Wednesday, May 5, 2021

Health Care Reform Articles - May 5, 2021

‘Why Is It So Expensive?’

We Asked People From Around the
World What They Think of U.S. Health Care.

Covid-19 Vaccinations: A Shot in the Arm for Universal Healthcare?

The national vaccination program has all the features of a single-payer health care system including no copays, no premiums, no insurance company blocking payment, and universal, affordable healthcare for all.


As millions of us get vaccinated against SARS-CoV-2, we will get a first-hand glimpse of what a single-payer, Medicare-for-All approach to health care might mean, at least at the federal level. At the national level, the development and distribution of the vaccines have features of a single-payer approach to health care that set the program apart from business as usual in our private market-oriented health care system.  

The vaccine is being treated as a public good, not a private commodity, and its priority process is determined by medical need, not by ability to pay.

Vaccines are not usually profitable for pharmaceutical companies. It was therefore necessary for the federal government to subsidize the development and distribution of the Covid19 vaccines, mainly through Operation Warp Speed. As a result of these subsidies, none of us have to pay to receive the vaccine. Moreover, there are no documentation requirements to show eligibility and no disputes with insurance companies before or after vaccination. According to guidelines from the Centers for Medicaid and Medicare Services (CMS), Vaccine doses purchased with U.S. taxpayer dollars will be given to the American people at no cost.” Additionally, providers may not seek any reimbursement, including through balance billing, from a vaccine recipient.” We will all be covered automatically with no out-of-pocket costs. 

The national vaccination program has all the features of a single-payer health care system including no copays, no premiums, no insurance company blocking payment, and universal, affordable healthcare for all. The vaccine is being treated as a public good, not a private commodity, and its priority process is determined by medical need, not by ability to pay. Notably, given all this, the vaccine rollout has drawn no allegations of “socialized medicine” by those opposed to government-financed health care.

One cannot deny that administering the vaccine is a massive undertaking and undoubtedly it had a rocky start, but it has improved dramatically over the past few months. The question remains: will our first-hand experience of the federal response to the pandemic (delayed though it was) dispel the usual objections to single-payer health care? Or will most Americans conclude that the public health crisis caused by this pandemic is a one-off exception?  Since we all need access to medical care at some point—whether because of a pandemic, a variant in our genetic code, getting hit by a bus, or being struck by cancer or heart disease—it is clearly short-sighted to regard it as an exception.

Much depends on how many of us get vaccinated and experience the desired community protection and sense of solidarity underlying a universal health care model. If the outcome is positive, increased political momentum for a single-payer health system may be one of the most important results of this horrific pandemic. We’re all in this together, and what we're learning is that government is not the problem; it's the solution.

Opinion: Biden isn’t pursuing socialism. He’s just trying to catch up with other wealthy democracies. 

by Max Boot - Washington Post - May 5, 2021

Republicans accuse President Biden of pursuing a radical agenda that will turn the United States into a failed socialist state. Sen. Marsha Blackburn (R-Tenn.), for example, tweeted a link to a 1974 article about day care in the Soviet Union and wrote ominously: “You know who else liked universal day care.”

It’s true that Biden is proposing a considerable amount of new spending that could reignite inflation: He wants $2.3 trillion for infrastructure and $1.8 trillion for child care, family leave and education. That’s on top of the $1.9 trillion in stimulus spending that was already passed. But those investments won’t turn us into North Korea, Cuba, Venezuela or the Soviet Union — all countries with government ownership of industry. They will simply bring us a little closer to the standard set by other wealthy industrialized democracies — our international peer group.

Many conservatives, of course, seem to think that, as an “exceptional” nation, we have nothing to learn from any other country. But that is hubris speaking. The coronavirus pandemic should have shattered illusions about U.S. omnipotence that not even our rapid vaccination campaign can undo. While other nations such as Brazil and India have much larger outbreaks today, the United States still has more verified covid-19 deaths (more than 576,000) than any other country. The United States remains a leader in some important areas, including our high-tech industry, our financial industry, our universities and our armed forces. But by most indexes we are an embarrassing international laggard.

The Commonwealth Fund notes that the United States spends nearly twice as much on health care as a percentage of gross domestic product than do other wealthy countries in the Organization for Economic Cooperation and Development (OECD). Yet, compared with our peers, we have lower life expectancy, higher suicide rates, higher levels of obesity, higher rates of chronic diseases and higher rates of avoidable deaths. It’s no coincidence that the United States, alone among advanced industrialized countries, does not have universal health care. The United States is also alone among OECD nations in not having universal paid family leave.

The Economic Policy Institute notes that income inequality in the United States has been worsening for years: “From 1978 to 2018, CEO compensation grew by 1,007.5%. … In contrast, wages for the typical worker grew by just 11.9%.” Our level of income inequality is now closer to that of developing countries in Africa and Latin American than to our European allies.

In other respects we are simply mediocre. The OECD reports that the minimum wage in the United States is the 15th highest in the world — well behind countries such as Germany and South Korea. The World Economic Forum rates U.S. infrastructure 13th in the world (Singapore is No. 1). The OECD found in 2018 that in an international test of 15-year-olds, the U.S. ranked 11th out of 79 countries in science and 30th in math.

While we spend more on prisons than other countries, we spend less on social services. The U.S. government’s share of GDP (37.8 percent) is considerably lower than in most other OECD countries (in France it’s 55.6 percent). Yet the United States is hardly a free-market paradise: The Heritage Foundation’s Index of Economic Freedom ranks the United States No. 20, far behind countries such as Australia, New Zealand, Canada and Denmark that have more robust welfare states.

Yes, it’s possible to combine a vibrant free market with generous social welfare spending. In fact, that’s the right formula for a more satisfied and stable society. In the OECD quality-of-life rankings — which include everything from housing to work-life balance — the United States ranks an unimpressive 10th. The leaders are Norway, Australia, Iceland, Canada and Denmark — again, all emphatically capitalist countries whose governments spend a higher share of GDP than we do.

Biden’s plans, even if fully implemented, won’t cause the United States to leap to the front of the pack in quality-of-life rankings. He doesn’t have the support in Congress to address our rampant gun crime with tougher licensing for handguns and a ban on assault rifles (as occurred in Australia and New Zealand). He is not even trying to institute universal medical care — something that every other wealthy country already has — because to do so would invite the same Republican protests against “socialized medicine” that greeted the creation of Medicare and Medicaid in 1965.

At most, with proposals such as federally subsidized child care, elder care, family leave and pre-K education — financed with modest tax increases on corporations and wealthy individuals — Biden is merely moving us a bit closer to the kinds of government services that other wealthy, industrialized democracies already take for granted. We will remain on the smaller-government, lower-tax end of the spectrum, but we will have a slightly stronger social safety net than we had before. That’s far from radical. It’s simply sensible.

