AHA Among Groups Opposing Price Transparency in Info-Blocking Rule

Image result for AHA Among Groups Opposing Price Transparency in Info-Blocking Rule images

Source: Modern Healthcare

Healthcare groups including the American Hospital Association came out strong against a suggestion that the Office of the National Coordinator for Health Information Technology require providers to disclose price information as part of its proposed rule.

The ONC in February released its long-awaited information-blocking proposal as a companion to the CMS’ interoperability proposed rule. The ONC’s rule outlines how regulators will require providers to share health data with patients, as well as steps to discourage healthcare organizations from creating barriers to data exchange.

But what data is included in that mandate has proved a point of contention.

In its proposal, the ONC asked stakeholders to weigh in on whether providers should offer patients information on how much they would be charged for certain services. “ONC has a unique role in setting the stage for such future actions by establishing the framework to prevent the blocking of price information,” the rule reads.

However, adding price information to the broader umbrella of health data that’s required to be shared with patients would go “well beyond what Congress intended and would seriously harm patients, hospitals and other healthcare providers,” the AHA wrote in a letter to the agency, arguing that the mandate extends past the goals of the 21st Century Cures Act. The data-blocking rule was a provision of the 21st Century Cures Act.

One of the AHA’s concerns is that publicly sharing price information would disrupt negotiations with payers.

Blue Shield of California raised a similar concern in a letter to the ONC, suggesting the agency should solely focus on providing patients with information on out-of-pocket costs, rather than on providers’ negotiated rates with health plans.

“We urge ONC to ensure any future proposals related to pricing information exclude plans’ proprietary pricing information and protect market negotiations between health plans and providers,” the health insurer wrote.

Other groups were more supportive of the idea, although they requested the ONC separate any rulemaking on price information from the information-blocking proposal.

The federal Health Information Technology Advisory Committee in May cautioned that tying price transparency to the information-blocking proposal would have an “unintended consequence of slowing down the finalization of the current ONC rule,” and recommended the ONC convene a price-transparency task force to consider the idea.

“As a task force, we absolutely agreed that we want to enable price transparency,” Andrew Truscott, co-chair of HITAC’s information-blocking task force and Accenture’s managing director for health and public service, said at the May meeting. “We believe that (price transparency) needs to be given a focus.”

Software company Wolters Kluwer voiced a similar sentiment in a letter to the ONC.

“We generally support including price information within the scope of (electronic health information) for purposes of information blocking, but not in the short-term,” the company wrote, noting price information is difficult to calculate, as it it requires knowing details of an individual patient’s insurance status.

“Factors such as insured status, in-network status, insurance deductibles, insurance co-pays and co-insurance add significant complexity to presenting usable information on price and until those factors are adequately addressed, it makes little sense to include price within the definition of EHI,” Wolters Kluwer wrote.

However, a review of individual comments submitted to the ONC—many of which come from patients sharing stories about expensive medical treatments—suggested there is demand for improving how providers share information on price. One submission from an anonymous commenter simply reads: “We want price transparency!”

Holy Name Medical Center in Teaneck, N.J., also expressed support for the inclusion of price information, arguing that current guidelines related to chargemaster prices are “woefully insufficient” as “the public should have the right to see which hospital systems and healthcare providers are driving higher costs.”

“The current healthcare market is a complex system of secret deals and discounts between insurance companies and healthcare providers,” the hospital wrote to the ONC. “In order to truly lower costs for consumers, we need greater transparency in the marketplace.”

White House Runs Into Health-Care Industry Hostility as it Plans Executive Order

Image result for White House Runs Into Health-Care Industry Hostility as it Plans Executive Order imagesSource: The Washington Post

President Trump is preparing to issue an executive order to foster greater price transparency across a broad swath of the health-care industry as consumer concerns about medical costs emerge as a major issue in the lead-up to next year’s presidential election.

The most far-reaching element favored by the White House aides developing the order would require insurers and hospitals to disclose for the first time the discounted rates they negotiate for services, according to health-care lobbyists and policy experts familiar with the deliberations.

The idea has stirred such intense industry opposition, however, that it may be dropped from the final version, the sources said.

Compelling disclosure of negotiated rates “would have the ultimate anti-competitive effect,” said Tom Nickels, the American Hospital Association’s executive vice president for government relations and public policy. “I know they are aware of the concerns.”

