Democrats Face Tough Messaging War on Prescription Drug Bill

Democrats vent their fury as Joe Manchin shelves action on climate changeSource: Bloomberg, by Alex Ruoff and Zach C. Cohen

Democrats want to go into their August recess telling their constituents they’re lowering what they pay for medicines — but many of their promised changes won’t be felt for years, and only by a fraction of the nation.

Drug-pricing legislation is expected to get a vote in the Senate as soon as this week as part of a larger domestic policy package. The pharmaceutical industry, conservative groups, and Republican lawmakers are already bashing the measure in television ads and in town halls, painting it as ineffective and harmful to drug innovation.

This messaging war could be challenging for Democrats because some of the major benefits of their drug-pricing bill won’t go into effect until 2025, too late for voters in elections this November. Opponents of the drug bill say they’ll try to capitalize on that.

“The administration knows none of this is going to help benefit people anywhere around the country, nobody this year,” said John Barrasso(R-Wyo.), a physician who’s chairman of Senate Republicans’ messaging operation.

The party of the president tends to lose seats during midterm elections, and this November is shaping up to repeat that precedent. President Joe Biden has a low approval rating and Americans report increasing dissatisfaction with the direction of the country and the economy.

The legislation is the culmination of more than a decade of work by Democrats to make good on their promise to reduce prescription drug prices in the US by allowing the government to negotiate with drugmakers.

Democratic leaders say they’ve got the backing of influential groups such as the AARP, who can help spread their message about coming benefits — namely a $2,000 out-of-pocket cap on what seniors pay each year for medicines.

“Of course it will take time to phase out, and of course the opposition will try to cause problems in the meantime, that’s just the nature of it,” said Sen. Debbie Stabenow (D-Mich.), head of the Democratic Policy and Communications Committee. “We just have to tell the story, and work with AARP and everyone else to tell the story of what we’ve done, and explain that relief is coming and it will come as fast as possible.”

Democrats also face concerns within their own party that the drug-pricing bill doesn’t go far enough because it would limit drug negotiations to only a set number of medicines that’ve been on the market for years. Sen. Bernie Sanders (I-Vt.), who caucuses with Democrats, said limiting negotiations is a mistake, and Americans want a more forceful effort to lower drug prices.

“This is a weak bill, which goes nowhere near as far as I think the American people want us to go,” Sanders said.

Attack Ads

Democrats seen as swing votes or who have difficult reelection bids already face attack ads around their drug-pricing bill. Outside groups have spent more than $8.2 million on broadcast ads lambasting the drug-pricing provision since it was unveiled in July, data from media tracker AdImpact show.

The dark-money group American Prosperity Alliance has spent $5.7 million and counting on ads in West Virginia, Georgia, Nevada, and Washington, D.C. The spots falsely claim that this legislation would strip Medicare of $300 billion, misinterpreting projections that the legislation would lower Medicare spending by $288 billion over 10 years.

Sen. Catherine Cortez Masto (D-Nev.), who is up for reelection this November, said last week “hundreds” of Nevadans called her office worried about the policy. “In Reno this past weekend, Nevadans came up to me because they were concerned about these false accusations,” Cortez Masto said on the Senate floor.

The Partnership to Fight Chronic Disease, a political tax-exempt group, has spent more than $1.1 million on ads in West VirginiaGeorgiaNevada, and Washington, D.C., urging key senators not to “mess with” Medicare. And PhRMA, the trade association for pharmaceutical companies, is spending more than $1 million across the country warning “government price-setting could mean fewer medicines in the coming years.”

Supporters of the proposal are outgunned, spending millions of dollars less in the same timeframe on broadcast advertising to celebrate the provisions. Some of this funding comes out of the pockets of Democrats who are on the ballot in November.

AARP is spending $436,000 on ads in Washington, D.C., and West Virginia applauding the plan for “putting money back” in voters’ pockets. Majority Forward, a political nonprofit with ties to Democratic Senate leadership, spent $310,000 thanking Sen. Maggie Hassan (D-N.H.) for her support for the domestic policy measure.

