Prices Soaring for Specialty Drugs, Researchers Find
Even as the cost of prescription drugs has plummeted for many Americans, a small slice of the population is being asked to shoulder more and more of the cost of expensive treatments for diseases like cancer and hepatitis C,according to a report to be released on Tuesday by a major drug research firm.
The findings echo the conclusions of two other reports released last week by major pharmacy benefit managers, which predicted that spending on so-called specialty drugs would continue to rise.
The report, by the IMS Institute for Healthcare Informatics, also found that consumers’ use of health care — visits to the doctor, hospital admissions and prescription drug use — rose in 2013 for the first time in three years, mainly because of the improving economy, it said.
“Following several years of decline, 2013 was striking for the increased use by patients of all parts of the U.S. health care system,” Murray Aitken, executive director of the IMS Institute, said in a statement. He noted that the spike came before the Affordable Care Act, which has helped providehealth insurance to millions of new customers, fully went into effect.
But even as consumers became more confident about spending money on health care last year, the report found that a divide is developing between those with medical conditions that can be treated with cheap generic drugs, and those with rare and often more serious diseases that can come with breathtaking price tags.
More than half of prescriptions cost patients, on average, less than $5 in out-of-pocket costs in 2013, and 86 percent of them were filled with generic medicines. Nearly a quarter of all prescriptions — 23 percent — required no out-of-pocket cost at all, an increase that the report’s authors attributed mainly to a requirement in the new health care law that contraceptive drugs be covered free.
On the other hand, those who need the costlier drugs paid disproportionately more. Only 2.3 percent of prescriptions accounted for 30 percent of all out-of-pocket costs, the report found.
Drug companies have increasingly turned to treatments for smaller and more complex diseases as sales of dozens of blockbuster drugs have collapsed in recent years in the face of competition by cheaper generic versions.
In 2013, drug companies debuted 36 new drugs, including 10 notable cancer treatments, the most in more than a decade, the report found. Other significant new drugs on the market included treatments for hepatitis C,multiple sclerosis and diabetes. Pharmaceutical companies began selling 17 drugs last year to treat so-called orphan diseases — those that affect fewer than 200,000 people nationwide.
Tax Preparers’ New Role: Health-Coverage Advisers
WASHINGTON — Iris I. Burnell, an adviser at Jackson Hewitt Tax Service, has prepared scores of returns in the last few months, as she does every year ahead of the April 15 filing deadline. But many of her consultations this year have also included educating clients about the tax implications of the Affordable Care Act.
“Many people don’t realize that it’s the law, and you have to have insurance,” said Ms. Burnell, the manager of a busy storefront tax preparation office just a few blocks from the Capitol. “They still think there’s a way to worm out of it. When I ask if they have insurance, they hem and haw. They are in a wait-and-see mode.”
Ms. Burnell has been trying to change those attitudes. Avoiding the politics of the health care law, she shows consumers what it means in dollars and cents. “It won’t be real until it hits you in the pocketbook, in the purse,” she said.
The tax system provides both the carrot and the stick for people to obtain coverage. Tax preparers like Jackson Hewitt and H&R Block say they have helped tens of thousands of people apply for tax credits to help defray the cost of private insurance bought through the exchanges.
In addition, the big tax service companies and makers of tax preparation software like Intuit’s TurboTax are calculating potential penalties for those who do not have insurance.
“It’s a tremendous business opportunity,” said Brian Haile, senior vice president for health policy at Jackson Hewitt. “We can do well by doing good.”
Major provisions of the health care law — the requirement for people to carry insurance and for larger employers to offer it, as well as the subsidies to help pay for it — were written as amendments to the Internal Revenue Code.
H&R Block highlights the connection on its website: “The name you trust for all your tax needs now also offers friendly, unbiased help when it comes to choosing health insurance.”
“Despite all the attention to the Affordable Care Act, many people — the average Joe on the street — are still confused about the law, the tax credits, the penalties,” said Mark A. Ciaramitaro, vice president for health care enrollment services at H&R Block.
Stan Dorn, a health policy expert at the Urban Institute, said: “It makes a huge amount of sense to involve tax preparers in the process of enrolling uninsured individuals into subsidized coverage. They are in the business of filling out forms for consumers. And they already collect 90 percent of the information needed to get help paying for health coverage.”
Obamacare’s victory lap
By Eugene Robinson,
It’s all over but the shouting: Obamacare is working.
All the naysaying in the world can’t drown out mounting evidence that the Affordable Care Act, President Obama’s signature domestic achievement, is a real success. Republican candidates running this fall on an anti-Obamacare platform will have to divert voters’ attention from the facts, which tell an increasingly positive story.
A new report by the nonpartisan Congressional Budget Office estimates that, despite all the problems with the HealthCare.gov Web sitelaunch, 12 million people who previously lacked insurance will obtain coverage this year. By 2017, the year Obama leaves office, the CBO predicts that an additional 14 million uninsured will have managed to get coverage .
Why was the Affordable Care Act so desperately needed? Because without it, 54 million Americans would currently have no health insurance. Within three years, according to the CBO, Obamacare will have slashed the problem nearly in half.
We should do better, and perhaps someday we will. Most industrialized countries have some kind of single-payer system offering truly universal coverage. But if you have to work within the framework of the existing U.S. health-care system — which involves private health insurance companies and fee-for-service care — the Affordable Care Act reforms are a tremendous advance.
Many Republican critics of Obamacare know, but refuse to acknowledge, that the reforms are here to stay. Does the GOP propose to let insurance companies deny coverage because of preexisting conditions, as they could before the ACA? Does the party want to reimpose lifetime caps on the amount an insurer will pay? Tell young adults they can no longer be covered under their parents’ policies?
I didn’t think so.
More likely, Republicans will continue to mumble vaguely about “private-sector incentives” and “consumer choice” — without acknowledging that the ACA reforms offer plenty of both. And the GOP will continue to bray about “big government health care,” which is an out-and-out lie.
Obamacare, to the contrary, will leave the present system basically intact. The CBO predicts that a decade from now, the great majority of non-elderly Americans will still obtain health insurance through their employers — an estimated 159 million, as opposed to 166 million if Obamacare never existed. Only about 25 million people are expected to get coverage through the federal and state health insurance exchanges. Even this coverage, mind you, will be provided by private health insurance companies, not the government.
For the working poor, new health premiums can be a burden
Cancer patient Barbara Garnaus' story illustrates how hard it can be to manage new Obamacare medical expenses of even hundreds of dollars a year.
By Soumya Karlamangla
6:26 PM PDT, April 13, 2014
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For nearly two decades, Barbara Garnaus maintained a modest, delicate life balance: keeping her part-time Orange County school district job and juggling her bills and credit card debt.
Now 63, living alone, she counts every dollar, has no cellphone and commutes an hour in traffic so she can keep an affordable apartment in Laguna Woods.
Having good health helped. Garnaus got by without medical insurance, relying on yearly exams at a free clinic. But that changed last year: Garnaus now needs treatment for cancer, and she bought insurance under Obamacare.
Thousands of Californians like Garnaus are poised to reap significant benefits from the nation's healthcare overhaul: access to levels of service and treatment previously out of their reach, and government subsidies that bring down payments dramatically. Still, Garnaus is anxious about taking on even modest additional monthly costs.
At the margins of poverty, even committing to premiums, co-payments and other new medical expenses of hundreds or a few thousand dollars a year can be difficult to manage, according to researchers and groups working with the low-income patients now required by federal law to buy insurance.
"When you talk about paying for something on a monthly basis like that, it's something very real that people have to consider," said Kandis Driscoll, a manager with the Santa Monica-based Insure the Uninsured Project. "It could be a survival decision."
Price was Garnaus' overriding consideration in choosing a policy.
"I got the cheapest one, the very cheapest one," she said. "And for me it's still not cheap."
::
As she reviews invoices at her desk, the tail of a blue scarf wrapped around Garnaus' head brushes her shoulder. Tacked to the wall behind her are photos of her with former colleagues and an old yearbook portrait showing off the wavy blond hair she lost to chemotherapy last year.
She works 20 hours a week ordering pencils and testing materials, earning $22,480 annually before taxes, and isn't eligible for the district's health insurance coverage. She's tried unsuccessfully to get full-time work at the district and elsewhere, she said, but felt it was best to hold on to what she had when the recession hit.
Her monthly take-home paycheck is about $1,750. With her $1,180 rent, about $150 on gasoline and $100 on utilities, she's left with less than $320 each month for food and any other expenses, including medical bills.
In March of last year, Garnaus was diagnosed with a rare but aggressive uterine cancer. She initially received treatment through Orange County's taxpayer-supported healthcare program. She qualified for the low-income program because her earnings fell below the $22,980 annual ceiling the county had set for a single-person household, roughly 200% of the federal poverty level.
When that county program expired Dec. 31, most of the patients transitioned to Medi-Cal, the state's program for the elderly and poor. But Medi-Cal covers people only up to 138% of the poverty level — $15,800 for a single person — which disqualified Garnaus.
http://www.latimes.com/local/la-me-obamacare-margins-20140414,0,1134987,print.story
Medicaid expansion debate has passed, but Maine still needs to tackle high health care costs
Posted April 12, 2014, at 5:58 a.m.
The Medicaid expansion debate is largely settled in the Maine Legislature, but lawmakers in Augusta still have a chance to take action that could make a dent in our state’s higher-than-average health care costs.
The U.S. has the highest health care costs on the planet — 50 percent higher than Norway, the next most expensive country — and among the fastest growing costs, yet there are 36 countries with health care systems that rank more effective than ours. Our economic competitors spend much less on health care. Therefore, they can offer lower prices for their goods or use their surpluses to invest in infrastructure improvements.
Maine has the fifth-highest spending per capita for health care among our 50 states and the second fastest-growing costs, yet there are 15 healthier states than Maine. Over 20 percent of our economy is devoted to health care — well over the national average and the highest portion in New England. Competing states spend 40 percent less than we do on health care. The only way we compete is by having some of the lowest wages in America. Is it not an accident that we do not attract younger workers.
Other states with high health care costs have high income. We don’t. We’re 39th from the top in earned income. Our highest income groups get their money from out-of-state sources. When their costs get too high, they can (and do) leave. It is not an accident that our coastal towns, such as Boothbay Harbor, are losing population, but adding part-time residents who do not pay Maine income taxes. Our high health care costs lead directly to high worker’s compensation costs, where we rank eighth.
It is very clear that Maine must lower health care costs to prosper. The excuse that our high health care costs are a direct result of having an older, sicker, lower-income or more rural population is not supported by the facts.
Lincoln County, where I live, has the oldest population and is tied for the lowest earned income county. Our hospital, Lincoln Health, where I serve on the Performance Improvement Committee, ranks as one of the very best rural health care systems in America. Consumer Reports just ranked us as the safest hospital in America. We are the only Maine hospital that has reduced its prices — an example Maine must follow if we are to have the resources to serve the medical needs of Maine people. Yet, because of low Medicare reimbursement rates, at 71 percent of actual costs, and high levels of free care, at 8 percent of revenue, Lincoln Health still faces constant fiscal challenges.
The Affordable Care Act has not, and likely will not, lower our health care costs. Current estimates have health care costs rising just as fast as they have for more than a decade — with Maine again among the states with the fastest growing costs. Unless we reform our cost structure, Maine will run out of money for health care — with no liquor contract to save us.
Shifting costs to the state’s Medicaid program by expanding it under the Affordable Care Act does not solve the problem. It only delays fiscal sobriety.
Louisiana taking away Medicaid lifeline for disabled, other vulnerable residents: Megan McLemore
Donna Risso, who died April 1, lost her disability Medicaid coverage in January and had to use emergency room care for her terminal illnesses. (Photo by Megan McLemore )
Contributing Op-Ed columnist By
on April 15, 2014 at 12:30 PM, updated April 15, 2014 at 12:42 PM
on April 15, 2014 at 12:30 PM, updated April 15, 2014 at 12:42 PM
Two years ago, Donna Risso and her friend Michael were living under a bridge in New Orleans. They were struggling not only with homelessness, but also with Donna's mounting health problems, which included hepatitis C, cirrhosis of the liver, encephalitis, pancreatitis and chronic anemia. Donna was a "frequent flyer" at the emergency room, often five to 10 times a month, but her health was getting steadily worse.
Social workers using federal and state resources helped Donna find housing and got her on a state program called "disability Medicaid," which covers health care costs for people who meet federal disability criteria but are not yet on the federal program. This important initiative, common in many states, is a bridge to health services for people applying for federal benefits, which can take years.
Although the program was a lifesaver for Donna, Gov. Bobby Jindal terminated "disability Medicaid" in Louisiana as of Jan. 1, leaving 9,200 people across the state with no coverage.
It's well known that Gov. Jindal steadfastly opposes expanding Medicaid in the state under the Affordable Care Act, and that the Legislature voted against expansion in 2013. This is misguided, as Medicaid expansion would cover as many as 300,000 uninsured residents, with 100 percent of the costs picked up by the federal government through 2016 and at least 90 percent thereafter.
But less widely known is that Medicaid in Louisiana is actually shrinking, through termination of programs and tighter eligibility requirements. In the state's view, since theAffordable Care Act's private insurance marketplace will cover people earning more than the federal poverty level, many people on Medicaid should pick up insurance on marketplace exchanges.
But it's not that simple. According to the Kaiser Family Foundation, most Louisianans who need health insurance have incomes below the federal poverty level, which is $11,490 a year for an individual. These folks, an estimated 242,000 people, fall into an enormous coverage gap in states that are not expanding Medicaid and taking people off Medicaid only adds to this group.
On Louisiana's Medicaid Purchase Plan, for example, people with disabilities who were working could receive Medicaid benefits if they earned no more than $25,000 per year. Now the program is available only to those who make less than $11,490, making half of the program's 2,300 participants no longer eligible.
A Health Care Reform Blog––Bob Laszewski's review of the latest developments in federal health policy, health care reform, and marketplace activities in the health care financing business.
Virginia Should Take the Obamacare Medicaid Expansion Money and So Should All Republican States
In a September 2012 post on this blog, I said that Republican governors should be expanding their Medicaid programs under Obamacare. I argued that Republicans have long called for state block grants and the flexibility to run their own Medicaid programs in what are the state "laboratories of democracy."
I made the point that, given the then recent Supreme Court decision enabling states to opt out of the expansion, the Obama administration would be hard pressed to deny any reasonable proposal from Republican governors. If Republicans really believed in state responsibility and flexibility for how they run their Medicaid programs, this was the opportunity to prove it. (See: The Medicaid Controversy––The Republican Governors Should Put Up or Shut Up)
Since then, a few Republican governors have taken that tack and the Obama administration has been very cooperative and flexible.
This is a good place to recognize outgoing HHS Secretary Sebelius for her leadership by being willing to work with state Republicans in order to get millions of people covered who wouldn't be getting coverage otherwise.
Good faith Republican Medicaid proposals have led to good faith responses from Sebelius' Department of Health and Human Services (HHS) and a few done deals and other deals still in the works.
Many Republicans have said that Medicaid is not sustainable and that the feds could well cut the new Obamacare funding in future years. Sebelius responded by giving these governors an out if funding were to be cut.
Of course Medicaid is unsustainable, that's why the states should be given the autonomy to run their own plans and deal with these challenges in any number of different ways the country can learn from.
Arkansas, a conservative state led by a Democratic governor and a very conservative Republican legislature, was one of the first states to secure a Medicaid waiver from the Obama administration. The Republican legislature just renewed that program.
But in a recent Forbes article, that expansion came under sharp criticism:
I made the point that, given the then recent Supreme Court decision enabling states to opt out of the expansion, the Obama administration would be hard pressed to deny any reasonable proposal from Republican governors. If Republicans really believed in state responsibility and flexibility for how they run their Medicaid programs, this was the opportunity to prove it. (See: The Medicaid Controversy––The Republican Governors Should Put Up or Shut Up)
Since then, a few Republican governors have taken that tack and the Obama administration has been very cooperative and flexible.