Other parts of the order are expected to make it easier for people on Medicare, the federal insurance program for older and disabled Americans, to find out what they would pay for treatment at various hospitals by widening the range of services for which hospitals must post their prices.

The order also may include an effort to promote more competition among hospitals by slowing a trend toward consolidation, according to an administration official who spoke on the condition of anonymity about details that continue to take shape.

“We’re still ironing it out,” the official said.

The executive order, likely to be announced by mid-June and first reported by the Wall Street Journal, would carry the force of law but not bring about immediate change. Such orders essentially direct federal agencies to rewrite rules to advance their goals — in this instance, the departments of Health and Human Services, Labor, and Justice, according to people familiar with the White House’s plans.

Other parts of the order are expected to make it easier for people on Medicare, the federal insurance program for older and disabled Americans, to find out what they would pay for treatment at various hospitals by widening the range of services for which hospitals must post their prices.

The order also may include an effort to promote more competition among hospitals by slowing a trend toward consolidation, according to an administration official who spoke on the condition of anonymity about details that continue to take shape.

“We’re still ironing it out,” the official said.

The executive order, likely to be announced by mid-June and first reported by the Wall Street Journal, would carry the force of law but not bring about immediate change. Such orders essentially direct federal agencies to rewrite rules to advance their goals — in this instance, the departments of Health and Human Services, Labor, and Justice, according to people familiar with the White House’s plans.

Supreme Court Rejects HHS’ Medicare DSH Changes

Image result for Supreme Court Rejects HHS’ Medicare DSH Changes images

Source:

The U.S. Supreme Court on Monday ruled that HHS improperly changed its Medicare disproportionate-share hospital payments when it made billions of dollars in cuts.

In a 7-1 decision, the justices said HHS needed a notice-and-comment period for the Medicare DSH calculation change. Justice Neil Gorsuch wrote in the decision that HHS’ position for not following the procedure was “ambiguous at best.”

“Because affected members of the public received no advance warning and no chance to comment first, and because the government has not identified a lawful excuse for neglecting its statutory notice-and-comment obligations, we agree with the court of appeals that the new policy cannot stand,” Gorsuch wrote.

The case was highly technical, and hinged on dueling interpretations of agency activity on what constitutes a “substantive legal standard” in a payment policy change to Medicare.

Under the new Medicare DSH formula, the CMS began to lump Medicare Advantage enrollees in with traditional Medicare enrollees to calculate a hospital’s DSH payment.

But Medicare spending is about $700 billion per year, and the program covers nearly one-fifth of Americans. 
“Not only has the government failed to document any draconian costs associated with notice and comment, it also has neglected to acknowledge the potential countervailing benefits,” Gorsuch wrote. “Notice and comment gives affected parties fair warning of potential changes in the law and an opportunity to be heard on those changes—and it affords the agency a chance to avoid errors and make a more informed decision.”

The majority opinion also emphasized the size and scope of Medicare, noting that “even seemingly modest modifications to the program can affect the lives of millions.”
“As Medicare has grown, so has Congress’s interest in ensuring that the public has a chance to be heard before changes are made to its administration,” Gorsuch wrote.

During oral arguments in the case in January, Gorsuch and Justice Sonia Sotomayor doubled down on the economic magnitude of the change, which HHS estimated to be $3 billion to $4 billion between fiscal 2005 and 2013.

Justice Stephen Breyer dissented from the majority, and Justice Brett Kavanaugh recused himself because he participated in the U.S. Court of Appeals for the District of Columbia Circuit ruling that the Supreme Court upheld.

Breyer wrote he believed the government had the legal grounds to skip the public comment period in this policy.
“The statutory language, at minimum, permits this interpretation, and the statute’s history and the practical consequences provide further evidence that Congress had only substantive rules in mind,” he wrote. “Importantly, this interpretation of the statute, unlike the court’s, provides a familiar and readily administrable way for the agency to distinguish the actions that require notice and comment from the actions that do not.”

