cnn--2019-01-19--5 ways Trump is changing health care

5 ways Trump is changing health care

(CNN) President Donald Trump hasn't fulfilled his campaign promise to repeal Obamacare outright, but he's fundamentally reshaped the debate over health care in America in myriad ways during his two years in office.  Along with chipping away at the landmark Affordable Care Act, the Trump administration has made a historic and controversial change to Medicaid, allowing states to require many participants who gained coverage through Obamacare to work or lose their benefits.  Another major focus of the President: the cost of drugs. Like Democrats, Trump has repeatedly decried the rising price of drugs, and his administration has unveiled multiple proposals to try to contain costs.  When it comes to Medicare, the administration has continued to make private Medicare plans more attractive. And in keeping with conservative positions, officials have rolled back access to contraceptives as well as abortion.  But after the Republican-controlled Congress failed to repeal Obamacare, Trump unleashed a series of executive changes to further undermine the law.  And Trump signed into law the GOP tax cut bill that effectively eliminated the individual mandate by reducing the penalty to $0 -- the basis for a federal court ruling invalidating the entire Affordable Care Act. That ruling is currently being appealed.  Trump also eliminated federal payments that help reduce deductibles and out-of-pocket costs for low-income participants, prompting insurers to raise premiums to cover the loss of these cost-sharing subsidies.  More recently, the Trump administration told states that they could apply for waivers to make more substantial changes to their Obamacare marketplaces, including altering the rules for who is eligible for federal help paying monthly premiums. These premium subsidies are essential to keeping Obamacare functioning, experts say.  Trump officials say their moves are aimed at providing greater access to more affordable health insurance options. They are particularly concerned about younger Americans and those who earn too much to qualify for federal subsidies. But Obamacare supporters say these actions will fray the strong protections for older consumers and those with pre-existing conditions.  The Trump administration plans to make even more changes to the Affordable Care Act for the coming year. It recently released a proposal that would increase the maximum amount enrollees have to pay out of pocket -- a change that would affect those in large-employer plans too. At the same time, it would make the federal premium subsidies a bit less generous, which it estimates would decrease enrollment by 100,000 people.  But even more consequentially, it is formally exploring eliminating that annual automatic renewal of Obamacare plans. This would have a devastating impact since 1.8 million people in the 39 states using the federal exchange were rolled over this year.  Officials are also seeking input on "silver loading," in which carriers increased their rates for silver plans to offset the loss of the cost-sharing subsidy payments. They did this to minimize rate increases on enrollees because federal premium subsidies are based on the second lowest-cost silver plan.  So far, only Arkansas has actually implemented the new rules, which require beneficiaries to work, go to school, volunteer or search for jobs for at least 80 hours a month. The impact has been pronounced: More than 18,000 residents have lost coverage.  On the campaign trail, Trump repeatedly promised to reduce the cost of drugs. While he has issued many tweets lambasting the industry for raising prices and his administration has unveiled many proposals, he hasn't moved the needle too much.  One of the boldest and most controversial efforts involves setting Medicare's reimbursement level for certain pricey drugs administered in doctors' offices and hospital outpatient centers based on their cost in other countries, which is typically far lower. This idea prompted howls of "price fixing" from the industry and conservative lawmakers.  Patient advocacy groups are concerned about another administration effort that would give Medicare Advantage plans the ability to restrict what medications they'll cover. The American Cancer Society Cancer Action Network, backed by nearly 60 organizations, just launched a print and digital ad campaign to oppose the policy changes.  Pharmaceutical companies aren't heeding the President's call. Sixty drug makers kicked off 2019 by raising list prices on nearly 300 medications, according to an analysis by Rx Savings Solutions. And more drug manufacturers are expected to quietly follow suit in coming weeks.  Companies do appear to be tempering their hikes in 2019, however. The average increase was 6.3%, down from nearly 9% a year ago, taking into account different dosages of the same drug.  An official with the Department of Health & Human Services pointed to the lower rate of increases this January.  One thing that the Trump administration has accomplished is approving a record number of generic drugs, which typically have lower prices. The White House Council of Economic Advisers estimates this has saved consumers $26 billion over the first 18 months of Trump's administration.  Trump officials are also trying to rein in costs. For instance, the Centers for Medicare & Medicaid Services is overhauling how it compensates doctors for office visits, reducing the tiers of payments from five to three, starting in 2021. But it also expanding reimbursements for telehealth services.  Another target: The Medicare Accountable Care Organization program, which has more than 10.4 million participants. Established by the Affordable Care Act, these organizations are groups of doctors, hospitals and other providers who voluntarily work together to better coordinate patients' care and reduce health care costs by avoiding duplication of services and medical errors. Known as ACOs, they share in the savings they achieve for Medicare, but only a few are on the hook for any losses they generate.  Currently, ACOs in the Medicare Shared Savings Program have up to six years before they must take on costs if their spending per patient exceeds their targets. Officials want to reduce that to as little as one year.  "His administration has not proposed directly reducing Medicare benefits or increasing beneficiary payments," said Mark McClellan, a former administrator of the Centers for Medicare & Medicaid Services under former President George W. Bush and director of the Duke-Margolis Center for Health Policy. "Instead, their proposals seek to continue to grow the Medicare Advantage program and continue to push for more payments based on value, not volume."  The administration is rolling back regulations that conflict with some Americans' religious beliefs. It issued two rules last year that would free more employers from Obamacare's contraceptive mandate.  The first one would allow non-profit and for-profit employers, including publicly traded companies, to receive an exemption based on their religious beliefs. The second would let all but public companies obtain an exemption based on moral objections. Government employers cannot request exemptions.  The administration also proposed regulations that would no longer permit federally funded family planning services at the same place where abortions are provided. And it has also proposed requiring Obamacare insurers to bill separately for abortion coverage and to offer plans that do not cover abortions in states that don't mandate it.


cnn--2019-03-28--White House has no fresh health care proposal but plans to send one to Congress this year

White House has no 'fresh' health care proposal, but plans to send one to Congress this year

However, the administration plans to submit a health care replacement to Congress this year, the chief of staff to Vice President Mike Pence told CNN's Wolf Blitzer on "The Situation Room."  "The President will be putting forward plans this year that we hope to introduce into Congress," Marc Short told Blitzer. "But, the reality is the court decision is likely not until the summer of 2020, by the time it would reach the Supreme Court."  "We don't know how they would rule," Short said. "The President has said repeatedly he would not sign any law unless it would protect pre-existing conditions."  On Monday, the Trump administration said the entire Affordable Care Act should be struck down, in a dramatic reversal . The Justice Department said in a filing with a federal appeals court that it agreed with the ruling of a federal judge in Texas that invalidated the Obama-era health care law.  The decision came after an internal debate about how to proceed in the wake of a December court ruling that invalidated the entire Affordable Care Act. Trump's Justice Department moved to back the court's decision. But that decision -- while important in terms of keeping a campaign promise to the President's base -- has highlighted the administration's lack of health care policy going forward. Asked whether the White House has a proposal for replacing Obamacare in the event the law is struck down in court, a senior White House official told CNN not as of yet. The official pointed to the proposal from Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, the previous Obamacare repeal bill which was ultimately unsuccessful. "But nothing fresh from the White House yet," the official conceded. When, and if, a proposal does come together, it's all but certain to fail in the Democrat-controlled House.