Democrats seek to push Medicare expansion as part of Biden’s $1.8 trillion families plan, defying White House

Biden has sought to address the contentious issue separately, but his congressional allies see an opening

by Tony Romm and Seung Min Kim - Washington Post - April 29, 2021

Congressional Democrats are planning to pursue a massive expansion of Medicare as part of President Biden’s new $1.8 trillion economic relief package, defying the White House after it opted against including a major health overhaul as part of its plan.

The early pledges from some party lawmakers, led by prominent members of its liberal wing, threaten to create even more political tension around a package that is already facing no shortage of it. The expansion push comes as Biden on Wednesday stressed in his first address to Congress that he is still committed to making health care more affordable.

Democrats specifically aim to lower the eligibility age for Medicare to either 55 or 60, expand the range of health services the entitlement covers and grant the government new powers to negotiate prescription drug prices. Party lawmakers say their approach could offer new, improved or cheaper coverage to millions of older Americans nationwide.

Roughly 100 House and Senate Democrats led by Rep. Pramila Jayapal (Wash.) and Sen. Bernie Sanders (I-Vt.) publicly had encouraged Biden in recent days to include the overhaul as part of his latest package, known as the “American Families Plan,” which proposes major investments in the country’s safety net programs. Yet Biden opted only to propose additional subsidies for Americans who purchase their health insurance, disappointing many lawmakers who still otherwise support the White House’s blueprint.

Sanders said Wednesday he would “absolutely” pursue a Medicare expansion as lawmakers begin to translate Biden’s economic vision into legislation. Sen. Ron Wyden (D-Ore.), the chairman of the tax-focused Finance Committee, similarly pledged that he would “look at every possible vehicle, and that’s starting today,” to lower drug costs.

And Sen. Richard J. Durbin (Ill.), the Democrats’ vote-counter in the chamber, said he planned to push for Medicare reforms he saw as a “game changer.” Durbin said he didn’t know why the White House ultimately chose to exclude the policies, but he predicted tough work ahead for Democratic leaders in crafting a legislative package that has sufficient support.

“I don’t presume that we have a majority going in,” Durbin said. “I think we have to listen carefully to all the members and particularly those who have some problems, trying to resolve [them].”

The early efforts reflect a broader belief among congressional Democrats that they must more aggressively seize on their narrow but powerful majorities to push policies that long have been stalled in Washington — no matter their cost. Many party lawmakers have pushed Biden at times to spend sky-high sums, sometimes even more than the president himself says he supports, arguing that they have a political mandate to pursue vast economic change.

But health-care revisions are likely to present a significant challenge, threatening to open rifts not just between the two parties but within the Democratic caucus itself. In an early sign of trouble, Sen. Joe Manchin III (D-W.Va.) told The Washington Post on Wednesday that he opposes expanding Medicare eligibility even as he supports broader adjustments to the Affordable Care Act.

“No, I’m not for it, period,” Manchin said when asked about efforts to expand the health-care entitlement.

Rethinking Medicare also risks touching off a fierce lobbying barrage on the part of health insurers and pharmaceutical giants, which have mobilized aggressively against such changes in the past. The corporate opposition could add to new political obstacles now facing one of the staple elements of Biden’s economic agenda.

In his address to Congress late Wednesday, Biden described his American Families Plan as a “once-in-a-generation” series of federal investments. And he specifically promised “in addition” to that package that he would try to lower health insurance premiums, reduce drug costs and pursue other reforms to the Affordable Care Act “this year.”

“This is all about a simple premise: Health care should be a right, not a privilege in America,” the president said in his address.

The families package as proposed touches on wide swaths of the economy: It endorses universal prekindergarten for all children, two years of tuition-free community college for adults, and hundreds of billions of dollars toward combating child poverty and improving child care nationwide.

The spending also has drawn staunch opposition from Republicans. Despite adding trillions to the federal deficit under President Donald Trump, GOP lawmakers blasted Biden on Wednesday for seeking to spend such sizable amounts — and for trying to couple the spending with proposed tax increases on wealthy families and profitable corporations. Sen. John Thune (S.D.), the Republican whip, sharply criticized the White House for putting forward “a big-government proposal financed largely on the backs of the American taxpayer.”

Rep. Virginia Foxx (N.C.), the top Republican on the House Education and Labor Committee, similarly faulted the Biden administration for pursuing community college and prekindergarten reforms she saw as pricey and ineffective.

“We can’t spend our way out of these problems,” she said.

Manchin, a closely watched swing vote in virtually all significant policy fights in the Senate, also expressed some trepidation about tax increases outlined by Biden, including roughly a doubling of the capital gains tax rate for those earning more than $1 million per year.

“That’s a heavy lift,” Manchin said. “We just can’t make ourselves noncompetitive. We have an economy that’s ready to take off and boom. We can’t put the brakes on it.”

Most other Democrats, however, did not seem deterred — and some of the party’s leading lawmakers instead said the White House should seize on its rare opportunity to pursue even larger investments across the economy as part of the new families plan.

“This is our chance to do big things on housing, and big things on infrastructure, and big things on poverty,” Sen. Sherrod Brown (D-Ohio), the chairman of a key committee that oversees housing, told reporters Wednesday.

For many Democrats, the most enticing target is Medicare, as they try to deliver on their 2020 campaign promises to make health insurance affordable and available. Biden himself endorsed a policy report after the party’s presidential primaries — part of a “unity” effort among Democratic contenders, including Sanders — that called for lowering the Medicare enrollment age and expanding the health services it covers.

But Biden opted against including any of those provisions as part of the American Families Plan on Wednesday, choosing instead to focus on extending the additional health insurance tax benefits that Congress previously adopted as part of the most recent coronavirus stimulus. The White House pointed as part of the plan to the president’s past support for a major expansion of Medicare that would lower the eligibility to age 60 and allow the government to negotiate drug costs.

Asked about the approach, a White House official said the administration had embarked on an outreach campaign in the Capitol. The aide, who spoke on the condition of anonymity, said Vice President Harris has been phoning lawmakers to get their views on the American Families Plan.

In the meantime, some Democrats pledged to address both priorities in tandem. Sanders, who had lobbied Biden before the release of his plan, said lawmakers are working “very hard” to ensure the inclusion of a Medicare expansion. His comment came just hours after he unveiled a government study that showed Americans pay between two and four times more for prescription drugs than citizens of other countries.

Citing the new data, Rep. Frank Pallone Jr. (D-N.J.), the chairman of the House Energy and Commerce Committee, also pledged to use his powerful gavel to turn to the issue in the coming weeks — stressing that tackling drug costs remains “one of my top priorities as we work to pass the American Families Plan.”

Jayapal, the leader of the Congressional Progressive Caucus, said Democrats across the Capitol are likely to intensify their political push in the coming weeks out of a belief that the president’s families plan is the most efficient route to improve Medicare — given the shrinking congressional calendar and the growing need for an overhaul.

“If we have to spend all the way through August working on the jobs and families plan[s], I don’t think we have the time,” Jayapal said about calls to tackle Medicare independently. “Everything gets harder heading into the midterms.” 

Telemedicine Is a Tool. Not a Replacement for Your Doctor’s Touch.

by Elizabeth Rosenthal - NYT - April 29, 2021

Earlier in the pandemic it was vital to see doctors over platforms like Zoom or FaceTime when in-person appointments posed risks of coronavirus exposure. Insurers were forced — often for the first time — to reimburse for all sorts of virtual medical visits and generally at the same price as in-person consultations.

By April 2020, one national study found, telemedicine visits already accounted for 13 percent of all medical claims compared with 0.15 percent a year earlier. And Covid hadn’t seriously hit much of the country yet. By May, for example, Johns Hopkins’s neurology department was conducting 95 percent of patient visits virtually. There had been just 10 such visits weekly the year before.

Covid-19 let virtual medicine out of the bottle. Now it’s time to tame it. If we don’t, there is a danger that it will stealthily become a mainstay of our medical care. Deploying it too widely or too quickly risks poorer care, inequities and even more outrageous charges in a system already infamous for big bills.

The pandemic has demonstrated that virtual medicine is great for many simple visits. But many of the new types of telemedicine being promoted by start-ups more clearly benefit providers’ and investors’ pockets, rather than yielding more convenient, high-quality and cost-effective medicine for patients.

“Right now there’s a lot of focus on shiny objects — ideas that sound cool — rather than solving problems,” said Dr. Peter Pronovost, a national expert in medical innovation at University Hospitals Cleveland Medical Center, who has written about finding the value of virtual medicine. “We know preciously little about its impact on quality.”

Even so, the financial world is abuzz with investment opportunities. In the first six months of 2020, telehealth companies raised record amounts of funding, with five start-ups each raising more than $100 million.

There are now telehealth apps that target niche markets like the mental health of pregnant women. Others provide medicines, like H.I.V. prevention pills, after a virtual consultation with their doctors. You can even do a digital eye appointment, meet with your dentist virtually to monitor your oral health and orthodontic progress and send a dermatologist a photo of a suspicious mole.

With telemedicine generously reimbursed, many practices are offering — even encouraging — patients to visit virtually. But, intentionally or not, that choice becomes a revenue multiplier, adding to patient expense.

When he noticed a curious rash, a relative was first directed to a practice’s telemedicine portal and billed $235 for a five-minute video appointment. Since rashes are often hard to evaluate in two-dimensions, he was told he needed to see a doctor in person for the diagnosis and then was charged $460 more for that visit. I worry that pandemic-era reimbursement practices have taken traditionally free screening calls and rebranded them as billed visits, with no value added.

Going forward, some types of virtual visits will deserve insurance coverage. Think of follow-up appointments to check blood pressure or an arrhythmia, where measurements can now be collected at a pharmacy or at home and transmitted to the physician digitally.

For most patients, in-person visits were required in large part because it was the only way a doctor could bill. But they are colossal time sucks, and for people with disabilities they created hardship. After a head injury last April — when I couldn’t yet drive — I was grateful for some insurance-reimbursed virtual visits with doctors and physical therapists.

But there are things that virtual medicine can miss, studies suggest.

One study showed that commercial telemedicine services were much more likely to prescribe antibiotics for children’s respiratory infections as a primary care doctor at an in-person visit. That’s in part because if you can’t see into the ear to observe a bulging drum, for example, the safer course is to overtreat — even though that’s contrary to prescribing guidelines intended to prevent antibiotic resistance.

An internist depresses the tongue and looks for pus on the tonsils to detect possible strep throat. A surgeon suspects appendicitis by pushing on the belly to see if there’s pain with rapid release.

Can psychiatrists develop a therapeutic relationship with a new patient equally well over Zoom? In some cases, sure. But better diagnosing of my own post-injury gait problems required office visits with hands-on maneuvers, like checking my reflexes and feeling my joints move.

“There is still real value in being in the same room, in touch, in the laying on of hands,” Dr. Pronovost said. Studies show that such interactions build trust, increasing the likelihood that patients will comply with treatment.

Telemedicine also raises new questions of equity. Even though it promises improved access for people in rural and underserved areas, video visits require high-speed internet, which is less common among those same groups. Alternatively, will the poor get mostly telemedicine clinics (cheaper, since no front desk staff needed), while those with good insurance have easy access to doctors’ offices?

Insurers are already rolling back their willingness from earlier in the pandemic to pay for telehealth visits. And providers and insurers are battling over reimbursement levels. Is a video call worth the same as an in-person doctor’s visit? If a commercial telemedicine-only doctor determines a patient requires an in-person assessment, is the fee discounted or waived? And how is a smart referral done if that telemedicine provider is thousands of miles away?

There is much to be resolved and fast, with scientific evidence and doctors, hopefully, driving the decisions. If we allow the market to make the choice, we risk preserving those telemedicine services that make money for business and providers — or save it for insurers — and lose those that most benefit patients. 


Students support Maine AllCare

Letter to the editor, Opinion -Ellsworth American - April 30, 2021 

Dear Editor:

We are eight senior Bachelor of Social Work students who are writing to you in support of Maine AllCare. Social workers are trained to advocate for their clients and for social justice. This is both an issue we see for our clients and is a social justice issue, so we are speaking out to the community. Maine AllCare is collecting signatures to place a universal health care resolve on the ballot for the people of Maine to vote on. Should this be enacted, the process will begin to develop universal health care for the state of Maine.

Maine AllCare did a study in 2019 that showed that 42.3 percent of mostly insured Mainers had put off medical treatment for themselves or a family member because of the cost. A total of 52.8 percent of the study population said they had experienced a significant impact on their finances because of an unexpected medical bill. There are many benefits to taking a universal health care approach in Maine. The Maine Center for Economic Policy found that with a state model that would cover all Maine residents, the state would save $1.5 billion per year. This model would fill coverage gaps and reduce out-of-pocket costs. With a universal health care coverage plan in Maine, 80 percent of households would see an increase in income because of the money they would save on insurance and other health care costs.

Maine AllCare is in the early steps of community organization that promotes a universal, publicly funded, easily used and simpler system of health care for all Mainers. Without Maine AllCare’s proposition, the health care system would stay as it is where individuals are living in poverty and experience great financial stress because of insurance payments and medical bills. Taking action on this issue and signing Maine AllCare’s petition would mean you have taken the first step to alleviating some of the issues that Mainers face in regard to health care.

As students who will be practicing social work in a few very short weeks, we urge you to sign Maine AllCare’s petition. Maine can have universal health care and Mainers can get the health care that they need and deserve.

Delaney Dow



Op-Ed: Want a Public Option? Not So Fast, Say Health Insurers

— The industry is spending millions to keep a big competitor out of the game

by Wendell Potter - Medpage Today - May 1, 2021


The nation's biggest health insurers are making it perfectly clear to lawmakers looking to fulfill campaign promises to establish a public option: you will face a massively financed lobbying and PR campaign if you even try.

