Archives for March 2023

Congressman Seeks to Plug ‘Shocking Loophole’ Exposed by KHN Investigation

Congressman Seeks to Plug 'Shocking Loophole' Exposed by KHN Investigation  | Kaiser Health NewsA U.S. lawmaker is taking action after a KHN investigation exposed weaknesses in the federal system meant to stop repeat Medicare and Medicaid fraud and abuse.

Rep. Lloyd Doggett (D-Texas) said he decided to introduce a bill in the House late last week after KHN’s reporting revealed what he called a “shocking loophole.”

“The ability of fraudsters to continue billing Medicare for services is outrageous,” Doggett said. “This is an obvious correction that is needed to safeguard our system. Wherever there are large amounts of government money available, someone tries to steal it.”

KHN found a laundry list of weaknesses that allows people accused or convicted of fraud to easily sidestep bans imposed by federal officials. Among those gaps is the Centers for Medicare & Medicaid Services’ lack of authority to deny or revoke National Provider Identifier, or NPI, numbers after federal regulators have prohibited a person or business from receiving payments from government programs.

Doctors, nurses, other practitioners, and health businesses use the unique, 10-digit NPI numbers to bill and file claims with insurers and others, including Medicare and Medicaid.

Taking away the NPI would “be equivalent of prohibiting a practitioner from practicing in total,” Dara Corrigan, director of CMS’ Center for Program Integrity, wrote in an email response to questions about KHN’s investigation. CMS declined to comment on Doggett’s proposed legislation.

The bill, HR 1745, would give CMS the authority to deactivate NPIs tied to anyone convicted of waste, fraud, or abuse and whose name appears on the exclusions list kept by the Office of Inspector General for the U.S. Department of Health and Human Services. The proposed law would also require CMS to implement recommendations that the inspector general has made to improve NPI reporting and provider transparency.

“This strikes me as what should be an easy bipartisan measure,” Doggett said, adding that he had presented the bill in a face-to-face meeting with Rep. Jason Smith (R-Mo.), who chairs the House Ways and Means Committee. Doggett also alerted that panel’s health subcommittee chair, Rep. Vern Buchanan (R-Fla.).

“They both talk about the need to eliminate fraud, and this is one modest but important way to do it,” Doggett said. Neither Smith’s nor Buchanan’s offices responded to requests for comment.

The OIG declined to comment.

Former Justice Department officials told KHN that repeat violators are savvy and find ways to circumvent the system. KHN examined a sample of 300 health care business owners and executives who are among more than 1,600 on the OIG’s exclusion list since January 2017. Journalists reviewed court and property records, social media, and other publicly available documents.

KHN found:

  • Eight people appeared to be serving or served in roles that could violate their bans;
  • Six transferred control of a business to family or household members;
  • Nine had previous, unrelated felony or fraud convictions, and went on to defraud the health care system;
  • And seven were repeat violators, some of whom raked in tens of millions of federal health care dollars before getting caught by officials after a prior exclusion.

Doggett’s bill is “a pretty smart step in the right direction in fixing this issue,” said John Kelly, a former assistant chief of health care fraud at the Department of Justice who is now a partner for the law firm Barnes & Thornburg. Kelly had previously recommended that NPIs should be “essentially wiped clean” when a person is on the exclusions list.

Kelly, who confirmed that Doggett’s office reached out to him after KHN’s investigation was published in December, said taking the NPI number away “certainly doesn’t eliminate all risk” but it’s a move “in the right direction.”

“If you want to bill Medicare, you have to have a valid NPI,” Kelly said.

What You Need To Know About 2023 Group Health Premiums

What You Need to Know About 2023 Group Health Premiums | Word & Brown

According to Statista, nearly half of Californians (48.1% in 2021) get their health insurance through their job. The percentage in Nevada is slightly less – at 45.9%.

The Kaiser Family Foundation (KFF) found in its 24th Employer Health Benefits Survey (EHBS) in 2022 that the average annual premiums for employer-sponsored health insurance were $7,911 for single coverage and $22,463 for family coverage. These amounts were up from $7,739 and $22,221 in the previous year, respectively – an increase of $172.00 for single coverage and $242.00 for family coverage. The average family coverage premium is up 20% over the past five years and up 43% during the past 10 years.

Average Contributions

Most employees contribute toward their insurance costs. On average, covered workers contribute 17% of the premium for single coverage and 28% of the premium for family coverage. These numbers are similar to those reported by KFF in its annual survey during 2021.

Small vs. Large: At smaller firms, the average employee contribution for workers at small firms is $7,556, which is more than a third higher than the average for workers at large firms ($5,580). Those employed by private, for-profit firms contribute a higher percentage of the premium as compared to those at public firms, regardless of coverage type.