cnn--2019-03-29--Heres what the GOP plans for health care look like

Here's what the GOP plans for health care look like

President Donald Trump is calling on Republicans to be the party of health care . But that's not going to be so easy to do since it requires them to have a plan.  "The President, I don't think, really has any idea what he's really saying there. It's more of a promotional and marketing impulse on his part," said James Capretta, a health care expert at the American Enterprise Institute, a free market think tank. "It leaves Republicans open to a little bit more attacks and ridicule by the Democrats that they don't have a plan."  While the party hasn't coalesced behind a health care plan, there are policies that Republicans have long supported. Yet some Republican think tanks, particularly the influential Heritage Foundation, are looking to drum up interest on Capitol Hill in their ideas to overhaul the health care system.  Some are still pushing a version of a 2017 bill from Sens. Lindsay Graham of South Carolina and Bill Cassidy of Louisiana to replace the Affordable Care Act.  The senators unveiled the legislation just before the GOP repeal effort collapsed for good in 2017. It would turn the federal funding for Medicaid expansion and Obamacare's subsidies for premiums and out-of-pocket costs into a block grant program. States would receive a lump sum of money and would have a lot of leeway over how to spend it.  The bill would also let states alter several key Obamacare protections for those with pre-existing conditions. While it would still require insurers to provide coverage to everyone, states could adjust other rules, including the mandate that insurers offer comprehensive policies.  Also, states could change the pricing rules so that younger, healthier people could see their premiums go down, but those who need care and older Americans in their 50s and 60s could find themselves unable to afford policies.  States could also revamp many of Obamacare's financial protections, including limiting how much people must pay out of pocket each year and how much of the tab insurers must pick up.  While Trump is enamored of the plan and incorporated it into his budget, it's not likely to get far in the Senate. Asked whether Congress could come together on a replacement plan, Graham told CNN's Kate Bolduan Wednesday that he doubts it.  Revamping the nation's health care system isn't exactly the GOP's strong suit. The party failed spectacularly to repeal and replace the Affordable Care Act in 2017 when it dominated Washington. The task will be only harder now that Democrats control the House and are pushing plans to strengthen Obamacare and protections for those with pre-existing conditions, likely a sharp contrast to whatever proposals or talking points Republicans roll out.  Key GOP senators also haven't expressed much appetite for going into full-scale battle again over the Affordable Care Act. Asked about health care, Sen. Chuck Grassley of Iowa on Wednesday pointed to his finance committee's work on lowering prescription drug prices. He is collaborating on that effort with Ranking Member Ron Wyden of Oregon.  "Most of it's going to be very, very bipartisan," Grassley said of his committee's plans on health care.  Sen. Roy Blunt of Missouri said he will let the Trump administration take the lead.  "All I'm going to say about that for a while is that I'm eager to see what the administration proposes," he said Wednesday.  The Trump administration, however, is not waiting for Congress to change the health care system, particularly Obamacare. Its strategy centers on letting states overhaul their health programs. For instance, it has allowed states to implement work requirements in its Medicaid program and is now considering requests to let states expand coverage only to those below the poverty line.  Meanwhile, a coalition of conservative groups and several GOP state representatives last year rolled out the Health Care Choices Proposal, which includes giving states more control and sending them a fixed amount of money, relaxing federal mandates and strengthening the private insurance market.  It also calls for bolstering Health Savings Accounts, which allow people to set aside funds for future health care needs. Republicans have long pushed HSAs, but critics say only higher-income Americans can afford to use them.  "The Republican answer needs to address the things Americans are telling us that we want," said Marie Fishpaw, director of domestic policy studies at Heritage, which is part of the coalition. "They want to make sure that they and the people they love don't lose access to coverage or care if they get sick. They want lower costs and they want better choices."


cnn--2019-04-02--Analysis Sanders sharpens the choice Democrats face on health care

Analysis: Sanders sharpens the choice Democrats face on health care

(CNN) Congressional Democrats are locking arms to protect the Affordable Care Act -- the party's signature achievement during Barack Obama's presidency -- as President Donald Trump renews his efforts to repeal it.  In media interviews last week, Sen. Bernie Sanders -- among the front-runners for the party's 2020 presidential nomination -- pointedly refused to endorse legislation that House Democrats had introduced to expand the ACA and to block Trump administration initiatives designed to weaken some of its core consumer protections. Instead, Sanders underscored his support for replacing the ACA with "Medicare for All" legislation, in which government would become the "single payer" for virtually all health care services.  "The incremental reform that I support," Sanders told The New York Times , "is phasing in 'Medicare for All.' " Even when Sanders later wrote on Twitter that Democrats "must defend the ACA from Trump's assault," he did not specifically endorse the House bill and sharply added that "protecting the ACA will not fully solve the health care crisis."  Sanders' cool posture toward the House legislation crystallizes the critical choice Democrats face on health care. On Tuesday, Trump tweeted that Republicans would seek to replace the ACA after the 2020 election, thus increasing the chances voters view the race as a referendum on whether to rescind the law.  With Trump again emphasizing his determination to undo the ACA -- both by backing litigation that would invalidate the entire law and by proposing to replace it with block grants for states in his latest budget -- Democrats must decide how to respond. The choice is whether to center the party's 2020 health care message on defending and reinforcing the ACA or to offer their own fundamental change by proposing to replace the law with a single-payer plan that would eliminate virtually all private health insurance.  That choice, in turn, illuminates the broader crossroads awaiting Democrats in the 2020 election.  More than any of his rivals, Sanders is betting that voters are open to fundamental changes that would vastly expand government's role in the economy. Although the party's center of gravity has undeniably moved left since the Vermont independent's unexpectedly strong showing against Hillary Clinton in the 2016 Democratic presidential primaries, almost all of the other contenders -- with the arguable exception of Sen. Elizabeth Warren of Massachusetts -- are offering more incremental changes that accept greater limits on government, both in cost and degree of control over the private-sector economy.  The congressional Democratic leadership is tilting clearly toward the latter camp, for instance by stressing the legislation to repair the ACA rather than the single-payer proposal that excites the left.  Almost all leading Democrats are now receptive to a greater role for government than in the 1990s, when President Bill Clinton famously declared, "The era of big government is over." Even compared with Obama, most of the 2020 field is offering proposals, on everything from increasing teacher pay (Sen. Kamala Harris of California) to imposing a wealth tax (Warren), that envision a more expansive -- and expensive -- role for Washington in driving economic and social change.  What do the voters want?  But the question of how much change -- and how great a role for government -- the electorate will accept looms as a key dividing line in the 2020 Democratic race. That will be especially true if former Vice President Joe Biden enters the race as expected. With his long roots in more centrist Democratic politics, Biden would likely question whether vanguard liberal goals such as a government takeover of health care, the near-term elimination of fossil fuels, or tuition-free public higher education are electorally feasible, or even desirable from a policy perspective.  An extensive new poll of likely Democratic primary voters released Friday by Third Way, a centrist Democratic group, offers some hints on how this debate may unfold.  The survey, conducted March 7 to 10 by Democratic pollster David Binder, generally found most Democratic voters leaning toward incremental change rather than a radical restructuring of government and the economy. That instinct surfaced across an array of questions:  Still, detailed results found a greater constituency for fundamental change among likely Democratic voters younger than 35. Nearly two-fifths of them in the survey, far more than older generations, preferred a candidate who called themselves a Democratic socialist rather than one who wanted to mend capitalism. And the share of younger Democrats who preferred a nominee who moved left to generate enthusiasm, while still a minority, was also higher than for older generations. Those findings help explain why Sanders ran so well among younger voters in 2016, and why polls again show him attracting much more support among younger than older Democrats.  Health care remains the issue where these broader choices are likely to reach the sharpest point for Democrats through the 2020 election.  Single payer legislation in which government would eliminate private health insurance and directly fund a guaranteed package of benefits through tax dollars remains the rallying cry for the left. Four other 2020 presidential contenders -- Sens. Kirsten Gillibrand of New York, Cory Booker of New Jersey, Harris and Warren -- have endorsed Sanders' single payer bill in the Senate. In the House, 105 voting Democrats have endorsed the companion bill from Rep. Pramila Jayapal of Washington state.  Fixing it vs. starting over  That bill, which would overturn Trump administration actions loosening protections for patients under the ACA and increase subsidies for people to buy insurance through the law, embodies the bread-and-butter focus that most Democrats emphasized on health care in the 2018 midterm elections -- and that many party strategists see as the most appealing course for 2020.  The bill represents a first step toward one future health care path for Democrats: building on existing programs, including the ACA and Medicare. For many Democrats, the next step might be legislation that allows all adults (or those over 50, depending on the proposal) to buy into Medicare while permitting those who want to maintain private health insurance to keep it.  Presidential contender Beto O'Rourke aligned with that option in his kickoff campaign speech Saturday in El Paso, Texas, when he declared: "We can give every American, every business in this country the choice to enroll in Medicare without eliminating plans that many Americans like for their families because those plans work for their families."  Sanders' position confused many Democratic health care experts and angered party centrists. (Asked for further detail on his view, his Senate office pointed to his tweet last week.)  "This is tone deaf among all but a small slice of Democratic primary voters," said Jim Kessler, Third Way's executive vice president for policy. "With so many people afraid about pre-existing conditions and losing their health care under Trump, there is a moral urgency to be pragmatic while we also try to get to universal coverage. This is precisely why Bernie Sanders has a ceiling (of support) and he just bumped up against it."  Still, the outcome of this debate among Democratic primary voters is far from certain.  Democrats under 50 preferred focusing on single-payer by a double-digit margin, while those over 50 narrowly broke toward strengthening the ACA, according to detailed results provided by Kaiser.  Whatever policy Democrats ultimately endorse, Trump has guaranteed a stark contrast in 2020 by renewing his efforts to repeal the ACA. The question is whether Democrats will counter that with proposals to build on the law or offer their own blueprint for uprooting and replacing it, as Sanders is urging.


cnn--2019-04-02--McConnell Republicans call Trump after health care flip-flop

McConnell, Republicans call Trump after health care flip-flop

(CNN) President Donald Trump's surprising new position last week on taking another legislative run at repealing and replacing the Affordable Care Act left Republican lawmakers scrambling in his wake.  But several, including Senate Majority Leader Mitch McConnell, took a proven path to try and talk Trump down from what they saw as an untenable position on the divisive issue: talk to him directly.  Over the course of several days, Republican lawmakers attempted to dissuade Trump from his stated idea that Republicans should craft a new replacement plan, according to multiple sources.  The focus, some argued, should be on prescription drug costs. But definitely staying away from a fractious intraparty debate that House Republicans like Minority Leader Kevin McCarthy firmly believe cost the GOP the House in the 2018 midterms.  Or in what several sources called the most persuasive argument: framing the election around Democratic calls for Medicare-for-all. That was a specific message from McConnell in a weekend phone call, the sources said.  The point was that with Democratic presidential candidates -- not to mention the energy of the progressive base -- are lining up behind the proposal, it provided a ripe target for the party. Add to that any Senate Republican effort this Congress would be completely rebuffed by House Speaker Nancy Pelosi, and that defending Obamacare was a unifying issue for Democrats. It makes political sense, rather, for Republicans to be patient rather than throw out their own -- potentially unpopular -- plans.  "(Trump) has some big ideas and to his credit wants to solve problems. That's what leaders do," said Sen. John Thune, R-South Dakota. "But you run into that wall of reality at some point, and, I think, trying to convey what the obstacles are to getting done what he wants done, done in the next two years, is something a number of our members conveyed to him."  Republican campaign arms and outside groups had already launched initial salvos attacking the Medicare-for-all proposal, (or in McConnell's parlance: "Medicare-for-none") and are working on shifting the focus at this stage could create new openings for frontline Democratic candidates and risks for Trump himself.  McConnell and other Republican lawmakers have also already spent time attacking Democrats on the proposal in floor speeches and press conferences themselves.  "I look forward to seeing what the President is proposing and what he can work out with the speaker," McConnell told Politico in a brief interview last week. "I am focusing on stopping the 'Democrats' Medicare for none' scheme."  The White House did not immediately respond to a request for comment on Trump's calls with McConnell.  The calls, especially McConnell's, had an impact on the President, who, according to one of the sources, secured the commitment that Trump would instead focus his energy on attacking Medicare-for-all and wait to see what the election led to before moving forward on any legislative efforts.  It was a framing reflected by the President himself in a tweet thread Monday night, that amounted to a full flip from his claims last week, and once again displays his haphazard approach to policymaking.  "Everybody agrees that ObamaCare doesn't work," Trump tweeted. "Premiums & deductibles are far too high - Really bad HealthCare! Even the Dems want to replace it, but with Medicare for all, which would cause 180 million Americans to lose their beloved private health insurance."  "The Republicans are developing a really great HealthCare Plan with far lower premiums (cost) & deductibles than ObamaCare. In other words it will be far less expensive & much more usable than ObamaCare," Trump said. "Vote will be taken right after the Election when Republicans hold the Senate & win back the House."  But one White House official said Trump's tweets "shouldn't be misunderstood to mean we won't be pushing our own version of health care -- basically health care policy principles."  The official said Trump is acknowledging the reality that there is not much hope for "Trumpcare" -- whatever that plan might be -- to make it through a Democratic-controlled House.  "He's just being realistic that there's no room for bipartisanship on this prior to 2020," the official said.  A separate senior White House official said Trump is simply stating more explicitly what White House aides have always known: that there will be no bill to replace Obamacare that can get through this Congress.  However, the official said "there is every intention of having a proposal" that Republicans can put on the table.  And yet, multiple White House officials Tuesday morning declined to commit that the President would actually release a plan before the 2020 election.  When asked by CNN if the President will commit to releasing a plan before the election, White House press secretary Sarah Sanders said she would not answer the question, saying only the President wants to talk about "principles."


cnn--2019-05-30--Trump takes aim at insurers and hospitals over health care costs

Now he's setting his sights on insurers, hospitals and other providers as a way to achieve one of his top promises -- lowering costs for consumers.  The administration is considering requiring these players to disclose the rates they privately negotiate, an idea that has sparked a backlash from the influential industry.  The Department of Health & Human Services touched on the concept in a proposed rule released in March, noting that making such information public could drive health care prices down.  Now, the administration is preparing an executive order that could require greater disclosure of negotiated health prices, a move first reported by the Wall Street Journal  Trump teased the effort earlier this month, saying that his administration plans to announce a new transparency effort in coming weeks.  While the President and administration officials often say they want to reduce government regulation on businesses to unleash more economic power, they acknowledge it doesn't mean hands off completely.  "We don't have a competitive market because we are not requiring price transparency," Seema Verma, administrator of the Centers for Medicare & Medicaid Services, told CNN. "That's where the government has a role to play -- in ensuring that we have a competitive free market and to make sure there's a level playing field so providers can compete for patients on the basis of price and quality. That's what we are trying to drive towards."  Just how transparent health care prices should be, however, remains a point of contention. The executive order has been delayed by internal disputes over how aggressively to mandate disclosure, according to the Journal.  Asked what type of disclosure she is focused on, Verma said: "Those are some of the things we are grappling with internally. At the end of the day, we want patients to understand what they are going to pay in advance."  Officials have already taken some initial steps to require drug makers and medical providers to release more cost information, though it has generally focused on the industry's list prices rather than the negotiated rates or what consumers are actually billed. Some experts question how much this will actually achieve, especially, they say, since most Americans don't shop when it comes to health care.  "Requiring the inclusion of drugs' list prices in TV ads is the single most significant step any administration has taken toward a simple commitment: American patients deserve to know the prices of the healthcare they receive," Azar said.  And starting this year, the Centers for Medicare & Medicaid Services is requiring hospitals to post their standard charges for their services on their websites in a format that can be imported into a computer system. It plans to do more in this arena to allow patients to more easily compare prices, as well as quality, said Verma, who believes consumers are interested in prices -- especially when they are still subject to deductibles -- and do have to power to influence what providers charge.  So far, however, the administration's efforts will likely do little to help consumers or to rein in health care spending, some experts said. Most people don't pay the list price for drugs or the full cost for hospital services so this information will not tell them much about what they are on the hook for and could even dissuade them from pursuing care.  The majority of Americans have health insurance, so what they pay is typically based on the deals the carriers work out with the health care providers and on their particular policies. What consumers are more interested in is their out-of-pocket costs for a medication or medical service.  That's why policy experts were more encouraged by a new rule that would require insurers in the Medicare Part D drug program to provide doctors with real-time information on patients' prescription benefits, including what a particular medication would cost them.  Still, even when consumers have tools to give them pricing information, they don't really shop around for health care, said Lynn Quincy, director of Altarum Healthcare Value Hub, a non-profit research firm. And they don't have the muscle to get doctors and hospitals to lower their charges.  "The people with the power to put pressure on providers is not the patient -- that's just really a ridiculous notion," Quincy said. "But the health plan who is at the point of contracting with providers for the next year, they're the ones who can say whether or not a given rate is out of line with the market."  Releasing details about the negotiated rates between specific insurers and hospitals, however, could reveal which providers are charging high prices. That could prompt insurers -- and large employers -- to try to get a better deal.  For instance, California Public Employees' Retirement System, which manages health benefits for more than 1.5 million members and their families, saw its spending drop after it set a maximum reimbursement level of $30,000 for hip and knee replacements in 2011, Quincy said. Patients, who had to foot the bill for any amount above this reference price, flocked to lower-priced hospitals, prompting some costlier institutions to lower their charges.  But some worry that more information could actually lead to higher prices. If the secret negotiations in the drug supply chain became public, for example, it might prompt those who charge less to demand more, said Ian Spatz, a senior adviser at Manatt Health, a consulting firm.  "It's great politics, but bad public health policy and bad economics," Spatz said.  Health care industry associations are already lining up to quash the idea of disclosing contracted rates, which they argue could cause more harm than good. The insurers' trade group pointed to a 2015 Federal Trade Commission blog post that said too much transparency can interfere with competition in the medical market.  "If every contract and every negotiated rate were public, no doctor or hospital would want to be paid the lowest rate -- they would all be motivated to demand higher payments," said Matt Eyles, CEO of America's Health Insurance Plans.  The main hospital lobbying organization also opposes this type of disclosure, saying that patients are more interested in their out-of-pocket costs.  "Disclosing negotiated rates between insurers and hospitals could undermine the choices available in the private market," Tom Nickels, executive vice president at the American Hospital Association said in March when the Centers for Medicare & Medicaid Services first broached the idea. "While we support transparency, this approach misses the mark."


cnn--2019-06-28--The Bernie Effect Sanders sets the bar in Democratic health care debate