And this isn't just in Washington. The industry has unleashed campaigns in at least two states so far -- Colorado and Connecticut -- where legislators are hoping to establish state-based public option plans.

Why do insurers care so much? When the status quo is extraordinarily profitable for most of them, they don't want a new competitor that might disrupt the insurance market. As a result, they're funneling millions of dollars collected from policyholders and taxpayers into what for all practical purposes is a front group to protect their ever-increasing profits.

Just recently we learned that CVS Health, which owns Aetna, alone poured $5 million into that group -- the Partnership for America's Health Care Future -- which is funded primarily by insurers and for-profit hospital chains, and run out of the PR and lobbying firm Forbes Tate.

The legislation in Connecticut facing fierce opposition from the insurers has the backing of State Comptroller Kevin Lembo and several Democratic legislators, but Gov. Ned Lamont (D) has remained quiet on the bill so far.

To try to move the governor into their camp, the CEOs of five insurers that do business in the state, including two that are based there, Cigna and Aetna, sent him a letter this month implying they would move jobs out of the state if the public option bill became law.

This tactic worked 2 years ago when lawmakers seemed to be on the verge of getting a similar bill to the governor's desk. According to published reports quoting Lembo, Cigna CEO David Cordani threatened that the company would leave Connecticut if a public option was established -- and this was despite the fact that Cigna doesn't sell coverage on the state's exchange and has relatively few large group customers in Connecticut. Cigna acknowledged it lobbied against the bill but denied the threat.

In response to the letter to Lamont, signed by CEOs of companies like Anthem and Cigna, Lembo issued a statement noting that insurers posted record profits during the pandemic and asked, "When will enough be enough ... Are legislators going to serve their constituents or do five corporations determine what becomes law in our state?"

Lawmakers and Connecticut residents are also hearing from Connecticut's Health Care Future, an offshoot of the Partnership. The Partnership spent heavily on TV and social media ads in Iowa and other states in the run-up to the Democratic primaries and caucuses last year. The ads attacked both Medicare for All, supported by Senators Bernie Sanders (I-Vt.) and Elizabeth Warren (D-Mass.), and the public option, which President Biden and other Democratic contenders backed.

Consistent in all the ads were messages like the ones I used to help write for similar front groups when I led communications at Cigna and worked with my peers across the industry to squash reforms our companies didn't like. The Partnership's ads claim that Medicare for All and even a public option would lead to higher taxes, job losses, and long waits for care. Left out of the ads: any mention of the fact that people would no longer have to pay premiums to insurers if they could enroll in Medicare or a public option.

The Partnership's affiliate in Colorado, Colorado's Health Care Future, is using essentially the same messaging, even though the legislation in that state is substantially different from the Connecticut bill. The Colorado legislation would give private insurers 2 years to begin to bring down the cost of healthcare, and the public option would only go into effect if they could not achieve the benchmarks set by the bill. One of the group's claims in Colorado is that a public option would lead to the closure of rural hospitals in the state. No mention is made of the fact that one of the Partnership's funders, HCA Healthcare, recently disclosed that its Colorado hospital's profit margins were more than 40%.

For-profit insurers are bigger, richer, and more powerful than ever. Recent mergers and acquisitions have bulked these companies up to the point that CVS Health is now No. 5 on the Fortune 500 list of American companies. UnitedHealth Group comes in at No. 7.

Their growth has been primarily at the taxpayers' expense. A whopping 72.4% of UnitedHealthcare's revenues in the U.S. during the first quarter of 2021 came from their government business, primarily through Medicare Advantage, Medicare Supplement plans, and the state Medicaid programs they manage. For several quarters, those programs have been their biggest -- and often only -- source of enrollment growth.

Medicare Advantage in particular has become a cash cow for big insurers. And history shows that the companies conduct business right on the line of what is legal -- often crossing it to maximize profits. Just recently, an analysis by HHS found that Humana overcharged CMS by nearly $200 million in just a single year (2015).

Insurers spend huge amounts lobbying Congress to keep the federal spigot flowing. And they have ramped up their Washington lobbying budgets to new heights this year, not only to protect their Medicare Advantage profits and to secure tax dollars to cover laid-off workers' COBRA premiums, but also, to keep a public option at bay. America's Health Insurance Plans spent more money lobbying Congress during the first 3 months of this year -- $3.9 million -- than any prior quarter. Centene, a big player in Medicare Advantage and Medicaid, increased its first quarter lobbying spend by 80%.

The big insurers have gotten bigger and more profitable as they've figured out how to game the system to their advantage in Washington and state capitals -- and they are prepared to spend whatever it takes to maintain that advantage. They certainly do not want a new competitor in the game that might be able to change the rules they've established. The status quo -- and its emphasis on profits over care -- suits them just fine.

Wendell Potter is a former vice president of Cigna turned whistleblower against the health insurance industry. He now leads the non-profit Center for Health & Democracy. After leaving the industry in 2008, he testified before Congress about the industry's abuses and became an advocate for systematically reforming America's healthcare system.

Big Pharma doesn’t want us to expand Medicare. We have to fight them

- The Guardian - May 3, 2022

By lifting the ban on Medicare negotiating prescription drugs prices we can expand benefits and lower the age of eligibility

We are beginning to make progress in creating a government that works for all people, and not just the very wealthy. But we still have a very long way to go.

By now you’ve heard the big headlines about the American Rescue Plan that Joe Biden signed into law in March: the $1,400 direct payments, the massive expansion of the child tax credit, the extension of unemployment benefits and the production and distribution of tens of millions of vaccine doses that are desperately needed if we are going to crush this pandemic.

What you might not have heard is that we have made primary healthcare far more accessible by doubling funding for community health centers and tripling funding to get doctors, dentists and nurses into medically underserved areas. Kids who have been stuck at home for the past year will now be able to do activities this summer because of major new funding for summer and after-school programs.

These are major steps forward.

But in this time of unprecedented crises, it is not enough. Joe Biden knows that, I know that and you know that.

The agenda the president laid out in his speech on Wednesday gives Congress a good road map, but we need to go further if we are going to seriously combat the enormous economic, social, health and environmental crises facing our country.

As chairman of the Senate budget committee, I’ll take an active role in helping to draft much of this new legislation. There are a number of critical areas we will address including our nation’s crumbling infrastructure, the need to combat climate change and provide childcare for every American family. But right now, I wanted to talk to you about one area I will be especially focused on.

It is outrageous that more than 50 years after Medicare was enacted seniors still do not receive basic hearing, vision and dental coverage. Many seniors are unable to read a newspaper because they can’t afford eyeglasses, they can’t talk with their grandchildren because they can’t afford hearing aids and they have trouble eating because they can’t afford dentures.

