Why a single-payer healthcare system is inevitable
by Robert Reich - Christian Science Monitor
The best argument for a single-payer health plan is the recent decision by giant health insurer Aetna to bail out next year from 11 of the 15 states where it sells Obamacare plans. Aetna’s decision follows similar moves by UnitedHealth Group, the nation’s largest health insurer, and by Humana, another one of the giants.
All claim they’re not making enough money because too many people with serious health problems are using the Obamacare exchanges, and not enough healthy people are signing up.
The problem isn’t Obamacare per se. It lies in the structure of private markets for health insurance – which creates powerful incentives to avoid sick people and attract healthy ones. Obamacare is just making this structural problem more obvious.
In a nutshell, the more sick people and the fewer healthy people a private for-profit insurer attracts, the less competitive that insurer becomes relative to other insurers that don’t attract as high a percentage of the sick but a higher percentage of the healthy.
Eventually, insurers that take in too many sick and too few healthy people are driven out of business.
If insurers had no idea who’d be sick and who’d be healthy when they sign up for insurance (and keep them insured at the same price even after they become sick), this wouldn’t be a problem. But they do know – and they’re developing more and more sophisticated ways of finding out.
Health insurers spend lots of time, effort, and money trying to attract people who have high odds of staying healthy (the young and the fit) while doing whatever they can to fend off those who have high odds of getting sick (the older, infirm, and the unfit).
As a result we end up with the most bizarre health-insurance system imaginable: One ever better designed to avoid sick people.
If this weren’t enough to convince rational people to do what most other advanced nations have done – create a single-payer system that insures everyone, funded by taxpayers – consider that America’s giant health insurers are now busily consolidating into ever-larger behemoths.
UnitedHealth is already humongous.
Aetna, meanwhile, is trying to buy Humana in a deal that will create the second-largest health insurer in the nation, with 33 million members. The Justice Department has so far blocked the deal.
Insurers say they’re consolidating in order to reap economies of scale. But there’s little evidence that large size generates cost savings.
In reality, they’re becoming huge to get more bargaining leverage over everyone they do business with – hospitals, doctors, employers, the government, and consumers. That way they make even bigger profits.
But these bigger profits come at the expense of hospitals, doctors, employers, the government, and, ultimately, taxpayers and consumers.
There’s abundant evidence, for example, that when health insurers merge, premiums rise. researchers found, for example, that after Aetna merged with Prudential HealthCare in 1999, premiums rose 7 percent higher than had the merger not occurred.
What to do? In the short term, Obamacare can be patched up by enlarging government subsidies for purchasing insurance, and ensuring that healthy Americans buy insurance, as the law requires.
But these are band aids. The real choice in the future is either a hugely expensive for-profit oligopoly with the market power to charge high prices even to healthy people and stop insuring sick people.
Or else a government-run single payer system – such as is in place in almost every other advanced economy – dedicated to lower premiums and better care for everyone.
We’re going to have to choose eventually.
Editorial: Government should not rely on private insurers
Editorial Board - The Des Moines Register
Aetna announced last week that it was reducing participation in health insurance exchanges created by the Affordable Care Act. It will sell plans in only four states next year, including Iowa, down from 15 this year. This follows similar market exits from UnitedHealth Group and Humana.
This is yet another reminder of why government should not rely on private companies to deliver health insurance to Americans. History has repeatedly shown this is a costly, dangerous and unsustainable idea. Yet politicians refuse to listen to history.
When Medicare was created in 1965, the goal was to insure seniors through a program administered by the government. In traditional Medicare, Uncle Sam directly pays providers for health services. The program is reliable, predictable and has low administrative costs. But politicians saw an opportunity to funnel public money to for-profit insurers to take over the job of administering benefits.
In the 1990s, private “Medicare+Choice” plans saved taxpayers no money while insurers demanded more and more money from the government. The companies failed to turn a healthy profit and disappeared. Fortunately, seniors could return to traditional, government-run Medicare.
Instead of learning from that experience, Congress embraced private insurers again in 2003. Medicare Advantage plans resulted in taxpayers paying 14 percent more per senior than the cost of care in traditional Medicare. Yet these plans are popular with seniors, who pay lower monthly premiums — and vote. Earlier this year, the GAO reported the feds improperly paid Medicare Advantage companies $14.1 billion in 2013. That’s billion with a "b."
Lucky private insurers. Unlucky taxpayers. Reckless politicians.
Then there are governors, including Terry Branstad, who insist on handing over Medicaid administration to for-profit companies. Let’s take a look at how this has worked in Florida, where former Gov. Jeb Bush pushed the idea, arguing the cost of Medicaid operated by the state was “unsustainable."
Privatization was rolled out statewide in 2014. Almost immediately, insurers complained they were losing money. They asked the state for a $400 million raise and a 12 percent increase in rates. This, of course, jeopardized any savings taxpayers may have realized. Two months ago Florida received a surprise Medicaid bill: It owed $433 million in unpaid reimbursements to insurers.
Then there is the Affordable Care Act.
One of the law’s fundamental flaws is its reliance on private insurers to provide coverage to millions of Americans through exchanges. With no “public option” safety net to offer government coverage if companies jump ship, the insurers have incredible political and financial power. They can, in fact, try to hold the government hostage. Pay higher reimbursements, don't dispute our business decisions, do what we say or we are dropping out of exchanges.
Enter Aetna.
In a July 5 letter, Chief Executive Mark Bertolini informed the Justice Department that if it sued to block Aetna’s dealt to acquire Humana Inc., the insurer would reduce its presence in exchanges. The Obama administration says such a merger would increase consumer costs.
“If the deal were challenged and/or blocked we would need to take immediate actions to mitigate public exchange and ACA small group losses,” he wrote.
Is that a warning? A threat? And how is the Obama administration supposed to respond?
The Justice Department sued to block the merger. Then Aetna announced it was scaling back its offerings in exchanges.
Americans’ access to health insurance should not depend on the profit margins, business dealings, or mergers of for-profit companies. Not in Medicare. Not in Medicaid. And not in exchanges created by health reform law. Instead of funneling tax dollars to private companies, government is better equipped to administer insurance. It is not beholden to stockholders. It does not seek to turn a profit. And it will not abandon the responsibility of providing health coverage to Americans.
Aetna announced last week that it was reducing participation in health insurance exchanges created by the Affordable Care Act. It will sell plans in only four states next year, including Iowa, down from 15 this year. This follows similar market exits from UnitedHealth Group and Humana.
This is yet another reminder of why government should not rely on private companies to deliver health insurance to Americans. History has repeatedly shown this is a costly, dangerous and unsustainable idea. Yet politicians refuse to listen to history.