Government Health Insurance Systems Pose Serious Risks to Americans

Image result for Government Health Insurance Systems Pose Serious Risks to Americans images

Source: The Hill

As proponents of Medicare for All struggle to defend their plan to repeal the foundations of American health care — including employer-provided coverage, Medicare, Medicaid, the Affordable Care Act (ACA) and the Children’s Health Insurance Program (CHIP) – and replace it all with a costly, one-size-fits-all, government-run, health-care system, many are claiming that a majority of Americans support their scheme. For example, in a recent opinion piece published by The Hill, George Goehl writes that “across party lines, a majority of Americans are in favor of Medicare for All.”

This claim is misleading at best, as polling makes clear that many Americans are not aware of what “Medicare for All” actually is, and when they are informed of what it means for them, a majority oppose it. In fact, a national poll conducted by the Kaiser Family Foundation earlier this year found that 70 percent of Americans oppose Medicare for All when they learn it would “lead to delays in some people getting some medical tests and treatments,” while 60 percent oppose it when they learn it would threaten the already at-risk Medicare program.

Sixty-percent also oppose the government-run system when they learn it would force most Americans to pay more in taxes, while 58 percent oppose it when they learn it would eliminate employer-provided and other private coverage.

Another national survey by Kaiser shows that most Democrats and Democratic-leaning independents “say they want Democrats in Congress to focus their efforts on improving and protecting the ACA” rather than passing Medicare for All. This should come as no surprise, as Democrats flipped the House last November in large part by focusing on strengthening the Affordable Care Act and protecting Americans with pre-existing conditions, not on upending our entire system.

Meanwhile, the nonpartisan Congressional Budget Office (CBO) recently reported that under Medicare for All, “patients might face increased wait times and reduced access to care,” and such a system “could also reduce the quality of care,” while “[t]he number of hospitals and other health care facilities might also decline as a result of closures, and there might be less investment in new and existing facilities.”

They have also confirmed that Americans “would not have a choice of insurer or health benefits,” and that Medicare for All “might not address the needs of some people.” A one-size-fits-all system, they confirm, “would significantly increase government spending and require substantial additional government resources,” which would mean significant tax increases for working families.

In the wake of last month’s House Budget Committee hearing on the impacts of a one-size-fits-all government-run health care system, it’s clear that many lawmakers on both sides of the aisle are taking experts’ warnings and the public’s opposition seriously.

Assessing the bill’s prospects, Bloomberg reported that Medicare for All “is hitting serious obstacles in the U.S. House … [and] the effort appears unlikely to go much further,” as the legislation “hasn’t gained much support since its release in February,” while POLITICO reported that “House Democratic leaders, who worry Medicare for All could hurt the party with moderate voters, have allowed hearings on the plan, but they haven’t committed to floor votes.”

That’s good news for patients, families and taxpayers, but Americans should be aware that other, so-called “moderate” proposals — like “buy-in” or “public option” systems — would also cost taxpayers’ hard-earned money, put families’ access to and quality of care at risk, and ultimately lead to the same unaffordable one-size-fits-all system they reject.

These new government-run insurance systems are intentionally designed to be “stepping stones” to one-size-fits-all health care — a fact acknowledged even by those in favor of such proposals, including one U.S. Senator who admitted it would cause the “slow death” of employer-provided and other private coverage and serve as an “on ramp to a single-payer system.”

Recent research provides important insight into the negative impacts a new government insurance system would have on Americans’ access to quality care. One study found that hospitals “could face financial peril,” and its affects could even “force the closure of essential hospitals,” while another study found that a government insurance system like “buy in” or a “public option” would “compound financial stresses [hospitals] are already facing, potentially impacting access to care and provider quality.”

In the end, these risky government insurance systems would cause Americans to pay more to wait longer for worse care.

Families, patients and taxpayers shouldn’t be forced to suffer these consequences – and with roughly 90 percent of Americans now covered, there are far more sensible ways to extend coverage to millions more. Rather than embracing costly proposals like these, which would upend our care and start over from scratch with a one-size-fits-all government-run system, our leaders should be building upon what works in American health care, while coming together to fix what doesn’t.

Health Insurance Inflation Hits Highest Point in Five Years

Image result for Health Insurance Inflation Hits Highest Point in Five Years images

Source: Modern Healthcare

The health insurance inflation rate hit a five-year peak in April, possibly because managed care is rising.

The Consumer Price Index for health insurance in April spiked 10.7% over the previous 12 months—the largest increase since at least April 2014, according to a Modern Healthcare analysis of the U.S. Bureau of Labor Statistics’ unadjusted monthly Consumer Price Index data.