It is also time to acknowledge that we must lower Medicare eligibility for the millions of older workers who are in desperate need of healthcare.

This pivotal moment in American history is the time for a Democratic president and a Democratic Congress to do what the American people want. We must expand Medicare benefits and lower the age of Medicare eligibility. Using our majority to take this step is not only the right thing to do for the American people – it’s good politics as well.

These steps might seem expensive, and they are. But here is something amazing. We can pay for the entire cost of these additions to Medicare by allowing the program to negotiate the cost of prescription drugs.

As incredible as it sounds the Medicare program is not allowed by law to negotiate with drug companies over the cost of medications seniors purchase. The lobbying power of the big drug companies means they are ripping off the government and charging the American people any price they want. Not only that. Because of the power of the pharmaceutical industry all Americans are forced to pay, by far, the highest prices in the world for prescription drugs. This absurdity must end.

Negotiating drug prices is what every other major country on earth does. The Veterans Administration does it. Only Medicare is prohibited from taking this obvious step.

What we are fighting for now is the very definition of a win-win-win situation. Seniors pay lower prices for prescription drugs and receive hearing, vision and dental care. Millions more Americans become eligible to participate in the Medicare program. And we lower prescription drug costs for all Americans.

It’s almost insane to think that we would have to fight for these commonsense policies that are supported in overwhelming numbers by he American people. But it comes as no surprise that the pharmaceutical industry will use all of their power in Washington DC to try to stop them from taking place. From 1999 to 2018 drug companies spent $4.7bn lobbying the federal government. That is $233m every year. That is in addition to more than $400m in campaign contributions to federal candidates and committees and $900m to state candidate and committees.

The pharmaceutical industry, the most powerful lobby in Washington, believes that their wealth and power can prevent Congress and the president from taking action to expand Medicare and lower prescription drug prices. Well, I disagree. I believe that in the days and weeks ahead, if all of us make our voices heard we can show how powerful the American people can be when we stand together and fight back. We will not allow the greed of the pharmaceutical industry to stand in the way of Americans getting healthcare and reasonably priced prescription drugs.

As a nation we are now beginning to make some real progress in protecting the interests of the working class. Not surprisingly, the Establishment and defenders of the status quo are resisting. But, in this pivotal moment, if we have the courage to educate, organize and go forward, we will win this struggle. At the end of the day a strong grassroots movement of millions of Americans fighting for justice can and will defeat the power of Organized Money.

The Potter Report


Biden's Big Chance 

by Wendell Potter - Tarbell  - May 3, 2021

In last week’s speech by President Biden, something stood out to me that was overlooked by many pundits: the president spoke of the NEED to fix sky-high health insurance deductibles immediately. It's not the sexiest topic, but here's why it matters.

Many think that the only ones suffering in this health care system are those without insurance. They're struggling big time, but know who else is? People with BAD insurance. The fact is, millions of Americans can’t use their coverage because their deductibles are so damn high.


These millions of Americans with bad plans don't go to the doctor or get the care they need, like cancer treatments that could save their lives. Why? Because they don’t have enough money to cover their deductible: the amount you have to pay out of pocket before coverage kicks in.


Democrats are talking about providing an extra $200 billion to subsidize premiums people pay for Obamacare plans. Insurers love that idea of course. To get that money, insurers should be forced to slash or eliminate deductibles.


High out-of-pocket costs have become an American scandal. For now, insurance companies and their shareholders are laughing all the way to the bank. Forcing us to pay through the nose means they pay far fewer of our medical bills. It’s no wonder insurers posted record profits last year.


Paying high deductibles and copays is like paying a massive bill for the right to use Netflix, and then still having to pay for each minute of each episode of "Tiger King" (or whatever the hell they're showing these days). And oh yeah, it's for basic health care to keep you alive.


The system is a total mess that's bankrupting and killing millions of Americans. And the insurance companies are hoping we won't notice. I know because I used to work for them. The bad news for them is the President Biden has taken notice. If he acts on this, it could save a lot of lives.

Commentary: Making health care work for Maine families like mine

Nobody with diabetes should have to ration vials of insulin. A new package would hold drugmakers accountable and make medications more affordable.

Tuesday, April 27, 2021

Health Care Reform Articles - April 27, 2021

Biden faces pressure from Pelosi, Sanders over whether to double down on Obamacare or expand Medicare

House Democratic leadership and Sen. Bernie Sanders split as Biden administration sculpts next package

Sanders said in an interview that he is arguing for lowering the age of Medicare eligibility to 55 or 60 and expanding the program for seniors so it covers dental, vision and hearing care.

The contrasting visions for the next phase of President Biden’s legislative agenda reflect divisions within the Democratic Party about how Biden should further overhaul health insurance in the United States. Pelosi is looking to double down on the ACA, which has become more popular in recent years as it offers insurance subsidies to people well above the poverty line. Sanders, meanwhile, is looking for an opportunity to make progress on his longtime efforts to make government health insurance universal.

Either approach would offer more health insurance to lower-income Americans. But the choice facing Biden will allow him to decide whether he wants to continue to focus on the ACA, which operates largely through private insurers, or use political capital on a government-run program.

The pressure comes as the White House works to formulate what it is calling the American Families Plan, a sequel to the infrastructure and jobs plan announced last month. The new program, which is likely to be focused on child care, higher education, anti-poverty initiatives and health care, is expected to propose cutting spending on prescription drugs by as much as $450 billion over 10 years.

That money, in turn, could be used for the health insurance expansions. White House officials have not said which direction they will pursue. A White House spokesman declined to comment.

“We cannot continue to deal with millions and millions of seniors — primarily low-income seniors — who cannot afford to go to a dentist, so cannot ingest the food they eat, or the millions of seniors who live in isolation because they can’t hear,” because they cannot afford hearing aids, Sanders said in an interview. He declined to discuss the push from Pelosi, but he said, “It is fair to say there are differences of opinion as to how we prioritize health-care needs.”

The divergent paths charted by Pelosi and Sanders point to one of many underlying tensions within the Democratic Party that the White House is being forced to navigate as it figures out its next major agenda item.

The path to passing either plan remains steep. Congressional lawmakers are just now taking up Biden’s $2 trillion jobs and infrastructure plan, which has faced a barrage of criticism from congressional Republicans and some centrist Democrats. The appetite in Congress for yet another $1 trillion or $2 trillion effort on top of the infrastructure package is unclear, although liberals in the Congressional Progressive Caucus have called for trying to move the two plans in unison.

Congressional Progressive Caucus Chair Rep. Pramila Jayapal (D-Wash.) says the group's policies push the Democratic Party left, despite moderate power brokers. (Blair Guild/The Washington Post)

Still, the early jockeying reflects how Democrats are already looking to the next legislative fight, as well as friction within the party over how best to expand health care.

Democratic leaders have celebrated the durability of the ACA, which has withstood more than a decade of criticism from congressional Republicans and seen its popularity rebound. The White House also has trumpeted figures showing that as many as 500,000 Americans have enrolled in the ACA exchanges during a special enrollment period the Biden administration created.