Forecasts for 2023

While not all analysts are forecasting the same increase in costs for 2023, most are anticipating higher costs. A survey of medical insurers by Willis Towers Watson (WTW) released in October 2022 forecast a 10% global increase, driven primarily by inflation and increased health care usage.

Rates in North America are expected to increase by 6.4% in 2023, according to WTW. Of more than 250 insurers included in the survey, more than three quarters (78%) are expecting higher or significantly higher increases in costs through 2025.

The National Business Group on Health, a trade organization devoted to health policy issues for larger employers, made a similar forecast for 2023. The group’s survey found large employers expect a 6.5% increase on average for 2023. That follows an 8.2% increase in 2021 during the height of the COVID-10 pandemic.

Mercer says employers expect health benefits costs to rise 5.4% in 2023 – with even faster growth anticipated in 2024. Aon’s analysis in 2022 forecast a 6.5% increase for employer health costs.

Out-of-Pocket Costs Increases

Whether the employer is paying all or a portion of the premium for health insurance coverage, employees almost always have out-of-pocket costs for their health care that they alone pay. If an employee has a $2,000 annual deductible, that amount must be paid before the plan begins to pay for health care services. There may also be coinsurance or copays for some services.

In 2022, the Employee Benefit Research Institute (ERBI) reported that out-of-pocket costs have increased. They were 17.4% in 2013, increasing to 19% by 2019. Although they declined in 2020 to 16.4%, that is attributed to COVID-19 and a decline in care sought by patients that year. According to the ERBI, “there is a clear upward trajectory in the share of medical expenditures borne by patients.” Paired with an increase in employees’ premiums in recent years, “this may have deleterious impact on workers’ personal finances.”

Addressing Cost Increases

Many factors influence health care costs: inflation, disease prevalence or incidence, medical technology, blockbuster and specialty drugs, care utilization, and catastrophic claims. Employers face a delicate balancing act managing increasing costs and making smart decisions about the best ways to attract and retain workers.

You can aid your clients by helping them understand the pros and cons of different plan types. For example, High Deductible Health Plans (HDHPs) have grown significantly in popularity. According to ValuePenguin, a record number of American private-sector workers were enrolled in HDHPs in 2021.
Enrollment is up more than 20% from 2021 to 2021. However, HDHPs are not for every employer or employee.

In fact, Preferred Provider Organization (PPO) plans remain the most common plan type. Nearly half (49%) of employees enrolled in a PPO in 2022. Twelve percent enrolled in an HMO, nine percent in a Point-Of-Service (POS) plan, and one percent in a conventional (indemnity) plan.

Talk with your Word & Brown representative about how our broad product portfolio, instant plan comparisons with highlighted plan differences, and industry-leading quoting technology can help you find the right plan for your clients and their employees – while still controlling costs.

If you’re not already working with us, it’s easy to get started. Register using our online form.

ACA’s Employer Mandate: IRS Announces Higher Penalties For Noncompliance

ACA's Employer Mandate: IRS announces higher penalties for noncompliance |  BenefitsPRO

The IRS has announced the 2024 employer mandate penalties under the Affordable Care Act for employers with 50 or more full-time equivalent employees.

Under the ACA, employers may be subject to an employer mandate penalty for (1) failing to offer minimum essential coverage to 95% of full-time employees (A Penalty) or (2) offering coverage that is not affordable (B Penalty).

The A Penalty for failing to offer minimum essential coverage to 95% of full-time employees and their dependents will be $2,970 per employee, which represents a $90 increase from 2023. The B Penalty for offering coverage that is “unaffordable” or does not provide “minimum value” will increase by $140 to $4,460 per employee. These new rates will be effective for plan years beginning after Dec. 31, 2023.


“While employers are given a buffer for the A Penalty (an employer can fail to offer 5% and the penalty is not assessed for the first 30 employees), the penalty’s nickname, the `sledgehammer’ penalty, is well-earned, since the penalty applies to all of the employer’s full-time employees in the EIN if triggered,” said Laura Bibb, a compliance attorney for Lockton.

“Generally, the coverage provides minimum value if the plan’s share of the total allowed costs of benefits provided under the plan is less than 60% of those costs,” she said. “Coverage is considered affordable for an employee if the employee’s required contribution for self-only does not exceed a specified affordability percentage (set annually by the IRS) of the employee’s household income.

“As a reminder, since employers generally do not know an employee’s household income, the IRS allows employers to determine affordability using one of three affordability safe harbors (W-2, rate of pay and federal poverty level).”


The IRS is actively issuing 226-J letters to employers informing them that they may be liable for employer mandate penalties, Bibb said.