The Bernie Effect: Sanders sets the bar in Democratic health care debate

For a second straight night in Miami, the political prospects of "Medicare for All" dominated stretches of the debate as candidates sparred over its cost, the radical overhaul that would be required to make it a reality, and whether support for a single-payer system would scare off moderate voters the party is banking on to boost its fate in 2020.  But for all the sharp and sometimes shout-y exchanges, there was one thing that no one on the stage disputed: the end goal. Universal coverage in the United States is now the default position of the Democratic Party's top presidential hopefuls -- even for those whose actual plans may not achieve it.  The questions going forward are about ambition and, most pointedly, process. Some candidates prefer a path that preserves a place for private insurance. Others, like Sanders, would do away with them as soon as possible.  Others prefer a path that preserves a place for insurers, primarily by adding a public option to the Affordable Care Act exchanges. Even the harshest critics of Medicare for All -- former Maryland Rep. John Delaney and former Colorado Gov. John Hickenlooper -- argue that their plans would cover anyone and everyone who wants it, even though the public option proposals would have a more limited impact than Sanders' ambitious plan.  The shift among Democrats began before Sanders became a household name during his 2016 primary run. Hillary Clinton and Barack Obama, when they faced off in 2008, debated the details of a policy that ended up becoming the Affordable Care Act. Generations of Democrats of have toyed with ideas for expanding or guaranteeing coverage. But it is Sanders' relentless push for Medicare for All -- a proposal with 14 Senate co-sponsors in its latest iteration -- that has set a measuring stick among Democrats in this primary.  "The fact of the matter is that the quickest, fastest way to do it is build on Obamacare, to build on what we did (during the Obama administration)," Biden said. "And, secondly, to make sure that everyone does have an option. Everyone, whether they have private insurance or employer insurance and no insurance, they, in fact, can buy in, in the exchange to a Medicare-like plan."  The questions candidates face over the policy have also matured. And the bar, for those who want to project their support, has risen -- or become more clearly defined. On both debate nights, moderators asked for a show of hands from those who wanted to eliminate private insurance as part of their road to achieving universal coverage. For activists, this is where the rubber meets the road -- the answer, for those who say yes, that will invite the harshest blowback. On Wednesday, Sen. Elizabeth Warren -- who then said "I'm with Bernie on Medicare for all" -- and New York Mayor Bill de Blasio raised their hands.  Sanders, who has made clear that any lesser step would fail to realize his goal, and Sen. Kamala Harris did the same a night later. (Harris has since said she misheard the question; she would be willing to give up her own private insurance but would not get rid of the industry.)  Hickenlooper has been one of Sanders' most vocal critics. He warned, again, on Thursday night that the Vermont senator's agenda and embrace of democratic socialism risked opening up the entire field to unwarranted Republican attacks.  But when he began to speak about health care, even Hickenlooper opened with a line that Sanders so often uses himself.  "I believe that health care is a right and not a privilege," he said, before launching his rebuttal, arguing that "you can't expect to eliminate private insurance for 180 million people, many of whom don't want to give it up. In Colorado, we brought businesses and nonprofits together, and we got near universal health care coverage."  Like his fellow Centennial State Democrat, Sen. Michael Bennet does not support Medicare for all. But when he was invited to criticize Sanders on the issue, Bennet moved swiftly along to his own plans.  "I have proposed getting to universal health care, which we need to do. It is a right. Health care is a right," Bennet said. "We need to get to universal health care. I believe the way to do that is by finishing the work we started with Obamacare and creating a public option."  The choice, he added, "would be like having Medicare for All."  New York Sen. Kirsten Gillibrand jumped in when Bennet escalated his argument against Medicare for All, noting that she helped write a piece of the legislation -- its four-year phase-in plan -- and argued that it "merges what the (Sanders and Bennet) said."  Despite keeping her hand down when the candidates were asked about abolishing private insurance, Gillibrand has -- after Sanders -- the longest track record of supporting a single-payer program.  "In 2005, when I ran for Congress in a 2-to-1 Republican district, I actually ran on Medicare for all, and I won that 2-to-1 Republican district twice," Gillibrand said. "And the way I formulated it was simple: anyone who doesn't have access to insurance they like, they could buy it at a percentage of income they could afford."  The argument over the best -- and least politically dangerous -- process for achieving universal coverage has, for many of the candidates, now overtaken whether or not it is desirable or even feasible. And it has led some of the rivals to overstate how closely their proposals hew to Sanders' grand plan.  "Everybody who says Medicare for All, every person in politics who allows that phrase to escape their lips has a responsibility to explain how you're actually supposed to get from here to there," South Bend, Indiana, Mayor Pete Buttigieg said, before explaining his preferred path forward.  "It's very similar, I would call it 'Medicare for all who want it,' " he said. And it would begin, Buttigieg explained, with some "flavor" of Medicare being offered as an option to every American.  The result, he said, would be "a very natural glide path to the single-payer environment."


cnn--2019-07-30--Sanders says Kamala Harris health care plan is not Medicare for All

Sanders says Kamala Harris' health care plan is 'not Medicare for All'

Washington (CNN) Democratic presidential candidate Sen. Bernie Sanders on Monday stressed the differences between his single-payer health care plan and a new proposal from Sen. Kamala Harris, labeling her approach "not ' Medicare for All.' "  Harris' plan, which was released Monday, would put the US on the path toward a government-backed health insurance system over the course of 10 years but stops short of completely eliminating private insurance. The future of health care in America has marked a rare point of difference in the crowded 2020 Democratic field.  "Well, first of all, I like Kamala. She's a friend of mine, but her plan is not Medicare for All," Sanders told CNN's Jake Tapper on "The Lead," hosted from Detroit on Monday. "What Medicare for All understands is that health care is a human right and the function of a sane health care system is not to make sure that insurance companies and drug companies make tens of billions of dollars in profit."  "The function of Medicare for All is to guarantee health care to all people as soon as possible," Sanders continued.  Speaking to Harris' goal to achieve Medicare for All in 10 years, Sanders said, "We think that four years is as long as it should be, not 10 years."  "And that's one of the reasons I disagree with Sen. Harris," he added.  Members of the Sanders campaign flooded the airwaves in defense of Medicare for All and against Harris' plan on Monday.  "Unfortunately, I think we've seen two major changes," Faiz Shakir, the campaign manager told CNN's Poppy Harlow on "Newsroom."  "One is she's decided she would like to privatize Medicare. She would like to introduce more insurance companies into Medicare. That introduces more corporate greed and profit seeking into Medicare. The second thing she wants to do is phase it in over 10 years, not in one term of a presidency, not in two, but that you would have to wait 10 years for people who have been struggling."  Shakir pointed out that Harris has not signed on to the pledge put forth by the Sanders campaign to reject donations from pharmaceutical executives as another sign that her campaign does not have its priorities right on health care.  "I don't believe Kamala Harris said she would take that pledge," Shakir said. "What that means is are you willing to fight these health insurance companies and pharmaceutical companies when you're in the Oval Office. And I don't think we know that. I don't think we have confidence. And obviously the plan here is suggesting that there's some concern over taking them on."  Josh Orton, the Sanders campaign's policy director, told CNN, "It's bad policy, bad politics, and compared to Medicare for All it vastly expands the ability for private insurance corporations to profit from overbilling and denying care to vulnerable patients who need it the most."  On the role private insurance companies play in Harris' plan, the Sanders campaign's chief of staff Ari Rabin-Havt, told CNN, "It would give a lot of money and a lot of power to private insurance companies over people's health care, and that's not what we believe in."  Harris wrote in a post outlining her plan that Medicare would "set the rules of the road."  "We will allow private insurers to offer Medicare plans as part of this system that adhere to strict Medicare requirements on costs and benefits," she said. "Medicare will set the rules of the road for these plans, including price and quality, and private insurance companies will play by those rules, not the other way around."  Warren told CNN Monday that while she hadn't "seen the details" of Harris' plan, she emphasized her support for Medicare for All.  "I'm not here to attack other Democrats. I'm here to talk about what I believe in," she said. "And as I've tried to make clear, I believe that health care is a basic human right. And I will fight for basic human rights. That means Medicare for all as the best possible way to give us maximum coverage at the lowest possible cost."  "Medicare for All critics tell us that Americans just love their private health insurance companies," Sanders said earlier this month. "You know what? I have never met one person who loves their insurance company."


cnsnews--2019-01-30--Math Problem Could Sink Democratic Socialists Plans for Americas Health Care Economy

Math Problem Could Sink Democratic Socialists’ Plans for America’s Health Care, Economy