Asked by a reporter on Thursday about making the ACA expansion permanent, Pelosi cited the Biden administration’s pending families plan and the $500 billion that could be saved for “further expanding access to health care.” She also kept the door open to other forms of health-care expansion, saying the savings “could be used for other purposes,” too.

For Sanders, however, Biden has a unique opportunity to expand on the $1.9 trillion stimulus plan by offering tangible economic benefits to millions of older voters. Sanders helped popularize the single-payer proposal that would enroll every American in Medicare, and lowering the eligibility threshold represents a step in the direction of universal government-provided insurance.

“Some Democrats are all in on solidifying the Affordable Care Act, while progressives want to use their majority to push the health agenda further in the direction of Medicare-for-all,” said Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation, a nonprofit organization.

As a presidential candidate, Biden campaigned on introducing a public option through which Americans could enroll in a government health system, as well as making the ACA subsidies more generous.

But the “unity task force” between Sanders and Biden aides after the 2020 primary produced policy recommendations that included dropping the Medicare enrollment age from 65 to 60. The task force report also said that gaps in dental, vision and hearing services “can lead to severe health consequences for Medicare patients” and stressed that “Democrats are committed to finding financially sustainable policies” to close those gaps.

The expected White House support for the prescription drug effort has helped create an opening for debating how Democrats want to expand health care. As The Washington Post previously reported, the administration is planning to include a measure to force pharmaceutical companies to reduce their prices or pay a steep penalty. Those plans are likely to be similar to the prescription drug bill House Democrats introduced in 2019, although its exact scope remains unclear.

The nonpartisan Congressional Budget Office has estimated that the House Democrats’ bill would save the government about $450 billion over the next decade. It does so by lowering the cost of prescription drugs, which allows the government to spend significantly less on Medicare and other public health programs.

Under House Democrats’ proposal, these savings are redirected to expand Medicare to cover costs for dental, vision and hearing care through Medicare, while also limiting yearly out-of-pocket spending on prescriptions to $2,000, said Alex Lawson, executive director of the advocacy group Social Security Works, which supports the prescription drug reform.

Congressional aides say the savings may be smaller if Democrats, as expected, are forced to pass the measure through the parliamentary procedure known as budget reconciliation.

Conservatives said the United States should use any easily recouped savings to help pay down the existing federal debt. Even passing the measure may be difficult, given warnings from powerful pharmaceutical groups that it would stifle innovation around lifesaving drugs.

“Any low-hanging-fruit budget savings should go to addressing the baseline deficit of $15 trillion,” said Brian Riedl, senior fellow at the Manhattan Institute, a conservative-leaning think tank. “If there’s $500 billion in heath-care savings, shouldn’t we be using that to pay for the programs we already have?”

Others played down the extent of the divisions. The disagreement about the policy direction has not been described by aides as acrimonious, and there may be room for a compromise that incorporates elements of both plans.

“Either one would be a blessing. There’s good arguments for both,” said Harold Pollack, a public health researcher at the University of Chicago, of the bids by Sanders and Pelosi. “I hope Democrats coalesce around whichever is most politically feasible and get it done.”

Still, tensions persist.

Biden’s rescue plan included expanded subsidies for very poor Americans and also extended them to those whose income is above 400 percent of the federal poverty level. That cost about $45 billion for two years, according to the Committee for a Responsible Federal Budget, a nonpartisan group.

“There’s been a robust conversation in the health-care [space] about the best uses of the savings,” said Leslie Dach, an Obama administration health official who is now chair of Protect Our Care, which advocates ACA expansion.

Dach said focusing on expanding the ACA delivers “the most health care for the buck,” noting that having insurance throughout one’s life improves long-term health outcomes. “Getting those folks covered really delivers a lot of health care, particularly to communities of color. … There’s a sense the ACA and Medicaid, which get people in the program early, have a lot of benefits.” Dach said there is also agreement on limiting out-of-pocket drug costs for Medicare enrollees.

Still, some advocacy groups are adamant that Biden increase the scope of public health programs, rather than putting more funding into plans that run through private health insurers.

Lawson said it was a “no-brainer” for Biden to demonstrate to seniors, a crucial voting demographic, that he was working on their behalf.

About half of Americans ages 65 to 80 lack dental insurance, according to University of Michigan researchers. As many as 23 million Americans would newly qualify for health insurance if the Medicare enrollment age is lowered to 60, Sanders’s office said in a statement, adding that half of Medicare recipients have not seen a dentist over the past year.

“Before the next election, we need the American people — and particularly seniors, who have suffered so much during this pandemic — to see that this government is working for them,” Lawson said. “People would get hearing aids, get their teeth checked, before the next election. That will show them Biden is on their side. Democrats have to deliver for seniors if they are going to win.” 


Docs Suffer From Noncompete Clauses: Any Hope for Change?

by Shelly M. Reese - Medscape Internal Medicine -April 7, 2021

When Traci Purath, MD, a Wisconsin neurologist, decided to leave the health system where she worked and go into private practice in 2012, she faced a major stumbling block: the noncompete clause in her employment agreement precluded her practicing within a 15-mile radius of either of the health system's facilities for at least 18 months.

Purath's lawyer said fighting the contract would cost about $50,000, and she wouldn't be able to practice medicine until the case was settled. Undaunted, Purath opened a clinic in a small town about 30 miles away.

But because her noncompete agreement restricted her ability to advertise, her patients didn't know what had become of her. When they called her former employer, they were sometimes told that she had moved out of state or was no longer practicing.

Purath ultimately landed on her feet — thanks to Google, many of her patients eventually found her, and when her noncompete clause expired, she moved her practice closer to home.

Her struggle is far from unique. In a recent Medscape poll of 558 physicians, more than 9 out of 10 respondents said that they were either currently bound by a noncompete clause or that they had been bound by one in the past that had forced them to temporarily stop working, commute long distances, move to a different area, or switch fields.

Some healthcare executives debate whether noncompete agreements are good or bad. Despite the blistering anecdotes, there are some defenders.

The Good and the Bad

Over the last few decades, noncompete clauses have become ubiquitous. Often used by employers to protect intellectual property and proprietary information, consolidation in the healthcare industry has made them a common element in physician employment contracts. Having invested heavily in acquiring physicians' practices and in recruiting and training physicians, hospitals and health systems use them to prevent doctors from leaving after a short time and setting up a competing clinic down the street.

Getting out of a noncompete agreement can be difficult. Almost a quarter (23%) of survey respondents said that they were unsuccessful when they tried to negotiate their way out of a noncompete agreement. Another 30% did not even try.

As a result, many, such as Purath, are forced to make accommodations to abide by the terms of the contract. Forty-two percent of physicians who left a job while under the terms of a noncompete agreement found work similar to their previous work outside of the noncompete area. Six percent found work of a different type, and 4% did not work during the time in which the noncompete agreement was active.

"In my market, noncompete clauses are still very much respected," writes a family physician in Indiana who commutes 45 minutes daily to comply with the 25-mile noncompete radius stipulated in her previous employer's contract



Our View: Closing disparities in health care critical to Maine’s well-being

Mainers face health challenges based on race, gender and which part of the state they live in. A new office within the Mills administration can help.  

The Editorial Board - Portland Press Herald -  April 12, 2021

Mainers face health challenges based on race, gender and which part of the state they live in. A new office within the Mills administration can help.

When COVID-19 hit Maine early last year, it didn’t hit everyone the same — by June, Black residents represented 27 percent of all cases while making up just 1.4 percent of the general population, the biggest racial disparity in the country. Latino and Indigenous residents were disproportionately hurt, too.

But that was only a more dramatic and visible example of the disparities that exist in health care at all times, not just during a global pandemic. Factors specific to certain groups, often based in discrimination and bias, lead to problems with access and substandard care — for not only Mainers of color, but women, LGBTQ residents, rural Mainers and those with disabilities.

That’s why we support the new Office of Population Health Equity, established recently by the Mills administration within the Maine Center for Disease Control and Prevention.

The office’s job will be to monitor health inequities in the state and intervene to ensure all Mainers have access to the care they need. A similar office, under different names, existed within state government for years before then-Gov. Paul LePage dissolved it in 2015.

It would be ridiculous to think such a change by itself could solve the systemic racism and bias that limits health care access. But the office should play an important role in that effort.

The office’s very existence is a much-needed acknowledgement that the disparities are real and must be addressed in order for all Mainers to have the opportunity to improve their well-being and live healthy lives.

The problems are not hard to find if you look. The disparities in health for Black Mainers did not begin with COVID; they have existed for years, driven by bias and lack of economic opportunity. Black women in Maine are found to have much less access to prenatal care and higher rates of infant mortality. Across the U.S., minorities face higher rates of chronic disease and premature death.

Transgender and other LGBTQ residents face similar barriers. In a large state with little public transit, and a lot of infrastructure unfriendly to their needs, Mainers with disabilities can struggle to get around.

The loss of hospitals, and maternity clinics specifically, in rural parts of the state mean residents there are at a disadvantage compared to their urban counterparts, with women traveling hours to deliver a baby.

The fact is, the health care system was built, intentionally or not, by the majority for the majority; it just doesn’t account for everyone. Great organizations have come in to fill the cracks, to advocate and care for the populations that have to struggle to get what comes easily to others.

But what we are doing now clearly is not enough. Maine has to look harder at the places where access to care and positive health outcomes depends on where you were born or how you look.

As long as those disparities exist, Mainers won’t be as healthy as they can be — and neither will Maine.

Mainers implore lawmakers to pass drug pricing bills, saying it’s a matter of life or death

by Evan Popp - The Beacon - April 14, 2021

One simple slip of the hand. That was all it took to put Sarah Lukianov’s life at risk. 

Lukianov, a type 1 diabetic from Bath, said she relies on two different insulins to survive. When she accidentally dropped one of those supplies on the floor, shattering the vial, she begged her insurance company to send her an emergency supply. But the company said she should go to a pharmacy to buy insulin, which would have cost Lukianov over $300. 

She decided to ration her supply rather than pay that exorbitant cost. Within days, she started suffering symptoms of Diabetic ketoacidosis (DKA) as a result of going without insulin. She described the feeling as “both excruciating pain and absolute terror. You feel like you’re dying. And that’s because you are.”

Lukianov survived the experience. But for others, the story has ended differently. “I’m lucky that DKA didn’t kill me like so many others who had to ration insulin because of the cost,” she said. 

Lukianov’s story was told during a public hearing Tuesday before the Maine Legislature’s Health Coverage, Insurance and Financial Services Committee on a package of bills introduced by Democratic lawmakers to help rein in the cost of drugs like insulin — which is cheap for drug makers to produce but sold at an exorbitant cost — and ensure that Mainers have access to life-saving medication and affordable health care. 

Those bills come as big pharmaceutical companies continue to raise prices for life-saving treatments beyond what many can pay while raking in massive corporate profits, with a study by the nonpartisan research organization RAND Corporation finding that prescription drugs in the U.S. cost an average of 2.5 times more than the same drugs in other Western nations. 

The slate of legislation put forward by Maine lawmakers includes two measures introduced by Senate President Troy Jackson (D-Aroostook). One would prohibit “excessive price increases for generic and off-patent prescription drugs” sold in Maine and allow the state attorney general to pursue action against drug manufacturers that violate the law. The bill defines excessive as when a price increase exceeds 15% of the wholesale acquisition cost of the previous calendar year, 40% of the wholesale acquisition cost of three years prior or if the price increase exceeds $30 for a 30-day supply of the generic or off-patent drug for treatment that lasts less than 30 days. 

Jackson’s other bill would establish the Office of Affordable Health Care within the legislature, which would be tasked with making recommendations “on methods to improve the cost-efficient provision of high-quality health care to the residents” in Maine. 

Another bill, introduced by Sen. Ned Claxton (D-Androscoggin), would make prescription drug manufacturers subject to fines for selling drugs in Maine “identified as having an unsupported price increase.” Determining what amounts to an unsupported price increase would be “based on whether there was no, or inadequate, new clinical evidence to support the price increase” as demonstrated by the annual analysis of prescription drugs by the Institute for Clinical and Economic Review.

An additional measure, sponsored by Sen. Cathy Breen (D-Cumberland), would establish “an insulin safety net program” in Maine, modeled after a program in Minnesota created after 26-year-old Alec Smith died because he couldn’t afford the insulin he needed. The measure in Maine would require manufacturers of insulin to make the product available to pharmacies to dispense to people who are “in urgent need of insulin or who need access to an affordable insulin supply.” The bill would allow pharmacies to dispense a 30-day supply to eligible people and would cap the copay a pharmacy could collect at $35. 

The final bill, introduced by Sen. Eloise Vitelli (D-Sagadahoc), aims to increase transparency around drug pricing by requiring greater public notice when a manufacturer implements substantial increases to the price of a drug. 

In his testimony in support of his bills and the others in the package, Jackson told the story of a woman in his district who was diagnosed with cancer. When she found out what her treatment would cost, the woman’s first thought was that she was going to die because she couldn’t afford it. 

“There’s no reason why we shouldn’t have basic protections for Maine people when it comes to medication,” Jackson said. “Pharmaceutical companies shouldn’t be allowed to exploit Maine people, who rely on live-saving medication, to pad shareholders’ pockets.” 

‘We are human beings, not bank accounts’

Being able to access medication is a huge issue for many Mainers, with 219,000 people in the state unable to afford drugs or medicine that a doctor prescribed, according to a survey from October 2020. 