In contrast, the other categories that make up the medical care services index—professional services and hospital and related services—rose 0.4% and 1.4% in April, respectively. The CPI for medical care services in April rose 2.3%, while overall inflation increased 2% year over year.

Because of the way the BLS calculates the health insurance index, the change year over year does not reflect premiums paid by customers, but “retained earnings” after paying out claims. These earnings are used to cover administrative costs or are kept as profit.

The BLS redistributes the benefits paid out portion of the health insurance index to other non-insurance medical care categories, such as physician services.

The likely reason health insurance inflation is rising is because of growth in managed care, including Medicare Advantage, Medicaid managed care and commercial insurance, according to Paul Hughes-Cromwick, an economist at Altarum. He noted that added administrative costs increase insurance price growth.

Hughes-Cromwick said the increase in the health insurance index could also be driven by the fact that insurers’ medical loss ratios may be decreasing as high premiums, particular in the individual health insurance exchanges, exceeded anticipated claims.

The medical loss ratio reflects the percentage of every premium dollar spent on medical claims and quality improvement. Insurers must pay at least 80% of premiums on those things and if they don’t, they must issue rebates to plan members, as part of the Affordable Care Act.

In response to rising inflation, a spokeswoman for America’s Health Insurance Plans, the industry’s biggest lobbying group, commented that “consumers deserve the lowest possible total costs for their coverage and care.” She pointed out the medical loss ratio requirements and said health insurers spend 98 cents of every premium dollar on medical care, operating costs that include care management, and preventing fraud, waste and abuse.

Affordable Care Act exchange insurers hiked premiums higher than necessary in 2018 and now expect to pay out $800 million in rebates to individual market customers this year because they did not meet the medical loss ratio threshold, according to a Kaiser Family Foundation analysis published this month. Because medical loss ratios are declining, health insurers in the individual, small group and large group markets expect to issue $1.4 billion in rebates based on their 2018 performance, the analysis stated.

Still health insurance profits have been on the rise. The eight largest publicly traded insurers posted net income of $9.3 billion in the first quarter of 2019, an increase of 29.9%. They made a combined $21.9 billion in profits over the course of 2018.

Democrats Grapple with Fully Embracing Medicare for All

Image result for Democrats Grapple with Fully Embracing Medicare for All images

Source: Associated Press

A half-dozen presidential candidates back “Medicare for All,” a proposal that would put the government in charge of most health benefits. But some of the Democrats they’re courting aren’t sure that the nation’s health care system should be overhauled so dramatically.

After watching Massachusetts Sen. Elizabeth Warren, a Medicare for All supporter, speak in a packed northeast Iowa tavern, 67-year-old Connie Suby said she backed the ambitious proposal as an ultimate goal. But she cautioned that “we’re not ready for that as a country,” urging “baby steps” that keep private health insurance in place.

“Give people the option,” she said.

Suby is among the Democratic voters concerned that such a major remodeling of America’s health care infrastructure might be too big of a leap for their party’s next president. While polls suggest Democrats like the idea of Medicare for All, it’s not clear that they’re sold on an abrupt shift away from private insurance. In more than two dozen interviews across three early-voting states, most Democratic voters told The Associated Press that they’re open to a more incremental approach toward single-payer health care that starts with making government-run insurance available to more people — such as a publicly funded health plan that Americans could choose as an alternative to their employer-sponsored plan.

That explains the complicated dance Warren and others, including Sens. Kamala Harris of California, Cory Booker of New Jersey and Kirsten Gillibrand, are performing as they balance their support for single-payer with rhetorical room for private insurance companies to still play a role in the system. Warren told a voter at a Virginia town hall on Thursday that it’s not “inconsistent” to pursue Medicare for All as well as smaller steps to get there, such as lowering the age for Medicare eligibility.

Other candidates have simply spurned Medicare for All. Former Vice President Joe Biden has called for the expansion of Medicare as an option for Americans of all ages to buy into “whether you’re covered through your employer or on your own or not.” Former Texas Rep. Beto O’Rourke touts “Medicare for America,” which would automatically provide government-run insurance to those who don’t get it through their jobs.

