Tagged Legislation

2 Senators Reach Deal On A Health Law Fix, But Bringing Congress Along Is Tricky

After nearly two months of negotiations, key senators said Tuesday they have reached a bipartisan deal on a proposal intended to stabilize the Affordable Care Act’s insurance market, which has been rocked by recent actions by President Donald Trump.

Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), respectively the chairman and the top Democrat of the Senate Health, Education, Labor and Pensions Committee, negotiated the emerging deal. The milestone agreement, they said, would guarantee payment of “cost-sharing reduction” subsidies that help some policyholders with low incomes afford their deductibles and other out-of-pocket costs for two years, 2018 and 2019.

Trump announced last week that he would stop funding the subsidies, which have been the subject of a long-running lawsuit. These subsidies are separate from the tax credit subsidies that help eligible consumers pay for their premiums. Those premium subsidies are not affected by Trump’s action.

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Even if it fails to become law, the deal marks a singular achievement that has been almost completely missing in Congress for the past eight years — a bipartisan compromise on how to make the nation’s health insurance system work.

“This is an agreement I am proud to support,” said Murray on the Senate floor, “because of the message it sends about how to get things done.

The proposal — which will require 60 votes to pass the Senate and agreement from a still-dubious House of Representatives — would also restore $110 million in “outreach” funding cut by the Trump administration. That funding would help guide eligible individuals to sign up for coverage on the health insurance exchanges during the open enrollment period that runs from Nov. 1 to Dec. 15.

In exchange for those provisions, urged by Democrats and state officials, Republicans will win some changes to make it easier for states to apply for “waivers” that would let them experiment with alternative ways to provide and subsidize health insurance. The deal would also allow the sale of less comprehensive “catastrophic” plans in the health exchanges. Such plans currently can be sold only to those under age 30.

On the Senate floor Tuesday afternoon, Alexander said, “This agreement avoids chaos. I don’t know a Democrat or a Republican who benefits from chaos.”

Senate Majority Leader Mitch McConnell (R-Ky.) reserved judgment about the deal.

Both parties still have some major disagreements when it comes to health care, Senate Minority Leader Chuck Schumer (D-N.Y.) told reporters Tuesday afternoon, but “I think there’s a growing consensus that in the short term we need stability in the markets. So we’ve achieved stability if this agreement becomes law.”

More than 60 senators have already participated in the meetings that led to the deal, Alexander said on the Senate floor. But the path to passage in the House is uncertain — with many conservatives vehemently opposed to anything that could be construed as helping the law they call “Obamacare” succeed.

Tweeted Rep. Mark Walker (R-N.C.), chairman of the conservative Republican Study Committee, Tuesday: “The GOP should focus on repealing & replacing Obamacare, not trying to save it. This bailout is unacceptable.”

Both Murray and Alexander said Tuesday they were still struggling over language to make sure that if the cost-sharing payments are resumed, insurers would not receive a windfall by keeping both those payments and the higher premiums that many states are allowing in anticipation of the payments being ended.

“We want to make sure that the cost-sharing payments go to the benefit of consumers, not the insurance companies,” Alexander said.

Trump, who as recently as Monday called the cost-sharing subsidies “a payoff” to insurance companies, took credit for the negotiations. “If I didn’t cut the CSR’s, they wouldn’t be meeting,” he said. That was not, in fact, the case. The negotiations had picked up some weeks ago after being called off earlier in September while the Senate tried for one last-ditch repeal vote.

On Friday, White House Budget Director Mick Mulvaney told Politico that the president would not allow a short-term fix, calling a restoration of the cost-sharing reduction funds “corporate welfare and bailouts for the insurance companies.”

But on Tuesday the president hailed the deal. “We think it’s going to not only save money, but give people much better health care with a very, very much smaller premium spike,” he told reporters.

Categories: Insurance, The Health Law

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New Law Challenges ‘Evils’ Of Pharma Profits, California Governor Claims

California Gov. Jerry Brown defied the drug industry Monday by signing a sweeping drug price transparency bill that will force drugmakers to publicly justify big price hikes.

“Californians have a right to know why their medical costs are out of control, especially when pharmaceutical profits are soaring,” Brown said. “This measure is a step at bringing transparency, truth, exposure to a very important part of our lives. That is the cost of prescription drugs.”

