Tagged Health Care Costs

Viewpoints: Applause For Push To Rescue Mo.’s In-Home, Nursing Care For Senior Citizens, Disabled People; Moving Toward Medical Quality

Here’s a review of editorials and opinions on a range of public health issues.

The Kansas City Star: Don’t Give Up On Restoring In-Home And Nursing Care In Missouri
Kudos to those Democratic Missouri lawmakers who still have not given up on trying to stop Gov. Eric Greitens from single-handedly taking in-home and nursing care away from 8,300 seniors and disabled people. On Monday, several legislators asked the state to drop plans to request a federal waiver from the Centers for Medicare and Medicaid Services that would allow them to cut the program. (7/25)

KevinMD: 5 Steps To Create Medical Quality Without Trying
The need for what we are calling medical “quality” is acute, yet the strategies employed to obtain it are destroying medicine. Patient outcomes are inconsistent, care varies depending on many factors outside of disease state, and the cost of our medical system is not sustainable. But to fix this, most health systems employ non-clinicians to audit charts while checking boxes such as “A1C<8%?” and “DVT prophylaxis ordered within 24 hours?” These non-providers then send threatening letters and cut salaries with “pay-for-performance.” Unsurprisingly, such efforts are not working, and only end up creating distorted physician-patient relationships. Yet, obtaining improved quality requires only a few key steps. (Kjell Benson, 7/25)

Stat: Doctors Have The Power To Help Their Patients Thrive Financially
StreetCred’s formula is simple. It takes advantage of the trusting relationships that families have with their pediatricians and makes productive use of the time typically wasted in doctors’ waiting rooms. In partnership with the IRS-sponsored Volunteer Income Tax Assistance program and other government agencies, StreetCred uses trained volunteers and staff to help families file taxes, attain tax refunds, and apply for anti-poverty government programs. (Andrea Levere, 7/25)

Stat: Human Trafficking Must Be Officially Recognized As A Medical Diagnosis
Early this week, nearly 100 people were found trapped in a sweltering tractor-trailer in San Antonio, Texas. Ten have died and others are in critical condition. Many were sent to local hospitals for treatment of severe dehydration and shock, medical conditions that are common in the emergency department. What may not be as obvious to emergency physicians is that these people are possibly victims of human trafficking. As physicians who have treated victims of human trafficking and research this scourge, we believe that this form of severe exploitation is under-recognized in health care settings and live are being lost because of that. (Abraar Karan and Hanni Stoklosa, 7/25)

Los Angeles Times: The ‘it’s All In Your Head’ Diagnosis Is Still A Danger To Women’s Health
TV personality Maria Menounos stunned fans when she announced this month that she was in recovery from surgery for a nonmalignant brain tumor, which she discovered while her mother was battling brain cancer. Perhaps most surprising was how quickly Menounos was treated. She explained to People magazine that when she told her mother’s doctor about her symptoms — headaches, dizziness, slurred speech — he immediately investigated what was wrong. (Emily Dwass, 7/26)

The Des Moines Register: Attorney General Sessions Should Not Re-Escalate War On Drugs
Attorney General Jeff Sessions has apparently learned nothing regarding the War on Drugs. He wants to re-escalate this failed policy at a time when many states are realizing its futility and trying to move in different directions. Drug treatment doesn’t work 100 percent of the time, but it is certainly more effective (and less costly) than incarcerating people with this illness. And as long as there are addicts, there will always be dealers, so incarcerating dealers has little long-term impact on the drug problem. (Allen Hays, 7/25)

Boston Globe: Mass. Should Pass Gun Restraining Order Bill
Representative David P. Linsky, a Natick Democrat, has filed legislation that would allow family and household members, police, district attorneys, and health care providers to go to court and seek “extreme risk protective orders” for individuals who pose a significant danger to themselves or others. The bill, which has raised the hackles of gun rights groups, stands up to constitutional scrutiny and builds in an important hearing mechanism before long-term restrictions can be imposed. (7/26)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Perspectives: Too Often In U.S. Profit Comes Before Public Interest

Read recent commentaries about drug-cost issues.

The New York Times: The Tasmanian Hep C Buyers’ Club
In 2014, when Greg Jefferys’s urine started smelling like dead meat, he knew there was something seriously wrong. For weeks, Jefferys, an Australian then 60 years old, had felt fatigued and noticed that just a slight bump would leave a dark purple bruise on his skin. Blood tests revealed to Jefferys that he had chronic hepatitis C – a disease he’d never heard of. (Sophie Cousins, 7/25)

Forbes: When It Comes To Abusive Drug Pricing, Don’t Confuse Shkreli With Hep C Drugs
Drug pricing is a topic commanding a lot of attention these days, particularly as healthcare in the U.S. is a national focus. The debate isn’t simple. The ways that drugs are distributed and paid for in this country can be best described as convoluted. Froma Harrop, a nationally syndicated, award-winning columnist who focuses on the financial world, has recently weighed in on this discussion with her op-ed “America’s addiction to abusive drug pricing.” Given her reputation, one would expect that her views would add substance to the debate. Instead, her op-ed is fraught with inaccuracies. (John LaMattina, 7/19)

Los Angeles Times: Shining A Light On Prescription Drug Pricing
After years of failed efforts, the California Legislature may finally pass a bill that responds to the problem of rising prescription drug costs. But temper your enthusiasm: Though this measure (SB 17) has been fiercely resisted by the pharmaceutical industry, it wouldn’t actually stop manufacturers from raising their prices as high as they think the market will bear. It would just make them reveal more about the cost and value of their drugs as they do so. (7/24)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Democrats Announce Three-Pronged Plan To Tackle High Drug Prices

News outlets report on stories related to pharmaceutical pricing.

Politico: Democrats’ ‘Better Deal’ Would Penalize Drug Price Hikes
Democrats are going straight at one of the top concerns of voters, using the rising cost of drugs to strike a more populist tone and counter President Donald Trump, who campaigned hard against the power of the drug industry, but took a friendlier stance after taking office. Congressional Democrats [on Monday] laid out a three-pronged approach to lower the cost of prescription drugs in the United States that aims to stop large price increases and give the federal government more power to influence what Medicare pays for medicines. (Karlin-Smith, 7/24)

CNBC: Democrats Take Aim At Big Business, Drug Prices, In Economic Campaign
Democrats are proposing an independent agency to tackle the high cost of prescription drugs. The director would be appointed by the president and confirmed by the Senate, charged with investigating drug manufacturers and able to slap fines on companies with exorbitant rate hikes. Pharmaceutical companies would also be required to notify the government of substantial price increases. (Mui, 7/23)

Stat: How Pricey Is Your Drug? These 10 Sold The Most In The U.S. Last Year
Awhopping $450 billion was spent in the United States on prescription drugs last year. Topping the list, perhaps unsurprisingly, are medications whose patents were still in force or had recently expired. When a patent expires, generic versions — or biosimilar versions of biologic drugs — can become available, driving down costs that in turn make them accessible to more patients. (Blau, 7/25)

Stat: FDA May Publicly Shame Drug Makers For Thwarting Generic Rivals
The idea is to break a logjam caused by an FDA program that is designed to boost safety. Typically such a program, known as a Risk Evaluation and Mitigation Strategy, requires drug makers to develop a plan to educate doctors and monitor distribution. But generic companies claim they have been denied samples of brand-name drugs needed to conduct product testing in order to win FDA approval. Brand-name companies argue that REMS programs do not permit such sharing. (Silverman, 7/19)

FierceHealthcare: Democrats Revive Calls For Medicare To Negotiate Drug Prices
As part of their newly unveiled “Better Deal” agenda, congressional Democrats are pledging to tackle one of healthcare’s thorniest issues—the high cost of prescription drugs. “Right now, there’s nothing to stop vulture capitalists from egregiously raising the price of life-saving drugs without any justification,” Senate Minority Leader Chuck Schumer, D-N.Y., said during a press conference Monday. (Small, 7/25)

Stat: Ohio Places Drug Pricing Measure On Its November Ballot
In a blow to the pharmaceutical industry, Ohio state officials have approved a controversial initiative designed to lower drug prices for the November ballot. Known as the Ohio Drug Price Relief Act, the ballot measure would require state agencies to pay no more for medicines than the Department of Veterans Affairs. The agency currently gets a 24 percent federally mandated discount off average manufacturer prices. (Silverman, 7/21)

The Blade: Television Ads Clash Over Ohio Drug Price Relief Act
The conflicting claims in the prescription drug issue that will be on the Ohio ballot in November are enough to cause a headache. Or even something requiring a prescription. The most recent flurry of ads last week on broadcast television attacked the previous flurry of TV ads, each accusing the other of deceptive tactics to manipulate Ohio voters. What to believe? (Troy, 7/24)

The Associated Press: ‘Pharma Bro’ Won’t Stop Talking, Except To Jury In Trial
“Pharma Bro” Martin Shkreli has kept up his trademark trolling on social media during his securities fraud trial — calling the case “bogus” — but the jury won’t hear him defend himself in court. The government’s last witness testified on Tuesday, a day after a lawyer for the former biotech CEO told the court that his client had chosen not to take the witness stand. Closing arguments are expected later this week. (Hays, 7/26)

Stat: Proposed Rule To Bolster Safety Data On Generic Drug Labels May Be Dead
Once again, a controversial rule for updating generic drug labeling is being postponed, but this time, its chances of being implemented appear slimmer than ever, according to consumer advocates. The rule was proposed four years ago by the Food and Drug Administration in an effort to bolster patient safety. Specifically, the rule would allow generic drug makers to independently update safety warnings, something only brand-name drug makers can currently do before receiving FDA permission. (Silverman, 7/24)

Marketplace: Drug Prices: How Generics Changed The Game
For a time, high drug prices made headlines, and it looked like the issue could be tackled by the Trump administration. But as we all know, efforts to repeal Obamacare have consumed Republicans much of this year. The drug problem hasn’t gone away; it’s just lingering in the background. Even the cost of some generic drugs are rising. (Gornstein, 7/25)

CQ Roll Call: FDA Notice Buys Senate More Time On User Fee Bill
The Food and Drug Administration will delay issuing furlough notices to employees whose salaries depend on congressional action renewing the agency’s fee-collection authority, FDA Commissioner Scott Gottlieb announced Monday in an email obtained by CQ. Gottlieb’s announcement effectively gives Congress until Sept. 30 to pass a bill that would provide the agency with about $1.4 billion in annual funding through fiscal 2022 from the prescription drug and medical device industries. That money mostly goes to the salaries of employees who review medical product applications. Lawmakers previously believed the agency would begin issuing furlough notices 60 days before funding lapsed on Sept. 30, and were aiming to finish work on the bill by late July. (Siddons, 7/24)

Stat: How Do You Measure Value In A Drug — Or Anything Else In Medicine?
At a swanky hotel in the Theatre District, about a dozen health policy experts and drug development academics gathered Wednesday to talk drug pricing. Speakers on the Manhattan Institute-curated panel see a future where the amount of money people pay for pharmaceuticals has something to do with how much “value” they provide — but seemed to have more questions than answers about what that actually means. (Swetlitz, 7/19)

The New York Times: Celgene To Pay $280 Million To Settle Fraud Suit Over Cancer Drugs
The pharmaceutical company Celgene has agreed to pay $280 million to settle claims that it marketed the cancer drugs Thalomid and Revlimid for unapproved uses, the company said on Tuesday. Under the terms of the settlement, which resulted from a lawsuit filed by a whistle-blower — a former sales representative at Celgene — the company will pay $259.3 million to the United States and $20.7 million to 28 states and the District of Columbia. (Thomas, 7/25)