Sens. Chris Van Hollen (D-Md.) and Richard Blumenthal(D-Conn.), who are up for reelection, have both spent thousands of dollars running ads touting their work to cut drug costs.

Pre-Recess Messaging

Democrats will likely keep up that drumbeat over the August recess. House Speaker Nancy Pelosi(D-Calif.) wrote to colleagues last week, encouraging members of her caucus to highlight work to “lower costs,” and the Democratic Congressional Campaign Committee in a pre-recess memo warned a Republican majority would “protect Big Pharma profits over people’s lives.”

House Republican leaders last week distributed communications kits—pamphlets meant to give lawmakers talking points while at home in their districts—that decry a a “Democrat Socialist drug takeover could lead to 135 fewer drugs and cures.”

Rep. Brad Wenstrup (R-Ohio), a physician, said Democrats’ bill would “limit production” and would be a “crushing blow to research and development in the pharmaceutical industry.”

“To me, one lost cure is too many,” Wenstrup said. “And one of the worst parts about this bill: if you’re someone, like most Americans, that pays into Medicare your whole life, this bill is robbing Medicare to go ahead and pay for insurance premiums.”

Both sides of this messaging fight are a bit divorced from the reality of the drug-pricing bill, said Spencer Perlman, director of health-care research for the consultancy Veda Partners.

The Senate drug-pricing bill is the “second-best possible outcome” for the pharmaceutical industry behind no congressional action, Perlman said. It’s weaker than what Democrats have proposed in the past and likely means Congress won’t return to drug pricing for years to come, he said. Meanwhile, drug spending will continue to grow over the next decade, and Democrats’ bill is expected to slow that growth rate by about 15% for Medicare and 12% for the commercial market, Perlman wrote in a recent analysis.

Significant Changes

Democrats are trying to advance one of the most significant changes to Medicare’s drug benefit since it was started in 2006. Some of them will be more apparent than others, researchers who study the program say.

In addition to the out-of-pocket cap, the bill would allow seniors in Medicare to spread out their drug costs over the year, and in 2023 Medicare beneficiaries would have no cost-sharing for adult vaccines, said Tricia Neuman, who heads the Kaiser Family Foundation’s research on Medicare.

In 2024, the bill would also eliminate the 5% coinsurance beneficiaries pay when they hit what’s known as a catastrophic threshold, which was more than $7,000 in out-of-pocket drug spending in 2022, she said. This will help people who take brand-name drugs costing thousands of dollars afford their pricey medicines, she said.

More than 1.3 million Medicare beneficiaries hit the catastrophic threshold for drug spending, and more than 1.4 million beneficiaries spent more than $2,000 on medicines in 2020, Neuman said. But that’s just a fraction of about 48 million enrollees in Medicare’s drug benefit.

“It’s a terrible program for people who need expensive, life-saving drugs,” said Stacie Dusetzina, an associate professor in the Department of Health Policy at Vanderbilt, with some seniors not filling their prescription for crucial medicines because of the cost. Dusetzina was part of an April study that found almost a third of people on Medicare weren’t filling anti-cancer drugs.

Dusetzina, who studies Medicare and drug policy, said the drug bill is a big step forward for Medicare.

“Even if they don’t fully get the public to understand the nature of these changes and why they’re so important, it’s still important to do them because the program is broken and needs to be fixed,” she said.

White House To Launch Effort To Develop Next Generation Of COVID Vaccines

White House discusses next generation of COVID-19 vaccines

Source: STAT News, by Matthew Herper and Lev Facher

The Biden administration is preparing a sweeping initiative to develop a next generation of Covid-19 immunizations that would thwart future coronavirus variants and dramatically reduce rates of coronavirus infection or transmission, building on current shots whose impact has been mainly to prevent serious illness and death, the White House told STAT.

To kick off the effort, the White House is gathering key federal officials, top scientists, and pharmaceutical executives including representatives of Pfizer and Moderna for a Tuesday “summit” to discuss the new technologies and lay out a road map for developing them.

“These are vaccines that are going to be far more durable, that are going to provide far longer-lasting protection, no matter what the virus does or how it evolves,” Ashish Jha, the White House Covid-19 response coordinator, said in an interview. “If we can drive down infections by 90% … Covid really begins to fade into the background, and becomes just one more respiratory illness that we have to deal with.”

Jha acknowledged that such a campaign would likely require more money from Congress, though he declined to provide a specific estimate.

The summit is the strongest sign of support to date for developing a new generation of Covid-19 vaccines — an effort that several prominent researchers have long advocated, but that has languished due to lack of investment. Several of those scientists praised the new White House initiative, expressing hope that it is a harbinger of bigger steps that will yield a next generation of Covid vaccines.

“I’m very thrilled they’re having this summit,” said Akiko Iwasaki, a researcher at Yale who conducted a promising study of a nasal vaccine booster and who co-founded a company that would seek to commercialize the technology. She will be attending the summit.

“It’s really important that the entire country be thinking about next-generation vaccines that may potentially prevent infection and transmission,” she said. “And that’s probably the only way to contain the spread of the virus.”

For all the initiative’s ambition, it is not without risk, both scientific and political. The Biden administration has struggled in recent months to execute a two-pronged messaging strategy: convincing Americans that the federal Covid response has been a success, while also stressing that the pandemic remains a clear and present danger. The vaccine initiative is likely to draw limited interest from the large segment of the public that would sooner act as if the virus threat is over. And it also risks wasting political capital on an initiative that would cost untold billions of dollars — and that lawmakers may be unwilling to fund.

Nonetheless, the administration is setting lofty goals.

One of the biggest hopes is for a new vaccine that would prevent infection no matter how the SARS-CoV-2 virus mutates. While current vaccines, like Pfizer’s and Moderna’s mRNA shots, are highly effective at preventing serious illness and death, they are less capable of preventing Covid from spreading. The recent emergence of new strains, like Omicron and its sublineages BA.4 and BA.5, have led the companies to develop new jabs specifically targeted at those variants, which should be available in the fall.

Experts, however, say that strategy is unsustainable.

“Variant chasing will never get us to where we need to be,” said Eric Topol, director and founder of the Scripps Research Translational Institute. “Variant chasing is a losing strategy. It’s temporally flawed and unacceptable.”

Jha said that there are two major strategies for creating a new vaccine, both of which likely require support from the federal government to develop, test, and manufacture.

One strategy would focus on the development of nasal vaccines that could create antibodies at the mucosal surfaces in the nose and elsewhere where viruses enter the body, thereby preventing infection and transmission. A second strategy would aim to create vaccine antigens that would work against a broader array of coronavirus strains, thereby providing more durable immunity. It may or may not be possible to combine the two strategies.

The scientific challenges ahead for either approach are massive, and will be even bigger if researchers hope to create a vaccine that both prevents infection and is resistant to variants.

A few studies have shown promise for the nasal approach, but among other issues, it’s not clear how long immunity from a nasal vaccine would last. More broadly, while researchers have found antibodies that appear to be effective against a wider variety of coronaviruses, there will be no guarantee that a new vaccine is “variant-proof” until it has been in use for several years.

Jha said that the administration’s current thinking was that the new technologies might be three to five years from broad use, but that the right investment could dramatically speed that timeline.

Scientific challenges aside, there’s also that matter of money — specifically, getting it from Congress, which has been increasingly resistant to allocating new funds for Covid efforts.

A government-backed initiative to develop a new generation of coronavirus vaccines would likely cost billions. The Trump administration spent $12.4 billion on Operation Warp Speed, its initial push to develop Covid-19 immunizations, in 2020 alone. The federal government continues to spend massive sums on vaccines: Last month, the Biden administration announced a new $3.2 billion contract with Pfizer to supply another 105 million doses.

In recent months, the administration has struggled to convince lawmakers that more funding is necessary for the ongoing Covid-19 response. Just last month, the White House repurposed $10 billion in existing funding to pay for vaccines and therapeutics, after a failed effort to convince Congress that it couldn’t make the purchases without new money.

Sen. Mitt Romney (R-Utah), in response, called the White House’s messaging “patently false.” Lawmakers still haven’t struck a deal to provide more cash for the Biden administration’s pandemic response.

Biden has also struggled to convince Americans that they should receive third or fourth vaccine doses, despite evidence that shows protection from shots wanes after several months. According to data from Centers for Disease Control and Prevention, as of late June, 71% of Americans over 5 have received the original two-dose vaccine series. But only 49% of those eligible received their first booster dose, and only 26% of those eligible for a second booster dose have received it.

Survey data from the Kaiser Family Foundation indicates that half of unvaccinated Americans say that nothing could convince them to receive a Covid vaccine. Only 3% of unvaccinated people surveyed told the KFF they would get vaccinated if a new vaccine prevented infection.

Still, Jha cast the next generation of vaccines as potentially transformative — not just in terms of their effectiveness, but in terms of the public’s interest.

“When we have a whole new platform of vaccines, I expect a vast majority of Americans to take it,” Jha said.

The regulatory requirements to determine the safety and efficacy of such next-generation vaccines are still unclear. Those decisions will eventually be made by the Food and Drug Administration. One challenge is that they will have to be better options than current vaccines, whose safety has been determined not only by huge clinical trials, but also by administration to billions of people.

“We have fantastic vaccines that are actually doing a lot of good right now and are quite safe,” Jha said. “And so the bar for approving new vaccines is going to be that it has to be better than that. And that’s going to be a high bar.”

While hospitalization rates remain low compared to the devastating Covid waves of January 2021, September 2021, and January 2022, they have steadily climbed since April, as contagious viral variants including BA.4 and BA.5 have rapidly spread. There is really no predicting, experts say, what the virus will throw at society next.

“There’s a sense that we’re playing catch-up with the virus,” Jha said. “The virus is constantly evolving. We’re having to evolve with it, that’s fine. But over the long run, we really need a serious breakthrough.”

Lowering Medicare Age Comes With Big Price Tag

Democrats push bill to lower Medicare eligibility age to 60 - CNNPoliticsSource: Axios, by Adriel Bettelheim

Giving Americans over 60 access to Medicare would add about 7.3 million people to the program’s rolls and swell the budget deficit by $155 billion over a five-year period, the Congressional Budget Office and Joint Committee on Taxation project said in a new analysis.

Why it matters: While it’s a popular idea with voters, the big price tag illustrates why Medicare expansion isn’t gaining centrist support and remains a legislative long shot.

What they’re saying: Lowering the eligibility age would result in about 3.2 million fewer people having employer-sponsored health coverage, with most transferring to Medicare.

  • * That would put the federal government on the hook for a larger share of medical spending while lowering per-person spending for work-based health plans.
  • * The policy would halve the uninsured rate for the newly eligible group, from 8% to 4%.

Flashback: While President Biden didn’t initially run on expanding access to Medicare, he agreed to support lowering the age from 65 to 60 in April 2020, when his campaign worked on a unity platform with Sen. Bernie Sanders (I-Vt.).

  • * The idea lost traction as centrists led by Sen. Joe Manchin (D-W.Va.) scaled back Biden’s social spending ambitions and the Build Back Better agenda.

TSA Stops Mask Enforcement After Federal Judge Voids Mandate

Biden Doubled Mask Fines for Travelers. What Does it Mean for Passengers? -  The New York TimesSource: The Washington Post, by Michael Laris and Justin George

Federal officials stopped enforcement of a federal mask mandate Monday in transportation settings after a federal judge struck down the requirement, raising public health concerns and prompting several airlines to announce that face coverings are optional on domestic flights.

 

U.S. District Judge Kathryn Kimball Mizelle of the Middle District of Florida said the mandate exceeds the statutory authority of the Centers for Disease Control and Prevention. Federal officials last week had extended the mask mandate for commercial flights and in other settings, including on buses, ferries and subways, until at least May 3.

 

The transportation mandate has been among the highest-profile mask requirements in the country, persisting after most school districts and other jurisdictions have allowed similar mandates to expire. Conflicts over masks have been particularly acute on airplanes, where some flight attendants have been physically attacked and verbally abused for enforcing mask rules.

The decision comes as coronavirus cases are again climbing in the Northeast as the BA.2 omicron subvariant, which is more contagious than its predecessor, becomes the predominant strain in the United States. Health officials say it’s not clear whether the rise is the start of a larger surge.

The CDC’s masking order has been enforced through directives issued by the Transportation Security Administration. A Biden administration official, who shared guidance with reporters on the condition of anonymity, said Monday evening that the court decision means the CDC’s order is “not in effect at this time. Therefore, the TSA will not enforce its Security Directives” requiring the face coverings.

Airlines began announcing they were dropping the requirement, with some caveats for international destinations. In a statement, United Airlines said that “effective immediately, masks are no longer required at United on domestic flights, select international flights (dependent upon the arrival country’s mask requirements) or at U.S. airports.”

In the Washington region, Metro announced late Monday that masks are optional on its rail and bus systems for customers and Metro employees.

In her decision Monday, Mizelle, who was appointed by President Donald Trump and clerked for Supreme Court Justice Clarence Thomas, said the CDC had relied on a 1944 law, the Public Health Service Act, to impose the mandate. But the government’s argument that it put the mask requirement in place for the purpose of “sanitation” falls short, Mizelle argued.

“Wearing a mask cleans nothing. At most, it traps virus droplets. But it neither ‘sanitizes’ the person wearing the mask nor ‘sanitizes’ the conveyance,” Mizelle wrote.

 

The case was brought on behalf of a legal group known as Health Freedom Defense Fund and airline passengers, including Ana Daza, who said she has anxiety aggravated by wearing a mask.

Mizelle found for the plaintiffs on three key issues, ruling that the CDC had exceeded its legal authority, that it had improperly avoided notice and comment procedures, and that its mandate was “arbitrary and capricious.” In her ruling, Mizelle argued that the mask mandate wrongly curtailed passengers’ freedom of movement.

“Anyone who refuses to comply with the condition of mask wearing is — in a sense — detained or partially quarantined by exclusion” from their means of transportation, she wrote.

 

Industry trade group Airlines for America said U.S. airlines “have been strong advocates for eliminating pandemic-era policies and are encouraged by the lifting of the federal transportation mask mandate.” The group said high U.S. immunity levels and widespread vaccine accessibility, plus hospital grade cabin-air filtration, should give travelers confidence.

The CDC said Monday it doesn’t comment on pending litigation.

In a legal filing last month defending the mandate, Justice Department lawyers said the plaintiffs in this case had relied on an “unduly narrow and grammatically incorrect” interpretation of the public health law. They noted that Congress had authorized health officials to make and enforce regulations “necessary to prevent the introduction, transmission, or spread of communicable diseases” from outside the country, or within it, using “sanitation” and “other measures.” They also noted that the Supreme Court, in a case last year, said those measures relate directly to preventing the interstate spread of disease “by identifying, isolating, and destroying the disease itself.”

 

Masking requirements have generally been made after considering emerging epidemiology on restricting the spread of the virus, and not on an “arbitrary or capricious” basis, Jeanne Marrazzo, director of the Division of Infectious Diseases at the University of Alabama at Birmingham, said in an email while quoting the words Mizelle used in her ruling.

“I believe the CDC was simply erring on the side of caution given the extraordinary mixing opportunities afforded by airports and mingling that occurs there,” she said. “On the plane, while it’s flying, as I have said before, air exchange is good, but we still don’t know HOW good it is with this much more contagious new variant.”

The Biden administration announced the mandate quickly after President Biden came into office, following the Trump administration’s resistance. Airline policies at the time had required that masks be worn.

 

“This is obviously a disappointing decision,” White House press secretary Jen Psaki said Monday, adding that the CDC and White House continue to recommend wearing masks in public transportation settings.

She said the Department of Homeland Security — which includes the TSA — was reviewing the decision. The Justice Department will “make any determinations about litigation,” Psaki said. A Justice Department spokeswoman said the agency is reviewing the decision and declined to comment further.

Sara Nelson, president of the Association of Flight Attendants-CWA, which represents nearly 50,000 flight attendants at 17 airlines, said many legal uncertainties remained on Monday. In a statement, she urged “calm and consistency in the airports and on planes.”

“The last thing we need for workers on the frontlines or passengers traveling today is confusion and chaos,” she said.

Nelson urged travelers to check with airlines for their masking requirements. She said clear communication would help flight attendants and other front-line workers avoid problems that could stem from the confusion over changing rules.

“In aviation operations, it is impossible to simply flip a switch from one minute to the next. It takes a minimum of 24-48 hours to implement new procedures and communicate this throughout the entire network,” she said.

A March poll by the health group KFF found Americans were roughly divided on whether the federal government should extend the mask requirement for airplanes, trains and other public transportation (48 percent) or let it expire (51 percent). More than 7 in 10 Democrats said it should be extended, while 76 percent of Republicans supported letting it expire.

Fliers on Monday had mixed reactions.

Stephanie Dexter, her husband, Brad, and their daughter, Eva, wore surgical masks and cone-shaped K95 masks as they walked out of Reagan National Airport on Monday afternoon. They had flown Eva from Omaha to D.C. for a spring vacation, where they planned to visit monuments and museums. The mask mandate did not weigh heavily on their minds.

“We were fine wearing them today,” said Stephanie Dexter. “I’m an asthmatic. I’m fine not getting sick.”

Phil Delin, 67, of Prince George’s County, Md., said he had heard “a sprinkle” about the judge’s ruling before he arrived at the airport with his golf clubs for a trip to Las Vegas.

“I still don’t understand a Florida judge reversing a federal mandate when the mandate is backed by as much science as it is,” he said. He had no second thoughts about wearing a mask aboard his Monday night flight.

Simon Rojas, 29, who had flown back into Reagan National from Las Vegas in shorts, stood outside while waiting for his ride as a chilly wind forced others waiting for a ride back into the terminal. He said he was pleased the judge ruled against the mandate, saying it made no sense to wear a mask on a plane when people are so close and are lifting masks to drink and eat.

“Just take them off,” Rojas, of Laurel, Md., said of mask regulations. “In the news, they’ve been saying the death rate is going down, right? Also, I think if you’re in such a closed space like a plane, that mask isn’t doing anything.”

The Biden administration has faced growing pressure to lift the mask requirement for air travel and public transit. Earlier this month, Republican leaders on the House and Senate transportation committees reiterated their call for Biden to “rescind or decline to extend the mask mandate.”

In late March, 21 mostly Republican-led states sued the government, seeking to immediately end the mask requirement.

Last month, executives from 10 airlines, including American, United and Delta, sent a letter to Biden urging him to end pandemic-related travel policies, including the mask mandate.

The ruling comes as airlines are seeing a surge in spring travel — one the industry anticipates will extend through the summer and beyond. Transportation Security Administration officials have reported an increase in the number of people screened at airport checkpoints, with many days routinely topping the 2 million mark, as they had before the pandemic.

Biden Administration Wants To Make Medical Debt Less Of A Threat To Consumers’ Financial Health: ‘People Who Get Sick Feel Like The System Is Out To Get Them’

Biden administration wants to make medical debt less of a threat to  consumers' financial health: 'People who get sick feel like the system is  out to get them' - MarketWatch

Source: MarketWatch, by Andrew Keshner

Medical debt can be a serious drag on consumers’ financial health, but the Biden administration hopes it has a dose of strong medicine coming.

The administration is asking federal agencies to erase medical debt as an underwriting factor in credit programs for certain consumer and small businesses whenever possible, the White House said Monday.

For example, the rural housing loans that run through the U.S. Department of Agriculture are going to stop incorporating medical debt loads when devising borrower repayment plans, the White House said.

Meanwhile, the Department of Veteran Affairs is looking at its guidelines after taking other steps to curb medical debt reporting. The Small Business Administration is reviewing its lending programs to spot ways to pull medical debt out of the equation when it comes to accessing capital, the White House said.

“Credit scores essentially are supposed to measure how responsible you are with your money,” Vice President Kamala Harris said Monday afternoon. “Having medical debt because you were sick or injured should not lower your credit score and make it more difficult to secure the help you need to get out of debt. It’s not logical.”

Alexander Sentayhu, a 25-year-old Washington D.C. resident who served in the U.S. Coast Guard, spoke at a Monday afternoon White House press conference about his family getting hounded by debt collectors while he recovered from multiple open heart surgeries and complications. It was a “crushing weight,” he said. Through a GoFundMe page, Sentayhu was able to raise more than $100,000, but he said that shouldn’t be the solution.

The White House announcement comes weeks after Equifax EFX, -0.25%, Experian EXPN, -1.61% and TransUnion TRU, -1.02% — the three major credit reporting companies — said they would overhaul how medical debt affects people’s credit scores. The change will remove nearly 70% of medical debt from credit reports, and paid medical bills sent to a collections department will not be included in reports, effective July 1.

The moves by the credit reporting companies are “important steps,” the White House announcement said Monday. But there’s more to do because medical debts amassed from health procedures and emergencies are not a reliable indicator of a person’s creditworthiness, the administration said.

That echoes consumer advocates who hailed the credit reporting companies’ announcements as a good first start to address the side effects of medical debt.

Approximately 43 million people had amassed $88 billion in medical debt on their credit reports as of June 2021, according to a recent Consumer Financial Protection Bureau estimate, which noted that the pandemic is only going to make a bad situation worse. Some 11 million people have at least $2,000 in medical debt, while 3 million people owe more than $10,000, the White House said Monday.

Medical debt isn’t shared equally, studies suggest. Black households, adults in the 35-64 year-old demographic (who aren’t yet eligible for Medicare), people making less money and households in the South tend to shoulder larger shares of medical debt, according to researchers at the Peterson Center on Healthcare and Kaiser Family Foundation.

While the Biden administration has government agencies looking at what they can do, it’s also reviewing what others are doing beyond the Washington D.C. beltway.

The Department of Health and Human Services is asking over 2,000 healthcare providers for information including bill collection approaches, lawsuits against patients owing money and financial aid, Monday’s announcement said.

“We look forward to learning more about this new initiative from the Administration. Hospitals and health systems are committed to treating all people equitably, with dignity, respect and compassion,” said Stacey Hughes, executive vice president of the American Hospital Association.

Collections are a “last resort,” Hughes said, noting that hospitals have given nearly $745 billion in uncompensated care to patients over the past two decades. ” The reality, however, is that the health care system must be adequately financed to ensure that hospitals and health systems are able to stay open and be there for their communities in times of need,” she said.

The CFPB is also investigating whether credit reporting and debt collection that’s tied to medical debt ever violates patients’ and consumers’ legal protections.

The agency’s director, Rohit Chopra, has previously said his agency is weighing whether medical debts should be included on credit reports. “In theory, credit reports are supposed to be an accurate repository of data about whether you have met your obligations on loans you have taken out. This theory is far from reality,” he said at a press conference tied to his agency’s look at medical debt.

On Monday, Chopra said the current consequences of medical debt make too many people feel like they are getting kicked while they’re down. “One of the things that many people who get sick feel like is that the system is out to get them,” he said.

FDA Mulls Drug Importation With States

Import Offices and Ports of Entry | FDASource: Axios, by Adriel Bettelheim

The FDA has started discussions with states over creating a way to import drugs from Canada — a policy the Biden and Trump administrations both embraced to bring down health costs but which experts regard as having limited impact.