“Care should be taken to ensure full-time employees are properly identified and offered    coverage and that required employee contributions for self-only coverage are affordable under one of the three allowable safe harbors,” she said. “Even still, errors on Form 1095-C can result in a Letter 226-J.”

Mobile Clinics Really Got Rolling in the Pandemic. A New Law Will Help Them Cast a Wider Safety Net.

Mobile Clinics Really Got Rolling in the Pandemic. A New Law Will Help Them  Cast a Wider Safety Net. | Kaiser Health NewsNearly 12 years ago, a nonprofit centered on substance abuse prevention in Lyon County, Nevada, broadened its services to dental care.

Leaders with the Healthy Communities Coalition were shocked into action after two of their food pantry volunteers used pliers to pull each other’s abscessed teeth. The volunteers saw no other option to relieve their overwhelming pain in the small town where they lived, 40 miles southeast of Reno, because of a dearth of dental care providers.

That drastic act, said Wendy Madson, executive director for the coalition, prompted her organization to use mobile clinics to offer health and dental services in rural communities where there aren’t enough patients to support brick-and-mortar offices.

The coalition now sends a van outfitted with dental equipment to county schools to treat hundreds of students per stop a few times each year. They also host events for adults in the region. The response has been overwhelming.

“Dental is the hot ticket,” Madson said. “Everybody wants dental. Availability of those services is what runs out first in those large mobile events.”

The coalition’s mobile programs mirror efforts nationwide to dispatch services to patients experiencing gaps in the health care system, especially in rural areas.

Rural residents face more significant health care provider shortages, including dentists, compared with their counterparts in larger cities. Since the beginning of the pandemic, mobile clinics have increased access to a range of services in hard-to-reach places with sparse populations.

A recently passed law, which makes it easier for rural communities to pay for new mobile clinics, could expand this trend. In the past, clinics that serve low-income rural residents couldn’t spend federal grant money, called new access point grants, on mobile services in communities where they didn’t already have facilities.

Then last fall, Congress passed the MOBILE Health Care Act, sponsored by Sens. Jacky Rosen (D-Nev.) and Susan Collins (R-Maine), which gives federally qualified health centers — health clinics serving medically underserved areas — greater flexibility to use federal funding to create and operate mobile units.

Since 2019, the number of mobile clinics on the road has expanded, according to the National Association of Community Health Centers. Many had been used for covid-19 testing and vaccinations. And health and community organizations have started using mobile units to bring primary care, behavioral health, and reproductive services to out-of-the-way patients. The new funding pathway could soon put even more mobile health vans on the road.

For now, the law is dependent on congressional funding, and experts predict it could be at least a year before health centers can access the grant money.

More than 2,000 health center advocates went to Washington, D.C., in early March to ask lawmakers to support multiyear grant funding, said Amy Simmons Farber, associate vice president of media relations for the National Association of Community Health Centers.

Once funded, the regulatory shift will allow health centers to collaborate with independent organizations like Madson’s Health Communities Coalition in Nevada to expand services in underserved regions. Because the coalition is not a federally qualified health center, it has relied on a mix of other federal and state grants.

Nearly 1,400 federally qualified health centers nationwide receive federal funding for providing comprehensive health services in underserved areas. The previous requirement that health centers establish brick-and-mortar clinics before expanding mobile clinics prevented many from applying, said Steve Messinger, policy director for the Nevada Primary Care Association. It was burdensome and costly for health centers.

But in rural areas with small populations, served well by mobile clinics, it wouldn’t make sense to first establish a building with a full-time provider, he said. That could eat up the budget of a federally qualified health center.

While health center advocates lobby Congress for base funding, the Healthy Communities Coalition is forging ahead with three dental events this year funded by a grant from the Health Resources and Services Administration, part of the Department of Health and Human Services.

At the first medical outreach event the coalition organized in 2012 in Lyon County, where 61,400 residents are spread across more than 2,000 square miles, more than 200 people showed up to receive free care and 150 teeth were pulled, Madson said. Since then, the organization has hosted several events a year — except in 2020, when the pandemic paused work.

Many of the dental events are school-focused and provide children with such services as screenings, X-rays, sealings, varnish, and cleanings. But an overwhelming need for care also exists among area adults, said Madson, because Medicare and Nevada’s Medicaid do not include comprehensive dental coverage for adults. It’s harder to fund those events, she said.

Of the five communities in Lyon County, at least one, Silver Springs, does not have a single dentist. There are 10 dentists total in Fernley and Dayton, communities with a combined population of 38,600 people, but only two of those practices accept Medicaid, which covers low-income people younger than 21 and limited dental services for adults.