When Medicare was created in 1965, the goal was to insure seniors through a program administered by the government. In traditional Medicare, Uncle Sam directly pays providers for health services. The program is reliable, predictable and has low administrative costs. But politicians saw an opportunity to funnel public money to for-profit insurers to take over the job of administering benefits.
In the 1990s, private “Medicare+Choice” plans saved taxpayers no money while insurers demanded more and more money from the government. The companies failed to turn a healthy profit and disappeared. Fortunately, seniors could return to traditional, government-run Medicare.
Instead of learning from that experience, Congress embraced private insurers again in 2003. Medicare Advantage plans resulted in taxpayers paying 14 percent more per senior than the cost of care in traditional Medicare. Yet these plans are popular with seniors, who pay lower monthly premiums — and vote. Earlier this year, the GAO reported the feds improperly paid Medicare Advantage companies $14.1 billion in 2013. That’s billion with a "b."
Lucky private insurers. Unlucky taxpayers. Reckless politicians.
Then there are governors, including Terry Branstad, who insist on handing over Medicaid administration to for-profit companies. Let’s take a look at how this has worked in Florida, where former Gov. Jeb Bush pushed the idea, arguing the cost of Medicaid operated by the state was “unsustainable."
Privatization was rolled out statewide in 2014. Almost immediately, insurers complained they were losing money. They asked the state for a $400 million raise and a 12 percent increase in rates. This, of course, jeopardized any savings taxpayers may have realized. Two months ago Florida received a surprise Medicaid bill: It owed $433 million in unpaid reimbursements to insurers.
Then there is the Affordable Care Act.
One of the law’s fundamental flaws is its reliance on private insurers to provide coverage to millions of Americans through exchanges. With no “public option” safety net to offer government coverage if companies jump ship, the insurers have incredible political and financial power. They can, in fact, try to hold the government hostage. Pay higher reimbursements, don't dispute our business decisions, do what we say or we are dropping out of exchanges.
Enter Aetna.
In a July 5 letter, Chief Executive Mark Bertolini informed the Justice Department that if it sued to block Aetna’s dealt to acquire Humana Inc., the insurer would reduce its presence in exchanges. The Obama administration says such a merger would increase consumer costs.
“If the deal were challenged and/or blocked we would need to take immediate actions to mitigate public exchange and ACA small group losses,” he wrote.
Is that a warning? A threat? And how is the Obama administration supposed to respond?
The Justice Department sued to block the merger. Then Aetna announced it was scaling back its offerings in exchanges.
Americans’ access to health insurance should not depend on the profit margins, business dealings, or mergers of for-profit companies. Not in Medicare. Not in Medicaid. And not in exchanges created by health reform law. Instead of funneling tax dollars to private companies, government is better equipped to administer insurance. It is not beholden to stockholders. It does not seek to turn a profit. And it will not abandon the responsibility of providing health coverage to Americans.
EpiPen Price Rise Sparks Concern for Allergy Sufferers
by Tara Parker Pope and Rachel Rabkin Peachman
A steep increase in the price of the EpiPen, a lifesaving injection device for people with severe allergies, has sparked outrage among consumers and lawmakers who worry that parents won’t be able to afford the pens for children heading back to school.
With a quick stab to the thigh, the EpiPen dispenses epinephrine, a drug that reverses swelling, closing of the airways and other symptoms of a severe allergic reaction to bee stings, peanuts or other allergens.
Mylan, the pharmaceutical company, acquired the decades-old product in 2007, when pharmacies paid less than $100 for a two-pen set, and has since been steadily raising the wholesale price. In 2009, a pharmacy paid $103.50 for a set. By July 2013 the price was up to $264.50, and it rose 75 percent to $461 by last May. This May the price spiked again to $608.61, according to data provided by Elsevier Clinical Solutions’ Gold Standard Drug Database.
Doctors advise allergic patients to carry two EpiPens with them at all times in case an extra dose is needed to quell a severe reaction. Most parents buy multiple EpiPens for home, in the car and school and may replace them annually, depending on the expiration date.
Mylan has declined to comment on the price hike, issuing a statement pointing the finger at high-deductible health plans that require consumers to pay much more out of pocket for many drugs. The company said a $100 coupon they offer for the product means most people don’t pay anything for the pens.
But how the price hike affects consumers varies widely, depending on the prices charged by their local pharmacy and the details of their insurance plan. People without insurance or with high-deductible insurance plans can’t always use the coupon and are paying about $640 a set, said Michael Rea, the chief executive of Rx Savings Solutions in Overland Park, Kan. Other patients say that even with good insurance, their copayments are as much as four times higher than in the past.
Naomi Shulman of Northampton, Mass., has a 12-year-old daughter who is allergic to cashews and keeps EpiPens at home and school. Last year, Ms. Schulman’s out-of-pocket copayment for an EpiPen two-pack was $100. But because EpiPens may expire after a year, Ms. Shulman had to buy another two-pack to send along to her daughter’s camp this summer. Her cost for the same two pens was $400.
“I called the insurance company and asked why it was so high and was told that, actually, it’s $700 total, and my co-pay is $400,” she said.
For the first time in 10 years, Ms. Shulman said she briefly considered forgoing the purchase, but didn’t want to risk it. “It’s very wrong,” she said. “It’s gouging parents about their children’s lives. It’s not like letting them sniffle. It’s life or death.”
Lauren Barr of Clark, N.J., said her copayment on EpiPens has risen from $141 to $245 in a year, and she will spend $735 this year for a supply of three EpiPen sets. Her 6-year-old daughter Leah is allergic to rice, tree nuts and mushrooms.
“The price of EpiPens has been getting progressively worse over the years, but now it is just obscene,” Ms. Barr said.
The price hike has caught the attention of Washington lawmakers. Senator Amy Klobuchar, Democrat of Minnesota, who has a daughter who carries an EpiPen, has called on the Senate Judiciary Committee and the Federal Trade Commission to review whether the price hikes violate any anti-competition rules. Last year, the drug maker Sanofi recalled a competing product, Auvi-Q, because it may not have been delivering the correct amount of epinephrine, leaving the EpiPen as the primary emergency treatment for severe allergic reactions.
“This is a mainstream product that people carry, and it’s getting harder and harder for people to afford it,” said Senator Klobuchar. “It’s just another example of what we keep seeing, outrageous price increases when a monopoly situation ends up in a company’s lap.”
Senator Chuck Grassley of Iowa called on Mylan to explain the price hikes, noting that they impose a burden on both parents and school districts, who often keep supplies of the pen at the ready.
A petition to Congress protesting the price increase, called “Stop the EpiPen Price Gouging,” has emerged on social media. It has collected more than 48,000 signatures.
Tonya Winders, president of the Allergy & Asthma Network, said her group is planning to work with other advocacy organizations to make the EpiPen a more universally-covered expense through a federal preventative services task force. She said most families are not feeling the impact of the EpiPen price hike because they have commercial insurance plans with lower copayments and deductibles. The families most affected by the price hike are those who don’t have insurance or those with high-deductible health plans, she said.
“A lot of the families that are being hit with sticker shock are the ones that opted into high-deductible health plans in 2016,” Ms. Winders said. “We believe that Mylan should design a program specifically for those in that high-deductible rate.”
In April, a pharmacist told Sarah Brown of Boulder, Colo., that her copayment on an EpiPen two-pack would be $585, even with a $100 coupon from Mylan. She said she had no choice but to take her chances and hold on to her expired EpiPens instead. “It was a gamble,” she said.
In August, Ms. Brown’s family switched insurance plans so they could afford three packs for home, school and a grandmother’s house. Now, with the new policy and the Mylan coupon, she gets her pens at no charge. “The difference in insurance coverage means being able to afford them or not,” Ms. Brown said.
Congress Presses Pharmaceutical Company to Explain Surge in Cost of EpiPen
by Carl Hulse - NYT
It’s back-to-school time — as well as campaign season — and lawmakers are becoming increasingly focused on the growing cost of pens: EpiPens, that is.
Members of Congress are expressing rising alarm about the increasing costs of the lifesaving injection device for people with severe allergies, and they are hearing from anxious parents.
Senator Charles E. Grassley, the Iowa Republican who leads the Judiciary Committee, was the latest to weigh in on Monday, sending a letter to the head of the pharmaceutical company Mylan, which produces EpiPens. Mr. Grassley demanded an explanation for the 400 percent price increase — to as much as $600 — since the company acquired the product in 2007.
“Access to epinephrine can mean the difference between life and death, especially for children,” Mr. Grassley wrote, noting that many of the children who need EpiPens are enrolled in government health care programs. “It follows that many of the children who are prescribed EpiPens are covered by Medicaid, and therefore, the taxpayers are picking up the tab for this medication.”
Senator Amy Klobuchar, Democrat of Minnesota, called earlier for a Judiciary Committee inquiry into the pricing and an investigation by the Federal Trade Commission.
“Many Americans, including my own daughter, rely on this lifesaving product to treat severe allergic reactions,” she wrote to the head of the commission.
In explaining the increase, Mylan has noted that product improvements have driven up the costs of the devices, that most EpiPens are covered by insurance and that the company also provides discounts. But company executives should prepare to answer many more questions from Capitol Hill in the weeks ahead.
The EpiPen, a Case Study in Health Care System Dysfunction
by Aaron E. Carroll - NYT
Three times in the last two weeks, people — a patient, a colleague and my wife — told me stories about how out of control the price of EpiPens were. Monday, my New York Times colleagues recounted in detail how expensive the devices have become in recent years. All tell the tale of how much even basic health care can cost in the United States.
But by digging a bit further, the story of EpiPens can also explain so much of what’s wrong with our health care system.
When people think of allergies to drugs, food or a bee sting, they often think of a rash. And in fact that’s how many allergic reactions develop and proceed. Most can be treated with diphenhydramine (Benadryl) and careful observation. But some are more serious. Between 1 and 2 percent of people can develop what’s known as anaphylaxis, when the airways you need to breathe swell and close.
Luckily, there’s a simple treatment for such reactions. Epinephrine — or adrenaline — is a hormone naturally produced by the adrenal glands. It’s part of your “fight or flight” response, and it causes your heart to beat faster, your blood vessels to constrict, your pupils to dilate and — most important here — your airways to open.
Epinephrine is very, very cheap. Even in the developing world, it costs less than a dollar per milliliter, and there’s less than a third of that in an EpiPen.
But to save a life, epinephrine must be delivered quickly, and in the proper amounts. People suffering severe allergic reactions often can’t do it themselves. Drawing the drug into a syringe and then administering it to someone else requires training and precision that most people lack.
For that, there is the EpiPen.
What makes this auto-injection device so special is not the drug, but the ease with which it automatically administers the correct dose without delay. The instructionsare right on the side, and even if you don’t read them, it’s pretty easy to figure out. Pull off the safety cap, put the tip against the thigh, and push. Boom. Epinephrine delivered.
The EpiPen isn’t new; it has been in use since 1977. Research and development costs were recouped long ago. Nine years ago, it was bought by the pharmaceutical company Mylan, which then began to sell the device. When Mylan bought it, EpiPens cost about $57 each.
Few competitors existed, and for various reasons, that has remained the case. The device actually worked and saved lives. People needed it. Mylan raised the price. It also began to raise awareness.
Unfortunately, epinephrine is inherently unstable. Research shows that it degrades pretty quickly over time, and it’s recommended that EpiPens be replaced every year. When my friends ask me if they can take an expired over-the-counter pain medication like acetaminophen or ibuprofen, I shrug and nod. If they don’t get a full dose, it’s usually not a big deal. But epinephrine is no joke. People in anaphylaxisneed a full dose every time. They therefore need to replace all their EpiPens every year, again and again.
Kids need them in many places. They need them at home. They need them at school. They need them at camp. They may even want to stash one at Grandma’s house. So people often need to buy quite a few.
More revenue for Mylan. And it raised the price.
Then in 2010, federal guidelines changed to recommend that two EpiPens be sold in a package instead of one. Studies showed that about 10 percent of children who received epinephrine from an EpiPen needed more than one dose. Better to be safe than sorry. Additionally, the Food and Drug Administration changed its recommendations to allow for the prescription of EpiPens for prevention for at-risk patients, not just for those with confirmed allergies. Mylan stopped selling individual EpiPens and began to sell only twin-packs.
It also raised the price.
In 2013, the government went further. It passed a law that gave funding preferences for asthma treatment grants to states that maintained an emergency supply of EpiPens. As the near sole supplier of the devices, Mylan stood to make even more money.
That year, Mylan raised the price again.
Of course, competition would bring the price down. But it’s very hard to bring such a device to market. In 2012, the Adrenaclick and Twinject were discontinued. In 2013, Sanofi began to sell Auvi-Q devices, which even gave audio instructions to walk people though their use. Unfortunately, they were found to give potentially improper doses, and were pulled from the shelves about a year ago.
Teva had hoped to offer a generic version of the EpiPen, but concerns from the F.D.A. sent it back to the drawing board until at least next year.
Adamis hoped to offer prefilled syringes, which would still be harder to use than EpiPens. But it was told by the F.D.A. that much more data would be needed before such a product could be sold.
These setbacks, all in the last year, have once again left Mylan with a veritable run of the market. It raised the price of EpiPens again. As of this May, they cost more than $600 a pack. Since 2004, after adjusting for inflation, the price of EpiPens has risen more than 450 percent.
An alternative still exists. The Adrenaclick, while still not cheap, is back and less expensive than the EpiPen. Some think it’s harder to use, though. It’s not on the accepted list for many health insurance plans. More important, few physicians think of it. Because of that, they write prescriptions for EpiPens. Since the Adrenaclick is not a generic version of the EpiPen, pharmacists can’t substitute one for the other. A prescription for an EpiPen must be filled with an EpiPen, regardless of what consumers might want.
Some people argue that we could still just use syringes and epinephrine for far less money. Sure, they would expire every few months. Sure, they would be harder to use and likelier to break. Sure, they would require training, be hard for the uninitiated to use in an emergency and be more likely to be administered with an incorrect dose. Nonetheless, you could argue that they’re an alternative when the “Cadillac” EpiPens are financially out of reach.
But those are unsatisfactory arguments. Epinephrine isn’t an elective medication. It doesn’t last, so people need to purchase the drug repeatedly. There’s little competition, but there are huge hurdles to enter the market, so a company can raise the price again and again with little pushback. The government encourages the product’s use, but makes no effort to control its cost. Insurance coverage shields some from the expense, allowing higher prices, but leaves those most at-risk most exposed to extreme out-of-pocket outlays. The poor are the most likely to consider going without because they can’t afford it.
EpiPens are a perfect example of a health care nightmare. They’re also just a typical example of the dysfunction of the American health care system.
http://www.nytimes.com/2016/08/24/upshot/the-epipen-a-case-study-in-health-care-system-dysfunction.html?smprod=nytcore-iphone&smid=nytcore-iphone-share&_r=0
Mylan Raised EpiPen’s Price Before the Expected Arrival of a Generic
by Andrew Pollack - NYT
In 2012, the company behind the EpiPen settled a lawsuit by agreeing to allow a generic competitor into the market in 2015, potentially cutting into a big part of its business.
The company, Mylan, had already been steadily increasing the price of EpiPen, an injector containing a drug that can save people from life-threatening allergy attacks. After the settlement, it started to raise the price even faster.
Now, as Mylan faces growing public furor over its pricing of EpiPen, the company’s history of pricing the product highlights a common tactic in the drug industry: sharply raising prices in the years just before a generic competitor reaches the market, as a sort of final attempt to milk big profits from the brand-name drug.
Whether the looming generic competition was a motive for the price increases is not entirely clear, because Mylan has declined to answer questions about its thinking. But while the company was once taking two 10 percent price increases a year, it has made two 15 percent increases annually starting in 2014, when the generic competition seemed imminent.
Over all, the list price for a pack of two EpiPens is now over $600, up from a little more than $100 in 2007, the year Mylan acquired the product. Most of that increase — a rise to $609 from $265 — has come in the last three years.
What has further fueled the increases is that the expected generic, from Teva, was unexpectedly rejected by the Food and Drug Administration. And a nongeneric alternative, Sanofi’s Auvi-Q, was pulled from the market last year because of dosing problems.
So rather than a last grasp for profits, Mylan has a near monopoly now, allowing it to continue the price increases for at least another year.
Mylan, while not commenting on why it has repeatedly increased the price, says that most EpiPen users are insured and that the company offers a coupon that can reduce or cover the patient’s co-payments.
Such co-payment assistance is part of the standard playbook for companies selling expensive drugs: The goal is to spare the consumer, who might create a political uproar, and yet still get paid by the insurance company or government health program.
However, some consumers, such as those with high deductibles, are having to pay nearly full price. And complaints about those costs have led to loud criticism from politicians. On Wednesday, senators demanded information on the company’s pricing decisions, and Hillary Clinton, the Democratic presidential nominee, called the price increases “just the latest troubling example of a company taking advantage of its consumers.”
Express Scripts, the nation’s largest pharmacy benefits manager, said that co-payments for an EpiPen pack for its commercially insured members had remained fairly stable in the last 18 months, averaging $73.50 in July compared with $73.03 in January 2015.
In the same 18-month period, the average price paid by insurers rose by about half, to $635 from $421. Those costs are often moved from the insurer to the consumer eventually, in the form of higher insurance premiums.
The cost for insurers rose after Mylan gained more leverage in pricing negotiations when Sanofi’s product was withdrawn and Teva’s generic failed to win approval.
“What we’re seeing from Mylan now is indicative of how many pharma companies negotiate during a momentary monopoly — they price as high as they can for as long as they can,” David Whitrap, a spokesman for Express Scripts, said in an email.
Early in 2015, when Auvi-Q was on the market and the Teva generic was expected, the insurers and pharmacy benefit managers were able to negotiate big discounts and rebates from the list price. It appears that Mylan received less money per prescription in 2015 than in 2014, despite the big increases in list price.
Mylan recorded virtually no increase in revenue from EpiPen in 2015, even though the list price of the product rose more than 30 percent and the number of prescriptions also increased. In a regulatory filing the company cited “lower pricing” for EpiPen. Mylan does not disclose sales of EpiPen other than to say they exceed $1 billion.
In other years, though, sales of EpiPen rose by larger amounts and Mylan seemed to have retained about half the extra revenue that would be expected from its list price increases and prescription growth, according to Umer Raffat, an analyst at Evercore ISI. Even in 2015, he said, the rebates were kept by insurers and pharmacy benefit managers, and were not seen in lower prices paid by consumers.
“Someone definitely got that,” Mr. Raffat said of the rebates. “Who is that? It wasn’t passed on to customers.”
One reason drug companies can raise prices sharply before generic competition arrives is that insurers and pharmaceutical benefit managers are willing to tolerate such increases if they know that lower prices from a generic are on the way.
One weapon the payers use in bargaining is to threaten to switch patients to a less expensive drug. But knowing a generic EpiPen was coming, an insurer might have been reluctant to switch patients from EpiPen to Sanofi’s Auvi-Q (when it was still on the market), because once patients got used to Auvi-Q, it would have been harder to switch them to the even cheaper generic EpiPen once it reached the market.
SSR, a pharmaceutical stock research firm, looked at 14 popular drugs — like Lipitor for cholesterol and Diovan for heart failure — that have lost patent protection.
The list prices for those drugs increased by an average of 35 percent in the two years before they lost exclusivity, compared with an average increase of 22 percent for brand-name drugs as a whole.
In some cases, increases are even higher. Last year, Valeant Pharmaceuticals acquired a diabetes drug called Glumetza and immediately raised the price 500 percent. J. Michael Pearson, the chief executive at the time, explained this to securities analysts by pointing to the looming patent expiration.
“Often, price increases are taken at the end” of a product’s patent life, he said. “So that was just consistent with what most companies do.”
One question that remains is why EpiPen is protected by patents since it has been on the market since the 1980s. The active ingredient, epinephrine— a hormone made by the body and also known as adrenaline — was first isolated more than 100 years ago.
But EpiPen is protected by patents on the device, particularly the safety cap on the needle. The patents are held by Meridian Medical Technologies, which is now part of Pfizer. One such patent, which was asserted in litigation trying to block Teva’s entry into the market, expires in 2025.
It is not clear why the F.D.A. did not approve Teva’s product. Teva has said that the agency found “certain major deficiencies” and that its product will not reach the market until next year at the earliest.
Mylan to Lower EpiPen Cost for Some Patients
by Andrew Pollack - NYT
Responding to a growing furor from consumers and politicians, the pharmaceutical company Mylan said on Thursday that it would lower the cost to some patients of the EpiPen, which is used to treat life-threatening allergy attacks.
The company said it would take immediate action, including providing a savings card that would cover up to $300 of the cost of a pack of two EpiPens, an increase from the $100 savings card it had been offering.
It also said it would increase the number of patients eligible for its assistance program, which provides the product free to patients who have incomes below a certain level and lack insurance coverage for drugs.
Mylan has steadily increased the price of EpiPen — a pack of two now has a list price of about $600, compared with about $100 when it acquired the product in 2007. In the last couple of years, the company has imposed two 15 percent price increases a year.
This has provoked outrage from some parents who are confronting the higher prices as they buy the product for their children returning to school. The Democratic presidential nominee, Hillary Clinton, said on Wednesday that it was “outrageous” to increase so drastically the price of a product that people needed to survive. Members of Congress have also called for investigations into Mylan’s practices.
The new moves will probably not fully mollify the critics. For one thing, Mylan is not lowering the list price of EpiPen, just making it easier for consumers to pay for it. So insurance companies, federal health programs like Medicare and Medicaid and school districts that stock the products could still pay the same price.
Also, in its statement, Mylan put much of the blame for the problem not on its price increases but on insurance companies for placing a higher burden on patients for out-of-pocket costs.
“We have been a long-term, committed partner to the allergy community and are taking immediate action to help ensure that everyone who needs an EpiPen Auto-Injector gets one,” Heather Bresch, Mylan’s chief executive, said in a statement. “We recognize the significant burden on patients from continued, rising insurance premiums and being forced increasingly to pay the full list price for medicines at the pharmacy counter.”
The EpiPen is an auto-injector containing the hormone epinephrine, which can be used to counter or stave off anaphylactic shock caused by an insect bite or food allergy. It is pressed against the thigh and automatically injects the drug.
Mylan said most commercially insured patients were already being helped by its savings coupon and many paid no out-of-pocket costs. But more patients now have high-deductible health plans and were having to pay the full cost. For those patients, using the $300 savings card would cut their costs by half.
Also, the company’s patient assistance program will now cover those with incomes up to 400 percent of the federal poverty level, compared with 200 percent previously.
Mylan said it would also allow patients to order EpiPens directly from the company, reducing their cost.
Mylan also said that more than half the amount paid by the health care system for EpiPens goes to pharmacy benefit managers, insurers, wholesalers and pharmacy retailers, not to the company itself.
The company said its net price for the product — what it actually receives after rebates, discounts, patient assistance and product donations — is $274 of the list price of $608, resulting in annual sales of $1.1 billion to the company from the product. The other parties, it said, get $334 per prescription, or $1.3 billion a year.
The pharmaceutical industry, under siege for high prices, is trying to point fingers at insurers and pharmacy benefit managers. Stocks of biotechnology companies dropped across the board on Wednesday after Ms. Clinton criticized Mylan and vowed to take action on drug prices if elected.
Drug companies spend millions to keep charging high prices
by David Lazarus - LA Times
armaceutical heavyweight Mylan, the latest poster child for drug-industry greed, finally stuck up for itself Thursday. It argued that “the system,” not avarice, was to blame for the company jacking up the price of EpiPens, a common (and life-saving) allergy remedy, by over 400%.
“Look, no one’s more frustrated than me,” Mylan Chief Executive Heather Bresch declared on CNBC.
Actually, millions of people — those with chronic medical conditions or other illnesses — are more frustrated than her.
Despite Mylan’s offer Thursday of discount coupons for some EpiPen users, the only system at work here is a cash-fat industry routinely preying on sick people. It’s a system that the drug industry will do whatever’s necessary to protect.
Of roughly $250 million raised for and against 17 ballot measures coming before California voters in November, more than a quarter of that amount — about $70 million — has been contributed by deep-pocketed drug companies to defeat the state’s Drug Price Relief Act.
Contributions aimed at killing the initiative are on track to be the most raised involving a single ballot measure since 2001, the earliest year for which online data are available, according to MapLight, a nonpartisan organization that tracks money in politics.
The Drug Price Relief Act would make prescription drugs more affordable for people in Medi-Cal and other state programs by requiring that California pay no more than what’s paid for the same drugs by the U.S. Department of Veterans Affairs. It would, in other words, protect state taxpayers from being ripped off.
Industry donations to crush the Drug Price Relief Act “will top $100 million by the election, I’m quite certain of it,” said Michael Weinstein, president of the AIDS Healthcare Foundation and a leading backer of the state measure, also known as Proposition 61. “They see this as the apocalypse for their business model.”
The drug industry already has succeeded in eviscerating Senate Bill 1010, legislation in Sacramento that would have required pharmaceutical companies to detail the costs of producing medicine and explain any price increases. The bill’s author, state Sen. Ed Hernandez (D-West Covina), pulled it from consideration last week after industry lobbyists succeeded in watering it down with business-friendly provisions.
Mylan’s money-grubbing approach to EpiPens is only the latest example of a drug company mercilessly putting the squeeze on patients.
EpiPens are a decades-old way of delivering epinephrine, a hormone that counters the potentially fatal effects of severe allergic reactions to things such as bee stings and peanuts. There’s about a dollar’s worth of epinephrine in each EpiPen, to which Mylan acquired the rights in 2007 and proceeded to steadily impose double-digit price hikes.
But don’t forget Gilead Sciences charging $1,000 a pill for its hepatitis C drug Sovaldi. Or Turing Pharmaceuticals, which purchased rights to a well-established parasite drug used by AIDS and cancer patients and promptly raised the price by 5,000%.