Stat: A New HIV Drug’s Strong Results Give A Big Boost To Gilead Sciences
An experimental HIV pill from Gilead Sciences suppressed the virus in newly diagnosed patients at a rate statistically equivalent to that of a similar, rival drug from GlaxoSmithKline, according to results from a late-stage clinical trial presented Monday. The positive data supporting Gilead’s new HIV pill, a second-generation integrase inhibitor called bictegravir, are vitally important to the Foster City, Calif.-based biotech company. Sales of Gilead’s hepatitis C drugs are falling and its oncology pipeline has largely disappointed, so the company is once again reliant on its HIV business for the majority of its profits. (Feuerstein, 7/24)

Stat: AbbVie Must Pay $150 Million For Misleading AndroGel Marketing
In a split decision, a federal jury in Chicago ordered AbbVie to pay $150 million in punitive damages for fraudulently misrepresenting the risks of its AndroGel testosterone replacement drug. But at the same time, the jury decided the drug maker was not liable for a heart attack that the plaintiff, Jesse Mitchell, suffered after taking the medication. The trial was the first in an estimated 6,000 lawsuits that the drug maker faces over its controversial marketing, which warned that low testosterone can interfere with sex drive, moods, and energy levels. However, the increased usage was accompanied by dueling medical studies — and subsequent debate — over the extent to which AndroGel and other such drugs could increase cardiovascular risks. (Silverman, 7/24)

Boston Globe: Vertex Reports Strong Findings From Cystic Fibrosis Drug Trials
Vertex Pharmaceuticals Inc. on Tuesday released clinical findings showing its new approach to combating cystic fibrosis substantially improved lung function in patients, lifting hopes for a treatment that could be used by about 68,000 people worldwide — including 24,000 who don’t respond to any existing medicines. The results prompted Boston-based Vertex to say it plans to launch one or two late-stage clinical trials of the biotech’s three-drug combination in the first half of next year. (Weisman, 7/18)

Stat: Merck: Keytruda Trial Comes Up Short In Head And Neck Cancer, But FDA Approval Stays
Merck’s checkpoint inhibitor Keytruda doesn’t help patients with advanced head and neck cancer live longer, but the failed phase 3 clinical trial, announced Monday night, won’t compel the FDA to rescind the drug’s conditional approval, the company said. And with that, the pile of evidence pointing towards FDA’s extreme flexibility when it comes to easy drug approvals grows even larger. (Feuerstein, 7/24)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Ideas About Issues: The Right Answers On Health Policy Are Beyond Politics; Could The Free Market Deliver A Solution?

Columnists offer thoughts on these issues as well as who has gained ground with Obamacare, how self-employed people are bracing for change and the future of single-payer concepts.

The Columbus Dispatch: Cast Aside Politics, Get Health Care Right
If you want to know what’s wrong with the never-ending political battle being fought in Washington to get rid of the Affordable Care Act, look no further than the lives, families, and communities that have been destroyed by opioid addiction all across America. Opioid addiction is a crisis ripping the heart out of our country. And every plan that’s been put forward by the Republican leadership in Congress takes a blow torch to the most important preventive care and treatment that’s currently covered by health insurance for those caught in the grip of addiction. If the Republicans get their way, that coverage goes away, and with it goes the best hope — and maybe the only real hope — that families and communities have to overcome the ravages of this terrible disease. (Joe Biden, 7/25)

Bloomberg: Obamacare’s Big Win: It Helps Some People Be A Little Less Poor
There are some eternal debates that may never be settled. If there is a God, why does God allow evil in the world? Great taste, or less filling? And of course, does Medicaid make people healthier? I’m not going to rehash that last debate here, which I have covered many times. Suffice it to say that while liberals insist that the evidence is clear that health insurance expansions improve physical health, at least modestly, I do not see that the evidence warrants the confidence they exude. The intuitive sense that this ought to be correct seems to me to be doing a lot of heavy lifting in these evaluations. In health care, our intuitions are often wrong. (Megan McArdle, 7/24)

Modern Healthcare: Self-Employed People Weigh Returning To Corporate Jobs If Senate Passes ACA Repeal Bill
Steven DeMaio of New York City has been happily self-employed as a writer and editor since 2008. At that time, he felt comfortable leaving a corporate job with health benefits and going out on his own because the state where he then lived, Massachusetts, had established a system guaranteeing affordable individual-market coverage without regard to health status. But DeMaio, 46, recently decided to look for a corporate job with health benefits because of uncertainty over the future of his health insurance posed by Republican efforts to repeal and replace the Affordable Care Act. As of Aug. 1, he will begin working for a company that offers a group health plan. (Harris Meyer, 7/24)

RealClear Health: Single-Payer Health Care Looms As 2020 Campaign Issue
With 115 co-sponsors, a House bill that calls for single-payer health insurance now enjoys majority Democratic support in the lower chamber. Paired with Bernie Sanders’ presidential campaign, which helped bring national attention to the issue, some observers say that a single-payer push may become part of Democrats’ platform in 2020. (Ford Carson, 7/25)

Los Angeles Times: Single Payer Can’t Happen In California. At Least, Not Right Away
Given the dismal state of healthcare reform in Washington, liberal Californians have rallied around the idea that the state should establish a single-payer program. Although in the future such a system would be workable and desirable, the reality is that at the moment a single-payer bill cannot pass. Fighting for one in the immediate term is a waste of time. Financing, first of all, is a heavy lift. In addition to higher state taxes, California would need to channel Medicare and other federal healthcare funding into the single-payer system. Before it can do that, Congress must pass a waiver and the president must sign it — which isn’t going to happen while Donald Trump is in office. (Steve Tarzynski, 7/25)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

State Highlights: In Special Session, Texas Senate Takes Up Abortion Bills; Ohio’s Cost Transparency Law Stalls Amidst Strong Opposition

Media outlets report on news from Texas, Ohio, Pennsylvania, Minnesota, California, Tennessee, Florida, Maryland and Kansas.

Texas Tribune: Texas Senate Tackles Special Session Abortion Bills
Under state Sen. Donna Campbell’s Senate Bill 10, in procedures where complications occur, physicians would be required, within 72 hours, to submit reports to the state health commission that include detailed information like the patient’s year of birth, race, marital status, state and county of residence, the date of her last menstrual cycle, the number of previous abortions, and the number of previous live births. Physicians who failed to comply with the reporting requirements would face a $500 fine for each day of each violation. (Smith, 7/24)

Texas Tribune: Texas Senate OKs Maternal Mortality Task Force
State senators on Monday tentatively approved a bill that would give a state task force more time to study why an alarming number of Texas mothers are dying less than a year after childbirth. Under Senate Bill 17, the state’s Task Force on Maternal Mortality and Morbidity would be able to continue its work until 2023. (Evans, 7/24)

Kaiser Health News: Price Transparency In Medicine Faces Stiff Opposition — From Hospitals And Doctors
Two years after it passed unanimously in Ohio’s state Legislature, a law meant to inform patients what health care procedures will cost is in a state of suspended animation. One of the most stringent in a group of similar state laws being proposed across the country, Ohio’s Healthcare Price Transparency Law stipulated that providers had to give patients a “good faith” estimate of what non-emergency services would cost individuals after insurance before they commenced treatment. (Bluth, 7/25)

The Philadelphia Inquirer/Philly.com: New Five-Year Contract Between Independence And Jefferson
Independence Blue Cross is pushing for new contracts with area health systems that accelerate the hoped-for transition from paying for volume of services to paying for positive results. But it is not taking a one-size-fits-all approach. “We need to adapt to different providers” because they have “different states of readiness,” Anthony V. Coletta, president of Facilitated Health Networks at Independence, said Monday after the announcement of a contract with Jefferson Health that starts Sept. 1 and will last five years. (Brubaker, 7/24)

The Star Tribune: Minneapolis Proposal To Restrict Menthol Tobacco Sales Sparks Debate
While public health advocates pushed for the restrictions at a packed public hearing — arguing that tobacco companies target black smokers and young people with menthol products — Minneapolis store owners said it’s the latest example of City Hall overreach and would devastate their livelihoods. …The City Council heard from dozens of speakers Monday in crowded council chambers and is expected to vote on the policy in August. (Belz, 7/24)

San Francisco Chronicle: Jahi McMath’s Family Wins Backing For Argument That She’s Alive
It’s been more than three years since 13-year-old Jahi McMath was declared dead after something went terribly wrong following throat surgery at Children’s Hospital Oakland. Her family has never accepted the declaration and has kept her on life support ever since — and in a new twist, a prominent neurologist says recent videos of the girl show she is alive, with a partially functioning brain. (Johnson, 7/24)

The Philadelphia Inquirer/Philly.com: Horizon Blue Cross Ordered To Turn Over Omnia Documents
The New Jersey Supreme Court on Monday ordered Horizon Blue Cross Blue Shield, the state’s largest health insurer, to turn over a McKinsey & Co. report and other documents it used to establish two tiers of health systems for an insurance plan introduced in 2015. Providers in the second tier, including Capital Health System Inc. and St. Peter’s University Hospital Inc., sued, alleging that Horizon treated them unfairly and breached their contracts when it set up the tiers for its Omnia insurance plan. At the seven Tier One health systems in the Omnia Health Alliance consumers have lower out-of-pocket costs. (Brubaker, 7/24)

Texas Tribune: Texas To Lose Galveston And Hill Country Children’s Therapy Providers
Children in the Galveston and Hill Country areas are going to be without state-funded speech, occupational and physical therapy services as two more providers prepare to leave the Early Childhood Intervention program. The Texas Health and Human Services Commission confirmed Monday that the University of Texas Medical Branch and Hill Country MHDD Centers are ending services through the program. (Evans, 7/24)

Nashville Tennessean: Children’s ER At TriStar Centennial Opens
A new children’s emergency room in Nashville — the city’s second — is now seeing patients. The first patient at The Children’s Hospital at TriStar Centennial arrived at 9:21 a.m. on July 24 to the new seven-bed, 6,000-square foot facility on the hospital’s campus in Midtown Nashville. (Fletcher, 7/24)

Columbus Dispatch: Mount Carmel Adding 80 Beds For Mental-Health Treatment
Mount Carmel Health System and Acadia Healthcare announced on Monday that they are teaming up to open an 80-bed inpatient behavioral health hospital in Columbus to replace a 20-bed hospital at Mount Carmel West hospital in Franklinton. Officials say they are still finalizing a site for the $26 million, 64,300-square-foot freestanding facility that will have units for adult and geriatric patients as well as for dual-diagnosis patients — those who are suffering from both mental-health and drug-addiction illnesses. (Viviano, 7/25)

The Baltimore Sun: CVS Opens First Maryland Hearing Center
CVS Pharmacy opened its first Maryland hearing center in an Ellicott City store, as part of the drug store chain’s move to capture more health related business in its retail outlets. The store, which sells and services hearing aids, is staffed by audiologists and can provide hearing screenings and fittings. Insurance is accepted for some services. (Cohn, 7/24)

Cleveland Plain Dealer: Johnson Amends Cleveland ‘Lead Safe’ Law Proposal To Exclude Owner-Occupied Homes
Cleveland City Councilman Jeff Johnson, after hearing from a slew of residents said today he’s changing the ‘Lead Safe’ ordinance he plans to propose next month so that it excludes mandatory compliance and fines for homeowners who live in their properties. The ordinance — which proposes that all city homes built before 1978 be certified safe from lead hazards by 2021 — would still apply to rentals and apartments, which comprise the majority of the city’s homes, as well as child care centers and schools constructed prior to 1978, Johnson said. (Dissell and Zeltner, 7/24)

KCUR: Safety Net Clinic To Reopen Facility In Quindaro Neighborhood 
Southwest Boulevard Family Health Care, a safety net clinic in Kansas City, Kansas, will reopen its Quindaro facility after several years’ hiatus. The satellite clinic will be located in a church building owned by Family Health Care. Initially, it will be open a couple of half-days per week and, depending on demand, may increase its hours of operation. (Margolies, 7/24)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Price Transparency In Medicine Faces Stiff Opposition — From Hospitals And Doctors

COLUMBUS, Ohio — Two years after it passed unanimously in Ohio’s state Legislature, a law meant to inform patients what health care procedures will cost is in a state of suspended animation.