Traci Rothman, who manages the coalition’s food pantries, said the dental outreach events made a difference for her 29-year-old son, who moved to Silver Springs last year. He went to two mobile clinics to receive free care, which Rothman said was a big relief because he’s uninsured and needed dental care badly.

“Otherwise, you’re going to somebody that you’re paying cash,” she said. “Oftentimes I cannot pay, honestly; it’s just out of reach for some people, or most people … in rural areas.”

Madson said the coalition stepped in to help a young student in desperate need of a root canal. The coalition is helping the girl’s family apply for Medicaid or Nevada Check Up, the state Children’s Health Insurance Program, and is paying $1,600 to cover the service with federal grant money. Another student had to be referred to several specialists before she had her decayed baby teeth surgically removed and received restorative treatment for adult teeth that had begun to decay.

“Her mom was so thankful, she was in tears,” Madson said. “She told me that her daughter woke up without instant pain for the first time in years.”

Madson said her organization has enough grant funding for three events through May, but she hopes the MOBILE Health Care Act will help expand services. Besides dental care, the group provides primary care mobile clinics for immigrant workers in Yerington, a small town in an agricultural region about 70 miles southeast of Reno.

Sara Rich, CEO of Choptank Community Health in Maryland, said she shares Madson’s hope.

Choptank serves five counties in Maryland, including small towns between the Chesapeake Bay and the Delmarva Peninsula. Amid the pandemic, the health organization struck an unlikely partnership with a car dealership and used federal covid relief money to buy a Ford Transit cargo van for mobile clinics.

Choptank used its new van to provide vaccines but has since started using it to provide primary care to immigrant workers and dental services to children at 36 schools. The mobile clinics have been so successful that the health center is working on purchasing more vans to expand its services.

Rich said the mobile clinics are “breaking down barriers that a lot of us have been working on for a long time.”

Among the new services Choptank seeks to provide are behavioral health, preventing and treating substance use disorders, and skin screenings for people working on the shores of Maryland.

“Flexibility has been a theme over the last few years,” Rich said. “I think this MOBILE Health Care Act will help us do that even more into the future.”

Workers Could Sue Over Bad-Faith Insurance Denials

Nevada workers could sue over bad-faith insurance denials | Las Vegas  Review-Journal

Reno Police Department Detective Janira Varty was injured in 2019 during a car accident when she slid on black ice while on duty.

Afterward, her entire body was in pain, and she was unable to lift things or raise her arms above her shoulders.


Despite doctors attesting that her injuries were a result of the on-duty accident, her workers’ compensation claim was repeatedly denied. After two years, she was able to get treatment using private health insurance, but that came too late, she said, and she’s still in pain. She’s not sure if she’ll be able to finish out her career in law enforcement.

“My body has been in constant pain for over three years, and I will likely have permanent life altering injuries for the rest of my life,” Varty told the Senate Committee on Commerce and Labor on Wednesday.

Varty was one of several injured workers in Nevada to testify in support of Senate Bill 274, which would revise the workers’ compensation system by allowing injured workers to sue insurers and third party administrators for acting in bad faith when denying their claims or delaying payment to workers.

“What hurts the most is not being able to carry my daughters to bed when they fall asleep on the couch, or carry them whenever they get hurt,” Varty said. “All my daughters want is for their mommy to lift them up, to hug them tight, to carry them … but I can no longer do that for them. The system is broken. The system is harmful for employees seeking treatment as an injured employee.”

The legislation, sponsored by state Sen. Skip Daly, D-Sparks, is the brainchild of former Washoe County sheriff’s Detective Kim Frankel, who, like Varty, was injured on-duty when a drunk driver hit her. She won her case, but the third party administrator is still denying her treatment.

After the Las Vegas Review-Journal published its first article highlighting the issues with the workers’ compensation system, Frankel decided to be the voice and face of all injured workers in Nevada and advocate for change, sharing her own story about her experience.

“I believe, if there were a deterrent, such as ‘bad faith,’ the cruel actions of employers, insurance companies and third party administrators would be mitigated,” Frankel told the committee Wednesday. “This bill is a deterrent. It does not open up the system to frivolous lawsuits.”

During the committee hearing, police unions and other labor representatives testified in support of the legislation, while representatives of insurers and chambers of commerce testified in opposition.

Jason Lesher, president of the Washoe County Sheriff Deputies Association, said the bill would help police officers injured in the line of duty while serving their communities, however it will help all workers injured in Nevada.


“These delays in treatments cost employees their health, their careers, as you’ve heard, and so much more,” Lesher said. “This bill simply seeks to level the playing field and allow employees some recourse when negligent or bad faith cases are proven to have occurred.”