Only Bernie Sanders, the author of the Senate’s Medicare for All bill, is solely focused on single-payer as a way to “fully solve the health care crisis,” an approach his team thinks adds to his progressive bona fides.

The Vermont senator’s legislation would set up a four-year transition to government-run care for almost all health treatments, free of premiums or deductibles, with private insurance available as a supplement. Warren, Harris, Booker and Gillibrand have been less clear on how they would treat private insurers under a Medicare for All system, and each has supported more incremental steps to increase access to care.

Despite enthusiasm from many progressives for Medicare for All, it’s unclear whether Democratic primary voters will choose a nominee based on a single-minded commitment to ending private health insurance. Chris Jeffrey, a 55-year-old grocery manager from Clive, Iowa, praised Sanders for having “pushed the debate” toward the most far-reaching health care vision. But even though Jeffrey caucused for Sanders in 2016, he said he’s open to Biden or Warren as well. While health care is a top issue for him, he doesn’t favor one candidate’s approach over another’s.

President Donald Trump and the GOP have used Medicare for All as a cudgel in their battle to paint the Democratic agenda as too extreme for most voters. The White House blasted Sanders’ bill last month in a statement predicting it would “cripple our economy and future generations with unprecedented debt.”

Liberal activists working to build support for single-payer are under no illusions about the difficulty of the task ahead of them, particularly given Republican and industry-backed efforts to tar government-run health care as a costly boondoggle. Congressional Democratic leaders are also not yet on board, with House Speaker Nancy Pelosi publicly focused on protecting the Affordable Care Act from Trump-backed efforts to kill it.

“We’re talking about Medicare for All as the policy that’s going to be implemented in 2021,” Jennifer Flynn Walker, senior director of mobilization and advocacy at the progressive Center for Popular Democracy, said in an interview. “We’ll have a new president, and by that time we’ll have done the work so you can’t be a sitting president and not have committed to the idea.”

Laying that groundwork with the Democratic electorate would seem to start with voters like 61-year-old Trudy Rand. The longtime New Hampshire nurse urged policymakers to “seize the day” and push for Medicare for All, adding that “the system is broken.”

But when asked to weigh Sanders’ strategy against a more incremental approach, Rand said it wasn’t a make-or-break issue. “I wouldn’t not vote for somebody because they weren’t going Medicare for All,” she said.

Single-payer health care advocates often point to polling that shows the majority of Americans supporting Medicare for All, though surveys also point to higher levels of support for more incremental changes that would allow for a choice between government-run and private insurance.

While 56% of respondents favored Medicare for All in January polling from the nonprofit Kaiser Family Foundation, up from just 40% between 2002 and 2004, the popularity of optional buy-ins to Medicare and Medicaid were significantly higher, at 74% and 75%, respectively.

“Once the fur begins to fly and arguments for or against the plan are made, in what would be a debate unlike any we’ve ever seen in health . we don’t know what the outcome of that will be,” Kaiser president Drew Altman said in an interview. “And so, no one should mistake current levels of support or opposition with what they might be if there was debate about a real proposal.”

To be sure, several voters said they’d prefer to see Sanders’ single-payer system become a reality.

Lemuel Anderson, a 24-year-old resident of Ames, Iowa, said he’s deciding between Sanders and Warren and health care is one of the issues tipping him toward Sanders. That Warren has left the door open to preserving some form of private insurance after a transition to Medicare for All was a problem for him.

“I think that currently it is about profit when it comes to health care and that’s something that people need, so it shouldn’t be about profit,” Anderson said. “And if you keep private insurance that will continue to be the case.”

Private Insurers in California Pay More than Double what Medicare Does for Similar Services

Image result for Private Insurers in California Pay More than Double what Medicare Does for Similar Services images

Source: Healthcare Finance

A new analysis of financial data from general acute care hospitals in California reveals that private insurers paid, on average, 209 percent more than what Medicare paid for similar services in 2015 and 2016.

Funded by the nonprofit West Health Policy Center, the findings reinforce the results of a recent RAND Corporation study that showed private health plans across 25 other states paid hospitals more than double, on average, than Medicare.

 

IMPACT

Using financial data hospitals submitted to the California Office of Statewide Health Planning and Development, researchers compared what private insurers and Medicare paid for hospital services. The ratio of private insurance to Medicare payments is substantially higher than the 209 percent average at some hospitals. For example, at Stanford University Hospital, the ratio is 276 percent, and at Sharp Memorial Hospital in San Diego, it’s 271 percent.