One of the most stringent in a group of similar state laws being proposed across the country, Ohio’s Healthcare Price Transparency Law stipulated that providers had to give patients a “good faith” estimate of what non-emergency services would cost individuals after insurance before they commenced treatment.

But the law didn’t go into force on Jan. 1 as scheduled. And its troubled odyssey illustrates the political and business forces opposing a common-sense but controversial solution to rein in high health care costs for patients: Let patients see prices.

Many patient advocates say such transparency would be helpful for patients, allowing them to shop around for some services to hold down out-of-pocket costs, as well as adjust their household budgets for upcoming health-related outlays at a time of high-deductible plans.

At the Ohio Statehouse, the law’s greatest champion in state government has been Rep. Jim Butler, a Republican and former Navy fighter pilot whose wife is a physician. He authored the legislation and has beat the drum for it since he got the idea in 2013, as he waited for a garage mechanic to repair his car and absorbed the shop’s posted rates for brake jobs, oil changes and tuneups.

Opposition has been formidable, led by the goliath Ohio Hospital Association. It has filed a court injunction that is currently delaying enactment, peppered local news media with editorials, and lobbied Republican Gov. John Kasich, who has eliminated funding that would allow implementation from the latest state budget.

Joining the hospital association in its legal action are a wide range of provider groups including the Ohio State Medical Association, the Ohio Psychological Association, the Ohio Physical Therapy Association, and the Ohio chapters of the American Academy of Pediatrics, the American College of Surgeons, and the American Osteopathic Association.

These groups say that the law, which applies only to elective procedures, is too broad and that forcing providers to create estimates before procedures would slow down patient care. “The only way to even try to comply with the law is to delay care to patients in order to track down information from insurance companies, who may or may not provide the requested information,” wrote Mike Abrams, the president and CEO of the Ohio Hospital Association, in an op-ed in The Columbus Dispatch in January.

But Jerry Friedman, a retired health policy adviser for the Ohio State University Wexner Medical Center, said the opposition doesn’t stem from genuine concern about patients but from a desire to keep the secret rates that providers have negotiated with insurers under wraps. Transparency would mean explaining to consumers why the hospital charged them $1,000 for a test, he said, adding that providers “don’t want to expose this house of cards they’ve built between hospital physician industry and the insurance industry.”

Ohio State Rep. Jim Butler (Chris Stewart/Courtesy of the Dayton Daily News)

Said Butler on his quest to see the law enacted: “The health care industry has a lot of political power and lots of money. It’s hard to fight on behalf of people against this kind of force.”

The law’s next test will come in August, when the first court hearing on the association’s lawsuit is scheduled. The Kasich administration said it couldn’t comment on the law because of the pending litigation.

Greater price transparency has been a popular policy prescription for America’s high health costs, especially at a time when many patients have high-deductible insurance plans and face larger copayments. Upfront estimates exist in other countries, such as Australia and, for patients facing out-of-pocket expenses, in France.

In Massachusetts, patients can get an estimate within two days of admission if they ask for it. Nebraska requires hospitals and surgical centers to provide a list of the average charges for services. New Hampshire has a website where consumers can compare costs.

Hospitals and doctors often oppose such measures. The American Hospital Association’s position is that health plans — not hospitals — are responsible for telling insured patients about their out-of-pocket costs, according to its website.

Aimee Winteregg, 35, of Troy, Ohio, said she would have liked such information before five miscarriages in four years left her buried in unexpected medical bills. She and her husband became first-time parents in November. Though they are well insured, tests and treatment cost the couple $4,000 out-of-pocket, demanded in bills that were sometimes no more descriptive than for “medical service.”

“We don’t want to deal with this, especially when the doctor tells you stress is bad for the pregnancy,” her husband, J.D., said. But imposing greater transparency has been controversial in both the medical industry and among some health care researchers, who say it puts patients in an untenable position.

The transparency law “was written by someone thinking about health care as a TV, and not as health care,” said Sandra Tanenbaum, a professor of health services management and policy at The Ohio State University College of Public Health.

She said people could not shop for procedures as they would for a TV or car repairs, since they often lack information on the quality of doctors and hospitals, and make health care decisions based on much more than cost.

Consumers are more likely to base their decisions on their doctors’ advice, not on cost alone, according to a report from the Health Policy Institute of Ohio.

Only around 10 percent of health care costs are even “shoppable” expenses — procedures that can be scheduled in advance, like an MRI or elective surgery — according to the HPIO.

Regardless, Butler maintains, the health care industry can give consumers better information upfront. “If you really want patients to be empowered, they really need the information,” he said.

In support of such access, Butler has written letters to the Ohio Hospital Association, the Ohio attorney general and the Dayton Daily News, all in defense of the transparency law.

The Ohio Hospital Association, along with seven other Ohio health organizations, went to court last December to block the law, a month before it was supposed to take effect.

Butler said Gov. Kasich’s administration is helping the hospital association stall by not writing regulations, eliminating funding for the law in the state budget, and declining to meet with Butler to discuss it.

State Rep. Michael Henne, also a Republican, has worked with Butler in the Ohio General Assembly on the transparency law. He called Butler a “driver” on the law, noting: “It’s frustrating. You don’t realize how much [influence] special interests have in the process.”

Categories: Cost and Quality, Health Care Costs, Health Industry, Insurance

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The Big Picture: The Health Issues We Should Be Discussing; How To Move The Debate Forward

Even as the heated discourse over the future of the Affordable Care Act continues, some people offer their thoughts on the serious issues that are being overlooked and on how bad manners have soured the process.

Boston Globe: The Health Care Debate We Should Be Having
Most of the life expectancy gains of the last century can be chalked up to what we call public health, a catch-all term for those interventions aimed not at a single patient, but at a whole community or the entire population. …Which helps explain the great riddle of American health care: How come we spend more than everyone else, yet generally have worse outcomes? We overspend on medical care and underinvest in public health. (Horowitz, 7/22)

St. Louis Post-Dispatch: Collapse To Compromise: A Better Way To Health Care Reform
Republicans and Democrats disagree about the role of government; the trade-off between individual freedom and societal good; and about money and taxes. These long-standing disagreements play out repeatedly on the national stage, and today, health care is front and center. On our present course, these disagreements will turn our health care system upside down every time we vote to change party control of the White House and the Congress. (Steven H. Lipstein, 7/23)

The Washington Post: The GOP Cannot Fix Itself — Let Alone American Health Care
The inability of a Republican Congress and a Republican president to repeal Obamacare, or even just dial it back, is yet the latest demonstration that Republicans simply aren’t ready to govern. The facile explanation for this is the unresolved division, within the party, between its radical tea party populist wing and its more moderate, business-friendly establishment wing. But the bigger issue is that the party’s elected politicians are unwilling to make the trade-offs that are the essence of what governing is about. (Steven Pearlstein, 7/23)

The Washington Post: How Health Care Controls Us
If we learned anything from the bitter debate over the Affordable Care Act (Obamacare) — which seems doubtful — it is that we cannot discuss health care in a way that is at once compassionate and rational. This is a significant failure, because providing and financing health care have become, over the past half-century, the principal activity of the federal government. (Robert J. Samuelson, 7/23)

Huffington Post: Former CBO Directors Express ‘Strong Objection’ To GOP Attacks On Agency
Every economist who has previously served as director of the Congressional Budget Office has signed a letter registering “strong objection to recent attacks” on the agency. The letter, sent Friday morning and addressed to congressional leaders, does not specify who has been making those attacks. But only one political party is attacking the CBO right now ― and only one party has so brazenly questioned the agency’s methods to draw this kind of response from such a distinguished, bipartisan group of economists. It’s the Republicans, because they don’t like what the CBO has been saying about GOP proposals to repeal the Affordable Care Act. (Jonathan Cohn, 7/21)

Roll Call: How Bad Political Manners Fomented The Health Care Mess
[I]t’s not surprising that a secretive, churlish and entirely-outside-the-normal-channels approach has, from the start, distinguished [Senate Majority Leader Mitch McConnell’s] balky and now repudiated tackling of the defining legislative battle of Trump’s first year. Straightforward legislative etiquette would have required at least a few hearings and legislative markups on health care where Democrats could have gone on record in opposition and Republican skeptics, on the hard right and in the center, could have vented concerns and offered mollifying language — long before spreading anxieties at both ends of the GOP ideological spectrum crippled the bill. (David Hawkings, 7/24)

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In Appalachia, Two Hospital Giants Seek State-Sanctioned Monopoly

JOHNSON CITY, Tenn. — Looking out a fourth-floor window of his hospital system’s headquarters, Alan Levine can see the Appalachian Mountains that have defined this hardscrabble region for generations.

What gets the CEO’s attention, though, is neither the steep hills in the distance nor one of his Mountain States Health Alliance hospitals across the parking lot. Rather, it’s a nearby shopping center where his main rival ­— Wellmont Health System, which owns seven area hospitals — runs an urgent care and outpatient cancer center. Mountain States offers the same services just up the road.

“Money is being wasted,” Levine said, noting that duplication of medical services is common throughout northeastern Tennessee and southwestern Virginia where Mountain States and Wellmont have been in a health care “arms race” for years, each trying to outduel the other for the doctors and services that will bring in business.

The companies now want to merge, which would create a monopoly on hospital care in a 13-county region that studies have placed among the nation’s least healthy places. The merger’s savings would pay for a range of public health services that they can’t afford now, the companies project. And they are trying to pull it off without Washington regulators’ approval, breaking with hospitals’ usual path to consolidation.

In a typical case, a plan that eliminates so much competition in a market would almost certainly provoke a court battle with the Federal Trade Commission, which enforces antitrust laws and challenges anti-competitive behavior in the health industry.

To avert such a fight, the hospitals are using an obscure legal maneuver available in Tennessee and Virginia and some other states.

The view of mountains is everywhere in Johnson City, Tenn. (Phil Galewitz/KHN)

Generally known as a Certificate of Public Agreement (COPA), the process works like this: If regulators in Virginia and Tennessee agree that the merger is in the public interest, Wellmont and Mountain States would operate as one company under a state-supervised agreement governing key parts of their operations, including setting prices. The states’ approval would prevent the FTC from challenging the merger under federal antitrust law.

Their decisions could come as soon as this month.

In exchange for approval, Mountain States and Wellmont promise to use money saved from the merger to offer mental health and addiction treatment services and attack public health concerns, such as obesity and smoking — areas previously neglected by the systems that don’t increase hospital admissions and bring in big revenue, hospital officials said

“The question that needs to be asked is whether tight state oversight of a monopoly is better than failed competition,” said Robert Berenson, a health policy expert at the Urban Institute.

Little-Used And Rarely Challenged Mechanism

The federal antitrust exemption made possible under a COPA dates to a Supreme Court ruling in the 1940s used only about a dozen times to allow hospital mergers. One was an hour away from here, in Asheville, N.C.

There’s little scholarly research on COPAs’ results.

Last summer, the FTC dropped its challenge to a merger of two West Virginia hospitals after the state adopted a COPA law and permitted the deal.

In recent years, hospital mergers and acquisitions have created behemoth health systems that have used their status to demand high payments from insurers and patients. Studies by health economists have repeatedly found that consolidation means higher prices.

But the same calculus may not apply here and in other regions where a preponderance of patients are poor or uninsured, officials from both Mountain States and Wellmont say.

While President Donald Trump and Republicans in Congress stress the value of free-market principles in health care, both hospitals argue that in their part of Appalachia the market has led to unnecessary spending, driven up health costs and forced them to focus on services that produce the highest profits rather than meet the community’s most pressing health needs. In this deeply conservative region where death rates from cancer and heart disease are among the nation’s highest, the hospitals say only a state-sanctioned monopoly can help them control rising prices and improve their population’s health.

Without their proposed merger, Levine said, both hospital systems would likely have to sell to an out-of-market chain. That would likely eliminate local control of the facilities and could lead to massive layoffs and the closure of hospitals and services, he said. Together, the two hospital systems employ about 17,000 people.

Alan Levine, CEO of Mountain States Health Alliance, outside his Johnson City, Tenn., office. (Phil Galewitz/KHN)

The FTC, which is urging the states to reject the hospitals’ plan, contends the hospitals could form an alliance or take other steps short of a merger to accomplish the benefits they say one will bring. The agency says the hospitals’ market probably would be no worse off if one chain merged with a company outside the area.

Feds Wary Of Promises

The hospitals are making big promises to sell their deal. They say no hospitals would close for at least five years, although some could be converted to specialized health facilities to treat problems such as mental health or drug addiction. After the merger, all qualified doctors would have staff privileges at all hospitals to treat patients. No insurer would pay lower rates than others. The new hospital system would spend at least $160 million over 10 years to improve public health, expand medical research and support graduate medical education for work in rural areas.

The FTC maintains the hospitals’ pledges are unreliable and dismissed them as having “significant shortcomings, gaps and ambiguities” in an analysis filed with state regulators in January.

Levine said the plan is the best deal for the community given the factors that handicap the hospitals. Those include declining populations and Medicare reimbursement rates that are lower here than other parts of the country because of lower average wages. Another concern is the cost of caring for uninsured people — neither Virginia nor Tennessee expanded Medicaid under the health law, which would have lowered uninsured rates.

“Competition is and should be the first choice, but in an area where competition becomes irrational and there are limited choices, there has to be a Plan B. If not this, then what?” he said.

Blue Cross and Blue Shield of Tennessee, the state’s largest health insurer, is not opposing the hospitals’ combination, a spokesman said. But its counterpart in Virginia, Anthem, hasn’t been persuaded.

“Anthem does not believe that there are any commitments that will protect Southwest Virginia and Northeast Tennessee health care consumers from the negative impact of a state-sanctioned monopoly,” the company said in a statement.

Wanted: Better Job Prospects

The proposed COPA has strong support among large employers in the region, including Eastman, a Kingsport, Tenn., chemical company with $9 billion in annual revenue that employs more than 7,000 people locally. “We get local governance, input and control … and that’s a lot better situation for us,” said David Golden, a senior vice president at Eastman.

Still, walking around Johnson City — the region’s largest city with almost 67,000 people — it’s easy to feel an unease among small employers and residents about a merger. Many worry about possible job cuts.

“Eliminating duplication of services means eliminating people,” said Dick Nelson, 60, who runs a coffee and art shop downtown and has lived here for 27 years. “I don’t care how much health care costs because my insurance will pay it,” he said.

In Kingsport, where Wellmont and Mountain States each has a hospital, Thorp is leery about a merger, too. “It’s an economic move, not an enhancement of medical care,” said Thorp, who runs a newsstand downtown. “We pride ourselves here for having good education and health care. They say there won’t be any services or jobs cut, but if that’s the case then what’s the point of the merger?”

Tom Throp owns Wallace News, a staple in downtown Kingsport, Tenn. Of the hospital consolidation plan, he says: “They say there won’t be any services or jobs cut, but if that’s the case then what’s the point of the merger?” (Phil Galewitz/KHN)

Levine said no place better supports the case for a hospital merger than Wise County in southwestern Virginia, a scenic area with about 40,000 people whose three hospitals all operate below half their capacity. Mountain States and Wellmont each own a hospital in Norton, the county seat with 4,000 residents. Despite few patients, the hospitals still bear hard-to-cut costs for buildings, equipment and adequate staffing levels, Levine said.

On a recent weekday morning, Lonesome Pine Hospital, a Wellmont facility in Big Stone Gap, Va., looked nearly deserted. No volunteers or staffers were visible inside its main entrance and fewer than a fifth of its 70 acute-care beds were being used.

A five-minute drive away, Mountain States’ Norton Community Hospital’s 129 beds are about a quarter filled. Its maternity unit delivers fewer than five babies a week. The hospital offers hyperbaric oxygen therapy — a treatment that pays well under Medicare’s reimbursement rates — to help diabetics heal their wounds. But it has no endocrinologists to help diabetics manage their disease to avoid such complications. Despite a high rate of heart disease in the community, there’s no cardiologist on staff.

Whether a state-sanctioned merger will resolve the incongruities — here or in other poor regions — depends on how firmly regulators hold the hospitals to their pre-merger commitments. If the merger plan gets rejected, Mountain States and Wellmont will resume arch-competitive business practices that do not always put community interests first, said Bart Hove, Wellmont’s CEO.

“It’s about competing for the dollar in any way you can and extracting a dollar from your competition,” Hove said. “You do what you can to drive patients to your hospital.”

Categories: Cost and Quality, Health Care Costs, Health Industry

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Policy Positions: Health Spending Is ‘The American Way’; What Becomes Of Medicare; And Does Universal Health Care Equal Freedom?

Media outlets explore important health policy questions.

Bloomberg: Spending A Lot On Health Care Is The American Way
The U.S. has some of the most expensive medicine in the world, with health-care spending now almost 18 percent of gross domestic product. But why? And might we hope to get this spending down? Unfortunately, expensive health care is embedded in the American way of life — more specifically, the American desire to live it up with high consumption. (Tyler Cowen, 7/20)

Forbes: How GOP Will Still Carve Up Medicare
The rehashed House GOP budget blueprint wants to reshape Medicare into more of a Medicare Advantage model, which now covers some 19 million Americans. What does that mean? Funding for the guaranteed part of Medicare would be shifted into the privatized scheme. You’d receive a fixed stipend or “premium support” to buy a private policy on an exchange. (John Wasik, 7/19)

USA Today: Dear America, Universal Health Care Is What Real Freedom Looks Like
In 1991, after nearly 10 years of recurring wracking pain in my lower abdomen, I walked into a hospital in Helsinki, Finland. I wasn’t a Finnish citizen and wasn’t, at that time, married to one. I was an American writer visiting my Finnish boyfriend, working temporarily in Helsinki. An admitting nurse listened to my symptoms and guessed my problem — a diagnosis that received preliminary confirmation by ultrasound within the hour. (Anne Korkeakivi, 7/20)

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Perspectives: End The ‘War On Medicaid’; Keep Eyes On Medicaid In Congressional Health Debate

Opinion writers examine Medicaid’s role in the current effort to replace the health law as well as ideas about controlling the program’s costs, ethical issues related to spending down assets to qualify for it and other provocative topics.

Morning Consult: Time To End The War On Medicaid
Any cuts to Medicaid would be devastating. Changing Medicaid from an entitlement into a state-based per capita grant program will cause permanent and growing damage to people’s health and the ability of our nation to respond to natural or economic disaster. Medicaid is the backbone of health coverage in America. One in two Americans will need Medicaid at some point during their lifetimes. Medicaid provides for healthy births and assistance for older people to be able to remain in their homes. Today, Medicaid is also there to help many thousands of people who lose their jobs in the aftermath of unforeseen disasters like recessions or hurricanes. Similarly, when an outbreak of illness occurs, Medicaid is there to provide coverage for needed care. (Doug Wirth, 7/20)

The Washington Post: Don’t Get Distracted: The GOP’s Cruel Health-Care Plan Isn’t Dead Yet
Focus, America, focus. The most urgent task right now is to make sure a stake is driven through the heart of the Republican effort to gut Medicaid and balloon the ranks of the uninsured. I know that the Russia investigations are charging ahead, with Capitol Hill appearances by members of President Trump’s inner circle scheduled for next week. I know that Trump gave an unhinged interview to the New York Times on Wednesday, bizarrely undermining his own attorney general. I know that one of the few remaining giants in Washington, Sen. John McCain (R-Ariz.), has received a tough medical diagnosis. (Eugene Robinson, 7/20)

The New England Journal Of Medicine: Controlling The Cost Of Medicaid
The federal–state Medicaid program is facing the possibility of the largest and most consequential changes to its funding since its inception in 1965. The American Health Care Act (AHCA), H.R. 1628, as adopted by the House of Representatives on May 4, would replace the current federal matching program for Medicaid with a per capita cap on federal funds. This cap would limit the growth of these funds to the growth rate of the medical care component of the Consumer Price Index, with an additional 1% growth allowed for older adult and disabled Medicaid enrollees. The Congressional Budget Office has projected that this policy would result in federal funding reductions of more than $800 billion over the next 10 years, equivalent to a 26% reduction in federal support by 2026. These large reductions represent an unprecedented shift of financial risk to the states. Missing from the debate has been consideration of policies that could improve the value of the Medicaid program, controlling Medicaid spending without diminishing coverage or quality. (K. John McConnell and Michael E. Chernew, 7/20)

The New York Times: The Ethics Of Adjusting Your Assets To Qualify For Medicaid
Whatever twists and turns the health insurance debates in Washington take, Medicaid will be at the center, and the program will probably affect you and your family more than you know. After all, if you run out of money in retirement, it is Medicaid that pays for most of your nursing home or home-based care. (Ron Lieber, 7/21)

Morning Consult: The Value Of A Human Life
As you can see, not only does McConnell’s BCRA dramatically roll back funding for hospitals and insurance companies to cover more people, and slash funding for Medicaid — a program which disproportionately helps poor and low-income Americans — but it also devalues human life as a whole. And with the value of a life now redefined, will Senate Republicans next move to make massive cuts to the Transportation Department highway safety programs, or the Food and Drug Administration’s food safety programs? (Dr. J. Mario Molina, 7/21)

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Research Roundup: Early Hospice Discharges Turn Profits; Integrating Mental Health Care

Each week, KHN compiles a selection of recently released health policy studies and briefs.

Health Affairs: A Positive Association Between Hospice Profit Margin And The Rate At Which Patients Are Discharged Before Death
Although certain live discharges are consistent with high-quality care, regulators have expressed concern that some hospices’ desire to maximize profits drives them to inappropriately discharge patients… Adjusted analyses showed positive and significant associations between both operating and total margins and hospice-level rates of live discharge: One-unit increases in operating and total margin were associated with increases of 3 percent and 4 percent in expected hospice-level live discharge rates, respectively. (Dolin et. al., 7/1)

Health Affairs: Medicare Advantage Associated With More Racial Disparity Than Traditional Medicare For Hospital Readmissions
We compared racial disparities in thirty-day readmissions between traditional Medicare and Medicare Advantage beneficiaries who underwent one of six major surgeries in New York State in 2013. We found that Medicare Advantage was associated with greater racial disparity, compared to traditional Medicare. After controlling for patient, hospital, and geographic characteristics in a propensity score based approach, we found that in traditional Medicare, black patients were 33 percent more likely than white patients to be readmitted, whereas in Medicare Advantage, black patients were 64 percent more likely than white patients to be readmitted. (Li et. al., 7/1)

RAND: Possible Legal Barriers For PCP Access To Mental Health Treatment Records
Provider and payer groups have endorsed the goal of improving the integration of primary care and behavioral health across a variety of programs and settings… Preliminary investigation found that in almost one third of the states (including large-population states such as Florida, Georgia, Massachusetts, New York, and Texas), primary care physicians (PCPs) may have difficulty accessing mental health treatment records without the patient’s (or his/her guardian/conservator’s) written consent. If a comprehensive legal analysis supports this conclusion, then those advocating integration of behavioral and primary care may need to consider seeking appropriate state legislative solutions. (Rothenberg et. al., 7/19)

New England Journal of Medicine: Implementation Of Medical Homes In Federally Qualified Health Centers 
We examined the achievement of medical-home recognition and used Medicare claims and beneficiary surveys to measure utilization of services, quality of care, patients’ experiences, and Medicare expenditures in demonstration sites versus comparison sites… Demonstration sites had higher rates of medical-home recognition and smaller decreases in the number of patients’ visits to federally qualified health centers than did comparison sites, findings that may reflect better access to primary care relative to comparison sites. (Timbie et. al., 7/20)

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Analyzing McConnell’s Health Plan Strategery: A Hail Mary Pass? Is The Game Over?

Opinion writers across the country take a hard look at the legislative tactics employed this week by Senate Majority Leader Mitch McConnell (R-Ky.) as his party’s health plan unraveled.

Bloomberg: A Chance For A New Beginning On Health Care
They may have avoided the ditch, but Republicans have driven themselves into a cul-de-sac. After the failure in the Senate of their disastrous plan to replace Obamacare, Majority Leader Mitch McConnell now promises to make his colleagues vote instead on just a repeal of the Affordable Care Act. (7/18)

The Washington Post: McConnell’s Health-Care Hail Mary
To paraphrase Mark Twain, reports of the death of Republican health-care reform are greatly exaggerated. Far from throwing in the towel, as some have reported, Senate Majority Leader Mitch McConnell is actually throwing a final Hail Mary pass in an effort to pass the Senate Republicans’ Better Care Reconciliation Act (BCRA). And he’s found an extremely clever way to do it. (Marc A. Thiessen, 7/18)

San Jose Mercury News: The Game Is Not Over For Mitch McConnell
McConnell’s biggest challenge was getting 50 Republican senators to agree to vote for a “motion to proceed” on a bill that they disagreed with — knowing that it was unlikely to be amended in ways that would make a difference to their final votes given the split between Republican conservatives and moderates and given the Democrats’ refusal to cooperate. Instead of cooperation, Republicans would have to endure an onslaught of politically toxic Democratic amendments, as Senate Democrats forced them to cast one vote after another designed to make them look like monsters come Election Day. (Marc Thiessen, 7/18)

Los Angeles Times: Uh-Oh, The GOP Has No Choice But To Work With Democrats On Healthcare Reform
The sudden collapse of Kentucky Sen. Mitch McConnell’s healthcare bill on Monday was much more than a tactical setback for the Senate Republican leader once considered an unbeatable legislative wizard. It was a catastrophic failure for the GOP’s attempt to make one-party government work. It’s one thing to produce gridlock when control of Congress is divided. When one party manages to produce gridlock all by itself, something is seriously wrong. The setback means that Obamacare will almost certainly survive for the foreseeable future, despite seven years of GOP promises to repeal it. (Doyle McManus, 7/19)

Miami Herald: Suddenly, A Defeated McConnell Sees The Value Of A Bipartisan Healthcare Plan
This is what happens when you try to muscle through in six months — and in secret — what you could have done over seven years. You bear the brunt of the responsibility for the GOP’s disaster of a healthcare plan getting flushed down the tubes. This is what happens when you do anything, short of crawling under a rock, to avoid having to look your scared and angry constituents in the eye at town hall meetings. When you emerge from wherever you’ve been hiding, those constituents are still scared, still angry, having flooded your offices on the Hill with phone calls and emails to make sure you get the message. (7/18)

The Charlotte Observer: The Last Big Republican Lie On Health Care
Moments after the latest Republican health care bill died Monday night, Senate Majority Leader Mitch McConnell proposed that Republicans instead repeal the Affordable Care Act immediately, but let it live for two years while they come up with a replacement. President Trump, at least initially, agreed in a tweet. (7/18)

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Perspectives: A Nonprofit Drug Company? It’s Not As Wild An Idea As It Seems

Read recent commentaries about drug-cost issues.

The New York Times: Escaping Big Pharma’s Pricing With Patent-Free Drugs
How’s this for a great deal? The United States government funded research and development of a new vaccine against Zika. But the Army, which paid a French pharmaceutical manufacturer for its development, is planning to grant exclusive rights to the vaccine to the manufacturer, Sanofi Pasteur, along with paying Sanofi up to $173 million. (Fran Quigley, 7/18)

Stat: Importing Drugs From Other Countries Undermines Safety
The Food and Drug Administration was established to ensure the safety of food and medicines sold in the United States. That original charter seems to be ignored by the advocates of drug importation, who brush aside legitimate safety concerns to advance a political agenda. (Jim Greenwood, 7/14)

The New England Journal Of Medicine: The Economics Of Indication-Based Drug Pricing
Pharmaceutical treatments and medical devices often have varying effectiveness depending on the indication for which they’re used: in oncology, for instance, response to a treatment varies with the type of tumor and stage of disease. The advent and proliferation of precision medicine in which biomarkers — whether genomic, proteomic, or structural — identify patients likely to receive greater treatment benefits only increase the range of variability in the effectiveness of the same product. (Amitabh Chandra and Craig Garthwaite, 7/13)

Bloomberg: Trump’s New Drug-Pricing Move Won’t Cut Prices
We’ve come a long way from President Donald Trump telling the pharmaceutical industry it was getting away with murder. His administration’s Center for Medicaid and Medicaid Services (CMS) on Thursday proposed deep cuts to reimbursement rates for the 340B drug-discount program, which mandates big price cuts for “safety-net” hospitals that treat a lot of poor patients. (Max Nisen, 7/14)

Stat: The Art Of The Deal? Why A Money-Back Guarantee For Drugs Is A Bad Idea
President Trump likes to boast that he mastered the “art of the deal.” But one option his administration is considering to encourage lower drug prices, which surfaced in a recent draft executive order, may not be much of a deal for consumers. The concept has a clunky name — value-based pricing — but it’s fairly simple. One increasingly popular version works like this: A drug maker refunds some money to an insurer if its medicine fails to improve patient health or prevent a costly incident, such as a heart attack. (Ed Silverman, 7/17)

The New England Journal Of Medicine: Targeting Unconscionable Prescription-Drug Prices — Maryland’s Anti–Price-Gouging Law
Why, in the early 21st century, are so many drugs that were cheaply available in the 20th century becoming prohibitively expensive? The past few years have seen a series of dramatic price hikes on essential off-patent medications, from albendazole to albuterol, digoxin to naloxone, Daraprim to EpiPen. In the storm of allegations and indignation that has followed each of these revelations, one explanation has remained consistent. To paraphrase Senators Susan Collins (R-ME) and Claire McCaskill (D-MO), who were the chair and the ranking member of the Senate Special Committee on Aging, firms that corner the market on off-patent medications and raise prices wildly often do so simply because they can. When the committee issued a 130-page report last December documenting the parallel strategies used by firms to engage in monopolistic price gouging on older essential drugs, the senators pointed out that these actions, though arguably unethical, have so far not been found to be illegal. (Jeremy A. Greene and William V. Padula,, 7/13)

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More And More, States Are Becoming Battleground For Drug Pricing War

News outlets report on stories related to pharmaceutical pricing.

The Wall Street Journal: Drug Prices Under Fire, In The States
All eyes are on Washington as the Senate grapples with health care legislation. Investors in drug companies should give some attention to state capitals, where a wave of bills designed to limit drug price increases are under consideration. Maryland is the first of about 30 states weighing such bills to pass a new law on drug pricing. The law, scheduled to take effect in October, outlaws “excessive” price hikes on generics and gives Maryland’s attorney general sweeping powers to roll back price hikes and fine companies for violations. Bills with similar enforcement mechanisms have been introduced in several other states, including New York, Missouri, Massachusetts, Maine, and Rhode Island. (Grant, 7/12)

Stat: Sanofi Denies Rejecting Army Request For A Fair Price On A Zika Vaccine
In a series of letters to the U.S. Army and several senators, Sanofi is denying that it rejected so-called fair pricing for a Zika virus vaccine that the company is developing with American taxpayer funds. The missives were sent as a growing number of federal and state lawmakers push the U.S. Army to negotiate a more favorable agreement with Sanofi, which is one of the world’s largest vaccine makers and has already received a $43 million U.S. research grant. (Silverman, 7/17)

Stat: Hurt By A Drug? You Can File Suit In California If A Clinical Trial Took Place There
Last month, the U.S. Supreme Court made it more difficult for people who file product-liability lawsuits against drug makers to engage in “forum shopping,” a practice in which someone files a lawsuit in a state where courts are seen as more hospitable to consumers. In that closely watched case, the court ruled hundreds of out-of-state plaintiffs failed to demonstrate a sufficient connection between injuries they allegedly suffered from a Bristol-Myers Squibb drug and company activities in California. The state has been a favorite venue for such suits, but the court noted the plaintiffs did not buy or ingest the drug there, and Bristol-Myers is not headquartered there. (Silverman, 7/18)

CQ Roll Call: Generics Could Get A Boost In Bid To Rein In Prescription Prices
The most talked about strategies to bring down sky-high drug costs involve letting the government more aggressively negotiate prices with manufacturers and permitting the importation of lower-cost drugs from abroad. But neither idea has sufficient support on Capitol Hill to move this year. That’s why, for now, the only likely bipartisan solutions that could move the needle on drug prices involve promoting competition from lower-cost generic drugs. When a drug’s patent expires, it opens the door for other companies to copy it. Since the generic makers don’t have to recoup the research costs, they can offer much lower prices. Still, while policy improvements now under consideration in Congress could help, they’re not a panacea. (Siddons, 7/17)

ProPublica: The Myth Of Drug Expiration Dates
The dates on drug labels are simply the point up to which the Food and Drug Administration and pharmaceutical companies guarantee their effectiveness, typically at two or three years. But the dates don’t necessarily mean they’re ineffective immediately after they “expire” — just that there’s no incentive for drugmakers to study whether they could still be usable. (Allen, 7/18)

Stat: What Are You Taking? Most-Prescribed Drugs Across The Nation Last Year
More than 4.4 billion prescriptions were filled in the United States last year, and the top 10 were all written for drugs now available in generic versions of pricier brand-name originals. Nearly half of all Americans are prescribed a drug at any given time. The most common ones, as you might expect, treat the most common chronic conditions — managing high blood pressure, for example, or controlling diabetes. Painkillers are also on the list, carrying with them the risk of substance abuse. But there are some surprises, too. (Blau, 7/19)

Stat: Trying A New Tack: Delivering Insulin To The Liver To Control Type 1 Diabetes
Type 1 diabetics, armed with glucose meters and insulin pens, are caught in a delicate high-wire act. Too much glucose wreaks havoc on nerves and blood vessels, while too little causes dizziness and nausea. A Cleveland biotech company is trying to change that by delivering insulin to the liver, where it naturally goes. (Woosen, 7/17)

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Congress Squares Off Over Drug Pricing And A Controversial Drug Discount Program

House Democrats are calling foul on Republican assertions that cuts to a little-known discount drug program will eventually reduce skyrocketing drug prices.

At a hearing Tuesday, Rep. Diana DeGette (D-Colo.) said high drug prices should be investigated separately from the focus on oversight of the drug discount program, known as 340B.

“I think we need an investigation, a robust investigation, and a series of hearings that explore in-depth the reasons for exorbitant cost of drugs and why the prices continue to rise,” DeGette said.

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Last week, Health and Human Services Secretary Tom Price proposed steep cuts in what Medicare reimburses some hospitals for outpatient drugs under the 340B program. In a release, Price said such cuts would be “a significant step toward fulfilling President [Donald] Trump’s promise to address rising drug prices.”

DeGette countered Tuesday that the proposal “would do nothing” to address high drug prices and said making that connection “seems more like fantasy than reality.”

Also on Tuesday, there were other hints at Trump Administration efforts to address drug pricing. Food and Drug Administration Commissioner Scott Gottlieb talked in a public meeting about lowering drug prices on a different front — saying that the agency needs to increase generic drug competition.

Trump routinely criticized high drug prices on the campaign trail last year and promised to take action during his presidency. In June, a leaked draft of an executive order on drug prices, first reported by The New York Times, spoke of facilitating more drug competition but also targeted the 340B program. That strategy immediately drew criticism from Sen. Al Franken (D-Minn.), who said scaling back the program would drive up what hospital patients pay for drugs and force Americans “to choose between health and other basic life necessities, like putting food on the table and a roof overhead for the family.”

The federal 340B program requires pharmaceutical manufacturers to provide outpatient drugs at a significant discount to hospitals and clinics that serve a largely low-income population.

After buying the discounted drugs, the hospitals and clinics can bill Medicare or other insurers at their regular rate, pocketing the difference.

About 40 percent of hospitals nationwide participate in the program and, as House members pointed out Tuesday, the program has grown dramatically in recent years to become a significant force in the pharmaceutical marketplace. The Medicare Payment Advisory Commission estimated that hospitals and other participating entities spent more than $7 billion to buy 340B drugs in 2013, three times the amount spent in 2005.

Advocates of the program say the discounts — and the money hospitals make on payments from Medicare — are necessary to combat skyrocketing drug prices.

But federal reports in recent years from the Medicare advisory board, as well as the Government Accountability Office and the Office of Inspector General, have raised concerns about oversight and abuse of the 340B program.

Rep. Joe Barton (R-Texas) noted “this is a difficult hearing” because while the program was created with good intent, its complexity makes it challenging to understand. For example, hospitals and clinics aren’t required to pass any discounts they receive on to patients — they can direct the money to their general fund.

Looking at his colleagues, Barton said: “We all support the program but it has grown topsy-turvy. We need to put the best minds on this.”

Republican lawmakers are not the only ones raising concerns about 340B oversight. The Pharmaceutical Research and Manufacturers of America, which represents drugmakers, advocates ensuring hospitals are “good stewards” of the money they gain from the program’s discounts.

Peggy Tighe, who represents hospitals in the 340B program as a principal at the D.C. law firm Powers, said “PhRMA has done a particularly good job of getting the attention of the administration …. They haven’t let up on 340B.”

The rule that Price proposed last week would cut what hospitals are paid for drugs from the Medicare Part B program, which covers outpatient drugs including those delivered through infusion.

Currently, Medicare pays hospitals an average sales price plus 6 percent for most of the Part B drugs they purchase. The administration’s proposal is to cut that to average sales price minus 22.5 percent.

340B Health, a coalition that represents hospitals, immediately responded to the proposal saying the cuts would be “devastating” to hospitals and would “lead to cuts in patient services.”

KHN’s coverage of prescription drug development, costs and pricing is supported in part by the Laura and John Arnold Foundation.

Categories: Health Care Costs, Health Industry, Medicare, Pharmaceuticals

Perspectives: The Senate GOP Health Bill Appears To Have Collapsed… But What Could Happen Next?

Editorial pages parse the breaking news late Monday night when two more Republican senators announced their opposition to the measure. What has gone wrong? What paths could go forward? And what issues remain in play?

The New York Times: In Congress, Obstructionists Are Obstructing Themselves
Republican legislative leaders are in a bind. While they appear to have failed for now in their goal of destroying the Affordable Care Act, their eagerness to shower tax breaks on the wealthy at the expense of health coverage for millions of Americans has crimped their ability to pass other fiscal legislation. (7/18)

The Washington Post: Is Trumpcare Finally Dead?
Perhaps the two “no” votes from Sens. Susan Collins (R-Maine) and Rand Paul (R-Ky.) would have been enough to sink the GOP health-care effort. Senate Republicans and virtually all political watchers have been cultivating a sense of suspense — who would be the third “no” vote? — when in fact there are likely, according to Collins, many more “no” votes (eight to 10, she said in TV interviews Sunday). Then a very public and simple barrier to passage emerged — Sen. John McCain’s (R-Ariz.) undetermined recuperation time. With two “no” votes already clinched, Senate GOP leaders could not even pretend to have sufficient support without McCain (who actually might be a “no” vote in the end). Now comes perhaps the death knell for Trumpcare: Sens. Mike Lee (R-Utah) and Jerry Moran (R-Kan.) both announced their opposition Monday night. (Jennifer Rubin, 7/17)

RealClear Health: The Disturbing Process Behind Trumpcare
Since I came to Washington in 1969, I have been immersed in Congress and its policy process. I have seen many instances of unpopular bills considered and at times enacted. I have seen many instances of bills put together behind closed doors. I have seen bills enacted and repealed after a public backlash. I have seen embarrassing mistakes in bills, and lots of intended consequences. (Norm Ornstein, 7/17)

Los Angeles Times: Is Rand Paul’s Opposition To The GOP Health Bill Principled, Or Cynical?
Thhe greatest trick any politician can pull off is to get his self-interest and his principles in perfect alignment. As Thomas More observed in Robert Bolt’s “A Man for All Seasons,” “If we lived in a State where virtue was profitable, common sense would make us good, and greed would make us saintly.” Which brings me to Sen. Rand Paul, the GOP’s would-be Man for All Seasons. Paul has managed to make his opposition to the GOP’s healthcare bill a matter of high libertarian principle. The fact that the bill is terribly unpopular in his home state of Kentucky — where more than 1 out of 5 Kentuckians are on Medicaid — is apparently just a coincidence. (Jonah Goldberg, 7/18)

McClatchy: The GOP Is Bungling Obamacare Repeal, And Democrats Could Be The Winners
The Republican Party in Congress could be on the verge of losing the 2018 midterm elections 16 months before they happen. Since 2010, the GOP has been vowing and planning and stunting to repeal the Affordable Care Act, that transformative legislative Frankenstein that Democrats crammed through Congress in 2010 without a single Republican vote. (Andrew Malcolm, 7/18)

The Wichita Eagle: Enough Flim-Flam: Move On Now To Solve Health Care Puzzle
When the Senate majority leader wields the possibility of bipartisanship as a threat and dismisses massive cuts to Medicaid as a shell game, you know it’s time to move on. Sen. Mitch McConnell’s desperate scramble for one or two more votes to repeal and replace the Affordable Care Act has actually reached those moral depths. And it isn’t working for congressional Republicans, let alone the American people. (Dave Merritt, 7/18)

Los Angeles Times: How I Got Caught In The Crossfire Between V.P. Pence And Ohio Gov. Kasich Over Medicaid
At the National Governors Conference on Friday, Vice President Mike Pence took Ohio Gov. John Kasich to task in a speech attacking the Affordable Care Act’s Medicaid expansion. Pence presumably had two goals. The first was to silence Kasich, the loudest voice among GOP governors opposed to congressional Republicans’ efforts to drastically roll back Medicaid as part of their ACA repeal plans. The second was to justify that rollback by claiming that the Medicaid expansion eroded services for the program’s traditional beneficiaries, including the disabled. (Michael Hiltzik, 7/17)

The Wall Street Journal: Return Medicaid To Its Rightful Role
Rolling back ObamaCare’s Medicaid expansion has become the focal point of the health-care debate, and rightly so. Without fundamental change, Medicaid—expanded or not—will push state budgets to the brink even as it fails to help the most financially vulnerable Americans. Consider Oklahoma, our home state. Despite intense lobbying by hospital corporations, the state Legislature stood strong and refused the Medicaid expansion. But the Medicaid rolls increased anyway, and at a dramatic cost to priorities like education, public safety and transportation. (Frank Keating and Doug Beall, 7/17)

Bloomberg: HSAs Can Show The Way To Bipartisan Health Reform
The Senate Republicans’ latest plan to overhaul Obamacare includes a significant expansion of Health Savings Accounts (HSAs), but exacerbates a key longstanding problem: HSAs provide significant tax benefits to those Americans who need the least help. That provides an opening for bipartisan compromise. Democrats and Republicans could find agreement on creating “equitable HSAs” — that is, HSAs that are subsidized more equally for everyone — to reform the healthcare system. (Samuel Estreicher and Clinto Wallace, 7/17)

Bloomberg: Taxing Hospitals Is A Lousy Way To Fix Health Care
Before Obamacare passed, we were bombarded with statistics about the uncompensated care that hospitals provide. The numbers were large — in the tens of billions — and the implication was that this was something of a national emergency. Certainly it was one very good reason to pass the Affordable Care Act, so that hospital budgets wouldn’t groan under unpaid bills, and the people getting care could be sure that they wouldn’t get turned away at the hospital door. (Megan McArdle, 7/17)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

State And Local Views: Senate GOP Health Bill ‘Fundamentally Wrong;’ Devastating To Rural Families

Editorial pages across the country take a hard look at the Senate GOP health care plan and examine their own senators’ roles in the debate and the current proposal’s local impact.

St. Louis Post-Dispatch: New GOP Healthcare Bill Is As Fundamentally Wrong As All The Others
The fifth iteration of congressional Republicans’ health care bill — two from the House, three from the Senate — is likely to be the last one for a while. If the Senate passes it this week, the House will surely go along. If it fails, Republican leaders appear ready to throw up their hands and work with Democrats to fix the Affordable Care Act rather than replace it. That would be the best outcome. Version 5.0 suffers from the same basic problem as its four predecessors: At its heart, it’s really an attempt by the well-off to cut spending for the less fortunate. Fundamentally, it is an attack on Medicaid, the federal-state program for the poor, the disabled, children and nursing home patients. (7/15)

Cleveland Plain Dealer: Senate Health Reform Bill Would Devastate Family Health Care In Ohio
As a practicing physician, I have seen firsthand how my patients have benefited from the Affordable Care Act (ACA) and Medicaid expansion, especially many patients in traditionally underserved communities such as those who are low-income or live in rural areas. The ACA and Medicaid have been critical sources of health coverage for these patients, increasing their access to many basic health care services, including maternity care, preventive health services, mental health care, and treatment for substance use disorder. (Wayne Trout, 7/16)

Lexington Herald Leader: Will Health-Care Repeal Drive Ky. Families Off Their Farms?
My husband, John, and I farm on land outside Versailles that has been in his family for generations. Over the years, it has produced tobacco, cattle and hay, and now pastured livestock for meat, organic vegetables and flowers. Farming is a calling we actively chose. We worked hard to gain the knowledge and skills we’d need. We expected the hard work, but we weren’t adequately prepared for the challenges presented by health care. (Sue Churchill, 7/14)

The Des Moines Register: Iowa Poll Shows GOP In A Corner On Health Care
No wonder Republicans in Congress are tying themselves in knots as they try to pass health care reform. In Iowa, at least, they have created a no-win situation, results of the new Iowa Poll indicate. Sen. Chuck Grassley, an Iowa Republican, warned on Twitter last weekend that Senate Republicans would face dire consequences if they didn’t pass health care reform. (Kathie Obradovich, 7/16)

Arizona Republic: Obamacare Has One Last (And Best) Defense
The Affordable Care Act has flaws that require fixing, but it continues to serve the people of this nation in ways that many are just now starting to appreciate. President Trump and congressional leaders should devote themselves to correcting the problems in Obamacare, not craving its collapse. (Reginald Ballantyne, 7/14)

Boston Globe: Fixing Health Care The Right Way
But there is a great deal of uncertainty and instability in health care due to changes being considered at the federal level that would result in higher costs for seniors and children with disabilities, a loss of federal revenue for the state, and a reduction in payments for health care providers… Without regard to what’s happening in Washington, Massachusetts needs to continue to innovate and create a sustainable health care system for both our residents and our economy. Health care costs currently strain not only the state’s budget, but also those of our businesses and families. (Stan Rosenberg and Jim Welch, 7/17)

The Columbus Dispatch: Portman, Brown Could Make History
Sen. Rob Portman was right to reject a Republican health-care bill that would have slashed the Medicaid spending upon which millions of Ohioans depend for basic health care. As the GOP effort to replace the Affordable Care Act grinds on, Portman finds himself in a position of great influence to stand up for an approach that balances fiscal pragmatism with compassion and decency. (7/17)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Perspectives: Governors Step Up As Senators Step Back; More Tough Takes On The GOP Health Plan

Opinion writers examine the policy and political dynamics in play as the Senate GOP continues its efforts to replace the Affordable Care Act.