Opponents to the legislation argue there are already systems in place to penalize insurers who refuse to pay or unreasonably delay the payment to an injured worker. They say the legislation would disproportionately impact small businesses and cause insurance rates to increase. It could also lead to insurance companies leaving the state, said Emily Osterberg, director of government affairs for the Henderson Chamber of Commerce.

“The system that you have crafted is not perfect, as no system is, but ‘bad faith,’ we believe, would be a mistake to introduce,” said Dalton Hooks, an attorney representing the Nevada Self Insurers Association.

The legislation also seeks to increase the benefit penalties that are given to injured workers from insurers when they refuse to pay or are unreasonably delaying payment to an injured worker from an amount not less than $5,000 to $15,000, and from an amount not greater than $50,000 to not greater than $200,000. Some opponents of the legislation did express support for that particular element of the bill.

The Nevada Division of Industrial Relations, which investigates benefit penalty complaints from injured workers, was neutral.

Victoria Carreon, administrator at the Nevada Department of Business and Industry Division of Industrial Relations, said about 230 cases come to the division each year, and there is currently a backlog of 178 complaints. Last year 361 cases were resolved, but there is limited staff, Carreon said.

Two investigators handle the complaints and can only investigate four per month, limiting the division’s ability to resolve cases for workers in a timely manner, Carreon said. The division estimates that demand would increase if the legislation is approved, so it would need additional support.

Daly concluded his arguments that as long as insurers are following the rules, “nobody has anything to fear.”

“Comply with the law … file the claims in good faith, you’ll have nothing to fear from anything we put into this statute,” Daly said.

No Surprises Act Arbitration Process Is A ‘Big Mess,’ Senate Tells HHS At Hearing

Volume of disputed claims, legal rulings creating obstacles for No  Surprises Act | BenefitsPRO

The arbitration process in the No Surprises Act, which was enacted to make the health care system more transparent, has become “a big mess,” a U.S. senator said last Wednesday at a Senate Finance Committee hearing.

The U.S. Department of Health and Human Services recently resumed determinations, after pausing in early February following a federal court decision in Texas.

“We’re seeing lawsuit after lawsuit from providers; insurers aren’t responding in a timely manner or sometimes not at all; and even when the payment determinations are won by providers, payers still don’t pay providers after the statutory deadline,” Sen. Michael Bennet, D-Colo.


Xavier Becerra, secretary of the U.S. Department of Health and Human Services, blamed an unexpectedly high volume of arbitration claims, many of them frivolous, for the backlog. “Everyone’s just filing all sorts of claims, and these arbitrators are trying to figure out what cases to handle,” Becerra testified at the hearing. “That’s what’s bogging down the system.”

The No Surprises Act got off to a robust start in 2022, preventing 9 million surprise bills in the first nine months of the year. However, regulators were not prepared for the volume of arbitration claims.

“Federal agencies thought there would be about 17,000 arbitration experiences last year,” said Ryan Work, senior vice president, government relations, for the Self-Insurance Institute of America. “Instead, 90,000 claims were disputed, and they had a huge surprise of their own at the end of the day. Saying the portal and the regulators are overwhelmed is an understatement.”


The high number of ineligible claims contributed to the bottleneck. Out of more than 41,000 disputes challenged for eligibility during that period, 21,000 were closed. “You are seeing a huge number of claims going in, very few actually closed and a huge number declared ineligible,” he said.

The Texas Medical Association has filed several lawsuits arguing that HHS has gone against congressional intent when implementing the arbitration process. The association has argued that the regulations implementing the law called for the arbiter to put too much weight on the qualifying payment amount, which is the average geographic rate for a service.

Although the agency is staying true to Congress’ intent with the law, Becerra said legislative action is needed to deal with the high number of claims.


“What we’re trying to do is have a system that works,” he said. “I plead with you to help us make sure that we get to the legitimate cases so a provider that’s looking for real payment, or an insurer that’s saying, `You’re asking for too much,’ we can adjudicate that.”

Senate Panel Advances Bill To Reform PBMs And Bring More FTC Scrutiny On Industry

PBM drug pricing transparency reform bill headed to the full Senate |  BenefitsPRO

A key Senate committee advanced legislation to ban pharmacy benefit manager tactics, such as spread pricing and clawback fees, and heighten transparency of the industry.

The Senate Commerce Committee passed the PBM Transparency Act of 2023 by a vote of 18 to 9 on Wednesday, advancing the reform legislation to the full Senate. Lawmakers said the legislation is meant to address a source of unfair and deceptive practices that increase drug prices.


