Health Care Reform Articles - December 17, 2015

Healthcare-NOW!

Philip,

This November, activists in Colorado successfully put a universal healthcare question on the 2016 ballot. Initiative 20, also known as ColoradoCare, would eliminate deductibles, premiums, and most other forms of cost-sharing, and would ensure access to healthcare for every resident of the state. If voters approve the measure, ColoradoCare will improve the health and financial stability of millions of Coloradans - and serve as a game-changer for the single payer movement.

Boxes of signed petitions were rolled into the Secretary of State's office on a gurney

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How does ColoradoCare Work?

Coverage: ColoradoCare takes a big step forward in realizing health care as a human right: all residents, regardless of documentation status, would be eligible to enroll. 

Access: All enrollees would have free choice of primary care provider. The plan covers a broad range of benefits, including primary care, prescription drugs, mental health and substance abuse treatment, and palliative and end-of-life care; the plan does not cover long-term care for most patients or dental for adults.

Financing: Most of the funds will come from a "Healthcare Premium Tax"; for both employers and employees, this takes the form of a payroll tax, and those who don't fit into those categories will pay a non-payroll tax. Almost everything else will be financed by the Affordable Care Act and Medicaid waiver funds, while the last 3% will be funded by out-of-pocket costs (such as copayments). Some of the finer points of these details- including the amounts and application of the copyaments - are left up to an appointed board.

Cost Control: The plan allows the state to create an annual budget and to negotiate with pharmaceutical companies - one reason that the plan is expected to save billions of dollars a year for Coloradans.

Administration: The administration of care would not be delivered by a government agency but through a cooperative, to be run by an elected board.

For those interested in learning more, the ColoradoCare website offers a detailed booklet and video. ColoradoCare is not a pure single payer plan; for discussion on how it differs, please refer to Physicians for a National Health Program's comments.

We applaud the work of our brothers and sisters in Colorado, and will offer our continued support as the campaign moves forward. Our affiliate Healthcare for All Colorado has endorsed the initiative, and will be using this as an opportunity to build the movement for single payer. Looking forward to following this exciting campaign in 2016!

Yours in solidarity,
Ben and Stephanie
Healthcare-NOW! National Staff

http://coloradocareyes.co/about/

Tentative Congressional Deal Alters Obamacare Provisions

By ROBERT PEAR and DAVID M. HERSZENHORNDEC. 15, 2015

WASHINGTON — House and Senate negotiators said Tuesday that they had tentatively agreed to alter major provisions of the Affordable Care Act, delaying a planned tax on high-cost health insurance plans and suspending a tax on medical devices for two years.

The provisions would be postponed as part of a huge package of year-end legislation, including a $1.1 trillion omnibus spending measure and a tax measure including about $750 billion in tax breaks for businesses and low-income individuals.

As negotiators struggled to work through the final details, congressional leaders said they hoped to unveil the text of the legislation late Tuesday night and to hold votes on Thursday, first in the House and then in the Senate the same day.

While the final contours of the legislation were still taking shape, lawmakers said the package would include the reauthorization and expansion of aid for emergency workers suffering from ailments related to the Sept. 11, 2001, terrorist attacks in New York City, as well as a lifting of the 40-year ban on crude oil exports from the United States.

Republican congressional leaders and the White House reached a budget accord in late October that set top-line spending levels for 2016 and 2017. Despite the agreement on the overall dollar amounts, negotiators have struggled to resolve an array of fierce disagreements over policy prescriptions that lawmakers hoped to attach to the must-pass spending bill.

The question of delaying important provisions of the Affordable Care Act provided a surprising area of common ground — among Republicans who have sought to dismantle President Obama’s signature health care law, and Democrats who had reservations about a tax on generous health plans. The White House and many economists have defended the “Cadillac tax” on high-cost employer-sponsored health plans as a way to reduce health costs and make the health care system more efficient.

But lawmakers negotiating the giant year-end deal on taxes and spending said they had tentatively agreed to delay the tax, originally scheduled to take effect in 2018, by two years. Labor unions strenuously opposed the tax, saying it could lead to reductions in health benefits prized by their members.

http://www.nytimes.com/2015/12/16/us/politics/congress-9-11-emergency-workers-zadroga-act.html?smprod=nytcore-iphone&smid=nytcore-iphone-share

If Obamacare is a train wreck, it’s a train wreck of Rubio’s making

By The BDN Editorial Board

Posted Dec. 16, 2015

Florida Sen. Marco Rubio is boasting that he’s killed the Affordable Care Act.

His declaration late last month that he’s delivered a final blow to President Barack Obama’s health care reform law is more a wish than the truth. But the Florida senator “has actually done something toward achieving that goal,” The New York Times reported last week.