The authors wrote that the significant difference in payment rates in the report may be due in part to consolidation in the hospital industry and the pressure private insurers face from employers and employees to offer broad networks. These factors can result in hospitals being able to extract higher payments from private insurers.

Alternatively, the authors acknowledge another perspective: that higher rates of private payments could be needed to offset payment shortfalls from Medicare and Medi-Cal, California’s Medicaid program.

Regardless of the reasons, the data could be helpful in assessing the likely effects of hospital rate-setting or single-payer proposals that may impact hospital payments in California, said the authors — adding the data could also provide useful information to the public and others interested in understanding hospital pricing in the state.

 

THE TREND

U.S. employers will spend more than $800 billion in 2019 on health coverage for employees — an amount that will exceed $2 trillion by 2040, according to a West Health analysis of National Health Expenditure Accounts illustrated on healthcostcrisis.org.

Newsom’s Tough Sell on Healthcare: Persuading Public on Fines for Those Without Coverage

Image result for Newsom’s Tough Sell on Healthcare: Persuading Public on Fines for Those Without Coverage images

Source: Los Angeles Times

Five months after unveiling a sweeping plan to lower health insurance costs for middle-class Californians, Gov. Gavin Newsom now must sell the politically unpopular part of his proposal — hefty fines on those who do not have medical coverage.

On Tuesday, he launched his pitch by highlighting how the high cost of health insurance is hurting small-business owners, and he warned lawmakers that failing to approve the fees to fund expanded subsidies is a “bad decision.”

“Without the mandate, everybody’s premiums go up,” Newsom said during a discussion with healthcare leaders and small-business owners at a Covered California enrollment office in Sacramento.

Newsom will travel over the next five days across the state — visiting San Francisco, Los Angeles and San Diego — to promote his healthcare agenda. His plan includes consolidating prescription drug purchases to lower the cost of medications and allowing young immigrant adults who are in the U.S. illegally to be covered by Medi-Cal, the state’s health program for people with low incomes.

While those proposals have received the most attention, he said shoring up a health insurance market “vandalized” by the Trump administration is a top priority.

Newsom proposed in January that California reinstate a mandate that everyone enroll in health insurance after the federal government eliminated the requirement. The fees created by the individual mandate helped prop up the Affordable Care Act. Newsom proposed the state’s new penalties go toward expanding subsidies that lower the cost of buying insurance. If approved, both the individual mandate and the subsidies would begin Jan. 1.

Nearly 600,000 Californians paid $446 million in penalties to the federal government for not having health insurance in 2016, the most recent year for which data was available.

Newsom’s revised budget estimated that tax filers in the state would pay $317 million in fines for not carrying health insurance in 2020-21. The nonpartisan Legislative Analyst’s Office estimated that roughly 3.5 million people in California do not have health insurance, with those who are uninsured more likely to be low-income.

The burden on the poor was highlighted by opponents of the bill, including the California Nurses Assn. That argument may cause lawmakers may balk as well.

Two bills to create the mandate, which require majority approval, are working their way through the Legislature — SB 175 and AB 414. Both are scheduled to be heard in fiscal committees this week.

Newsom said the mandate and subsides will help alleviate uncertainty in the health insurance market and stabilize premiums that increase when younger healthy people do not buy in.

Individuals earning up to $72,000 and families of four making up to $150,000 would qualify for lower premiums under Newsom’s plan.

However, Newsom’s budget calls for the subsidies to sunset in three years and be adjusted in 2021 and 2022 based on how much the state takes in from the individual mandate penalty. That too could create uncertainty in the market, although Newsom said much less so than doing nothing.

“Perfect is not on the menu,” he said.

The California Nurses Assn. argues the fees target people who can’t afford health insurance in the first place, a key reason they are opposed. The powerful lobbying group also said that nothing would prevent insurance companies from raising rates and thus eliminating the benefit of the subsidies funded by the fees.

The nurses association has been the driving force behind efforts to create a single-payer system that covers every resident. Newsom earned the nurses association’s backing during his run for governor after pledging to lead the effort on single-payer healthcare.