The greatest constraint on the objectives of democratic socialists in Congress, such as Representative Alexandria Ocasio-Cortez or Senator Bernie Sanders, may not be Republicans or even centrist Democrats—but rather, two government institutions, the Joint Committee on Taxation (JCT) and the Congressional Budget Office (CBO). JCT and CBO have developed sophisticated models of the U.S. economy and federal budget, and they use those models to help Congress understand the impact of its legislative proposals.  Ocasio-Cortez and Sanders have championed several policies that would greatly expand federal spending, such as implementing a single-payer health care system and radically expanding the scope of environmental regulations. According to an Urban Institute analysis, the healthcare plan alone would raise federal expenditures by $32 trillion over ten years. Though the CBO and JCT have not yet analyzed such policies—they usually wait until the plans are more developed—when they do, their analyses will find that the only way to finance such large increases in federal spending is through much higher taxes, a politically unpalatable result that will surely make headlines and produce difficulties for any nascent legislation.  I worked for several years at a research group called the Tax Foundation that advised members of Congress and President Trump’s economic team during the 2017 tax reform process. These policymakers had to be mindful of the JCT scores. I therefore began to learn how sensitive its model is to policy ideas—what it “likes” and “dislikes,” if you will. My experience taught me that Democrats will have a treacherous path ahead as they try to push legislation such as single-payer healthcare. There are four reasons why, which I outline below.  The JCT’s and CBO’s macroeconomic models despise deficits. Both operate on the same assumption about deficits, which is that federal budget deficits reduce economic growth. The theory goes like this: when the government borrows, lenders choose to lend to the government instead of to private-sector businesses. This is sometimes called a “crowd-out” effect, in that government borrowing will “crowd out” funds that would otherwise have been lent to the businesses. With less money available to businesses, they invest less, and the workers are less productive.  This is a problem for those on the left, like Ocasio-Cortez, who seeks to fund her environmental program, known as the “Green New Deal,” with debt. The standard line on the left is that a government deficit will put more money in the hands of consumers, who will spend it on goods and services. Employers will then hire more workers to satisfy that demand.  But the CBO and JCT operate on the crowd-out assumption, and it is very strong in their models. In recent publications, the CBO has shown that a policy of $500 billion in debt-financed public investment reduces GDP in the long run. In other words, the positive effects of the public investment are ultimately outweighed by the negative effects of the deficit.  2. The Model Knows Where the Money Is  The distribution of U.S. income is less skewed towards the extremely wealthy than democratic socialists imagine, and the mechanisms they propose to fund their policies will be woefully insufficient. For example, Ocasio-Cortez, in an interview on 60 Minutes, proposed a 70 percent marginal tax rate applied only to income above $10 million a year to finance her Green New Deal.  At first, this may sound like a substantial revenue-raising tax: people earning above that threshold have a lot of money, and the U.S. produces a fair number of them—over 16,000 as of 2016, according to IRS data. But this group of earners has only $245 billion of taxable income above the $10 million threshold. That comes to just over 1 percent of GDP. Most of the money in the U.S. lies elsewhere. Starting with a tax base this small limits the revenue one could possibly raise; for example, even the high rates set by Ocasio-Cortez would raise only between $164 billion and $382 billion over ten years, according to an estimate from the independent Penn Wharton Budget Model.  This is not enough for the Green New Deal, which is intended to be a multi-trillion-dollar investment. Furthermore, any tax increases intended for the Green New Deal will be unavailable for health care reform, and vice versa. Obviously, democratic socialist proposals will need a bigger tax base to work.  Sanders, for his part, seeks to capture a larger tax base: the vast income earned by middle and upper-middle class Americans. In his 2016 presidential campaign, Sanders proposed broad-based tax increases on virtually all Americans. His 2016 platform included many taxes, including a payroll tax that would affect all workers. Taxpayers in the middle quintile (40th to 60th percentile) for income, for example, would see a tax hike of 8 percent. Overall tax revenues would increase by $15.3 trillion over ten years, but even this would be insufficient to pay for his spending proposals. According to the Urban Institute, Sanders’ tax proposals would pay for only $15.3 trillion of the $33.3 trillion of spending he had proposed.  It is certainly theoretically possible to raise taxes to cover ambitious programs. But these tax increases must be distributed broadly across the U.S. population—and they must be truly enormous, so big that nobody, not even Bernie Sanders, has had the courage to propose them.  3. The Model Distributes Taxes on Institutions to Individuals  Democratic socialists might propose raising taxes on businesses or institutions instead of individuals to make their policies more politically palatable.  For example, consider the Cadillac Tax from the Affordable Care Act. It was intended to be a 40 percent levy on expensive health care plans, those with premiums exceeding $10,800 for individuals or $29,500 for families. The tax would be applied only to the amount by which those thresholds were exceeded, and paid by insurance companies. MIT economist Jonathan Gruber, who advised Democrats on the policy later explained that the strategy for the tax was “mislabeling it,” by “calling it a tax on insurance plans rather than a tax on people when we all know it's a tax on people who hold those insurance plans."  What Gruber described is the difference between legal incidence and economic incidence. While insurance companies would write the check for the Cadillac Tax, incurring the legal incidence, they would also likely raise the cost of plans eligible for the tax, passing on the tax to the insured. In effect, the insured would still end up paying the tax, just indirectly, with the insurance company acting as a middleman. Since the insured still loses money because of the tax, he incurs the economic incidence of the tax.  The economic incidence is certainly less immediately visible than legal incidence. But the JCT’s distributional analysis does not play these political games. It passes on the tax increase on an institution to the individuals who ultimately feel the burden. For example, if Ocasio-Cortez proposes raising taxes on oil companies as part of an environmental package, she would effectively be advocating for a tax on the middle class; the JCT model will show that oil companies will pass the cost along to oil consumers.  As a footnote, the Cadillac Tax has still not gone into effect. Its implementation has now been delayed until 2022 in a series of bipartisan votes because of political pressure from anti-tax groups and unions. The constituency against middle- and upper-middle-class tax increases is strong, even if the incidence is only economic.  The JCT model suggests that people respond to tax increases in ways that will be unhelpful to Democrats. First, the model accounts for the fact that people work less and take more leisure hours when their wages are taxed more. This is known as the substitution elasticity of labor to taxation. The effect is small—typically, for every 10% increase in marginal tax rates, there’s a 2% decrease in labor supply. Lower labor supply reduces economic growth, a result that critics of the Democrats will surely note.  An even more difficult problem may be with capital gains taxes. Specifically, Democrats might propose hiking taxes on capital gains to pay for their projects. But empirical experience and JCT models both hold that as capital gains taxes rise, people sell stock less often, so as to defer paying the tax. Recent JCT research into the subject suggests that for every 10% increase in capital gains taxes, capital gains from stock sales fall about 8% in the long run because of fewer sales. In many cases, especially in the short run, the increase in tax rate is swamped entirely by this effect, meaning tax hikes on capital gains could lose revenue.  Those are just four of the problems democratic socialists must face in turning their policies into viable legislation. Many establishment Democrats respect JCT and CBO, and will require acceptable numbers from the analyses of these two governmental groups. The only way democratic socialist policies will pass muster with the CBO and JCT is if they’re dramatically reformed. But that will require a willingness to compromise that Ocasio-Cortez and Sanders have thus far not demonstrated.  Alan was an Economist with the Center for Federal Tax Policy at the Tax Foundation from 2013 to 2017 and is a contributor to Economics21.  : This piece was originally published by Economics21 at the Manhattan Institute.


cnsnews--2019-04-30--New California Bill Would Turn College Health Centers Into Abortion Clinics

The California state Senate Education Committee recently approved Senate Bill 24, known as the College Student Right to Access Act.  The bill would add a new chapter to state education code to require student health care clinics at all 34 California public colleges and universities to “offer abortion by medication techniques”—aka “the abortion pill”—starting on Jan. 1, 2023.  A similar bill, SB 320, was put forward last year by the same state senator, Connie Leyva, D-Chino. Thankfully, it was vetoed by then-Gov. Jerry Brown, a fellow Democrat, who saw the mandate as “unnecessary” since “the services required by this bill are widely available off-campus.”  In his veto statement, Brown said that “according to a study sponsored by supporters of this legislation, the average distance to abortion providers in campus communities varies from five to seven miles, not an unreasonable distance.”  The study he was referring to was commissioned by the University of California at San Francisco, which supports the campus abortion mandate. That only shows how college campuses are targeted by the abortion industry.  SB 24 and last year’s SB 320 are similar, but SB 24 includes new grant amounts and deadlines for implementation, as well as language that would allow “contracted external agency” personnel to administer chemical abortions in student health centers.  In other words, the public university system in California could begin contracting with Planned Parenthood to send its abortionists into student health centers to administer chemical abortions.  That means Leyva and the other sponsors of the bill made no effort to address serious flaws with this type of mandate, raised by both sides of the debate. Even the universities themselves are apprehensive. Putting the abortion business on campus does not meet a need, but places considerable liabilities on the colleges.  To bring this bill up a second time without addressing its many serious flaws shows a reckless disregard for the 400,000 young women on those 34 public campuses.  You can imagine what potential risks and liabilities would come with forcing colleges to dispense the abortion pill.  Foremost among the many concerns about SB 24 is its vague funding language.  Like its failed predecessor, SB 24 would allow the $10.2 million in private funds to cover costs associated with the purchase of new equipment, facility upgrades, staff training, and other costs associated with making student health clinics ready to administer chemical abortions.  Also, as with SB 320, SB 24’s funding mechanism is vague and leaves open the possibility of taxpayer-funded abortion after 2023.  It provides no safeguards to prohibit state funds or student fees from paying for the ongoing support of the program. Public funding of abortion is something we know that a majority of Americans strongly oppose, yet SB 24 takes no precautions to prevent that. Not saying “no” is effectively saying “yes.”  Furthermore, the legislation offers no maternal assistance for women who choose not to abort. It supports abortions only. The Institute for Women’s Policy Research found that more than one-quarter of all undergraduate students are raising dependent children—yet no assistance is offered for them.  Parenthood and education are compatible, and there are plenty of women who can prove that. A bill that purposely goes out of its way to take away women’s children, rather than help them raise their babies and continue their education, is a slap in the face to “women’s empowerment.”  “Abortion by medication techniques,” as the legislation calls it, involves early-stage chemical abortions via the abortion pill, but it can still be quite traumatic. What makes chemical abortions different from surgical abortions is that the mother has to see and dispose of the remains of the aborted child herself.  One can imagine the mental trauma that would occur to a young woman whose abortion takes place in her college dorm room or in a student health center bathroom. Is that really a good thing for a young college woman?  But legislation like SB 24 couldn’t care less about women. It only cares about expanding the business of abortion.  Abortion proponents, however, view such a mandate as model legislation for other states to follow, and California is vying to be the first state to implement it.  The California state Senate Health Committee first passed the bill on a 7-3 vote, and it has now passed out of the Senate Education Committee. The next stop is the Committee on Appropriations, which is set to meet next week.  Brown’s successor, Gov. Gavin Newsom, has already insinuated his support for the bill, and that has only encouraged supporters of SB 24. However, it’s still not known how much support will actually come from the public universities themselves, which remain apprehensive of the considerable liability that they would have to assume.  Patrina Mosley is the director of life, culture, and women’s advocacy at the Family Research Council.  : This piece was originally published by The Daily Signal.