While Rubio hasn’t killed the Affordable Care Act — enrollments this year are already outpacing last year’s — the GOP presidential candidate has managed to undermine a temporary provision in the health care law that’s set up to temper the instability inherent in the first years of a health insurance market with millions of new customers, new requirements for health insurance plans and no history to help insurers set premium levels that match health care costs.

A provision Rubio pushed for in last December’s comprehensive budget bill that again made it into the 2016 spending accord reached Tuesday night bars the Obama administration from tapping alternative sources to fund the health care law’s “risk corridor” program. That program transfers money from profitable insurers selling plans on Obamacare’s online exchanges to other insurers so they can partially cover major losses in Obamacare’s first three years.

Many of those insurers ran up losses in the first year of a health insurance market, in which everybody has to sign up for insurance, insurers can no longer turn away patients because of pre-existing health conditions and insurance plans must meet more stringent coverage requirements while limiting consumers’ out-of-pocket costs. Risk corridor payments were one mechanism meant to mitigate those losses so insurers wouldn’t drop out en masse.

http://bangordailynews.com/2015/12/16/opinion/editorials/if-obamacare-is-a-trainwreck-its-a-trainwreck-of-rubios-making/?ref=OpinionBox

Maine Med, 7 other Maine hospitals fined for having too many avoidable infections

The penalties are part of an effort to improve patient safety by the federal Centers for Medicare and Medicaid Services.

BY JOE LAWLOR

Maine Medical Center and seven other Maine hospitals have been fined by the federal government because they were in the bottom 25 percent of hospitals in the nation for patients contracting avoidable infections.

Maine Med’s score was the worst in Maine, and the Portland hospital had a much higher infection rate than the national median.

Even so, Dr. Joshua Cutler, vice president of quality and patient safety at Maine Med, said the hospital’s infection rate has declined significantly over the past 10 years because of reforms that have been put in place. But more improvement is needed, Cutler said.

While the exact dollar figure of the fine is an estimate based on a formula, Cutler expects that Maine Med will have to pay the U.S. Centers for Medicare and Medicaid Services, or CMS, more than $1 million.

“Every time there’s an infection now, we assemble a team of physicians and nurses and do a root-cause analysis of why the infection may have happened in the first place,” Cutler said. “The way we look at it is (that) much of these occurrences are avoidable.”

The federal government evaluates infections in a number of categories where hospitals can improve patient safety – such as urinary tract infections from catheters, infections from central line catheters placed in large veins, and infections resulting from common surgeries such as hysterectomies. The scores are one facet of sweeping Affordable Care Act reforms that aim to improve patient safety.

http://www.pressherald.com/2015/12/16/eight-maine-hospitals-face-patient-safety-penalties/

Study: Bangor Hospitals Charge Privately Insured Patients More Than Those on Medicare 

By PATTY WIGHT • 18 HOURS AGO

A new national study finds that Bangor hospitals charge privately insured patients substantially more than Medicare patients. While much of health care reform addresses quality, advocates say the study underscores the need to focus on another area of health care reform — cost.

According to the study, called the Health Care Pricing Project, there has been a general assumption that spending for Medicare patients translates into spending for other patients. In other words, if a particular region has low Medicare spending, then the costs are also low for privately insured patients.

But the results of the study show there can actually be wide variation.

"My initial reaction was finally the evidence is catching up with the practice that we have known about for decades," says Elizabeth Mitchell, CEO of the Network for Regional Healthcare Improvement in Portland. "While some regions are lauded for low cost, if you only look at the Medicare data, you often miss the fact that those are some of the highest-cost regions for commercial payers. So employers like L.L. Bean and Bath Iron Works and Jackson Laboratories are paying more, in some cases, because Medicare rates are low."

The study found that in Bangor hospitals, spending on Medicare patients is average. But spending in the same hospitals by those with private insurance is relatively high — the 65th highest of 306 hospital regions.

The range in spending between Medicare and privately insured patients is narrower in Portland — about average for both, according to the study.

HTTP://NEWS.MPBN.NET/POST/STUDY-BANGOR-HOSPITALS-CHARGE-PRIVATELY-INSURED-PATIENTS-MORE-THOSE-MEDICARE

Turing CEO Martin Shkreli in custody after securities probe

Shkreli's pharmaceutical company raised the price of a life-saving drug by more than 5,000 percent.

THE ASSOCIATED PRESS

NEW YORK – Martin Shkreli, the former hedge fund manager under fire for buying a pharmaceutical company and ratcheting up the price of a life-saving drug, is in custody following a securities probe.

Calls to an attorney who has represented Shkreli in the past were not immediately returned. His arrest was confirmed Thursday by FBI spokeswoman Kelly Langmesser.

Shkreli stirred public outrage earlier this fall when his company, Turing Pharmaceuticals jacked the price of a drug used to treat a life-threatening infection by more than 5,000 percent. Turing raised the price on Daraprim, a 62-year-old drug whose patent expired decades ago, from $13.50 to $750 per pill. The drug is the only approved treatment for a rare parasitic infection called toxoplasmosis that mainly strikes pregnant women, cancer patients and AIDS patients.