On Tuesday, he said those efforts continue, but that subsidies and the individual mandate are the immediate band-aid needed to help Californians.

“That pursuit continues here in the state, but in the absence of the ideal, there is the pragmatic and there is the reality of today and how we provide relief today, and that is what we are pursuing in the interim,” Newsom said.

California Eyes Health Care for Immigrants in US Illegally

Image result for California Eyes Health Care for Immigrants in US Illegally images

Source: Associated Press

Lilian Serrano’s mother-in-law had lots of stomach problems, but she always blamed food.

Doctors at a San Diego-area clinic suspected Genoveva Angeles might have cancer, but they could not say for sure because they did not have the equipment to test for it and Angeles, who had been in the country illegally for 20 years, could not afford to see a specialist and did not qualify for state assistance because of her immigration status.

In September, Angeles finally learned she had gallbladder cancer. Serrano said she was in the hospital room when Angeles, in her late 60s, died about two weeks later.

“We don’t know if she would have survived treatment, but she was not even able to access it,” said Serrano, chairwoman of the San Diego Immigrant Rights Consortium.

“She never had a chance to fight cancer.”

Stories like that have prompted California lawmakers to consider proposals that would make the state the first in the nation to offer government-funded health care to adult immigrants living in the country illegally. But the decision on who to cover may come down to cost.

Democratic Gov. Gavin Newsom wants to spend about $98 million a year to cover low-income immigrants between the ages of 19 and 25 who are living in the country illegally.

The state Assembly has a bill that would cover all immigrants in California living in the country illegally over the age of 19. But Newsom has balked at that plan because of its estimated $3.4 billion price.

“There’s 3.4 billion reasons why it is a challenge,” he said.

The state Senate wants to cover adults ages 19 to 25, plus seniors 65 and older. That bill’s sponsor, Sen. Maria Elana Durazo, scoffed at cost concerns, noting the state has a projected $21.5 billion budget surplus.

“When we have, you know, a good budget, then what’s the reason for not addressing it?” she said.

The Senate and Assembly will finalize their budget proposals this week before beginning negotiations with the governor. State law says a budget has to be passed by June 15 or lawmaker forfeit their pay.

At stake, according to legislative staffers, are the 3 million people left in California who don’t have health insurance. About 1.8 million of them are immigrants in the country illegally. Of those, about 1.26 million have incomes low enough to qualify them for the Medi-Cal program.

“Symbolically, this is quite significant. This would be establishing California as a counter to federal policies, both around health care and immigration,” said Larry Levitt, senior vice president for health reform at the Kaiser Family Foundation.

If enacted, it could prompt yet another collision with the Trump administration, which has proposed a rule that could hinder immigrants’ residency applications if they rely on public assistance programs such as Medicaid.

The proposed rule from the Department of Homeland Security says the goal is to make sure “foreign nationals do not become dependent on public benefits for support.”

California is also considering a measure requiring everyone in the state to purchase health insurance. People who refuse would have to pay a penalty, and the money would go toward helping middle-income residents purchase private health insurance plans.

“We’re going to penalize the citizens of this state that have followed the rules, but we’re going to let somebody who has not followed the rules come in here and get the services for free. I just think that’s wrong,” Republican state Sen. Jeff Stone said about coverage of people in the U.S. illegally.

Many immigrants who are in the country illegally are already enrolled for some government-funded programs, but they only cover emergencies and pregnancies.

Serrano was one of hundreds of immigrant activists who came to the Capitol on Monday for “Immigrant Day of Action.” She and her husband spent the day meeting with lawmakers, sharing the story of Angeles.

“The conversation that I have is about the cost,” she said, describing her interactions with lawmakers. “The conversation we want to have is about our families.”

Teva and Other Generic Drugmakers Inflated Prices Up to 1000%, State Prosecutors Say

Image result for Teva and Other Generic Drugmakers Inflated Prices Up to 1000%, State Prosecutors Say images

Source: New York TImes

Leading drug companies including Teva, Pfizer, Novartis and Mylan conspired to inflate the prices of generic drugs by as much as 1,000 percent, according to a far-reaching lawsuit filed on Friday by 44 states.