cnsnews--2019-07-31--Delaney Challenges Sanders and Warren on Health Insurance We Dont Have toBe the Party of Subtr

Delaney Challenges Sanders and Warren on Health Insurance: 'We Don't Have to...Be the Party of Subtraction'

(CNSNews.com) - Health care was the first issue raised at the CNN-hosted Democrat debate, where moderators cut off many candidates before they could finish their answers.  Sen. Elizabeth Warren (D-Mass.), a candidate who wants to do away with private insurance in favor of "Medicare for All," told the audience: "We are not about trying to take away health care from anyone. That's what the Republicans are trying to do."  Warren was reacting to former Rep. John Delaney (Md.), who said:  We can create a universal health care system to give everyone basic health care for free, and I have a proposal to do it. But we don't have to go around and be the party of subtraction, and telling half the country who has private health insurance that their health insurance is illegal. My dad, the union electrician, loved the health care he got from the IBEW. He would never want someone to take that away. Half of Medicare beneficiaries now have Medicare Advantage, which is private insurance, or supplemental plans. It's also bad policy. It'll underfund the industry, many hospitals will close.  "Five minutes away from me, John, is a country, it's called Canada. They guarantee health care to every man, woman and child as a human right. They spend half of what we spend. And by the way, when you end up in a hospital in Canada, you come out with no bill at all. Health care is a human right, not a privilege. I believe that, I will fight for that," Sanders told Delaney.  "The fact of the matter is, tens of millions of people lose their health insurance every single year when they change jobs or their employer changes that insurance. If you want stability in the health care system, if you want a system which gives you freedom of choice with regard to a doctor or a hospital, which is a system which will not bankrupt you, the answer is to get rid of the profiteering of the drug companies and the insurance companies, move to Medicare for all," Sanders said.  Delaney said his plan is "really simple."  "We should deal with the tragedy of the uninsured and give everyone health care as a right. But why do we got to be the party of taking something away from people? That's what they're running on -- telling half the country that your health insurance is illegal, Delaney said of Sanders and Warren.      "We don't have to do that. We can give everyone health care and allow people to have choice. That's the American way," Delaney said, as moderator Jake Tapper cut him off.  It was now Sen. Warren's turn, and she launched into a story about someone she knows with ALS, a terminal and expensive condition.  Tapper steered Warren back to "Medicare for All," asking if her plan will raise taxes on middle-class Americans, as Bernie Sander's plan does:  "So giant corporations and billionaires are going to pay more. Middle-class families are going to pay less out of pocket for their health care. And I'd like to finish talking about Ady, the guy who has ALS," Warren said.  At the end of her spiel, Tapper gave Warren an extra 15 seconds to answer the question she dodged: "Would you raise taxes on the middle class to pay for Medicare for All, offset, obviously, by the elimination of insurance premiums -- yes or no?"  "Costs will go up for billionaires and go up for corporations," Warren replied. "For middle-class families, costs -- total costs -- will go down."  In other words, it appears that Warren, like Sanders, would have the middle class pay higher taxes in exchange for universal coverage and the elimination of insurance premiums.  Former Colorado Gov. John Hickenlooper steered a less radical course on health insurance, disagreeing with Sanders and Warren:  "You know, it comes down to that question of Americans being used to being able to make choices, to have the right to make a decision. And I think proposing a public option that allows some form of Medicare that maybe is a combination of Medicare Advantage and Medicare, but people choose it, and if enough people choose it, it expands, the quality improves, the cost comes down, more people choose it, eventually, in 15 years, you could get there, but it would be an evolution, not a revolution," Hickenlooper said.  Rep. Tim Ryan (D-Ohio), said the Sanders-Warren plan "will tell those union members who gave away wages in order to get good healthcare that they're going to lose their healthcare because Washington's going to come in and tell them they got a better plan." Ryan suggested moving the eligibility age for Medicare to 50."  "I'm trying to explain that these union members are losing their jobs, their wages have been stagnant, the world is crumbling around them -- the only thing they have is possibly really good healthcare," Ryan said.  "And the Democratic message is going to be, we're going to go in and the only thing you have left we're going to take it and we're going to do better. I do not think that's a recipe for success for us, it's bad policy and it's certainly bad politics."  Candidate Marianne Williamson told the audience she's usually "way over there" with Bernie and Elizabeth, but not when it comes to eliminating private insurance:  "And I do have concern about what the Republicans would say. And that's not just a Republican talking point. I do have concern that it will be difficult. I have concern that it will make it harder to win, and I have a concern that it'll make it harder to govern."  To which South Bend Mayor Pete Buttigieg said, "It is time to stop worrying about what the Republicans will say."  Montana Gov. Steve Bullock does not support Medicare for All:  "At the end of the day,” he said, “I'm not going to support any plan that rips away quality health care from individuals," Bullock said. "This is an example of wish list economics. It used to be just Republicans who wanted to repeal and replace. Now many Democrats do, as well,. We can get there with a public option, negotiating drug prices, ending...” (He was cut off.)


conservativehome--2019-02-26--Alan Mak To be fit for the future the health service must axe the fax and the pager

Alan Mak: To be fit for the future, the health service must “axe the fax” – and the pager

Alan Mak is the MP for Havant and is the Chairman of the APPG on the Fourth Industrial Revolution. His NHS Fax Machines and Pagers Bill is presented in Parliament today.  Conservatives have a long and proud record of supporting and investing in our NHS. As Health Secretary, Matt Hancock, said when launching the new NHS Long Term Plan last month, the Health Service is “one of our proudest achievements” as a nation, and for over 40 of the NHS’ 70 years it has been under the care of Conservative Ministers.  Our Party has nurtured the NHS to serve generations of patients and the £20.5 billion a year delivered by the Long Term Plan is the biggest ever cash injection in its history. This means more investment in our hospitals, more doctors and nurses, and more resources to tackle major diseases. But extra funding alone won’t secure the NHS’s future. To boost productivity and improve patient care and safety, Conservatives must ensure that the NHS seizes the opportunities presented by new technologies too.  We have a duty to prepare the NHS for radical technological change, and in so doing, an electoral opportunity to strengthen our Party’s standing on the NHS by being the patients’ champion – harnessing technology to drive up clinical standards and improve patient care. That was the argument I made in my NHS technology report published last year by the Centre for Policy Studies and launched by the then Health Secretary, Jeremy Hunt. By adopting the new technologies of the Fourth Industrial Revolution (4IR) in the Health Service we can put patients at the heart of a reformed digital-first NHS.  Rightly, the Long Term Plan shares this ambition and sets out the Government’s vision for a modern NHS that uses digital tools to improve patient care and safety. This means pushing forward with an unabashed desire to change the culture of a large public service organisation that has not always been the quickest to adapt to innovation. Decades of underinvestment in our digital health infrastructure has left the NHS at risk of being unable to take full advantage of the new waves of technological breakthroughs that are already revolutionising healthcare – and indeed other aspects of our society and economy. Fuelled by artificial intelligence, Big Data, wearable devices and personalised medicines, these 4IR innovations are set to turbocharge our fight against cancer, heart disease, dementia and other diseases and illnesses.  The Long Term Plan includes a welcome commitment for the NHS to become fully digital and paperless within the next decade. This digital-first NHS would see seamless interactions between GPs, hospitals, and community care; patients not having to wait for appointment confirmations in the post; and an end to health records being lost through human error. Embedding 4IR technologies into the NHS would also drive improvements in detection rates, pioneer new treatments and ultimately deliver better patient outcomes. Meanwhile, precision medicines, personalised for each patient and taking into account an individual’s genetic profile, can be at the forefront of treating disease in the years ahead, becoming a staple in the doctors’ toolbox. Put simply, the future of healthcare is exciting – and has the potential to catch-up with the smartphone era and patients’ digital expectations if we give the NHS the right tools.  But holding back the NHS from achieving these outcomes is a stubborn reliance, in some areas, on ageing technology such as pagers and fax machines. While the Long Term Plan clearly sets out a desire to “axe the fax”, there remain 8,000 of them in use across the NHS making the Health Service the largest consumer of fax machines worldwide. These archaic machines cause patients to miss appointments, hospitals to lose records, and cost NHS Trusts millions of pounds in paper storage each year, as well as being slow, unwieldy, and hard to maintain.  Meanwhile, the pager, which reached the height of its popularity in the mid-1990s, provides doctors and nurses with a limited amount of information, sometimes no more than a bleep, as they tackle a multitude of complex situations on hospital wards. This has led to 97 per cent of doctors admitting in a British Medical Journal survey that they use instant messaging services such as WhatsApp as an alternative, despite these being banned due to concerns over patient confidentiality. Of the one million pagers believed to be left in use worldwide, around ten per cent of them are used in our Health Service.  Yet there are cheap and easy-to-use alternatives available to NHS Trusts. As the Health Secretary has rightly pointed out, e-mail could be used as a way of communicating without the need for paper. And instead of relying on pagers, there are several specialist WhatsApp-style messaging systems available to the NHS. These include Medic Bleep, an app which when trialled at West Suffolk Hospital was found to save £4.5 million worth of staff time largely because doctors and nurses don’t have to wait by a landline phone to respond to pager bleeps. I visited the Hospital to see Medic Bleep in action first hand (see film above) and witnessed its obvious versatility when compared to old-fashioned pagers. If replicated across the 227 NHS Trusts in England new digital messenger systems that replace pagers could potentially save the Health Service more than £1 billion every year which can be redirected to frontline services.  The availability of modern replacements, and the need to rapidly upgrade the Health Service’s technology base, are the reasons I’m introducing new legislation in Parliament today that would ban fax machines and pagers in our NHS by 2021. My National Health Service (Prohibition of Fax Machines and Pagers) Bill can be a firm foundation on which to build a digital-first NHS that fully harnesses the benefits of the Fourth Industrial Revolution that is taking place in healthcare, consigning fax machines and pagers to the scrapheap of history.  Equally importantly, I hope the Bill also sends a clear message that we Conservatives are serious about renewing our NHS for the future, coupling serious financial investment with determined renewal of the tools that our doctors and nurses use and the care patients receive. By investing in the best technology – and phasing out the worst – we can ensure our NHS continues to serve us well for the next 70 years and beyond.