A recent Reuters investigation found that prices for four of the nation's top 10 drugs have more than doubled since 2011, with the remaining six jumping in price by at least 50%.
“It’s like being held hostage,” Weinstein told me. “The public’s hatred of this industry is an incredible thing. They create life-saving drugs, but, because of their greed, people can’t afford them. What good is a life-saving drug if you can’t get it?”
The Drug Price Relief Act aims to protect California taxpayers by using purchases by the VA as a yardstick by which state agencies can measure if they’re getting a reasonable deal.
It probably would make more sense if Medicare, with more than 55 million beneficiaries, served in that federal capacity rather than the VA. But Big Pharma, abetted by the industry’s Republican cronies, has consistently blocked efforts to allow Medicare to negotiate drug prices. The VA has no such constraint.
The drug industry, ambitiously, is positioning itself as a defender of California consumers. For example, industry representatives have warned that if the prices charged to state agencies were as low as what the VA pays, some drug companies might stop doing business with the likes of Medi-Cal, the prison system and the California Public Employees’ Retirement System, making certain meds unavailable.
The industry “has serious concerns about this poorly written measure because of the negative impact it will have on Californians,” said Pricilla VanderVeer, a spokeswoman for Pharmaceutical Research and Manufacturers of America, a trade group.
I asked Kathy Fairbanks, a spokeswoman for the No on 61 Campaign, if she’d characterize sky-high drug prices as a problem for patients. No, she said, that’s not how she’d put it.
“It’s an issue, how about that?” Fairbanks allowed.
“Healthcare and healthcare costs are top of mind for a lot of people,” she said. “However, Proposition 61 isn’t the answer.”
I asked Fairbanks if she was taking any prescription meds.
“No,” Fairbanks answered. “Are you?”
I told her that, as a person with Type 1 diabetes, I’ve watched helplessly as the price of insulin has tripled since 2002.
“Oh,” Fairbanks replied.
Oh indeed.
No one’s saying drug companies shouldn’t recover the costs of developing and marketing drugs, or that the industry shouldn’t enjoy reasonable profit for its efforts.
But what Mylan and other maestros of greed show us is that this is an industry that fleeces the most vulnerable members of society, and rewards itself handsomely for its morally dubious behavior. From 2007 to 2015, Mylan’s CEO — daughter of Democratic Sen. Joe Manchin of West Virginia — saw her total compensation soar from $2.5 million to $19 million, according to regulatory filings.
The Drug Price Relief Act wouldn’t force pharmaceutical companies out of business. It simply would provide a mechanism for state programs to pay something closer to fair prices for medication.
The fact that the drug industry is willing to spend as much as $100 million to keep that from happening tells you all you need to know.
Discounts Aren't Enough to Halt Outrage At High EpiPen Prices
by Alison Kodjak - MPBN
The EpiPen, an injectable drug that reverses severe allergic reactions, just got a little cheaper for some consumers.
The device's manufacturer, Mylan NV, announced Thursday that it will offer coupons worth as much as $300 off a two-pack.
The move is a reaction to harsh criticism from consumers and several lawmakers over repeated price increases that have boosted the cost of the medication to more than $600 from less than $100 just a few years ago.
The company says it will offer the discounts to patients whose insurance doesn't cover the costs because of high deductibles or limited pharmacy benefits.
But coupons may not be enough to tamp down anger over the price hikes.
"This step is much more a PR fix more than a real remedy," Sen. Richard Blumenthal, D-Conn., said in an interview Thursday. "What's needed is robust, real action to lower the price for everyone, not just a select few."
He says the EpiPen has such enormous market share that the company may be violating antitrust laws by exploiting that. A report by the health care website Stat says some of Mylan's contracts to give schools free or discounted EpiPens may have done just that, because they bar the schools from buying competitors' products.
Mylan told Stat that the provision restricting school purchasing has since been discontinued, but did not say when it was halted.
Blumenthal is just one of several lawmakers who have called for investigations into Mylan's business practices and have asked for justifications of its price increases in recent days. He and a few others say the discounts aren't enough.
Blumenthal sent a letter to the company earlier this week demanding that it lower the price.
Sen. Charles Grassley, R-Iowa, sent a letter to Mylan demanding an explanation for the increase. And Sen. Amy Klobuchar, D-Minn., has asked the Federal Trade Commission to investigate whether Mylan has violated antitrust laws in its marketing of the EpiPen.
Rep. Elijah Cummings, D-Md., says his Oversight and Government Reform Committee would hold hearings. "Offering a meager discount only after widespread bipartisan criticism is exactly the same tactic used by drug companies across the industry to distract from their exorbitant price increases," Cummings said in a statement.
Importance of Boston City Council supporting single-payer health care reform
By Ture Richard Turnbull
Jamaica Plain (Mass.) News, Aug. 22, 2016
The Boston City Council will take a bold step on Wednesday, August 24, by passing a resolution reaffirming its support for a single-payer health care system. The resolution calls upon the state legislature in the upcoming 2017-2018 legislative session to propose and pass a measure to achieve a single-payer system in the Commonwealth.
This resolution is an extremely important endorsement for true health care reform that would make health care a right for all Massachusetts citizens and “provide availability and affordability of healthcare for all Massachusetts citizens.”
In 2001 the Boston City Council passed a similar resolution supporting single payer (also known as Improved Medicare for All). In 2008 the Commonwealth adopted Chapter 58 in an attempt to cover more people by mandating that everyone must buy health insurance or pay a stiff fine; but it lacked the ability to control health care costs. We now have the Affordable Care Act (ACA) that is largely based on Chapter 58. It does cover more people, but it is still unable to control costs. In Massachusetts there are about 300,000 people who are uninsured and many more who have insurance, but the co-pays, deductibles, co-insurance and high cost of medications make it impossible to access the medical care they need.
We need to ask ourselves why our present health care system fails to provide everyone with affordable, high quality coverage. If we look at the money trail it is clear that the private health insurance companies, the pharmaceutical corporations, and the big hospital groups are stashing away billions of dollars while patients are struggling to pay for needed and routine medical care.
We have a profit-based or market-based system that basically allows the health insurance companies to make huge profits by skimping on medical care creating a large profit margin that satisfies their shareholders. The pharmaceutical companies are on a rampage to raise prices on their prescription drugs to the point that in some cases life-saving medications for HIV, hepatitis C, and cystic fibrosis will cost as much as $300,000 per year. These corporations say they need the money for research and development, but most of the money goes to the CEOs with obscene salaries and to payouts to satisfy their shareholders. We need a health care system that is patient-centered not market-based.
Why should Massachusetts move to a single-payer system?
• It guarantees access to medical care for everyone, up front, with no co-pays, deductibles, or high out-of-pocket costs.