The industrywide scheme affected the prices of more than 100 generic drugs, according to the complaint, including lamivudine-zidovudine, which treats H.I.V.; budesonide, an asthma medication; fenofibrate, which treats high cholesterol; amphetamine-dextroamphetamine for A.D.H.D.; oral antibiotics; blood thinners; cancer drugs; contraceptives; and antidepressants.

“We all know that prescription drugs can be expensive,” Gurbir S. Grewal, the New Jersey attorney general, said in a statement. “Now we know that high drug prices have been driven in part by an illegal conspiracy among generic drug companies to inflate their prices.”

In court documents, the state prosecutors lay out a brazen price-fixing scheme involving more than a dozen generic drug companies and just as many executives responsible for sales, marketing and pricing. The complaint alleges that the conspirators knew their efforts to thwart competition were illegal and that they therefore avoided written records by coordinating instead at industry meals, parties, golf outings and other networking events.

The bulk of the collusive activity occurred from July 2013 to January 2015, according to the complaint, when Teva raised prices on nearly 400 formulations of 112 generic drugs. A key element of the scheme, the complaint alleges, was an agreement among competitors to cooperate on pricing so each company could maintain a “fair share” of the generic drug markets. At the same time, the companies colluded to raise prices on as many drugs as possible, according to the complaint.

Though the complaint paints Teva Pharmaceuticals USA, which is based in Pennsylvania, as a leader in the conspiracy, it describes the conduct as “pervasive and industrywide.”

“Rather than enter a particular generic drug market by competing on price in order to gain market share,” the complaint states, “competitors in the generic drug industry would systematically and routinely communicate with one another directly, divvy up customers to create an artificial equilibrium in the market, and then maintain anticompetitively high prices.”

Teva denied the allegations. “Teva continues to review the issue internally and has not engaged in any conduct that would lead to civil or criminal liability,” the company said in a statement.

The Israeli drugmaker Teva Pharmaceutical Industries is one of the world’s largest manufacturers of generic medicines. The company faced criticism in February 2018 for charging $18,375 for a bottle of 100 pills for a rare medical condition known as Wilson disease. Mylan has also generated outrage for raising the price for a two-injection EpiPen set to over $600 from $100. The latest lawsuit comes as drug companies are already facing widespread scrutiny from lawmakers over drug prices.

The lawsuit was filed in the Federal District Court in Connecticut, where the multistate investigation began. On Saturday, William Tong, the Connecticut attorney general, said on Twitter that the organized effort to maximize profits was “a highly illegal violation of antitrust laws.”

The new lawsuit is a more expansive version of a similar suit filed by the previous Connecticut attorney general in December 2016 in the Federal District Court for the Eastern District of Pennsylvania.

Pfizer denied any wrongdoing in a statement on Saturday. The company said that Greenstone, a Pfizer subsidiary that produces generic drugs, “has been a reliable and trusted supplier of affordable generic medicines for decades and intends to vigorously defend against these claims.”

State prosecutors say the conspiracy has negatively affected the national economy while damaging state health plans and federal health care programs like Medicare and Medicaid.

In his statement, Mr. Grewal described the pharmaceutical industry in New Jersey, where much of the illegal conduct is alleged to have occurred, as “the envy of the world.”

“But no New Jersey company will get a free pass when it violates the law and harms our residents.”

Last Updated 06/19/2019

Arch Apple Financial Services | Individual & Family Health Plans, Affordable Care California, Group Medical Insurance, California Health Insurance Exchange Marketplace, Medicare Supplements, HMO & PPO Health Care Plans, Long Term Care & Disability Insurance, Life Insurance, Dental Insurance, Vision Insurance, Employee Benefits, Affordable Care Act Assistance, Health Benefits Exchange, Buy Health Insurance, Health Care Reform Plans, Insurance Agency, Westminster, Costa Mesa, Huntington Beach, Fountain Valley, Irvine, Santa Ana, Tustin, Aliso Viejo, Laguna Hills, Laguna Beach, Laguna Woods, Long Beach, Orange, Tustin Foothills, Seal Beach, Anaheim, Newport Beach, Yorba Linda, Placentia, Brea, La Habra, Orange County CA

12312 Pentagon Street - Garden Grove, CA 92841-3327 - Tel: 714.638.0853 - 800.731.2590
Email:
Jay@ArchApple.com
Copyright @ 2015 - Website Design and Search Engine Optimization by Blitz Mogul