The Washington Post: Governors Push Back While GOP Lawmakers Roll Over
If House and Senate Republicans have largely been supine in the face of President Trump’s assaults on the truth, fiscal probity, conflicts of interest, climate change and health care, governors have not and therefore point the way toward restoration of a once admirable party. (Jennifer Rubin, 7/16)

Los Angeles Times: Here Are The Hidden Horrors In The Senate GOP’s New Obamacare Repeal Bill
enate Republicans unveiled a new, “improved” version of their Affordable Care Act repeal bill Thursday, so the treasure hunt is on: the search for provisions so horrifically inhumane that they’ve had to be concealed deep in the measure’s legislative language and procedural maze. We’ve found quite a few, with the help of professional spelunkers Andy Slavitt, David Anderson, Larry Levitt and others. Here are some of the provisions in the so-called Better Care Reconciliation Act, or BCRA, that the Senate GOP really doesn’t want you to know about. (Michael Hiltzik, 7/14)

Bloomberg: Put Trumpcare Out Of Its Misery
Congressional Republicans have just produced their latest version of Trumpcare. On the plus side, this one gives up on earlier proposals to repeal three taxes that the Affordable Care Act imposes on the wealthy, making it a bit less fiscally reckless. On the minus side, it’s still a terrible plan. (7/14)

The Washington Post: On Health Care, History Is Watching. And It’s Watching Four Senators In Particular.
Over the past century, there has been a characteristic American cycle of response to far-reaching social reforms. When the breakthroughs are first proposed, conservatives fight them with a devout passion, warning that the measures on offer would move the nation toward socialism and perdition. Then, over time, the disastrous consequences never materialize, the reforms prove their worth, and Americans come to see the once-new benefits as rights. (E.J. Dionne, 7/16)

USA Today: The ‘Pro-Life’ Movement Is A Joke And Trumpcare Proves It
They might have gotten away with it if not for those meddling disability activists. Until several members of ADAPT were yanked from their wheelchairs and arrested for conducting a sit-in outside Senate Minority Leader Mitch McConnell’s office on the day the Senate GOP’s first draft of Trumpcare went public, Republicans had done a beautiful job of hiding the truth about their effort to “repeal and replace” Obamacare. (Jason Sattler, 7/17)

The Washington Post: The Fundamental Error In The CBO’s Health-Care Projections
In the coming days, the Congressional Budget Office will release an updated analysis of the Senate bill to repeal and replace Obamacare. The CBO will likely predict lower health insurance coverage rates if the bill becomes law. The American people and Congress should give this prediction little weight in assessing the bill’s merit. (Marc Short and Brian Blase, 7/14)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Hospitals Lobbied Hard To Keep Tax Breaks Under ACA, But They’re Not Sharing Their Windfall

Through millions of newly insured patients, hospitals have raked in money since the Affordable Care Act was passed. But their spending on direct charity care has actually fallen.

Politico: How Hospitals Got Richer Off Obamacare
A decade after the nation’s top hospitals used all their advertising and lobbying clout to keep their tax-exempt status, pointing to their vast givebacks to their communities, they have seen their revenue soar while cutting back on the very givebacks they were touting, according to a POLITICO analysis. (Diamond, 7/17)

Politico: How The Cleveland Clinic Grows Healthier While Its Neighbors Stay Sick
On the Cleveland Clinic’s sprawling campus one day last year, the hospital’s brain trust sat in all-white rooms and under soaring ceilings, looking down on a park outside and planning the next expansion of the $8 billion health system. A level down, in the Clinic’s expansive alumni library, staff browsed century-old texts while exhausted doctors took naps in cubbies. And in the basement, a cutting-edge biorobotics lab was simulating how humans walk using a cyborg-like meld of metallic and cadaver parts. (Diamond, 7/17)

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Preventive Care Efforts Were Boosted Under ACA, But GOP’s Plan Would Make Them Vulnerable Again

Regular screenings and preventive care are responsible for catching serious problems before they become expensive disasters. But with the cuts under the GOP’s proposed legislation, some worry the progress made through the Affordable Care Act will be lost. Meanwhile, the Republicans’ plan depends on young people buying insurance even though that lesson was already learned, and a look at the winners and losers under the plan.

The Associated Press: Trump’s No ‘Dying In The Streets’ Pledge Faces Reality Check
President Donald Trump has often said he doesn’t want people “dying in the streets” for lack of health care. But in the United States, where chronic conditions are the major diseases, people decline slowly. Preventive care and routine screening can make a big difference for those at risk for things such as heart problems and cancer, especially over time. (Alonso-Zaldivar, 7/15)

The Associated Press: New GOP Health Care Bill Will Determine Winners, Losers
Republicans’ latest health care plan would create winners and losers among Americans up and down the income ladder, and across age groups.It would give consumers more responsibility for their insurance choices, a goal long held by conservatives who argue that’s key to a true health care market. Younger adults and healthy people in the solid middle class may find more agreeable options. But low-income people may not be able to afford coverage, along with older and sicker adults. (7/15)

In other news on the Republicans’ proposed legislation —

The Wall Street Journal: Health-Law Taxes Divide The GOP, Signaling A Shift
Republican efforts to pass a health-care bill have revealed a party fissure on tax policy with potentially far-reaching repercussions. In his latest attempt to rewrite President Barack Obama’s signature health-care law, Senate Majority Leader Mitch McConnell (R., Ky.) retained a 3.8% investment-income tax and a 0.9% payroll tax that apply to individuals earning more than $200,000 and married couples earning more than $250,000. (Rubin, 7/17)

Kaiser Health News: Podcast: What The Health? Senate Health Bill 2.0. Still On Life Support
Julie Rovner of Kaiser Health News, Joanne Kenen of Politico, Sarah Kliff of Vox.com and Margot Sanger-Katz of The New York Times discuss the changes to the proposed Senate health bill, and whether they can win the 50 votes needed to pass it. Plus, for “extra credit,” the panelists recommend their favorite health stories of the week they think you should read, too. (7/14)

Des Moines Register: 58% Of Iowans Oppose Congress’ Actions On Health Care, New Iowa Poll Shows
Few Iowans like how Congress is attempting to revamp the nation’s health care system, a new Des Moines Register/Mediacom Iowa Poll shows. Just 29 percent of Iowa adults say they mostly support the direction congressional Republicans are taking on health care, according to the poll. Twice as many — 58 percent — say they mostly oppose that direction. Thirteen percent are unsure. (Leys, 7/15)

Bloomberg: Obamacare’s Pocketbook Problems Made Worse In GOP Health Bill 
Concern about patients spending too much of their own money on health care has driven the debate over repealing and replacing Obamacare. But the latest Senate Republican health bill does little to address those fears and may exacerbate them. The bill, rolled out anew on Thursday after a raft of Republican defections threatened to sink the original legislation, faces a narrow road to passage despite alterations aimed at winning over lawmakers who balked at the earlier draft. Two Republican Senators signaled their opposition; a third dissent could doom the measure, and a long-held GOP vow to overturn the Affordable Care Act. (Tracer and Edney, 7/14)

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Possible Return Of ‘Junk Insurance’ Worries Those Who Remember Bare Bones Coverage All Too Well

Many Republicans, including President Trump, say giving insurers the leeway to offer less-comprehensive plans will give people greater choice and cheaper options, but experts say it will skew the marketplace in favor of young, healthy people at the expense of sick people.

The New York Times: In Clash Over Health Bill, A Growing Fear Of ‘Junk Insurance’
Julie Arkison remembers what it was like to buy health insurance before the Affordable Care Act created standards for coverage. The policy she had was from the same insurer that covers her now, but it did not pay for doctor visits, except for a yearly checkup and gynecological exam. “I couldn’t even go to my regular doctor when was I sick,” said Ms. Arkison, 53, a self-employed horseback-riding teacher in Saline, Mich. (Abelson, 7/15)

The Associated Press: Health Plan Hinges On The Young, But They’re A Tough Sell
Julian Senn-Raemont isn’t convinced he needs to buy health insurance when he loses coverage under his dad’s plan in a couple of years — no matter what happens in the policy debate in Washington, or how cheap the plans are. The 24-year-old musician hasn’t known a world without a health care safety net. But he hates being forced by law to get coverage, and doesn’t think he needs it. (Johnson, 7/17)

The Hill: Insurers Warn Cruz Provision Will ‘Skyrocket’ Premiums For Sick People 
The two leading health insurer trade groups sent a strongly-worded letter Friday expressing opposition to a controversial conservative provision included in the latest GOP ObamaCare replacement bill. America’s Health Insurance Plans and the Blue Cross Blue Shield Association warned that the provision from Sen. Ted Cruz (R-Texas) would mean “premiums will skyrocket for people with preexisting conditions” and “millions of more individuals will become uninsured.” (Sullivan, 7/14)

The Wall Street Journal: Senate Health Bill Frays Republicans
Insurers have worried that under the Cruz proposal, the health market would be split in two. Healthy and younger people would flock to cheaper, less comprehensive plans, while people with pre-existing conditions who need more comprehensive coverage could have to pay far more. That has alarmed centrist GOP senators who want to maintain protections for people with pre-existing conditions. And although conservatives sought the Cruz measure, its current version has left them divided because of a change in the way the market where people buy insurance when they don’t get coverage on the job would be structured. (Armour and Peterson, 7/14)

Kaiser Health News: Analysis: Senate’s Latest Health Blueprint Cuts Costs At The Expense Of Chronically Ill
The latest Senate health proposal reins in costs by effectively splitting the individual insurance market, with healthy people diverted into stripped-down plans and chronically ill individuals left with pricey and potentially out-of-reach options, insurance analysts said. This draft — a fresh attempt by the Republican Party to undo the Affordable Care Act — injects more uncertainty into plans for people with preexisting conditions such as cancer, asthma, diabetes or other long-term ailments. Those people, insured through ACA marketplaces now, could be more isolated than in an earlier version of the Senate bill. (Hancock, 7/17)

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Health Insurers Try Paying More Upfront To Pay Less Later

Michael McBrayer of St. Paul, Minn., needs to pay a lot attention to his health.

“I give myself shots multiple times a day, as well as controlling my diet and exercise,” he said.

Ten years ago, McBrayer learned he has Type 1 diabetes. Now he knows he faces dire consequences if he fails to control his blood sugar.

“Kidney failure, blindness, heart disease — all those things are looming out there,” he said.

McBrayer has health insurance through his wife’s employer, the state of Minnesota. It’s a HealthPartners plan that charges extra to employers — in this case, the state — to cover diabetes care. So for the past several years, McBrayer’s plan has paid for everything he needs to keep his diabetes in check. He doesn’t spend a dime on supplies.

Diabetes, high blood pressure and other chronic conditions account for the vast majority of health spending in the U.S., according to the Centers for Disease Control and Prevention. Almost half of American adults have at least one chronic physical or mental health condition, and spending on those adds up to some $2.3 trillion a year.

Some health plans are beginning to offer free maintenance care for people with chronic health problems, hoping that spending a little more early on will save a lot of money in the long run.

“We’ve been trying to change the health care conversation in the United States from how much we spend to how well we spend,” said Dr. Mark Fendrick, head of the University of Michigan’s Center for Value-Based Insurance Design.

He said it makes both medical and economic sense to make properly managing chronic conditions affordable.

“I want the health insurance plan my patients have to charge my patients the least for the services that are going to make them healthier,” he said. “Let’s allow those to be covered on a pre-deductible basis; you’re not leaving the patients paying 100 percent of the cost.”