• It is continuous from birth to death, no eligibility requirements if you reside in Massachusetts, with no loss of coverage if you change or lose a job, and no need to stay in a bad job just because of the health insurance it provides.
• Businesses and municipalities would benefit because they would no longer be responsible for providing health insurance for their employees. Instead they would pay a payroll tax that would be predictable for long-term planning and in most cases would cost less than what they pay now, allowing for growth in businesses and more funding for vital municipal programs such as schools and fire and police for towns and cities.
• A single-payer system would be funded by income taxes made as progressive as possible under Massachusetts law, a business contribution through a payroll tax, and possibly taxes on unearned income. State income taxes might rise for some people, but the rise in taxes would be in most cases much less than what we pay now for health insurance premiums (around $22,000?!?! for a family of four), co-pays, deductibles, co-insurance, all of which would be eliminated.
• Private health insurance companies would be streamlined to cover only things not covered by the single-payer system. This would eliminate the wasted money spent on unnecessary administrative functions and the profits that are siphoned off the system estimated to be around 30% of total health care expenses for the state. Pharmaceutical companies would be forced to negotiate their prices with the single payer administration. This would keep the cost of medications affordable and set better guidelines for development of new drugs.
• Hospitals and large medical groups would be funded by a negotiated budget for all hospital expenses. Capital improvements would have to be approved by the single payer administration to avoid duplicated services that aren’t necessary for the system.
• A single-payer system is a patient-oriented system that would reduce health disparities since everyone is covered, and improve the quality of care. It would also strengthen the healing power of the doctor-patient relationship by giving doctors the right to make decisions about medical care instead of insurance bureaucrats allowed full choice of doctors. A single-payer system is based on the premise that a healthy society promotes opportunities for the young, comfort and dignity for the elderly, and good health care for families that make up the workforce of the country.
The timing of the resolution by the Boston City Council is tremendously important. A single-payer system is being championed by candidates across the country and it is now a mainstay of the large and growing progressive movement. In Massachusetts there are many new candidates who will be added to the strong group of legislators who already support a single-payer system. The primaries will be held September 8th and it is extremely important for everyone to vote and to support the candidates who will vote for a single-payer system. Cities and towns across the Commonwealth have the incentive now to follow the Boston City Council and make resolutions of their own to support a single-payer system. The 2017-2018 legislative session will show whether we have the political will to achieve what almost all the other countries in the world already provide, a single-payer (Improved Medicare for All) system that covers everyone with high quality care, is affordable, sustainable, and equitable.
Thank you Boston City Council!
http://www.pnhp.org/print/news/2016/august/importance-of-boston-city-council-supporting-single-payer-health-care-reform
Jamaica Plain (Mass.) News, Aug. 22, 2016
The Boston City Council will take a bold step on Wednesday, August 24, by passing a resolution reaffirming its support for a single-payer health care system. The resolution calls upon the state legislature in the upcoming 2017-2018 legislative session to propose and pass a measure to achieve a single-payer system in the Commonwealth.
This resolution is an extremely important endorsement for true health care reform that would make health care a right for all Massachusetts citizens and “provide availability and affordability of healthcare for all Massachusetts citizens.”
In 2001 the Boston City Council passed a similar resolution supporting single payer (also known as Improved Medicare for All). In 2008 the Commonwealth adopted Chapter 58 in an attempt to cover more people by mandating that everyone must buy health insurance or pay a stiff fine; but it lacked the ability to control health care costs. We now have the Affordable Care Act (ACA) that is largely based on Chapter 58. It does cover more people, but it is still unable to control costs. In Massachusetts there are about 300,000 people who are uninsured and many more who have insurance, but the co-pays, deductibles, co-insurance and high cost of medications make it impossible to access the medical care they need.
We need to ask ourselves why our present health care system fails to provide everyone with affordable, high quality coverage. If we look at the money trail it is clear that the private health insurance companies, the pharmaceutical corporations, and the big hospital groups are stashing away billions of dollars while patients are struggling to pay for needed and routine medical care.
We have a profit-based or market-based system that basically allows the health insurance companies to make huge profits by skimping on medical care creating a large profit margin that satisfies their shareholders. The pharmaceutical companies are on a rampage to raise prices on their prescription drugs to the point that in some cases life-saving medications for HIV, hepatitis C, and cystic fibrosis will cost as much as $300,000 per year. These corporations say they need the money for research and development, but most of the money goes to the CEOs with obscene salaries and to payouts to satisfy their shareholders. We need a health care system that is patient-centered not market-based.
Why should Massachusetts move to a single-payer system?
• It guarantees access to medical care for everyone, up front, with no co-pays, deductibles, or high out-of-pocket costs.
• It is continuous from birth to death, no eligibility requirements if you reside in Massachusetts, with no loss of coverage if you change or lose a job, and no need to stay in a bad job just because of the health insurance it provides.
• Businesses and municipalities would benefit because they would no longer be responsible for providing health insurance for their employees. Instead they would pay a payroll tax that would be predictable for long-term planning and in most cases would cost less than what they pay now, allowing for growth in businesses and more funding for vital municipal programs such as schools and fire and police for towns and cities.
• A single-payer system would be funded by income taxes made as progressive as possible under Massachusetts law, a business contribution through a payroll tax, and possibly taxes on unearned income. State income taxes might rise for some people, but the rise in taxes would be in most cases much less than what we pay now for health insurance premiums (around $22,000?!?! for a family of four), co-pays, deductibles, co-insurance, all of which would be eliminated.
• Private health insurance companies would be streamlined to cover only things not covered by the single-payer system. This would eliminate the wasted money spent on unnecessary administrative functions and the profits that are siphoned off the system estimated to be around 30% of total health care expenses for the state. Pharmaceutical companies would be forced to negotiate their prices with the single payer administration. This would keep the cost of medications affordable and set better guidelines for development of new drugs.
• Hospitals and large medical groups would be funded by a negotiated budget for all hospital expenses. Capital improvements would have to be approved by the single payer administration to avoid duplicated services that aren’t necessary for the system.
• A single-payer system is a patient-oriented system that would reduce health disparities since everyone is covered, and improve the quality of care. It would also strengthen the healing power of the doctor-patient relationship by giving doctors the right to make decisions about medical care instead of insurance bureaucrats allowed full choice of doctors. A single-payer system is based on the premise that a healthy society promotes opportunities for the young, comfort and dignity for the elderly, and good health care for families that make up the workforce of the country.
The timing of the resolution by the Boston City Council is tremendously important. A single-payer system is being championed by candidates across the country and it is now a mainstay of the large and growing progressive movement. In Massachusetts there are many new candidates who will be added to the strong group of legislators who already support a single-payer system. The primaries will be held September 8th and it is extremely important for everyone to vote and to support the candidates who will vote for a single-payer system. Cities and towns across the Commonwealth have the incentive now to follow the Boston City Council and make resolutions of their own to support a single-payer system. The 2017-2018 legislative session will show whether we have the political will to achieve what almost all the other countries in the world already provide, a single-payer (Improved Medicare for All) system that covers everyone with high quality care, is affordable, sustainable, and equitable.
Thank you Boston City Council!
http://www.pnhp.org/print/news/2016/august/importance-of-boston-city-council-supporting-single-payer-health-care-reform
Big Obamacare Rate Increases Don't Reflect What People Actually Pay––Wrong!
How many people in the individual health insurance market don't get a subsidy to pay for their health insurance or wouldn't be eligible for one it they did buy it?
by Bob Laszewski - Health Care Poicy and Marketplace Review
Here is what an Obama administration spokesperson said yesterday about all of the big 2017 Obamacare rate increases: "Headline rate increases do not reflect what consumers actually pay," said Kathryn Martin, acting assistant secretary for planning and evaluation at the Department of Health and Human Services.
What she is once again referring to is that 85% of those getting subsidies could get their rate increases eliminated or blunted by the subsidies. It is worth pointing out that the consumer only avoids the big increase if they are in, or move to, the lowest or second lowest cost Silver Plan.
Staying with a higher priced plan they might now be in will not avoid the increases.
And, once again, the administration doesn't tell us that moving to a lower price plan may require higher deductibles and co-pays and more limited provider networks.
But more importantly, why does this administration, and so many Obamacare supporters that parrot this line, continue to ignore the many millions of people who do not get a subsidy and have no choice but to take the full whack from these rate increases if they want to stay covered?
The administration did appear to accomplish this week's spin goal of getting a message out that Obamacare is doing just fine. Here are some of the headlines driven by the administration's press briefing as they appeared in Kaiser Health News today under the heading: "HHS Analysis Says Subsidies Will Help Buffet Consumers From Marketplace Turmoil:"
Also this week, Mark Farrah Associates, an insurance industry data aggregator and web publisher, did take a look at that question. They looked at all of the individual health insurance regulatory filings in each of the states.
What she is once again referring to is that 85% of those getting subsidies could get their rate increases eliminated or blunted by the subsidies. It is worth pointing out that the consumer only avoids the big increase if they are in, or move to, the lowest or second lowest cost Silver Plan.
Staying with a higher priced plan they might now be in will not avoid the increases.
And, once again, the administration doesn't tell us that moving to a lower price plan may require higher deductibles and co-pays and more limited provider networks.
But more importantly, why does this administration, and so many Obamacare supporters that parrot this line, continue to ignore the many millions of people who do not get a subsidy and have no choice but to take the full whack from these rate increases if they want to stay covered?
The administration did appear to accomplish this week's spin goal of getting a message out that Obamacare is doing just fine. Here are some of the headlines driven by the administration's press briefing as they appeared in Kaiser Health News today under the heading: "HHS Analysis Says Subsidies Will Help Buffet Consumers From Marketplace Turmoil:"
- The Hill: "White House: Most Obamacare Users Will Be Shielded From Premium Spikes"
- Modern Health Care: "HHS Says 2017 Obamacare Plans Will Be Affordable Despite Insurer Exits"
- Morning Consult: "HHS Report: Most Marketplace Consumers Will Have Affordable Coverage Options"
- Dallas Morning News: "HHS Department: Fear Not, Obamacare Will Remain Competitive"
Also this week, Mark Farrah Associates, an insurance industry data aggregator and web publisher, did take a look at that question. They looked at all of the individual health insurance regulatory filings in each of the states.
Here's what they found:
As of February 2016, 7.5 million people bought individual coverage outside the exchanges and therefore did not get an exchange subsidy. They reiterated the administration's claim that 12.7 million people bought coverage in the exchanges as of last February.
In fact, by March, only 11.1 million people had completed/paid their enrollments with only 9.4 million getting a subsidy and 1.7 million not getting one.
Adding the 1.7 million not getting a subsidy on the exchange to the 7.5 million off the exchange not being subsidized as of February, there are apparently about 9.2 million people in the U.S individual health insurance market that do not get a subsidy!
Now, some of these 9.2 million could be in grandfathered plans soon to be terminated, or even in limited medical plans still on the books. But any new policy these people would have to buy would have to be Obamacare compliant in order for them not to face the fine.
While this estimate serves to approximate what the market looks like, it is not definitive.
You would think with all of the endowment money the likes of The Commonwealth Fund or The Kaiser Family Foundation has someone would have attempted to find out how many people are out in the cold having to pay the full premium, deductibles, and rate increases for their coverage. After all, how many times have you seen a study, poll, or report from these folks supportive of the Affordable Care Act's accomplishments––particularly the good the law has done to expand coverage for the poor? Are they also not interested in the middle class?
And of course, this data only looks at the people who have bought a policy. While we know that only about 40% of the subsidy eligible have bought a policy, how many of those not subsidy eligible are still without any coverage?
Arguments referring to the 85% of those in the exchange getting a subsidy, in the narrowest sense, are correct. They are also incredibly disingenuous.
But you wouldn't know that reading these headlines.
In fact, by March, only 11.1 million people had completed/paid their enrollments with only 9.4 million getting a subsidy and 1.7 million not getting one.
Adding the 1.7 million not getting a subsidy on the exchange to the 7.5 million off the exchange not being subsidized as of February, there are apparently about 9.2 million people in the U.S individual health insurance market that do not get a subsidy!
Now, some of these 9.2 million could be in grandfathered plans soon to be terminated, or even in limited medical plans still on the books. But any new policy these people would have to buy would have to be Obamacare compliant in order for them not to face the fine.
While this estimate serves to approximate what the market looks like, it is not definitive.
You would think with all of the endowment money the likes of The Commonwealth Fund or The Kaiser Family Foundation has someone would have attempted to find out how many people are out in the cold having to pay the full premium, deductibles, and rate increases for their coverage. After all, how many times have you seen a study, poll, or report from these folks supportive of the Affordable Care Act's accomplishments––particularly the good the law has done to expand coverage for the poor? Are they also not interested in the middle class?
And of course, this data only looks at the people who have bought a policy. While we know that only about 40% of the subsidy eligible have bought a policy, how many of those not subsidy eligible are still without any coverage?
Arguments referring to the 85% of those in the exchange getting a subsidy, in the narrowest sense, are correct. They are also incredibly disingenuous.
But you wouldn't know that reading these headlines.
No comments:
Post a Comment