Many people spoke to that struggle during the public hearing Tuesday, urging the legislature to pass the group of bills. Bonnie Deane from Appleton told the committee about her son, who was diagnosed with severe Crohn’s Disease and juvenile arthritis when he was 14. To treat his conditions, he began receiving Remicade infusions every six to nine weeks, without which he would die, Deane said. Each infusion of Remicade costs $78,000, she said. But even after signing up for a discount program with the drug manufacturer, Deane said she and her husband have medical debt that has grown to six-figures. 

“If you’re really sick and you need a drug like Remicade to survive, you’re going to lose everything — and there’s something wrong with that. I don’t want anyone else to ever go through what we continue to go through,” Deane said during her testimony. 

The exploding cost of prescription drugs can sometimes have fatal consequences. Catherine Begin of Waterville told the committee about her son, who was diagnosed with type 1 diabetes and struggled to afford the insulin he needed because of the exorbitant cost, often rationing it as a result. In 2017, Begin’s son died. 

“It wasn’t his fault he couldn’t afford his insulin,” Begin said, noting its cheap cost of production and the expensive price paid by those who need it. She said a bill like Breen’s to create an insulin safety net program could have saved her son’s life.  

Another person who testified at the hearing was Patricia Taniashvili of Surry, who spoke on behalf of her husband. Taniashvili said her husband has type 2 diabetes. The best drug to treat his condition is a medication called Trulicity, she said. However, he has been without that drug for the last two years because it costs $600 a month, even with his health insurance plan through the Affordable Care Act marketplace. Taniashvili said her husband can’t afford that cost, as his only income is a once-a-month Social Security check for just over $1,000. 

The lack of the medication has had a dire impact on her husband’s health. His blood sugar is over 200 regularly, Taniashvili said, and he often doesn’t have the energy to get out of bed. 

Taniashvili urged the legislature to take action to address such situations, describing it as immoral for drug companies to jack up the prices of medication. 

“We feel like we are being squeezed,” she said. “If you as legislators have the capacity to control these drug prices in some way, which it appears you would with this package of bills, it is your duty. We are not the only ones suffering. There are children and adults with type 1 diabetes in the same dire situation and this is patently unfair to them and us. We are human beings, not bank accounts.”


Biden officials rescind Trump’s okay for Texas’s $100 billion-plus Medicaid plan

The decision is seen as an effort to push Texas officials toward expanding Medicaid under the Affordable Care Act to cover more low-income residents

by Dan Diamond - Washington Post - April 16, 2021

The Biden administration on Friday rescinded approval for changes to Texas’s Medicaid program granted by the Trump administration, saying that federal Medicaid officials “materially erred” by speeding approval for the state’s $100 billion-plus request in January.

The decision was characterized as an effort to push state officials toward accepting the Affordable Care Act’s Medicaid expansion, which would cover more low-income residents, said two federal health officials, who spoke on the condition of anonymity to discuss private conversations. Texas, which has more uninsured people than any other state, is one of 12 that have not expanded the program.

“[W]e are rescinding the approval issued on January 15, 2021,” because it did not go through the full federal rulemaking process, Liz Richter, the acting administrator of the Centers for Medicare and Medicaid Services, wrote in a letter to Texas officials obtained by The Washington Post.

In its final week, the Trump administration told Texas officials that it had approved a 10-year extension for its Medicaid plan, which was set to expire in 2022. The waiver provides more than $11 billion in federal funding per year to the state, meaning that the Biden administration’s decision puts billions of dollars in federal funding to Texas at risk.

Health advocates had described that waiver as an effort to work around the federal Medicaid expansion by setting up alternate funding to help cover the costs of uninsured patients.

In a statement Friday, Texas Gov. Greg Abbott (R) slammed the Biden administration decision, saying it was “obstructing health-care access for vulnerable Texans and taking away crucial resources for rural hospitals in Texas. … With this action, the Biden administration is deliberately betraying Texans who depend on the resources made possible through the waiver.”

The approval for Texas’s changes, known as a Medicaid 1115 waiver, was among a flurry of last-minute activities overseen by Trump health officials in the waning days of the administration. Public health advocates and researchers decried the moves as inappropriate attempts to grant GOP governors’ requests and lock in Trump-era changes. Trump officials said that they were moving to provide stability for health-care providers.

“The 10-year extension permits greater financial certainty for the state and its safety net providers that serve Medicaid populations,” Seema Verma, then-administrator for the Centers for Medicare and Medicaid Services, wrote in a Jan. 15 letter to Texas.

Verma also said there was no need for the approval to go through the standard public notice-and-comment process, citing the coronavirus pandemic. But the Biden administration concluded the decision was a mistake.

“Upon further review, we have determined that CMS materially erred in granting Texas’s request for an exemption from the normal public notice process,” Richter wrote in her letter Friday.

In a statement, CMS said the agency had “erred in exempting the state from the normal public notice process — a critical priority for soliciting stakeholder feedback and ensuring public awareness.”

The new Democrat-led administration has been unwinding a series of actions overseen by Trump officials, including the prior administration’s approval of Medicaid work requirements.

The Biden administration also has pushed a dozen holdout states to accept the federal Medicaid expansion. Medicaid officials said on a briefing call for state officials last month that if Texas opted in to the federal expansion, the state would get a $3.9 billion funding boost over two years and 2.06 million uninsured people would become eligible for Medicaid coverage, according to a presentation obtained by The Post.

The Texas Medicaid program has been the subject of political disputes across multiple administrations. Texas officials in 2011 excluded Planned Parenthood from its Healthy Texas Women program, prompting the Obama administration in 2012 to cut federal women’s health funding to the state. But the Trump administration in January 2020 restored the funds by approving Texas’s Medicaid waiver, which was originally set to run through December 2024. 


Bill Would Extend MaineCare, CHIP Insurance Coverage To Immigrants 

by Patty Wight - Maine Public - April 15, 2021

The Legislature's Health and Human Services Committee is considering a bill on Thursday that would allow noncitizen immigrants — including asylum seekers — to get insurance coverage through MaineCare and the Children's Health Insurance Program, or CHIP.

Assistant House Majority leader Rachel Talbot Ross said that coverage was stripped away in 2011 under the LePage administration.

"Preventing a child, an adult, an older Mainer, from getting health care because of their immigration status is wrong. It is discriminatory. And it must end," she said.

Talbot Ross said immigrants contribute to the economy and should have access to health care. She said in 2018, noncitizen immigrant households paid $193 million in state taxes and more than double that in federal taxes.

During a virtual press conference on Thursday morning, Crystal Cron of Presente Maine said immigrants provide labor for some of the largest industries in Maine.

"Even when they have raked thousands of crates of blueberries, shucked hundreds of thousands of pounds of lobster, harvested broccoli, packed potatoes, washed our dishes, cooked our meals, built our houses and cleaned our toilets, they cannot afford to go to a single check up at the doctor," she said.