts the Republican claim their tax plan is supposed to spur the economy. “But targeting 40% of GDP, then saying that’s how you are going to spur economy, by putting arrow into economic heart of these 12 states? There are predictions it will drop the value of homes in our states because property taxes in effect will go up 20-25% over night. If you drop the value of homes, disrupt the whole financial system. Mortgage foreclosures. I don’t think they understand what they are doing.

“We talk about [eliminating SALT deductions] as if it were a new concept,” Governor Cuomo said. “It’s not new. They proposed eliminating SALT during Reagan’s time. At that time, Democrats and Republicans both said it was wrong and defeated it. The difference now is the political extremism and their willingness to divide, and the political extremes they will go to.

“This is only step one of their plan – we know what their plan is, because not new, we’ve seen the playbook. Step one is tax cuts for the rich. Step 2, is to drive up the debt, the deficit, and then come back and say we have $1.5 trillion debt that we created (by cutting taxes for rich), and now we have this debt, we have to address it by cutting government spending. Where will they go? The right to Medicaid, healthcare for poor people. The right to CHIP for poor children, Right to housing programs, food stamps, etc. That’s inevitable. They are creating the debt that will then justify their philosophical step to cut government spending to hurt the poorest Americans.”

“Look at this in its entirety, beyond SALT,” Murphy added. “This is their way to cut Medicaid, Medicare, Social Security. It is the height of hypocrisy from the so-called deficit hawks. Look at higher education and student loans, Obamacare individual mandate, Seen result of trickle down. Pass through. Taken in its entirety, the Republican tax plan is exceedingly damaging not just to our states, but entire country.”

“Republicans saw Obamacare passed and the next day they started Repeal & Replace,” Cuomo said. “If they do this, the next day, we will start the repeal and replace of the divisive Tax Act.”

None of them mentioned, but should have, the increasing pressures on the federal government for disaster relief from climate catastrophes (hundreds of billions of dollars in 2017 alone), the need to address the opioid crisis, and to rebuild and mitigate infrastructure.

See also:

Republican Tax Scam: They Don’t Care 85% Oppose. Here’s Why

Republican Tax Plan is Attack on Blue States; Fight Back by Holding Money ‘in Escrow’

Ready the Revolution: GOP Tax Plan Decimates Middle-Class, Gives Rise to New American Aristocracy

Trump Selling Tax Plan in Missouri, the Show Me State: This is going to cost me a fortune, this thing — believe me.

Democrats Should Shut Down Government over Republican Tax Scam

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