Tagged Drug Costs

KHN’s ‘What the Health?’: How to Expand Health Coverage

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Democrats in Congress and several states are making it a priority to try to boost health insurance coverage, but they have very different ideas. Some are working to expand the Medicaid program, some seek to build on the Affordable Care Act, and others want to expand Medicare. And as support for a federal “public option” government-run plan wanes in Washington, several states are attempting their own proposals.

Meanwhile, efforts to rein in prescription drug prices continue, and lawmakers may have to reach an agreement if they want to be able to finance their coverage expansions with the savings from those proposals.

This week’s panelists are Julie Rovner of KHN, Alice Miranda Ollstein of Politico, Tami Luhby of CNN and Shefali Luthra of The 19th.

Among the takeaways from this week’s episode:

  • Sen. Ron Wyden’s (D-Ore.) outline for reducing Medicare drug prices leaves many questions unanswered. Among them is what sort of mechanism he would use to set drug prices, which drugs would be subject to drug price cuts, how the government would determine prices and whether price controls would affect health plans for younger people not on Medicare.
  • Finding a way to cut Medicare drug prices could provide a major windfall for the federal government, and Democrats hope it would help finance other programs, such as making permanent the enhanced premium subsidies for insurance plans purchased on the Affordable Care Act’s insurance marketplaces. But proponents of efforts to cut drug prices don’t yet have buy-in from all Democratic lawmakers, many of whom maintain close ties to drugmakers.
  • It’s also unclear whether drug prices are a top priority for the administration. President Joe Biden has said he supports efforts to bring down pharmaceutical costs, but he has not emphasized it in his budget or policy initiatives.
  • Lawmakers from the progressive wing of the Democratic Party are signaling they hope to lower the eligibility age for Medicare and expand its benefits as part of a budget deal this summer. Biden ran on a platform of establishing a health plan run by the government — called a “public option” — that consumers could choose on the ACA marketplace, but that is not being discussed much right now.
  • For progressives, that public option has never been as enticing as a single-payer plan run by the government that would cover the entire nation. And since the health care industry might fight a public option as vehemently as it would a single-payer plan, expanding Medicare seems a better choice to those liberals.
  • Democratic lawmakers are also looking for ways to provide health coverage to uninsured, low-income people living in states that refused to accept the ACA’s Medicaid expansion. Some propose bills that would allow cities or counties to opt into the expansion program when state officials don’t or while others back proposals that would let those consumers purchase subsidized plans on the ACA marketplaces, a provision that was not provided in the landmark health law because it was assumed that states would expand their Medicaid programs.
  • Missouri legislators have begun negotiations to renew funding proposals for long-term care in the state’s traditional Medicaid program. As part of that effort, they are considering new limits on what contraceptives Medicaid will cover. Lawmakers are considering banning reimbursement for IUDs and emergency contraception, on the incorrect belief that those methods are abortifacients.
  • Colorado and Nevada, following an initiative by Washington state, are setting up public options for their residents. But the programs will not necessarily reduce premiums, and if the federal government opts to make permanent the increased premium subsidies that took effect this year for marketplace customers around the country, such state efforts may look less appealing.
  • Even as the U.S. begins to return to more normal routines and open up businesses and events as the pandemic eases, concern is growing about the covid virus’s delta variant, which is spreading quickly across the country and the world. Public health experts are working to persuade residents who haven’t been vaccinated to step up for a shot because that can prevent serious illness. Officials have been keen to use incentives to bring people in for vaccination — cash and merchandise prizes, for example — but have been hesitant to penalize anyone for not getting inoculated. That strategy may not be working.

Also this week, Rovner interviews Michelle Andrews, who reported and wrote last month’s KHN-NPR “Bill of the Month” episode about a very expensive sleep study. If you have an outrageous medical bill you’d like to send us, you can do that here.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too:

Julie Rovner: The Washington Post’s “Workplace Wellness Programs Are Big Business. They Might Not Work,” by Katherine Baicker and Zirui Song

Tami Luhby: The Associated Press’ “Watchdog: Nursing Home Deaths Up 32% in 2020 Amid Pandemic,” by Ricardo Alonso-Zaldivar

Alice Miranda Ollstein: The New York Times’ “Desperate for Covid Care, Undocumented Immigrants Resort to Unproven Drugs,” by Amy Maxmen

Shefali Luthra: KHN’s “Hemmed In at Home, Nonprofit Hospitals Look for Profits Abroad,” by Jordan Rau

To hear all our podcasts, click here.