crooksandliars--2019-04-08--More News About That Non-Existent GOP Healthcare Plan

Hey guys, remember that time after Prznint Stupid received TOTAL EXONERATION from Low Barr, and immediately decided to spend his (non-existent) political capital by announcing that his DOJ would not defend the ACA in court, thus taking healthcare away from everyone?  And then he announced a stellar panel of nincompoops, flim-flam artists, and grifters to draft a great replacement plan! Better than anything, frankly, Dim-o-Crats could even conceive of, bigly!  “Sen. Rick Scott (R-Fla.) says any new plan has to come from the White House — and that he had no warning Trump planned to make him part of the health policy group. Mitt Romney (R-Utah) won’t say more than he and colleagues are “working on health care thoughts.” John Barrasso (R-Wyo.), when asked about the Republican plan, turned the question back on the opposition, saying, “Democrats want to go to the complete government takeover of health care.” “And Sen. Bill Cassidy (R-La.), the fourth member of Trump’s team, hasn’t committed to anything more than “conversations with colleagues”about health care affordability.”  So, you know, about as you expected!  I think we are about 10 years in and the Republicans still have not come up with a replacement plan, and I’m cynically thinking that they don’t have one. Wait, what’s that you say?  But with no sponsors, that kinda tells me that the GOP bottom line is on ensuring that Corporate America’s Bottom Line remains healthy, and the rest of us can go to hell.  I swear to blog, Republicans would get into fights over who gets to take the crutch away from Tiny Tim.


dailybeast--2019-10-07--Mayor Pete Buttigieg Targeting Big Pharma in Bid to Set Health-Care Plan Apart

The debate over the future of health care has dominated the first segment of every Democratic presidential debate this cycle, and next week’s 12-person pileup in Ohio is likely to be no exception.  Ahead of the largest primary debate in history, Mayor Pete Buttigieg of South Bend, Indiana, has added specifics—and teeth—to his proposed expansion of access to health care, in a white paper on pharmaceutical pricing that could help distinguish his wordily named “Medicare For All Who Want It” plan from similar proposals put forward by his Democratic rivals.  The plan, released on Monday morning, focuses on cutting prescription drug costs, which are higher in the United States than any other country in the world. Through a combination of new legislation, the creation of a public option, a tax hike on pharmaceutical companies, and aggressive enforcement of the government’s ability to declare “eminent domain” over intellectual property, Buttigieg’s plan markets itself as the first proposed that would cap monthly out-of-pocket costs for prescription drugs.  “This plan is aggressive on capping out-of-pocket costs for consumers and aims to shift the power from corporate health care to American consumers that rely on lifesaving drug prescriptions,” Marisol Samayoa, the Buttigieg campaign’s deputy national press secretary, told The Daily Beast. “Pete is the only candidate to cap monthly out-of-pocket costs for those on public plans.”  Sen. Kamala Harris’ “Medicare For All” proposal also promises “strong caps on out-of-pocket costs” at $200 per year, and Sen. Bernie Sanders’ bill to that effect also caps those costs. The Buttigieg campaign points out that its plan is the first to cap expenses per month, which would prevent the sudden onset of an expensive illness from wiping out savings.  The proposal could help set Buttigieg’s stance on health care apart from other upper-level candidates. Former Vice President Joe Biden, who has aggressively defended the Affordable Care Act passed under President Barack Obama, has called for pegging prescription drug price increases to inflation, as well as limiting prescription prices for Medicare and potential public-option consumers to an average of international prices. Sen. Elizabeth Warren (D-MA) has advocated for the Department of Health and Human Services to manufacture generic medication. Sen. Bernie Sanders (I-VT), like Warren, has called for the creation of a trillion-dollar “Medicare For All” system that would provide health insurance coverage to all Americans.  Buttigieg’s plan to cap monthly out-of-pocket costs is still a relative novelty in the crowded battle arena of Democratic health care proposals (although not the singular one promised by the campaign). Under the proposed plan, out-of-pocket costs for seniors using Medicare would be capped at $200 per month, and at $250 per month for those on the “Medicare For All Who Want It” public option. For seniors, those on Medicaid assistance, and public-option consumers, copays for generic medication would be eliminated.  Although most Americans don’t spend that much in a year on out-of-pocket expenses, the caps would provide major relief for the elderly and those with serious and chronic illnesses. Twenty-nine percent of Americans report not taking medications as prescribed due to cost in the past year, including one in five who have not filled a prescription because of high prices and one in 10 who have skipped doses or cut pills in half to stretch their medication.  Buttigieg’s plan, like those of his chief rivals, would also empower the government—the largest purchaser of pharmaceuticals in the world—to negotiate drug prices for consumers on government health plans, what the campaign calls “Walmart logic,” allowing for lower drug prices across the board.  For pharmaceutical companies that refuse to comply, Buttigieg puts forward a host of potential punishments, including taxes on companies that refuse to negotiate pricing or raise drug prices by more than inflation. For so-called “worst offenders,” Buttigieg proposes that the government exercise the right of eminent domain to acquire intellectual property rights from pharmaceutical companies found to be harming consumers through “irresponsible pricing.”  This sharp-elbowed approach to pharmaceutical companies, which are the most profitable companies in the entire health-care sector, also has the potential upside of dulling attacks that the mayor’s popularity with health-care industry donors might steer policy—in addition to setting Buttigieg’s plan apart from his rivals.  But the plan still has potential weak spots. Buttigieg’s plan would not be able to automatically guarantee universal coverage for all who live in the United States, unlike Warren and Sanders’ proposals, although there are provisions in the plan that would help fill the gaps of individuals who can’t afford employer-based coverage or who live in states that have refused to expand Medicaid. Those who can’t afford insurance through employers would receive income-based subsidies for the public insurance option, and those in states that have not expanded Medicaid will be automatically enrolled.  Despite its crackdown on the pharmaceutical industry’s pricing practices, the plan would also still allow for private insurance, which progressives have called to eliminate, although Buttigieg has proposed subsidizing coverage for those who are uninsured for financial reasons.  Buttigieg has also contended that the existence of a superior public option, under the government’s imprimatur, would eventually lead to more Americans ditching inferior private plans.  “We don’t have to stand up here speculating about whether the public option will be better or Medicare-for-all will be better than corporate options. We’ll put it to the test,” Buttigieg said at the Democratic presidential debate in September. “If people like me are right, then the public alternative is going to be not only more comprehensive but more affordable than corporate options around there. We’ll see Americans walk away from the corporate options into that Medicare option and it will become Medicare-for-all.”  Biden, Warren and Sanders have all joined the call for the government to be able to negotiate drug prices for Medicare with pharmaceutical companies in the same way that insurance companies do. But the South Bend mayor has said that his proposal would allow for consumers to choose health care that best fits their needs, while still reforming a health-care system where Americans pay roughly $600 more per year for prescription drugs citizens of other developed countries.  “The problem, Senator Sanders, with that damn bill that you wrote, and that Senator Warren backs is that it doesn’t trust the American people,” Buttigieg said at last month’s presidential debate. “I trust you to choose what makes the most sense for you—not my way or the highway.”