The new law will require drug companies to give 60 days’ notice to state agencies and health insurers anytime they plan to raise the price of a drug by 16 percent or more over two years on drugs with a wholesale cost of $40 or higher. They must also explain why the increases are necessary.

Most of the reporting requirements will take effect in 2019.

Brown said the bill is part of a larger effort to correct growing income inequality in the United States.

He called on top pharmaceutical leaders to consider doing business in a way that helps Americans who are spending large sums of money for lifesaving medications.

“The rich are getting richer. The powerful are getting more powerful,” he said. “We’ve got to point to the evils, and there’s a real evil when so many people are suffering so much from rising drug profits.”

The drug lobby fiercely opposed the bill, SB 17, spending $16.8 million on lobbying from January 2015 through the first half of this year to kill an array of drug legislation in California, according to data from the secretary of state’s office. For the pricing bill alone, the industry hired 45 lobbyists or firms to fight it.

The bill drew support from a diverse coalition, including labor and consumer groups, the hospital industry and even health insurers, who agreed to share some of their own data. Under the new law, they will have to report what percentage of premium increases is related to drug prices.

“Health coverage premiums directly reflect the cost of providing medical care, and prescription drug prices have become one of the main factors driving up these costs,” said Charles Bacchi, CEO of the California Association of Health Plans. “SB 17 will help us understand why, so we can prepare for and address the unrelenting price increases.”

Drug companies criticized the governor’s move, saying the new law focuses too narrowly on one part of the drug distribution chain — and ultimately won’t help consumers afford their medicine.

“There is no evidence that SB 17 will lower drug costs for patients because it does not shed light on the large rebates and discounts insurance companies and pharmacy benefit managers are receiving that are not always being passed on to patients,” said Priscilla VanderVeer, spokeswoman for the Pharmaceutical Research and Manufacturers of America.

Indeed, some experts have said transparency alone is not enough to bring down drug prices, and that California’s law may lack the muscle being applied in other states to directly hold drug prices down.

This year, at least two states have passed laws that may have a more immediate effect on consumer costs than the California measure. Maryland and New York, for example, adopted bills that use a variety of legal levers to impose financial penalties or require discounts if prices are too high.

But other policy experts argue that California’s law is part of a broader campaign to adopt stronger drug price measures across the country. So it makes sense to start with the source of the drug prices: the drugmakers themselves, said Gerard Anderson, a health policy professor at Johns Hopkins Bloomberg School of Public Health who tracks drug legislation in the states.

“The manufacturers get most of the money — probably about three-quarters or more of the money that you pay for a drug, and they’re the ones that set the price initially,” he said. “So they are not the only piece of the drug supply chain, but they are the key piece to this.”

California Healthline Sacramento correspondent Pauline Bartolone contributed to this report. 

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

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

Categories: Cost and Quality, Health Industry, Pharmaceuticals

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Your Grandma’s Guide To Grass: Calif. Rolls Out Website To Cut Through Cannabis Haze

SACRAMENTO, Calif. — Every day, Anna Denny encounters people who know their way around a joint.

Denny owns Elevated 916, a smoke shop in north Sacramento that sells tobacco products and smoking accessories. But many of her customers don’t limit their smoking to tobacco.

Because they’ve been there, done that, Denny just can’t imagine them using a new state website that offers resources — and plenty of warnings — about the use of marijuana now that lighting up recreationally is legal in California.

“Some of this, I can see it being useful for a grandma who might be interested [in marijuana] and is getting her information from her grandson,” Denny said. “In that case, this website is probably a better source.”

Grandmas and all other Californians can now visit the “Let’s Talk Cannabis” website launched last month by the state Department of Public Health. The site is the first step in the department’s public education campaign to inform state residents about the drug as it becomes more widely used and available.

Last November, voters approved Proposition 64, the Adult Use of Marijuana Act, making California one of eight states — plus the District of Columbia — to legalize the drug for recreational use. California’s recreational measure immediately made it legal for adults 21 and over to possess up to 1 ounce or 28.5 grams of cannabis, although the state delayed sales by licensed retailers until the beginning of next year. Colorado and Washington were the first to approve recreational use, passing referendums  in 2012.

California’s website is not a user guide. Instead, it is geared to youth, parents and drivers, mostly focusing on weed’s potential risks and harms. Research on its effects has been mixed, but marijuana has been linked to potential cognitive impairments and driving accidents; it may be hazardous for developing fetuses. Today’s dope is also two to seven times stronger than it was in the 1970s, according to researchers at the University of Washington.

For novices, the state also helpfully lists the many synonyms for pot, including  “weed, grass, ganga, dope, herb, chronic, bud, trees, broccoli, nuggets, skunk, kief, sticky icky, Mary Jane.”

But in general, California is no stranger to Mary Jane.

The state was the first to outlaw it in 1913. In the 1930s and 1940s, anti-weed cultural references were far-reaching and even graced movie posters that warned against the “smoke of hell,” linking reefer to crime and “weird orgies.”

Since then, illegal use has been widespread. Dope experienced a renaissance in the 1960s when gleeful hippies “turned on” by smoking grass. Now, California’s pot industry, legal and illegal, is worth billions of dollars.

Back in 1996, with the passage of Proposition 215, the Golden State became the first of 29 states, plus the District of Columbia, to allow use of marijuana for medical purposes, with authorization from a doctor.

In 2004, the state began issuing medical marijuana ID cards, which allow patients to purchase pot from dispensaries. About 95,000 have been issued so far.

“Getting a card is not that hard,” said Denny, whose clients have received medical marijuana cards for ailments including menstrual cramps, difficulty sleeping and depression.

Devonte Legaspi, 20, a student at Sacramento City College, agrees. “There are even apps that let you FaceTime a doctor for your consultation,” he said.

Devonte Legaspi said he doubts young people will make much use of the website, but Aatiqah Murdoc argues they might, especially to answer questions about what’s legal and what’s not. (Ana B. Ibarra/California Healthline)

Many of his friends have used websites and phone apps to get theirs. “It’s so easy,” he said.

Legaspi hasn’t gotten around to getting his own card. But he turns 21 in February, he said, about a month after licensed retailers will be allowed to sell to the public.

“Right on time,” he said.

California’s medical marijuana ballot measure didn’t require a public education campaign, but this broader law does.

“We are committed to providing Californians with science-based information to ensure safe and informed choices,” said Karen Smith, director of the Department of Public Health, in a prepared statement.

The new website provides details about what’s legal to buy, sell and give to others.

It’s not overtly anti-drug like the infamous “This is your brain on drugs” ads from the 1980s that warned youth that their brains would get fried like eggs if they got high.

The site, however, advises pregnant women that if they get stoned, their babies may be born underweight — putting them at risk for all sorts of medical problems. Pet owners are cautioned that Fido might freak — and in rare cases, suffer potentially deadly poisoning — if he accidentally gobbles a pot brownie.

And parents who find out their teen is getting baked — which remains illegal — are urged to “stay calm. Overreacting may lead youth to rebel, feel resentment or take greater risks,” the state advises.

The website has a resource page specifically for youth, but Legaspi doesn’t think it will be the first stop for curious teens and young adults.

“You ask your friends first, then Google,” he said. “I think we’ve been exposed to it for a while. … We know almost everything there is to know about it.”

Still, there are things that some young adults want to see on the website. Aatiqah Murdoc, 22, is Legaspi’s friend. She wants information about possible ingredients in marijuana products, such as brownies and candies.

The site doesn’t offer that. But it does warn that “edibles may have higher concentrations of tetrahydrocannabinol (THC). If you eat too much, too fast you are at higher risk for poisoning.”

THC is the chemical responsible for providing marijuana’s high.

Tamara Cross, who works at Broham Smoke Shop in Sacramento, said she might share the website link with customers who walk in with questions, mostly around legality.

“I have a lot of questions myself, so it’s good to know this exists,” Cross, 24, said. Some customers already ask her when they’ll be able to buy marijuana for recreational use, or whether their access to medical pot will change with the new law.

Sharon Duplechan says education about the risks of cannabis should have been more widespread when the measure to legalize recreational marijuana was on the ballot last year. (Ana B. Ibarra/California Healthline)

Sharon Duplechan, 65, who helps care for four of her grandchildren, voted against legalization last year, she said.

As she watched her grandchildren play at a Sacramento park, she said she wishes that the precautions offered on the state website had been more widely available when Californians were deciding how to vote. Now she worries that her grandchildren are growing up in an era when pot is more available and accepted.