And subscribe to KHN’s What the Health? on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts.

KHN’s ‘What the Health?’: Our 200th Episode!

Can’t see the audio player? Click here to listen on SoundCloud. You can also listen on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts.

The Food and Drug Administration found itself in the hot seat this week when it approved a controversial new drug to treat Alzheimer’s disease with scant evidence of its effectiveness.

Meanwhile, as health policy watchers wait for the Supreme Court to rule in a case threatening the Affordable Care Act, the Biden administration is reporting that a record 31 million Americans have health insurance as a direct result of the health law. And President Joe Biden seeks to gain goodwill overseas as he announces the U.S. will provide 500 million doses of covid vaccine to aid international health efforts.

This week’s panelists are Julie Rovner of KHN, Margot Sanger-Katz of The New York Times, Joanne Kenen of Politico and Sarah Karlin-Smith of the Pink Sheet.

Among the takeaways from this week’s episode:

  • The FDA announcement on the drug Aduhelm to treat Alzheimer’s disease was assailed by many scientists, doctors and consumer groups who say the drug’s benefits haven’t been proven and it is not ready for general use. But patient advocacy groups pushed the FDA hard to give the medication a thumbs up. They argue that FDA approval will spark more investment from drugmakers in therapies for the disease.
  • Aduhelm will be priced at $56,000 a year, which does not include scans and other medical tests and preparations that patients will require. The decision to approve a costly drug that has apparently marginal benefit is likely to spur the debate over high prescription drug pricing for both consumers and the government.
  • If Medicare opts to cover the drug, it could drive up costs of Part B premiums even for the millions of beneficiaries not taking the medication.
  • In addition to this major announcement about the Alzheimer’s drug, the FDA has a heavy docket, including a decision on whether to give full approval to the covid vaccines being used in the U.S. under a special authorization and how to handle these vaccinations for children. But it is dealing with these major issues without a permanent leader since Biden has not yet named his choice to be FDA commissioner.
  • Biden’s announcement that the United States will provide the Pfizer covid vaccine to other countries will help ease tensions at his meeting this week with foreign leaders, who have criticized the U.S. for holding onto vaccine while the world suffers. But it probably does not assuage progressives who have been calling for the transfer of the vaccine patents and technology to those other countries.
  • The podcast panelists, marking the show’s 200th episode, noted that over four years they have been surprised that the public health system was unprepared for a major pandemic, that face masks could become part of the political wars, that researchers could so quickly provide a successful vaccine for covid-19, and that Republicans, when in control of Congress and the White House, could not overturn the Affordable Care Act. But they also noted they weren’t surprised that the ACA is still a political lightning rod and that the nuances of health policy have thwarted other major reforms, including efforts to curb drug prices.

Also this week, Rovner interviews Chiquita Brooks-La Sure, the new administrator of the Centers for Medicare & Medicaid Services at the Department of Health and Human Services.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too:

Julie Rovner: HuffPost and the Center for Public Integrity’s “Spreading Vaccine Fears, and Cashing In,” by Liz Essley Whyte


Politico’s “What My Covid-19 Vaccine Saga Taught Me About the U.S. Health Care System,” by Joanne Kenen

Margot Sanger-Katz: The New York Times’ “’On That Edge of Fear’: One Woman’s Struggle With Sickle Cell Pain,” by John Eligon

Sarah Karlin-Smith: Pink Sheet’s “Patient Support May Have Helped Push Aduhelm Toward Approval,” by Derrick Gingery

Joanne Kenen: The New Yorker’s “The Death of Hahnemann Hospital,” by Chris Pomorski

To hear all our podcasts, click here.

And subscribe to KHN’s What the Health? on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts.