Saturday, October 29, 2016

Health Care Reform Articles - October 29, 2016

Donald Trump Says ‘Obamacare Is Just Blowing Up,’ Citing Rate Increases

by Patrick Healy and Abby Goodnough - NYT

Donald J. Trump, desperate for a winning political issue in the final two weeks of the presidential race, mounted a new offensive Tuesday, tying Hillary Clinton to sharp premium increases that will hit some Americans covered under the Affordable Care Act, the signature program of her closest ally, President Obama.
“It’s over for Obamacare,” Mr. Trump declared on Monday night at a rally in Tampa, Fla.
On Tuesday morning in Miami, he proclaimed that “this election is going to be about Obamacare.” And he said, “Obamacare is just blowing up” — a message his advisers said he would hammer at two rallies and in interviews through the day.
The Department of Health and Human Services reported Monday that premiums for midlevel health plans on the health law’s federal insurance exchange would rise by an average of 25 percent, but in some cities and states, premium increases will be considerably higher. Mr. Trump asserted that rates would go up “60, 70, 80 percent” — apparently referring to exorbitant jumps in select markets.
Those increases, however, will be cushioned for most people on the exchanges by government subsidies that will rise with the premiums.
The higher premiums pose an 11th-hour test for both Mr. Trump and Mrs. Clinton in a campaign that, since starting in the spring of 2015, has not revolved around policy issues to any great extent. Mr. Trump has repeatedly struggled to prosecute a political case against Mrs. Clinton in a sustained way, most notably failing to focus this summer on the scathing Federal Bureau of Investigation report on her State Department email.
Whether he can make Mrs. Clinton pay a political price for supporting the Affordable Care Act, and more broadly for championing Mr. Obama’s presidency, will reveal his ability to turn a policy issue into a political weapon at this late stage of the race.
For Mrs. Clinton, the problems with the Affordable Care Act could force a reckoning that she had hoped to avoid. As a candidate, she has linked herself more closely to Mr. Obama than any nominee has done with a sitting president in modern times, defending his economic record and praising him for pushing the health law through a sharply divided Congress. Republicans had hoped that their nominee would force Mrs. Clinton to own the health care law, politically speaking, or at least be forced to defend it, but she has mostly skated past its flaws in cost and coverage.
In fact, parts of the health law are politically popular. The United States has the lowest percentage of uninsured citizens in its history. Because of the Affordable Care Act, insurers cannot deny coverage for a pre-existing medical condition and cannot cap lifetime coverage. Children can remain on their parents’ policies until age 26.
Mrs. Clinton wants to improve the law, she says, by increasing the subsidies that help cover premium amounts and by allowing more Americans to get government help. She also wants to add a government-run insurance option, which she says would increase competition and choice in the marketplaces created under the health law. And she has proposed allowing people younger than 65 to buy in to Medicare.
A Clinton campaign aide, Jennifer Palmieri, talking to reporters aboard the Clinton campaign plane, did not shy from the topic.
“The choice in the election is: Are you going to repeal the Affordable Care Act, kick 20 million people off of insurance, go back to putting health insurers in control of whether or not pre-existing conditions are covered?” she said. “Or are you going to improve upon it?”
Mr. Trump says he wants to repeal the health law and take more of a free-market approach. He would reduce federal regulation and coverage requirements so insurance would cost — and cover — less. He would not require Americans to have health insurance, as the Affordable Care Act does.
“By failing to denounce it, Hillary Clinton owns it,” Kellyanne Conway, Mr. Trump’s campaign manager, said of the health care act in an interview on Tuesday. “She is in an impossible spot: extol and expand the features of a program that millions of Americans see as having reduced quality, choice and access, or lurch leftward to embrace a Senator Sanders-type single-payer plan in the hopes of embracing Sanders voters.”
That political attack will not necessarily resonate.
While the problems in the individual insurance market are real, they affect only a small fraction of Americans. In 2015, 49 percent of Americans got health insurance through a job, 34 percent got it through Medicare or Medicaid, and 7 percent got it through the individual market, according to the Kaiser Family Foundation, a nonpartisan research group. Of the 10.5 million Americans who get health insurance through the Affordable Care Act marketplaces, about 85 percent receive income-based subsidies to defray the cost.
That leaves seven million people buying insurance on their own without subsidies, either because their income is too high or they are not aware of the option — a significant number but not a huge voting base.
Still, some Republicans said on Tuesday that the premium rises were an unexpected political gift. “It needs to be the principal message — you can’t dilute the attack by all the other stuff Trump talks about everyday,” said Ed Rollins, a veteran Republican strategist. “The hour is late and the time is short.”
Mr. Trump has already stumbled in that effort. Speaking to scores of his own workers at his Miami golf course Tuesday, he said that “all of my employees are having a tremendous problem with Obamacare” — suggesting that his company doesn’t provide health insurance or else misunderstanding the health law. Moments later, he said of his employees, “They’re not worried about their health care because we take great care of people.”
After finishing, Mr. Trump left it to the resort’s general manager to talk to reporters about the confusion and confirm that only a few employees may be insured through the Affordable Care Act.
Steve Elmendorf, a Democratic strategist and lobbyist, argued that Mr. Obama’s job approval rating was strong enough – 54 percent, according to the latest Gallup tracking poll data – that Mrs. Clinton did not need to rethink her dual strategy of championing his leadership and proposing changes to the health law.
“Trump has shown no ability to ride any substantive issue with any consistency, and Obama’s numbers are going up, not down,” Mr. Elmendorf said.
Elaine C. Kamarck, director of the Center for Effective Public Management at the Brookings Institution, said that Mrs. Clinton stood a chance of brokering a deal to fix the health care program if elected president, and that she was skeptical Mr. Trump could get much traction on the issue.
Ms. Kamarck, a domestic policy adviser in Mr. Clinton’s White House, said the problems with the health law had been apparent for some time. Neither the law’s subsidies nor its penalties for those who refuse to buy insurance have persuaded enough young, healthy people to go into the insurance marketplaces it created. That has left a pool of customers in some parts of the country that is too sick and too small. Because so many marketplace customers have needed expensive medical care, some insurers have spent more on claims than they have earned in premiums. And the federal government’s strategies for protecting insurance companies from large losses have not been as effective as hoped.
While benchmark premiums are going up an average of 25 percent, rates are set to increase much more in some places. For a 27-year-old in Phoenix, the average monthly premium for a benchmark plan will rise next year by 145 percent, to $417 from $170, according to the Department of Health and Human Services. But subsidy amounts will keep pace with rate increases, so people who qualify for assistance may not face nearly that much of a price rise.
Another reason for the volatility in the marketplaces is political. The Obama administration, blocked by Republican opponents in Congress, has paid out only a fraction of the $2.5 billion it owes insurers under a provision of the health law that was supposed to protect them from unexpectedly large losses during their first few years in the marketplaces. Several insurers cited the minimal payments as one of the main reasons they raised rates or abandoned the marketplaces.
On Tuesday, Republicans zeroed in on the Phoenix rate increase to press their case in the new battleground of Arizona.
“I can’t imagine Arizona voting for Democrats,” said Hugh Hewitt, a conservative talk show host, said during an interview with Mr. Trump’s running mate, Gov. Mike Pence of Indiana.
“Yeah, it really is incredible,” Mr. Pence said. “Isn’t it amazing that you had Barack Obama a week ago literally celebrating the launch of Obamacare, and then we find out from his own H.H.S. in the last 24 hours that premiums are going to go up 25 percent across the board?”

Affordable Care Act: imploding and beyond repair

Our experience with the first six and a half years of the Affordable Care Act already tells us whether it will work.
Despite the law’s goals of containing costs and making health care affordable, it’s proven to be too expensive to be sustainable, overly complex and bureaucratic, and a gift to the private health insurance industry and other corporate stakeholders in the medical-industrial complex.
• We still have 29 million uninsured Americans (compared to 48 million at the start), plus tens of millions underinsured.
• Insurance plan deductibles and co-pays have sharply increased, deterring people from seeking necessary care. A brand new market is opening up, “gap insurance,” to cover what is not covered in today’s market – insurance for those who have insurance.
• Narrowed networks under the ACA have forced many millions of patients to change their desired physicians and hospitals.
• The ACA has accelerated a national trend of corporate consolidation of insurers and hospitals, with growing market and political power.
• The ACA’s regulation of health insurers has been lax, leaving insurers many ways to game the system (e.g. by overstating the health risks of their enrollees) in their self-interest.
• Expanding hospital systems, facing less competition, are free to charge much higher prices, by up 40 percent to 50 percent.
• Pharmaceutical drug prices have been sharply increasing, often shockingly so. A one-year course of cancer drugs often exceeds $200,000, forcing many patients to choose between bankruptcy and treatment.
• The costs of insurance and health care now exceed $25,000 for a family of four covered by an average employer-sponsored PPO plan.
• Overpayments to privatized Medicaid plans are endemic in more than 30 states, often involving unnecessary and duplicative payments.
• The ACA’s accountable care organizations have failed to contain costs and improve quality of care.
• Most of the nonprofit co-ops established under the ACA have failed.
• Sign-ups for ACA coverage on the exchanges have fallen far short of expectations – just 11 million this year compared to 24 million forecasted, with many people unable to afford even subsidized coverage.
• Premium increases of 50 percent or more for 2017 are being reported in a number of states, including Minnesota, while many insurers are exiting their markets.
Given this dysfunctional reality under the ACA, it’s remarkable that neither major political party has a plan to truly fix the situation.
If elected, Hillary Clinton proposes to bring on the public option (which can’t possibly succeed against the overwhelming market share of a subsidized insurance industry), increase subsidies, add new tax credits for deductibles and co-payments, and lower the age for Medicare eligibility to age 55. These tweaks would not reverse the huge private bureaucracy bent on increasing profits in markets subsidized by taxpayers.
Given the opportunity, Republicans would repeal the ACA with no credible plan for replacement – relying on such long-discredited approaches as consumer-directed health care, health savings accounts, high risk pools, selling insurance across state lines, and giving states more leeway with block grants.
We should have learned by now that segmented risk pools designed for profits by private health insurers will never provide universal access to affordable health care in this country.
Virtually all advanced countries around the world learned this long ago with one or another form of universal health insurance.
Multiple studies have demonstrated that in the U.S. we could save about $500 billion a year by enacting a nonprofit single-payer national health program that streamlines administration. Those savings would be sufficient to guarantee everyone high-quality care, with no cost sharing, on a sustainable basis. The system could also negotiate lower drug prices.
Studies over the past two decades have shown 3 of 5 Americans supporting an improved version of Medicare for all. Support for single payer is also growing among doctors and other health care professionals. Yet the Expanded and Improved Medicare for All Act, H.R. 676 (Rep. John Conyers’ bill), with 62 co-sponsors, sits neglected in a House committee.
Until we recognize that the largest possible risk pool is required to implement universal coverage in the public interest, and that the private health insurance industry is on a death march, we cannot make necessary health care available to all Americans.
Can’t we get to real health care reform on a nonpartisan, win-win basis?
John Geyman, M.D., is professor emeritus of family medicine at the University of Washington, Seattle, and author of “The Human Face of ObamaCare: Promises vs. Reality and What Comes Next.” He is past president of Physicians for a National Health Program.

Obamacare Hits a Pothole

by Paul Krugman - NYT

For advocates of health reform, the story of the Affordable Care Act, a.k.a. Obamacare, has been a wild roller-coaster ride.
First there was the legislative drama, with reform seemingly on the edge of collapse right up to the moment of passage. Then there was the initial mess with the website — followed by incredibly good news on enrollment and costs. Now reform has hit a pothole: After several years of coming in far below predictions, premiums on covered plans have shot up by more than 20 percent.
So how bad is the picture?
The people who have been claiming all along that reform couldn’t work, and have been wrong every step of the way, are, of course, claiming vindication. But they’re wrong again. The bad news is real. But so are reform’s accomplishments, which won’t go away even if nothing is done to fix the problems now appearing. And technically, if not politically, those problems are quite easy to fix.
Health reform had two big goals: to cover the uninsured and to rein in the overall growth of health care costs — to “bend the curve,” in the jargon of health policy wonks. Sure enough, the fraction of Americans without health insurance has declined to its lowest level in history, while health cost growth has plunged: Since Obamacare passed Congress, private insurance costs have risen less than half as fast as they did in the previous decade, and Medicare costs have risen less than a fifth as fast.
But if health costs are looking good, what’s with the spike in premiums? It only applies to one piece of the health care system — the “exchanges,” the insurance markets Obamacare established for people who aren’t covered either by their employers or by government programs, mainly Medicare and Medicaid.
The way the exchanges were supposed to work was that both healthy and less-healthy people would sign up, providing insurers with a good mix of risks that let them offer reasonably priced policies. Broad participation was supposed to happen because the law requires everyone to have insurance — the “mandate” — or face a penalty. Buying insurance was supposed to remain affordable because the law provides subsidies for middle- and lower-income families, ensuring that health costs don’t become too large a share of income.
Many insurers entered the market in the belief that the system would work as advertised. After all, conceptually similar systems work in other countries, like Switzerland; Massachusetts has had a system along the same lines since 2006 (which is why some of us call it ObamaRomneycare); and even now it’s working O.K. in California, which has managed the program well.
In many states, however, not enough healthy people signed up — and now insurers are either pulling out or hiking their premiums to reflect the not-so-good risk pool. Since premiums have until now been well below projections, this only brings them back up to expected levels. But it’s clearly not good news.
How many people are hurt by these premium hikes? Not as many as you may think.
If you are covered by your employer, Medicare or Medicaid, this isn’t about you. Even if you buy a policy on the exchanges, you’re protected if your income is low enough — $97,200 for a family of four — to make you eligible for subsidies. So we’re talking about a fraction of a fraction of the population (which admittedly may still be several million people).
Oh, and bear in mind that many of those affected by the rate hikes have pre-existing conditions, which means that without Obamacare they wouldn’t be insured at all.
Even if the direct effects of this year’s hike aren’t that big, could it mean that Obamacare is about to unravel? No. Most people on the exchanges receive subsidies, which means that the rate hikes won’t induce them to drop out; people talking about a “death spiral” haven’t done their homework.
So the news is bad, but its badness is limited. Still, the architects of Obamacare had hoped to create a system that would eventually cover almost everyone.
Can the current problems be fixed?
As a technical matter, the answer is clearly yes. Strengthen the mandate; expand the subsidies; close the loopholes that have allowed some insurers to bypass the exchanges; take a more active role in setting standards and reaching out to families to make them aware of their options. Some states are doing much better than others, and it wouldn’t take a lot of money to expand best practices to the nation as a whole.
The trouble is that Congress would have to vote to spend that money. So unless Democrats manage to take the House (unlikely) or Republicans are willing to cooperate in the public interest (even more unlikely), the easy fix that’s clearly in sight will have to wait for a while.
So, is the latest health care news disappointing? Yes. Is it catastrophic? Not at all.

Editor's Note: Paul Krugman must want a cabinet-level position in the Hillary administration pretty badly!

Get the Insurance Companies the Hell Out' of Healthcare System

Premium spikes for Obamacare plans are just latest example of backward for-profit system
Jon Queally - Common Dreams
Right-wingers like Charles Krauthammer don't "think anybody should buy it"—and too many Democrats actually don't want to talk about it—but that doesn't mean advocates for a single-payer or 'Medicare for All' healthcare system aren't responding to news about rising insurance premiums for the Affordable Care Act (ACA) with renewed demands.
Just weeks away from national elections, the U.S. Department of Health and Human Services (HHS) made financial and political news late Monday by announcing the average premiums for plans under the ACA (aka Obamacare) will rise significantly for many consumers in 2017
And while Republicans predictably seized on the development as an easy opportunity to again use Obamacare as an electoral cudgel, backers of the legislation—including many Democrats who voted for it—were left trying to defend a healthcare system that has enriched (and emboldened) the private health industry since its passage in 2010. Though progressives have been able to champion specific positive impacts of the law—including Medicaid expansion, the use of pre-existing conditions to prohibit coverage, and expanding the number of insured people—there remain significant shortcomings that critics say cannot be ignored. 
According to Jean Ross, co-president of the National Nurses United, which has longed organized for a single-payer system, the premium increases announced Monday are "outrageous" and just the most recent "sign of a broken, dysfunctional healthcare system."
In its report on Monday, HHS explained that for consumers who have Obamacare mid-level plans purchased on the federal exchange, premiums will increase an average of 25 percent next year. While some states will see larger increases, others will be less than that. And while the Obama administration pointed out that many people who use these plans receive government subsidies to pay for them, the Associated Press reports how an "estimated 5 million to 7 million people are either not eligible for the income-based assistance, or they buy individual policies outside of the health law’s markets, where the subsidies are not available."
Additionally, as some major insurers have withdrawn from the federal exchange, as well as certain state-level exchanges, AP notes that about 1 in 5 consumers will only have plans from a single insurer to pick from during the 3-month enrollment period which begins on November 1.
Despite those numbers, HHS Secretary Sylvia Burwell said that 72 percent of those enrolled in an Obamacare plan should be able to find a plan with a premium of less than $75 per month. "Our nation has made historic progress under the ACA," Burwell said in a statement, "and now we want to build on that progress to further improve affordability, access, and quality."
But while the White House and DHHS tried to alleviate consumer concerns, critics like Ross remain unconvinced that a system so fundamentally flawed can be salvaged with incremental reforms.
"The excuses being offered by the Obama administration are far from reassuring: give more public money to profiteering insurance corporations, or switch to a cheaper plan with much higher out-of-pocket costs and more restrictions on access to the doctors and hospitals of your choice. Nurses know there is only one permanent fix—stepping up work for enactment of a humane health care system based on patient need not private profits that guarantees universal health care for all through an expanded and updated Medicare for All—the same approach that works in virtually every other country on earth."
Earlier this year, more than 2,000 doctors put forth a plan arguing the political moment was once again right to put single payer back on the table as a serious and necessary policy proposal.
"Our nation is at a crossroads," said Dr. Adam Gaffney, a Boston-based pulmonary disease and critical care specialist who co-chaired the working group that produced the proposal. "Despite the passage of the Affordable Care Act six years ago, 30 million Americans remain uninsured, an even greater number are underinsured, financial barriers to care like co-pays and deductibles are rising, bureaucracy is growing, provider networks are narrowing, and medical costs are continuing to climb."
And during his radio show on Wednesday, journalist and commentator Bill Press said the latest Obamacare news only proves that "Bernie [Sanders] was right" when he said "let's just go all the with single-payer and get the insurance companies the hell out of the business."
He continued, "This is one place where Obama really did let progressives down, because there was such a hunger for universal healthcare in this country—and this was the moment when we could do it. Democrats were in charge of the congress. President Obama had every opportunity. This was the opportunity to get the insurance companies out of the business, to free people from being basically held hostage by [them], and come up with a plan like western Europe has and like Canada has, where every American gets healthcare coverage as a birthright."

But that's not what happened. "No, no, no," Press lamented. "We didn't go there. We went into this mess called Obamacare."

A Quick Guide to Rising Obamacare Rates
by Reed Abelson and Margot Sanger-Katz - NYT

The Obama administration released the prices for many Obamacare health plans on Monday, and they showed big increases in many parts of the country. Obamacare customers will begin shopping for new plans next week, just a few days before the presidential election.
The news fanned political interest in the health law — both presidential campaigns were talking about the topic on Tuesday — and whether its structure of private insurance markets is sustainable. The health law will almost certainly stay on the minds of politicians in the next administration: Both Hillary Clinton and Donald J. Trump have proposed substantial changes to it.
If you’re just catching up now, here’s our quick guide to what’s happening and who will be affected. If you’re in a hurry, you can just read the sentences in bold.
Obamacare rates are going way up. The latest estimate from the federal government is that the average midlevel Obamacare plan, the most popular choice, will cost about 22 percent more in 2017 than it did in 2016. This is based on data from 39 states where people sign up through the website and some preliminary data from four other states and the District of Columbia.
There is big variation nationwide. Customers in Phoenix are looking at a premium increase of 145 percent, while customers in Providence, R.I., are looking at a 14 percent decrease, according to a Kaiser Family Foundation analysis.
This is not a huge surprise. There have been signs for months that insurance rates for people who buy individual policies would rise more next year than they have in previous years. There are a number of reasons, including the fact that some of the programs meant to keep rates lower are ending at the end of this year.
Many insurers also mispriced their plans in the early years of the law and have either left the market or have had to raise their prices sharply to cover the cost of providing coverage. The insurers say they need higher rates to pay for the expensive medical care that so many people are receiving under the law.
We didn’t know the exact amount of the increases until now. But Charles Gaba, a blogger who has scrutinized state insurer filings, has been forecasting increases in this range for some time.
The 2017 premiums are actually a pretty good match for what the Congressional Budget Office forecast back before the Affordable Care Act passed in 2009. The big question now is whether this is a one-time jump in the rates — or the start of ugly increases from now on.
These increases really matter only for those who buy their own insurance. Most people are unaffected by the rate increases because they get their insurance through an employer or are covered through government programs like Medicare, Medicaid or the Department of Veterans Affairs.
Only a small fraction of Americans who have insurance buy individual policies. There are about 10 million people in the Obamacare markets and around an additional seven million who buy health plans outside the marketplace, according to Obama administration estimates. The published rate increases apply only to people who shop in the markets, but premiums are expected to go up sharply for the other plans as well.
If you get a subsidy, and you’re willing to switch plans, you won’t have to pay these big increases. More than 80 percent of Obamacare customers get subsidies that help them pay the cost of their premiums. Those people do not pay the full cost of insurance out of their pockets, and they will not feel the full brunt of these increases, as long as there is a less expensive plan available in their market and they are willing to switch.
People who don’t get subsidies will be the ones hardest hit by the increases.
Customers may have to switch plans to save money, and switching health plans can be a big deal. Obamacare plans tend to cover a narrow group of doctors and hospitals, so people who change their plans may also have to find new health care providers. For healthy people, that may not matter, and they may just want to find the cheapest policy. But patients with complex health needs may have a hard time abandoning a hospital or doctor and starting over with new ones.
That means that the sickest patients are most likely to be squeezed. They’ll either have to suffer the inconvenience of switching all their doctors and records around, or they’ll have to stomach the biggest increases.
Despite the burdens for these people, annual switching is a feature, not a bug, of Obamacare. The law relies on market competition to keep premiums as low as possible. If customers aren’t willing to change into the cheapest plans, the insurance companies won’t have any incentive to compete on price.
If you get insurance through work, you don’t have to worry too much about this news. The health law is much bigger than just the Obamacare exchanges, and many of the new rules offer protections against having coverage that is too skimpy. Your health plan must cover basic services, like drugs and hospitalization; basic preventive services provided by your doctor, like a checkup, a flu shot or a mammogram, can be free.
But while you may feel as if you’re paying more for your medical care, premiums for employer-based insurance have been increasing at historically low rates. Premiums for the average single person in the employer market are the same this year as they were in 2015, according to a large survey of employers from the Kaiser Family Foundation; prices for most family plans are rising by 3 percent.
What has probably changed is the size of your deductible, which has been going up steadily. Employers have been shifting costs to their workers, a trend that began long before Obamacare went into effect.
Of course, federal tax dollars pay for the subsidies for low-income people who buy insurance in Obamacare markets — about $32 billion this year, according to the Congressional Budget Office. If premiums go up by more than 20 percent every year, that will put pressure on the federal budget.
People buying their own insurance should shop around for the best deal.Average numbers aren’t that useful to a person buying insurance in a particular place. If you already have Obamacare insurance or are buying it for the first time, you need to go to your state exchange website and look at the choices available to you. If you are eligible for a subsidy and willing to switch plans, your costs might actually go down.
If you’re not eligible for a subsidy and live in one of the places with big price spikes, finding affordable coverage may be more of a struggle. Wherever you are, if you’re on a budget, it pays to look at all the options and see whether there’s a plan that’s similar to yours and has a better price.
Even if you don’t want to shop, you may have to. Several large insurance carriers, like UnitedHealth Group and Aetna, have decided to exit many of the places where they had been offering policies.
Some markets are not functioning well. Because what is happening varies around the country, it’s hard to generalize about whether Obamacare is “working” everywhere. But the combination of insurer exits and sharp price increases is a sign that the markets are in trouble in at least a few parts of the country. There are many places where customers have only one insurer offering plans and where prices have risen sharply. That’s a bad sign for a system built around choice and market competition.
Fixing what ails the markets is complicated. There are a number of policy proposals out there to help stabilize the Obamacare marketplaces. But experts have not coalesced around one simple fix that by itself can solve the problems. Some of the suggested changes involve complex regulatory changes, but most are legislative. The ideas include increasing penalties for remaining uninsured so that more healthy people will join the insurance pool, and extending safety-net payments for insurers who end up with very sick, very expensive patients.
As for the candidates, Mrs. Clinton has said that she’d like to introduce the public option, a government-run insurer, in markets with limited competition. She has also discussed an option for middle-aged Americans to buy Medicare instead of marketplace coverage if they want it. She wants to expand subsidies so that more middle-income people will have help buying insurance.
Mr. Trump says he wants to repeal the Affordable Care Act, which would mean eliminating the new markets altogether. Rather than adjusting the markets, he proposes starting over with a new system for buying and selling health insurance.

The U.S. Is Standing in the Way of Cheaper Drugs for the Poor

by Jason Cone and Raymond C. Offenheiser - NYT

Every few months, a drug company gets caught cranking up prices. Most recently, Mylan, the maker of EpiPen, took its turn in the hot seat for raising the price of a lifesaving allergy treatment by 500 percent. Congress was rightly enraged and opened yet another inquiry into pharmaceutical price gouging. Mylan offered discount coupons.
The story will soon fade from the headlines — until the next pricing scandal.
In the United States, companies have raised prices on many drugs over the past five years, mostly with little public notice or scandal. Pfizer alone raised the prices of more than 100 drugs in one year. Drug prices have seen double-digit inflation over the past three years, at a time of relatively low inflation in the rest of the economy. Recent research suggests that cancer patients may be delaying use of lifesaving drugs, while there are reports that prisoners are rationed access to hepatitis C treatments — all because of high prices.
But this problem is also international. In poorer countries across the world where our organizations work, millions of people are priced out of medicines that could save lives and relieve suffering. For example, a recent World Health Organization study found that in some 30 countries, hepatitis C medicines were unaffordable for much of the population.
Pharmaceutical companies simply charge whatever they want — or can. They have big budgets to counter image problems from bad press and congressional hearings. And while they claim that high prices are necessary to develop new drugs, it’s just not true. Public funding and subsidies pay for much of today’s pharmaceutical innovation.
Many world leaders recognize that high drug prices are a public-health crisis. Earlier this year, Ban Ki-moon, the secretary general of the United Nations, commissioned a panel of industry, government, academic and civil society experts, including Oxfam International’s executive director, to recommend ways to bring drug prices down to affordable levels and to improve research and development of new medicines in order to fulfill the human right to health.
The panel’s report, released last month, found that today’s system is failing. Pharmaceutical monopolies reap huge profits from high prices, while medicines are unaffordable for too many people. The report called for more transparency and competition in the drug industry and for preserving and implementing existing policies that help reduce prices.
Shamefully, the American government sought to obstruct and oppose the panel, even denying the premise that high drug prices undermine public health.
The Obama administration’s response to the report’s release called the panel’s work “deeply flawed” and accused it of recommending “divisive policies,” which it warned ominously “could have significant unintended negative consequences.” In other words, if we want new medicines and innovations, we must continue to support a system in which the pharmaceutical industry has unlimited power to set prices. Considering alternative pathways is apparently off limits.
These scare tactics not only contradict the United States’ stated global and domestic health priorities, they are also an offense to people unable to afford critical treatment. Worse yet, the American government actively exports this approach to other countries through trade agreements like the Trans-Pacific Partnership, which, if allowed to take effect, will lock in and extend global monopoly protections and high medicine prices for years to come.
This can’t be allowed to happen. High prices and monopolies are not delivering innovation that responds to people’s needs. In fact, many public health issues are being neglected by the pharmaceutical industry because the market for the needed medicines is not sufficiently profitable.
A clear example is the emergence of drug-resistant bacteria, which turn once-treatable infections deadly. Drug-resistant infections already kill 23,000 people each year in the United States and 700,000 people globally. Yet it has been more than 30 years since a new class of antibiotics has been introduced, and the pipeline for critically needed new antibiotics is nearly dry.
There are alternative means to stimulate innovation that do not rely on monopolies and high prices. Grants, prizes and other research incentives could go a long way. The Drugs for Neglected Diseases initiative, a public-private partnership that Doctors Without Borders helped to found, was able to develop therapies to treat malaria, sleeping sickness, kala azar and Chagas’ disease — illnesses long ignored by the pharmaceutical industry.
These approaches, which do not depend entirely on the pharmaceutical industry alone to fund research, show that it is possible to separate the cost of developing drugs from their final product price, ensuring both innovation and affordability.
Yet to really transform how drugs are developed, governments must lead the charge. There are hopeful signs this might happen. In September, world leaders agreed to address antibiotic resistance in part, by committing to develop new drugs through such new research and development models.
The United Nations panel recommendations, which the Obama administration has tried to attack and discredit, are precisely designed to open new paths to medical innovation that benefit us all. Access to existing and new medicines and treatments should not depend on how much money you have, where you were born or whom you know.
The United States government, especially the next president, must stop defending industry profits and work to reform how we pay for medical research to ensure that all patients’ needs are addressed. High prices of medicines are not inevitable; they are a choice the American government has made. Many lives and livelihoods hang in the balance until that choice changes.