That may seem like common sense, but health plans have been running hard in the opposite direction. Consumers are on the hook for a rapidly increasing amount of their health costs — in large part to try to curb health costs.

But corporate buyers of health insurance are starting to realize that people may be putting off necessary care, says Mike Thompson, who runs the National Alliance of Healthcare Purchaser Coalitions. The organization advises around 12,000 organizations that buy health plans for tens of millions of Americans. He said those who provide insurance need to take a thoughtful look at what they pay for and what consumers should pay for.

“So that people are more prudent on discretionary care but are more compliant with the care they need and certainly the care they need to stay healthy,” Thompson said.

If people have to pay out-of-pocket for care they might not need, they might think twice, but their day-to-day health needs are taken care of.

One major obstacle to this approach, known as “value-based health insurance,” is an IRS rule that does not allow free maintenance care for chronic conditions for the 20 million Americans with health savings account-qualified, high-deductible insurance.

Michael McBrayer tests his blood sugar before eating lunch. He gets supplies he needs to manage diabetes for free as part of a deal between his employer and health insurer. (Evan Frost/MPR News)

The enhanced insurance benefit that pays for all McBrayer’s Type 1 diabetes maintenance is paying off for state taxpayers, according to HealthPartners, his provider.

That program has helped quadruple the number of diabetes patients with optimal care, saving the state about $1 million on medical services since its inception almost 10 years ago, said Dan Rehrauer, a program manager at HealthPartners.

“We’ve shown that we’ve reduced hospitalization and emergency department utilization, which is exactly what we want to see,” Rehrauer said. “You’ve got a healthy employee and that results in not ending up in the hospital [which saves] money.”

This story is part of a partnership that includes MPR News, NPR and Kaiser Health News.

Categories: Cost and Quality, Health Care Costs, Insurance

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Critics’ Take: The Updated Senate Health Bill Is Still Ugly After Cosmetic Changes; An ‘Abomination’

Opinion writers reacted with tough talk to Senate Majority Leader Mitch McConnell’s latest health bill tweaks. The Wall Street Journal, however, terms the bill a “net improvement over the Obamacare status quo.”

USA Today: Senate Health Bill: Don’t Throw Momma From The Medicaid Train
In the river of retrograde effects certain to follow if the latest version of the Senate Republican health care bill passes largely intact, none is more surprising than the injury to elderly Medicaid recipients. To state this is not to prioritize poor elderly over other deserving beneficiaries. It is simply to say that nearly two-thirds of Americans in nursing homes are, well, on Medicaid. And while not every American has a loved one who is disabled, or a poor child, or struggling with opioids, or belongs to another beneficiary group, it does seem fair to say that at one time in their life every American had parents. If they live long enough, most will be on Medicaid. (Peter Fromuth, 6/14)

The New York Times: The Cruelty And Fraudulence Of Mitch McConnell’s Health Bill
A few days ago the tweeter in chief demanded that Congress enact “a beautiful new HealthCare bill” before it goes into recess. But now we’ve seen Mitch McConnell’s latest version of health “reform,” and “beautiful” is hardly the word for it. In fact, it’s surpassingly ugly, intellectually and morally. Previous iterations of Trumpcare were terrible, but this one is, incredibly, even worse. (Paul Krugman, 7/13)

The Wall Street Journal: ObamaCare Moment Of Truth
Republican leaders unveiled a revised health-care bill on Thursday, setting up a Senate watershed next week. Few votes will reveal more about the principles and character of this Congress. Months of stations-of-the-cross negotiations between conservative and GOP moderates have pulled the bill towards the political center, and for the most part the new version continues the journey. This leftward shift is Majority Leader Mitch McConnell’s bid to meet the demands of still-recalcitrant Republican moderates. The bill remains a net improvement over the Obama Care status quo, but the question now is whether they’ll take yes for an answer. (7/13)

The Washington Post: The New Senate Health-Care Bill May Be Worse Than The Old One
Senate Republicans released Thursday a new version of their Obamacare repeal-and-replace bill. It is arguably worse than the unpopular bill that preceded it. The Congressional Budget Office projected that the previous iteration would result in 22 million more uninsured in a decade. “Looking at the revised Senate health bill, it’s hard to see how it could meaningfully alter CBO’s projection of how the uninsured will grow,” the Kaiser Family Foundation’s Larry Levitt noted. “The revised Senate bill reinstates taxes on wealthy people, but it mostly does not spend that money on health care for low-income people.” (7/13)

The Washington Post: The New GOP Health-Care Plan Is Still An Abomination
Senate Republicans are releasing the latest version of their health-care plan today, and there’s a temptation to focus solely on what’s changed from the previous iteration. The changes are important, and we have to understand them. But what we shouldn’t do is allow a relative judgment (maybe it’s better in this way but worse in that way) to distract us from the big picture, because what’s still in the bill from before is even more important than what has changed. (Paul Waldman, 7/13)

The Washington Post: The Senate Health Bill Would Make The Opioid Epidemic Worse. Here’s How.
Over the past two decades, the number of Americans dying each year from opioid overdoses has quadrupled. In the hardest-hit state, West Virginia, where the overdose death rate is about three times the national average, the crisis has resulted in an overwhelmed foster-care system and a state burial program for the poor that ran through its entire annual budget three months into the year. (Jonathan Gruber and Angela Kilby, 7/13)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Perspectives On The Political Landscape: Winners, Losers, Distractions And… Is Bipartisanship Even Possible?

Editorial pages examine the political dynamics involved in the debate surrounding the Senate GOP’s efforts to pass a health bill.

The New York Times: Revised Senate Health Bill Tries To Win Votes, But Has Fewer Winners
The revised Senate health bill has a dwindling list of winners and a bigger pool of potential losers. It would still make insurance much less affordable for poorer and older Americans who don’t get coverage through work or Medicare. It would make that insurance less valuable for many people with the most significant health care needs. The biggest beneficiaries of the original bill — the rich — would get less. (Margot Sanger-Katz, 7/13)

Bloomberg: The Senate’s Health-Care Follies Are Years In The Making 
That’s right. Senate Majority Leader Mitch McConnell new plan is to ask Republicans to suspend reality until after casting their vote: Regardless of what the bill actually says, it means whatever they want it to mean. To state the obvious, this is not exactly a strong position. Conservatives will believe they are being betrayed, while Republicans (and everyone else) who want to preserve Medicaid won’t believe the reassurances. McConnell, whether his reputation as a master legislative technician is deserved or not, is no fool. He simply has only a few choices remaining at this point in the game. Playing pretend is one of the last tools left at his disposal. (Jonathan Bernstein, 7/13)

Bloomberg: How Would A Bipartisan Health Bill Even Be Possible?
Mitch McConnell is once again announcing that the Senate is going to come out with a new health-care bill and try to hold a vote next week. That exhaustion you feel is the same despair that seeps over you when a pair of ill-matched friends announce for the 17th time that they’re getting back together. (Megan McArdle, 7/13)

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State Highlights: Minn. Marks New Measles Case; Three Mass. Hospitals Reach Merger Agreement

Media outlets report on news from Minnesota, Massachusetts, Georgia, Missouri, California, Ohio, Michigan, Texas and Florida.

The Star Tribune: New Measles Case In Minnesota Extends Threat
A new measles case in Minnesota, reported just as the recent outbreak seemed to be winding down, has state health officials on alert because it involved a white adult who had visited public places in Hennepin, Ramsey and Carver counties while infectious and who had circulated among several people known to be unvaccinated. Reported Thursday by the Minnesota Department of Health, the case brings the total for the current measles outbreak to 79. (Olson, 7/13)

WBUR: Proposed Beth Israel-Lahey Merger Includes 13 Hospitals
A proposed hospital merger, spearheaded by Beth Israel Deaconess Medical Center and Lahey Health, became formal Thursday with the signing of a definitive agreement and a filing with the state’s Health Policy Commission. If approved, it would be the largest hospital merger in Massachusetts since Partners HealthCare formed in 1994 — and it would include more hospitals. (Bebinger, 7/13)

Atlanta Journal-Constitution: Georgia To Pursue $49 Million For School Nurses
In a joint effort with the Georgia Department of Education, the Department of Community Health board voted to approve a nursing services reimbursement program that would draw an estimated $48.6 million in additional federal dollars, assuming no major changes to Medicaid. There were 1,629 nurses and 307 unlicensed health care and clinic workers in Georgia schools last spring. (Tagami, 7/13)

The Associated Press: Confusion Over How Anti-Abortion Bill Could Affect St. Louis
Missouri lawmakers are at a standstill on broad anti-abortion legislation more than a month after Republican Gov. Eric Greitens called them into a special session to deal with abortion issues. The legislation calls for several new regulations, such as annual state inspections of abortion clinics. But one of the provisions causing the most confusion addresses a St. Louis ordinance that city leaders say is intended to prevent discrimination based on reproductive health decisions, such as pregnancy and abortion. (7/14)

Atlanta Journal-Constitution: Best Hospitals In US: 8 Georgia Hospitals Among Most Advanced In Tech
And according to Hospitals and Health Networks 19th annual “Most Wired Hospitals and Health Systems” survey, eight Georgia hospitals or health systems (including four in metro Atlanta) rely heavily on digital innovation “to improve population health, capitalize on data analytics, boost patient engagement and introduce new efficiencies” …The survey, conducted with the help of the American Hospital Association and health care experts, showed 82 percent of the nation’s hospitals and hospital systems use technological analysis tools to help improve quality and reduce costs, both clinically and administratively. (Pirani, 7/13)

Detroit Free Press: Beaumont Trumpets, Defends New Pricey Proton Beam Cancer Center
Beaumont Health officials showed off their new $40-million cancer-fighting machine on Thursday — the first of its kind in Michigan and purportedly more advanced and less costly to operate than earlier models of the sometimes controversial technology. The proton beam device is the centerpiece of the new Proton Therapy Center on Beaumont’s Royal Oak hospital campus and one of just 25 in the country. (Reindl, 7/13)

Austin American-Statesman: Lawmakers Propose Reining In Health Costs For Texas Retired Teachers
After failing to temper soaring health care costs for retired teachers, state lawmakers are considering giving retired teachers up to $1,200 more a year and pumping $200 million into their health care over the next two years. Starting in January, many retired teachers, particularly those under the age of 65, will see higher premiums and deductibles grow as much as 10 times what they’re paying now. (Chang, 7/13)

Minnesota Public Radio: Crisis Connection Hotline Rescued, As Least Temporarily
A mental health hotline that’s served Minnesotans for nearly 50 years will keep operating thanks to an eleventh-hour infusion of money. Crisis Connection had been scheduled to shut down Friday evening, but a grant from the state health department means the service will continue linking people suffering mental health emergencies to professional counselors. (Sepic, 7/14)

The Star Tribune: Minnesota Mental Health Crisis Line Gets Rescued At The Last Minute
<p class=”Text_Body”>In a last-minute move, the agency agreed late Thursday to provide enough funding, $139,000, to keep the crisis hot line open until late September. Canvas Health, the Oakdale-based nonprofit agency that operates the service, had previously announced the hot line would go dark on Friday, citing financial difficulties and a lack of state funding. The planned closing of Crisis Connection concerned state health officials and mental health advocates, because the line is so widely used and remains the only mental health crisis line that serves the entire state. (Serres, 7/13)</p>

Health News Florida: Federal Judge Dismisses Request To Stop Spraying Pesticide Naled In Miami-Dade County
A federal judge has dismissed a request to stop aerial spraying of the pesticide Naled in Miami-Dade County, describing the plaintiffs’ complaint as “poor” and recommending they get a lawyer before pursuing further legal action. Judge Federico Moreno, of the Southern District of Florida, gave the two Miami Beach residents who filed the complaint 60 days to amend it by clarifying why the case belongs in federal court and which laws they contend are being violated. (Stein, 7/13)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.