“This bipartisan bill would not only put a stop to deceptive and opaque pricing schemes that burden consumers with higher prices, it also saves taxpayers $740 million,” said Sen. Chuck Grassley, R-Iowa, one of the original co-sponsors, in a statement. “It’s a win-win and warrants swift approval in Congress.”

The legislation would ban the tactic PBMs use called “spread pricing,” where the manager charges payers more for a drug than what they reimburse a pharmacy, thus pocketing the difference, a summary of the bill said.

“This practice can result in pharmacies being reimbursed less than their acquisition cost for a drug,” the summary said.


It would also ban clawback fees where a PBM attempts to get back part of a payment made to pharmacies or increase fees to offset any changes to reimbursement from federally funded health plans, the committee summary added.


The legislation also seeks to boost transparency for PBMs, including requiring each manager to file an annual report with the Federal Trade Commission (FTC) on how much each plan paid the PBM for prescription drugs and in turn how much the PBM paid the pharmacy.

The report would also have to detail why a copay or deductible for a consumer increased or the reason pharmacy reimbursement declined. Any PBM that doesn’t follow the law could face fines from the FTC and state attorneys general of up to $1 million.

The FTC has already launched a comprehensive study of the PBM industry and has sent subpoenas to six of the industry’s major players.

The PBM industry slammed the vote by the Commerce Committee as giving the FTC far too much power.

“The bill would grant the FTC unprecedented power to pick industry winners and losers, rather than maintaining the agency’s focus on the consumer welfare standard, and would set a precedent for allowing the FTC to regulate prices,” according to a statement from the Pharmaceutical Care Management Association, = a PBM lobbying group.

The bill’s margin of victory and reliance on the FTC could be major headwinds for getting it through Congress.

Sen. Ted Cruz, R-Texas, was reluctant to grant more power to the FTC.

“I am also concerned that additional FTC enforcement actions under this bill could reduce the ability of smaller PBMs to compete and compete effectively,” Cruz said during the markup hearing.

Several other senators were concerned about granting the FTC more powers when there will not be any Republican members on the commission in the near future.

Cruz sought to amend the bill to only apply the FTC scrutiny to the largest PBMs, but the amendment was not accepted. Cantwell said that limiting the scrutiny would not work as PBMs are “masters at creating new entities just to escape accountability.”

He added that the bill would be a major departure from current law and give the FTC authority to regulate beyond its expertise.

Cruz’s reticence could signal apprehension among some Republicans despite the bill’s bipartisan support. Similar legislation passed out of the Senate Commerce Committee in the last congressional session but never came to a vote by the full Senate.

‘It’s About Your Security’: Biden Talks Drug Costs During UNLV Stop

President Joe Biden on Wednesday urged lawmakers to work together to lower prescription drug costs for Americans.

“It’s not just your health,” Biden said in the lobby of UNLV’s William F. Harrah College of Hospitality. “It’s about your dignity. It’s about your security. That’s why my administration is focused intensely, intensely in getting more people affordable health care.”


Biden spoke about how his 2024 budget will help complete the job that his Inflation Reduction Act couldn’t: lowering health care costs for all Americans, rather than just those who use Medicare.

Biden’s $6.8 trillion budget released last week proposes expanding the requirement for drug manufacturers to pay rebates if they raise drug prices faster than the rate of inflation. The Inflation Reduction Act instituted that requirement for drugs on the Medicare market.

His budget also proposes capping the price of insulin at $35 per month for everyone and expanding Medicare’s negotiation authority to increase the number of drugs that are selected sooner after they launch, according to the White House.


Republicans in Congress have been opposed to the proposal, which would cut budget deficits by about $3 trillion over 10 years by raising taxes on those earning more than $400,000 a year and increase spending from $6.2 trillion to $6.8 trillion. GOP lawmakers urged the president to rein in federal spending and called Biden’s plan “reckless.” With Republicans in control of the House of Representatives, it is unlikely many parts of the president’s plan will be enacted.

‘Basic fairness’

At the event Wednesday, Biden said there is nothing “radical” about his proposal and instead it is about “basic fairness and decency.” He criticized the “MAGA Republicans’” plans for health care, such as their attempts to remove the Affordable Care Act and to roll back the Inflation Reduction Act.

“Let’s finish the job,” Biden said. “Let’s expand health care for more people. Let’s keep building the economy from the middle out and the bottom up, not from the top down.”

A House GOP adviser sent a plan to the GOP members of Congress that consists of $2 trillion in cuts to Medicaid, $600 billion in cuts to the Affordable Care Act, and $400 billion in cuts to food stamps.

While framing Republicans as a danger to Medicaid and Obamacare, Biden has mostly retained a Trump-era program that opponents — mainly progressive Democrats — say takes steps to privatize Medicare, the country’s public health insurance program for elderly Americans.