The big picture: With President Biden’s drug pricing agenda stalled, importation could allow states to take advantage of lower drug prices abroad without the need for direct action to limit prices in the U.S.

  • Under one pathway, states, wholesalers and pharmacies submit importation proposals to HHS, which would be subject to safety and cost conditions.

Driving the news: The FDA last week held its first meeting with five states — Florida, Colorado, Vermont, Maine and New Mexico — that have submitted reimportation plans or are thinking about doing so, Politico first reported.

  • Biden’s executive order on promoting competition directed the FDA to work with states and Native American tribes on safely importing prescription drugs from Canada.
  • “The FDA is committed to working with states and Indian tribes that propose to develop … importation programs to reduce the cost of products to the American consumer while still protecting public health and safety,” an agency spokesman told Axios.

Yes, but: The Pharmaceutical Research and Manufacturers of America sued to block a 2020 federal rule that would facilitate importation, citing patient safety and other concerns.

  • Canada also said it has no plans to participate and has told drugmakers not to take steps that could lead to drug shortages there.

Cowen analyst Rick Weissenstein notes the Biden administration has been inconsistent on reimportation, supporting the idea in theory while arguing that it won’t work in legal briefs filed in response to the drug industry trade group’s legal challenge.

Our thought bubble: With Canadians officials adamant they won’t participate in the process, any importation plan is unlikely to actually bring down drug prices. The issue still could be politically appealing as the campaign season heats up.

Biden Admin Plots To Fix Obamacare’s ‘Family Glitch,’ Expand Coverage

About That ObamaCare 'Glitch' - WSJ

Source: Politico, by Adam Cancryn

The Biden administration is planning on Tuesday to propose a long-sought change to the Affordable Care Act aimed at lowering health insurance costs for millions of Americans, four people with knowledge of the matter told POLITICO.

The new policy is designed to close a loophole in the ACA known as the “family glitch” that’s prevented an estimated 5 million people from qualifying for subsidized health plans — even when they can’t find affordable coverage elsewhere.

Biden administration officials are expected to unveil the proposed regulation ahead of a celebration of the landmark 2010 health law that will also mark former President Barack Obama’s return to the White House for the first time since he left office.

Obama, alongside President Joe Biden and Vice President Kamala Harris, is slated to tout the ACA’s coverage gains and the administration’s broader efforts to slash health costs.

In its rollout on Tuesday, the administration will highlight its new bid to fix the family glitch as the largest administrative action to expand ACA coverage since the law’s enactment, one person with knowledge of the matter said. Still, the proposed regulation could take months to finalize.

Democrats last year also expanded ACA subsidy eligibility as part of the passage of the American Rescue Plan, and enrollment through the law’s insurance exchanges reached 14.5 million last year, a record high. Those expanded subsidies are due to expire later this year, raising concerns within the party about the potential for millions of people to get hit with higher health costs right around the midterm elections.

The White House declined to comment.

Democrats and health advocacy groups have long pushed for a fix to the family glitch, which locked certain Americans out of subsidized coverage due to the complex way the federal government determines eligibility for family members of workers who have access to employer-based health plans.

Under the ACA, people can qualify for subsidized health insurance if the cost of their employer-based coverage rises above a set percentage of their household income.

But the Obama administration originally interpreted that provision as applying to the premium charged to one individual — even if that person’s spouse and children would be covered under the plan, driving up its overall cost.

Health law experts have since argued that the statute could be reinterpreted to incorporate the added cost of additional family members. The administration began work last year on changes to the law, resulting in the proposed rule that cleared OMB’s regulatory review in late March.

The vast majority of people affected by the glitch would pay less for ACA coverage than their employer-based plan if the loophole were closed, the Kaiser Family Foundation estimates.

“Fixing the family glitch is the most consequential thing they can do without Congress to improve the affordability of ACA coverage,” said Larry Levitt, KFF’s executive vice president for health policy.

Last Updated 08/10/2022

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