Shkreli said the company would cut the drug’s price. Last month, however, Turing reneged on its pledge. Instead, the company is reducing what it charges hospitals for Daraprim by as much as 50 percent. Most patients’ copayments will be capped at $10 or less a month. But insurance companies will be stuck with the bulk of the tab, potentially driving up future treatment and insurance costs.

Turing, with offices in New York and Switzerland, bought U.S. rights to sell Daraprim in August, when it had no competition. Daraprim is one of numerous old drugs with limited competition whose makers have raised prices sharply.

Rising pharmaceutical prices has become a topic in the upcoming U.S. presidential race.

http://www.pressherald.com/2015/12/17/turing-ceo-martin-shkreli-in-custody-after-securities-probe/

Lawyer for Martin Shkreli Hikes Fees Five Thousand Per Cent

BY ANDY BOROWITZ

BROOKLYN (The Borowitz Report)—A criminal lawyer representing Turing Pharmaceuticals chief Martin Shkreli has informed his client that he is raising his hourly legal fees by five thousand per cent, the lawyer has confirmed.

Minutes after Shkreli’s arrest on charges of securities fraud, the attorney, Harland Dorrinson, announced that he was hiking his fees from twelve hundred dollars an hour to sixty thousand dollars.

Shkreli, who reportedly received the news about the price hike while he was being fingerprinted, cried foul and accused his attorney of “outrageous and inhumane price gouging.”

“This is the behavior of a sociopath,” Shkreli was heard screaming.

For his part, Shkreli’s lawyer was unmoved by his client’s complaint. “Compared to what he pays for an hour of Wu-Tang Clan, sixty thou is a bargain,” he said.

http://www.newyorker.com/humor/borowitz-report/lawyer-for-martin-shkreli-hikes-fees-five-thousand-per-cent?mbid=nl_121715_Borowitz&CNDID=22403094&spMailingID=8359213&spUserID=MzE0Njg2MTc4MDMS1&spJobID=821913818&spReportId=ODIxOTEzODE4S0

Maine Voices: Control cost of prescription drugs before the health care system collapses

Why can drug companies charge whatever price they want? Because no one will stop them, despite the damage being done.

BY JIM O'CONNORSPECIAL TO THE PRESS HERALD

SOUTH PORTLAND — For the past 30 years I have worked as an independent insurance broker in Maine, selling group and individual health plans.

About 25 years ago, the insurance industry came out with the first widely distributed prescription drug cards. Many people may remember the PCS card, one of the earliest. It was the industry’s attempt to eliminate the paper processing of trivial claims that these prescriptions usually represented.

The first cards on the market allowed you to get your prescription filled at a cost of $2 for a generic medication and $5 for a brand-name drug. How quaint.

Unfortunately, and apparently unforeseen, we had created a system in which the buyer did not care what the product cost, because no matter whether their brand-name medication had a price of $10 or $50, their cost was $5. This led not only to drug price increases well beyond regular inflation, but also to a country increasingly enamored of prescription drugs. Usage rates shot up exponentially.

Fast forward 25 years, and television is jammed with ads for various brand-name medications. You almost can’t watch TV without seeing an ad for Humira (used to treat inflammatory diseases such as rheumatoid arthritis and plaque psoriasis) or its chief competitor, Enbrel.

And when those well-produced ads flash on the screen, few take the time to think what this might be costing all of us, or costing our health care system. Unfortunately, it’s a lot.

According to the pricing website goodrx.com, the Portland-area price of Humira is $3,532.31 a month at CVS. That works out to $42,388 a year (that’s enough for a new, well-equipped BMW 3 with money left over to pay sales and excise taxes). Humira and Enbrel are not alone – there are numerous drugs being advertised at equally jaw-dropping prices. Some make their cost pale by comparison.

All of the pharmaceutical companies, of course, are quick to point out the tremendous research and development costs of startup drugs, and the fact that some never make it to market.

True, but here is an odd thing: Humira and Enbrel are made by two entirely different drug companies. There would have been different paths and associated costs to get their drugs through the long process and to market. And yet, according to goodrx, Enbrel sells at CVS for $3,533.15, just 64 cents a month more than Humira. How can that be?

Because there are no limitations in place to prevent it. Six months ago, both drugs were selling for $2,800 a month at CVS. They sell more, they charge more, and typically in business it should be just the opposite.Medicare has long put limits on what it pays to doctors who accept Medicare “assignment” (i.e., what Medicare is willing to pay). The program even put a limit of an additional 10 percent on doctors who don’t accept assignment.

http://www.pressherald.com/2015/12/17/maine-voices-control-cost-of-prescription-drugs-before-the-health-care-system-collapses/