The pilot program, known as direct contracting, aimed to introduce value-based payment arrangements for traditional Medicare. Opponents argue the program allows doctors and private health insurers to switch patients from Medicare to privately run insurance.


The Biden administration has also drawn criticism for changes to Medicare Advantage after the Centers for Medicare and Medicaid Services proposed changes that could lead to higher out-of-pocket expenses and reduced benefits for 30 million Americans, including nearly 250,000 seniors in Nevada, according to a study published in February.

As of January 2023, 248,357 Nevadans were enrolled in a Medicare Advantage plan. In the U.S. 30 million seniors use Medicare Advantage. More than 52 percent of all Medicare Advantage beneficiaries live on an annual income of less than $25,000, according to Better Medicare Alliance.

In January, Nevada’s Democratic U.S. Sens. Catherine Cortez Masto and Jacky Rosen sent a letter to the Biden administration urging it to continue supporting the Medicare Advantage program, and many Nevada-based groups have spoken in support of the program following the news of the proposed changes.

“These proposed cuts would backtrack the program’s stability and harm the traditionally underserved and vulnerable communities that rely on the program to access affordable and high-quality care,” said Diego Trujillo, CEO of Las Vegas Health Education Advocacy Leadership of Southern Nevada in a statement.

A Centers for Medicare and Medicaid Services spokesperson said in an email to the Review-Journal that it does not expect changes to the Medicare Advantage market and is “confident people with Medicare will continue to have access to a broad array of choices of Medicare Advantage plans that have low or no premiums and generous coverage of extra benefits.”

Crying wolf?

After Biden spoke, Rep. Dina Titus, D-Nev., said in an interview with the Review-Journal she does not think there will be increasing costs for people with Medicare Advantage.

“Medicare Advantage, they often cry wolf but it usually evens out,” Titus said. “I think they are against supplemental, but if you can bring down Medicare costs with negotiations, that also has the private companies bringing down costs. So I don’t see that as a serious problem.”

Through the Inflation Reduction Act, the price of insulin was capped at $35 for people with Medicare, but Biden called on Congress on Wednesday to cap the price for all Americans who use the medication.

He has also called on insulin manufacturers to lower their prices. On March 15, Novo Nordisk, one of the largest sellers of insulin, said it would cut the price of its insulin by 75 percent. Eli Lilly on March 1 announced it would lower its list price of insulin by 70 percent and cap insulin co-pays at $35 for those with commercial health insurance and uninsured patients.

“Now instead of paying whatever the drug company wants to charge you, Medicare, Medicare will be able to negotiate prices,” Biden said.

Pharmaceutical companies have argued against the president’s plan to lower drug prices, saying it will result in fewer innovative drugs being developed, as the often-expensive process of research and trials would become even more expensive if drug prices are capped.

At the event, Biden asked how many people in the room had a family member diagnosed with cancer, and many raised their hands. He talked about his son who died of cancer, as well as his wife and daughter who were killed in a trucking accident, and the psychological toll of those tragedies.

“Some people are paying $10,000, 12,(000), $14,000 a year for expensive treatments like cancer,” Biden said. Due to the Inflation Reduction Act, people on Medicare will never have to pay more than $2,000 a year, he said. “It’s going to save seniors money. It’s also going to save the government money.”

Biden ended his speech with a call to action to make health care more affordable, asking for cooperation.

“We are the United States of America,” Biden said. “There is nothing beyond our capacity if we work together, so let’s work together.”

The ‘Harvard Diet’ May Be The Standard For Living A Long And Healthy Life—Here’s What To Know

Healthy Eating Plate | The Nutrition Source | Harvard T.H. Chan School of  Public HealthYou’ve almost certainly heard of the Mediterranean diet and the MyPlate method, but what about Harvard University’s Healthy Eating Plate?

Back in 2011, nutrition experts at the Harvard T.H. Chan School of Public Health worked alongside researchers at Harvard Health Publications to compile an eating plan for optimal health.


“In terms of major chronic diseases like prevention of cardiovascular disease, different types of cancers [and] Type 2 diabetes, this way of eating is going to be helpful to prevent those diseases that are common in America, and the world,” says Lilian Cheung, lecturer of nutrition at Harvard’s school of public health.

Now that the topics of longevity and healthy aging are more popular than ever, people are looking for more ways to live longer, and the Harvard diet has found its way back into the news cycle.

What is the ‘Harvard diet’?

The Harvard diet is actually Harvard’s Healthy Eating Plate, and it can be used as a guide for “creating healthy, balanced meals,” according to “The Nutrition Source,” a section of Harvard’s site that provides nutritional information.

For the diet, you should prioritize vegetables and fruits for half of each meal and supplement the other half with whole grains and healthy proteins.

Here’s a thorough breakdown of how to set your plate.

1. Vegetables and fruits should be prominent in most meals (1/2 of your plate)

When plating your vegetables, “aim for color and variety,” and eat a bit more veggies than fruits, the researchers suggest.

Keep in mind that, for this diet, “a potato is not a vegetable from a nutrition point of view,” says Cheung.

Why? Well, “potatoes almost behave like a refined carbohydrate. It increases your blood sugar,” she adds.

Whole fruits are important to add to meals, and Cheung especially recommends reaching for them over juice.

2. Add in whole grains (1/4 of your plate)

In comparison to the U.S. Department of Agriculture’s MyPlate method, the Harvard diet specifies the type of grains that you should eat. The plan strongly encourages eating whole grains, as opposed to refined.

“Whole grains have much more vitamins and also phytochemicals and minerals, which is much healthier for us and won’t raise [our] blood sugar so fast,” Cheung says.

A few whole grains that you should consider are:

  • Oats
  • Quinoa
  • Barley
  • Whole wheat (including whole wheat bread and pasta)
  • Brown rice

3. Get some healthy protein (1/4 of your plate)

More than most diets, the Healthy Eating Plate dives into which proteins are healthy for you and which you should limit in your diet.

Some healthy proteins include:

  • Fish
  • Chicken
  • Beans
  • Nuts
  • Duck

You should aim to limit your red meat consumption, and avoid processed meats like bacon and sausage if you can, according to Cheung.

4. Cook with healthy oils (in moderation)

In order to avoid consuming unhealthy trans fats, you’re advised to not cook with partially hydrogenated oils like margarine and certain vegetable oils.

Instead, Cheung recommends reaching for healthier options like:

  • Olive
  • Canola
  • Soy
  • Corn
  • Sunflower
  • Peanut (unless you’re allergic)

5. Go for water, tea and coffee over milk

“We were really deliberate in terms of the drinks,” says Cheung. For years, it was recommended that people should drink three cups of milk each day.

“We didn’t think that it was the most prudent way to go about it, especially because there are some populations in the U.S. that are lactose intolerant,” says Cheung.

“Even with just the amount of calories from drinking [milk] that way, it would be more preferable to be drinking water, tea or coffee.”

The Harvard diet encourages you to alternate between water, tea and coffee to pair with your meals, especially with little to no sugar.

Additionally, they suggest reducing milk and dairy consumption to one to two servings a day and juice to one small glass per day. You should avoid sugary drinks altogether if possible.

6. Move your body

But what makes the eating plan standout is the disclaimer to stay active, which is almost as prominent as the breakdown of foods and drinks.

“We need to be engaging [for] half an hour a day, or at least five times a week, in vigorous activity,” Cheung notes.

She encourages you to consider engaging in physical activity through brisk walking and fitness classes. The key is to avoid being sedentary for most of your day.

“We’re all aging, and we should form good habits while we are young,” says Cheung, “so they become part of our habit and our routine.”

‘Dad Jokes’ Help Kids Develop Into Healthy Adults: Study

Study Shows 'Dad Jokes' Help Kids Develop Into Healthy Adults | Ep. 51 -  YouTube

A recent study says that despite the embarrassment that “dad jokes” can cause, it might do some kids good in the future.

Humor researcher Marc Hye-Knudsen published a study in British Psychological Society‘s journal this week arguing that “dad jokes” actually have a positive effect on development.

“When considered properly, dad jokes are an intricately multi-layered and fascinating phenomenon that reveals a lot not just about how humour and joke-telling work but also about fathers’ psychology and their relationships with their children,” Hye-Knudsen wrote.

Dad jokes are typically inoffensive, corny puns. They are wholesome and age-appropriate, making it suitable for fathers to tell their children.

“It’s also what makes dad jokes so susceptible to accusations of being stupid, lame, and unfunny,” the study observed.

Hye-Knudsen suggests that when fathers embarrass their children with unfunny jokes, it teaches them how to overcome awkwardness.

“By continually telling their children jokes that are so bad that they’re embarrassing, fathers may push their children’s limits for how much embarrassment they can handle,” the article said. “They show their children that embarrassment isn’t fatal.”

The study ends by encouraging fathers to continue aiding their children’s development by telling embarrassing jokes.

“You’re partaking in a long and proud tradition, and your embarrassingly awful jokes may even do them some good,” the paper concludes. “Keep repeating the same old stale puns, year-in and year-out.”

Last Updated 03/29/2023

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