This is a good place to recognize outgoing HHS Secretary Sebelius for her leadership by being willing to work with state Republicans in order to get millions of people covered who wouldn't be getting coverage otherwise.
Good faith Republican Medicaid proposals have led to good faith responses from Sebelius' Department of Health and Human Services (HHS) and a few done deals and other deals still in the works.
Many Republicans have said that Medicaid is not sustainable and that the feds could well cut the new Obamacare funding in future years. Sebelius responded by giving these governors an out if funding were to be cut.
Of course Medicaid is unsustainable, that's why the states should be given the autonomy to run their own plans and deal with these challenges in any number of different ways the country can learn from.
Arkansas, a conservative state led by a Democratic governor and a very conservative Republican legislature, was one of the first states to secure a Medicaid waiver from the Obama administration. The Republican legislature just renewed that program.
But in a recent Forbes article, that expansion came under sharp criticism:
Any Governor or legislator still considering a "Private Option" style ObamaCare Medicaid expansion in their state should take an extra-long look, as the Razorback state's version is turning out to be hugely expensive. While the "Private Option" plans are required to look almost exactly the same as Old Medicaid from an enrollee's perspective, the plan does have one big difference from a straight "traditional" ObamaCare expansion: state taxpayers are on the hook for all cost overruns. The trend of enrollment in the first few months project a cost overrun of tens of millions of dollars for 2014 alone, with potential overruns growing larger in the future.Sounds like a Medicaid block grant success story to me!
Maine report urges steps to prevent shortage of health-care professionals
A Department of Labor’s Center for Workforce Research and Information report suggests boosting state health-care education enrollment and recruiting more workers from outside Maine.
Maine is likely to suffer a shortage of medical professionals in the coming years unless the industry boosts student enrollment at health care-related schools in the state and recruits more workers from outside Maine, according to a report issued this week.
The workforce development problem will be especially dire in the fields of dentistry and psychology, in which two-thirds of all current practitioners in the state are older than 50 years old, said the report, by the Maine Department of Labor’s Center for Workforce Research and Information.
Occupations for which nearly half of the existing practitioners are older than 50 include pharmacists, nurse practitioners and licensed practical nurses, it said.
Overall, the need to replace currently practicing health care professionals is expected to outstrip the need to expand Maine’s medical workforce because of population growth, the report said.
As a result, the future job market in Maine will favor those seeking employment in a variety of health care specialties, it said, but hospitals and medical clinics are expected to face difficulties maintaining a full staff.
Paul Bolin, Eastern Maine Healthcare Systems vice president of human resources, east region, understands the problem well. He said experienced nurses, certified medical assistants and pharmacists with residency experience have been the most difficult employees to find.
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| 04/15/2014 Reported By: Patty B. Wight | |||||||||
If you're contemplating a sure-fire career in Maine, think nursing. A new report on Maine's health occupations finds that nursing is the largest health occupation in the state - and growing. But along with the demand comes an expected shortage of health care professionals in Maine in the coming decades. Patty Wight reports.
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When Sherri Woodward was young, she considered two career options: nurse or cowgirl. She chose nursing, and 40 years into her career, Woodward works as chief nurse executive at Maine General Hospital in Augusta. Today she's checking in with nurses in the surgical unit.
Sherri Woodward: "I'm just stopping by to see how you're doing on getting your admissions up from the ED, or from the OR. Nurse: "We're doing very well today. The charge nurse has been right on it this morning. We got four discharges out." Woodward says nurses are the safety net for patients. "I think it's what makes us unique in the healthcare profession, that we really are the people that develop the relationships with the patients. They trust us, they depend on us." What also makes nursing unique is that it's the largest health occupation in Maine, representing about 14,000 jobs that earn around $60,000 a year each. The number of nursing jobs is expected to climb another 20 percent within this decade.
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