eveningstandard--2019-06-27--US Democrat presidential debate Candidates battle on gun control healthcare in high stakes TV deba

US Democrat presidential debate: Candidates battle on gun control, healthcare in high stakes TV debate

Donald Trump has branded the US Democratic presidential debate “boring” and slammed the host networks after a technical glitch derailed its second half.  Ten Democratic candidates faced off in the first round of back-to-back TV debates in the crowded race to oust Mr Trump from the White House next year.  Several contenders clashed over healthcare coverage and border policy as some of the lesser-known candidates vied for attention.  The US Republican President fired off a one word tweet in the first hour of the debate: “BORING!”.  He also took aim at NBC News and MSNBC when a technical glitch delayed the debate's second hour. He has consistently accused the networks of not treating him fairly.  "@NBCNews and @MSNBC should be ashamed of themselves for having such a horrible technical breakdown in the middle of the debate. Truly unprofessional and only worthy of a FAKE NEWS Organization, which they are!" he tweeted.  Millions of voters tuned in to watch the candidates debate topics such as gun control, climate change, private health insurance and immigration.  Headliner Elizabeth Warren, a Massachusetts senator, was looking to cement her surge in opinion polls after unveiling a string of policy proposals such as free universal healthcare, higher taxes on the rich and breaking up tech giants.  "Who is this economy really working for?" she said in response to the first question. "It's doing great for a thinner and thinner slice at the top."  Ms Warren drew a big cheer as one of only two contenders on stage, alongside New York Mayor Bill de Blasio, to say she supports government-run healthcare.  She backs a government-sponsored Medicare-for-All approach and criticised those who say it is not politically feasible.  She said: "There are a lot of politicians who say, 'oh, it's just not possible'… what they're really telling you is, they just won't fight for it.  "Well, healthcare is a basic human right and I will fight for basic human rights."  On gun violence, Mr de Blasio said: "There's something that sets me apart from all my colleagues running in this race and that is for the last 21 years I've been raising a black son in America."  He said his son, Dante, has to use "special caution because there have been too many tragedies between our young men and our police".  When asked how he’d win over voters worried about possible government overreach in climate-related restrictions, former Texas congressman Beto O'Rourke pledged to help communities including the debate host city Miami, an area "on the front lines of climate change today."  He also took aim at immigration policies while showing off his fluency in Spanish, saying that a stable American democracy should “listen to all voices.  Taking a question in Spanish he answered it saying, "We are going to treat everyone with respect."  But he came under attack from former Obama housing secretary Julian Castro over the separation of families and detention of migrants at the southern border.  Mr Castro said he would decriminalise border crossings by migrants, which he said had led to the separation of families. He challenged the others to support him.  Mr O'Rourke said that as a congressman he helped introduce a bill that would ensure that those who are seeking asylum and refuge in the United States would not be criminalised.  New Jersey Senator Cory Booker was also on stage and was the only the only candidate who did not raise his hand when asked whether he would sign back on to the 2015 Iran nuclear deal as it was originally negotiated under the Obama administration.  The Democrats also agreed with each other frequently, particularly when it came to Mr Trump. They criticised his economic policies, saying they had benefited the wealthy at the expense of working Americans, and calling his border policies heartless.  Also on stage were Minnesota Senator Amy Klobuchar; the only Latino in the race; Representatives Tulsi Gabbard and Tim Ryan; Washington state Governor Jay Inslee; and former congressman John Delaney.  All 10 participants in the first encounter had an opportunity to step out of the shadow cast by front-runners Joe Biden and US Senator Bernie Sanders, who are scheduled to take the stage on Thursday night with eight other contenders.


eveningstandard--2019-11-12--General election 2019: Labour vows to out spend Tories on health with £26bn 'rescue plan'

General election 2019: Labour vows to out spend Tories on health with £26bn 'rescue plan' for NHS

Labour will today vow to outspend the Tories on health funding as they unveil a £26 billion “rescue plan” for the NHS ahead of the general election.  The party said its proposal will provide safe, quality care, recruit thousands of staff, rebuild crumbling facilities and provide modern state-of-the-art equipment.  Shadow Chancellor John McDonnell and Shadow Health Secretary Jonathan Ashworth will on Wednesday announce the “rescue” plan to "end the Tory NHS crisis" with a £26 billion real-terms - £40 billion in cash terms - healthcare funding boost.  The commitment amounts to £6bn more than the funding pledged last year by the Conservative government.  In a speech at the Royal Society of Medicine, they are expected to announce an annual average 4.3 per cent funding increase for health spending over the next four years, funded from Labour's proposals to reverse corporation tax cuts and tax the wealthiest people in society.  The plan includes NHS capital expenditure rising to the international average, £1 billion-a-year training and education budgets, and £1 billion more to fund an expansion of public health services.  There will be a focused drive on prevention measures to stop people getting sick, as part of Labour's mission to tackle health inequalities and prioritise children's health and well-being.  Mr McDonnell is expected to say: "The world-class health service we all need and depend on needs proper funding.  "Labour's policies to tax the richest in society and invest for the future through our Social Transformation Fund mean we will be able to improve millions of lives.  "And ending privatisation means that money can be spent on healthcare rather than dividends for Boris Johnson's friends in the private healthcare industry."  Mr Ashworth is expected to say: "With experts warning this winter is set to be one of the worst, the truth is our NHS is crying out for a financial rescue plan to deliver real change for patients.  "We are announcing today the levels of investment our NHS needs to not only again provide the quality care our sick and elderly deserve but secures the NHS for the future as well.  "We'll invest more to prevent people becoming ill in the first place and we'll give mental health and well-being a greater priority than ever before.  "This General Election is about millions on waiting lists and hundreds of thousands who've waited on trolleys under the Tories - only Labour has a plan to rescue our NHS."  The pledge comes amid a row over both Labour and Tory election spending, with the Institute for Fiscal Studies warning that some plans are “not deliverable”.  Director Paul Johnson said it was not sensible to double investment spending within three or four years. He also warned the Conservatives and Labour about the promises they were making, saying they need to be “very careful”.  Liberal Democrat spokesperson for health, Luciana Berger, said Labour's latest announcement "misses the point".  Ms Berger said: "Labour's health announcement today completely misses the point. They are ignoring the fact that Brexit is the biggest threat to the NHS - if Labour allow Brexit to happen, they cannot rescue our NHS.  "Brexit has already cost the economy as much as £66 billion. If Corbyn had not tacitly supported Brexit, Labour could have funded their NHS plan more than two times over.  "Only the Liberal Democrats can offer voters a brighter future through stopping Brexit and transforming our NHS and social care services for the future."  However Nuffield Trust chief executive Nigel Edwards said this funding would mean the NHS could "breathe a sigh of relief", adding: "A 4 per cent increase a year will make a big difference compared to the 1.4 per cent average the NHS has grown used to in recent years.  "It is enough to get most waiting times back on track over time, but tough decisions will still have to be made.  "Although 'ending privatisation' will appeal to many, stopping the NHS from funding private procedures will not actually save much money as private companies and NHS trusts get paid the same price per operation."  Mr Edwards said money is not the be-all and end-all, pointing out that extreme staff shortages are the greatest problem facing the NHS.  Richard Murray, chief executive of The King's Fund, said: "The success of any NHS funding policy will rest on the ability to recruit and retain enough workers to staff NHS services.  "Labour's pledge to reinstate a training bursary for nurses is welcome, although it will be critical to focus on retaining existing NHS staff over the next few years, at a time when many are leaving the service due to the intensity of their workload."  Mr Murray said that for many UK voters, the distinction between the NHS and social care is unclear, and many are surprised to find that social care is not free at the point of use.  "The current social care system is not fit for purpose and is failing the people who rely on it. A key test for party manifestos will be whether they include plans for fundamental reform of social care funding," he said.  Unison general secretary Dave Prentis said: "This rescue plan can't come soon enough and will give hope to health service employees and patients across the UK. It takes the NHS back to the time before heartless Tory cuts."  Dame Donna Kinnair, chief executive and general secretary of the Royal College of Nursing, said all parties need to commit to investing in nursing, adding: "No matter how people voted in the EU referendum, nobody wants the NHS left open to a carve-up as a result of a post-Brexit trade deal.  "Brexit chaos and rows about deals cannot become a distraction from solving the mounting nurse shortage at home."  Niall Dickson, chief executive of the NHS Confederation, which represents organisations across the healthcare system, said further detail is needed from parties about their plans to tackle the crisis in social care, an issue he said politicians of all parties have "ducked for too long".  Mark Littlewood, director general at the Institute of Economic Affairs, said: "The endless billions of pounds that are being pledged to the National Health Service in this election cycle are not costed, not responsible, and crucially are not going to cure the health system's long-term ails.  "The NHS remains an international laggard in terms of health outcomes and has some of the highest rates of avoidable deaths in western Europe. The structure of the NHS is fundamentally outdated and no amount of money is going to get the health system to function and operate at the level patients deserve."