“The warnings are a little late,” she said. “You don’t put the cart before the horse.”

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

Categories: California Healthline, Public Health, States

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Your Grandma’s Guide To Grass: Calif. Rolls Out Website To Cut Through Cannabis Haze

SACRAMENTO, Calif. — Every day, Anna Denny encounters people who know their way around a joint.

Denny owns Elevated 916, a smoke shop in north Sacramento that sells tobacco products and smoking accessories. But many of her customers don’t limit their smoking to tobacco.

Because they’ve been there, done that, Denny just can’t imagine them using a new state website that offers resources — and plenty of warnings — about the use of marijuana now that lighting up recreationally is legal in California.

“Some of this, I can see it being useful for a grandma who might be interested [in marijuana] and is getting her information from her grandson,” Denny said. “In that case, this website is probably a better source.”

Grandmas and all other Californians can now visit the “Let’s Talk Cannabis” website launched last month by the state Department of Public Health. The site is the first step in the department’s public education campaign to inform state residents about the drug as it becomes more widely used and available.

Last November, voters approved Proposition 64, the Adult Use of Marijuana Act, making California one of eight states — plus the District of Columbia — to legalize the drug for recreational use. California’s recreational measure immediately made it legal for adults 21 and over to possess up to 1 ounce or 28.5 grams of cannabis, although the state delayed sales by licensed retailers until the beginning of next year. Colorado and Washington were the first to approve recreational use, passing referendums  in 2012.

California’s website is not a user guide. Instead, it is geared to youth, parents and drivers, mostly focusing on weed’s potential risks and harms. Research on its effects has been mixed, but marijuana has been linked to potential cognitive impairments and driving accidents; it may be hazardous for developing fetuses. Today’s dope is also two to seven times stronger than it was in the 1970s, according to researchers at the University of Washington.

For novices, the state also helpfully lists the many synonyms for pot, including  “weed, grass, ganga, dope, herb, chronic, bud, trees, broccoli, nuggets, skunk, kief, sticky icky, Mary Jane.”

But in general, California is no stranger to Mary Jane.

The state was the first to outlaw it in 1913. In the 1930s and 1940s, anti-weed cultural references were far-reaching and even graced movie posters that warned against the “smoke of hell,” linking reefer to crime and “weird orgies.”

Since then, illegal use has been widespread. Dope experienced a renaissance in the 1960s when gleeful hippies “turned on” by smoking grass. Now, California’s pot industry, legal and illegal, is worth billions of dollars.

Back in 1996, with the passage of Proposition 215, the Golden State became the first of 29 states, plus the District of Columbia, to allow use of marijuana for medical purposes, with authorization from a doctor.

In 2004, the state began issuing medical marijuana ID cards, which allow patients to purchase pot from dispensaries. About 95,000 have been issued so far.

“Getting a card is not that hard,” said Denny, whose clients have received medical marijuana cards for ailments including menstrual cramps, difficulty sleeping and depression.

Devonte Legaspi, 20, a student at Sacramento City College, agrees. “There are even apps that let you FaceTime a doctor for your consultation,” he said.

Devonte Legaspi said he doubts young people will make much use of the website, but Aatiqah Murdoc argues they might, especially to answer questions about what’s legal and what’s not. (Ana B. Ibarra/California Healthline)

Many of his friends have used websites and phone apps to get theirs. “It’s so easy,” he said.

Legaspi hasn’t gotten around to getting his own card. But he turns 21 in February, he said, about a month after licensed retailers will be allowed to sell to the public.

“Right on time,” he said.

California’s medical marijuana ballot measure didn’t require a public education campaign, but this broader law does.

“We are committed to providing Californians with science-based information to ensure safe and informed choices,” said Karen Smith, director of the Department of Public Health, in a prepared statement.

The new website provides details about what’s legal to buy, sell and give to others.

It’s not overtly anti-drug like the infamous “This is your brain on drugs” ads from the 1980s that warned youth that their brains would get fried like eggs if they got high.

The site, however, advises pregnant women that if they get stoned, their babies may be born underweight — putting them at risk for all sorts of medical problems. Pet owners are cautioned that Fido might freak — and in rare cases, suffer potentially deadly poisoning — if he accidentally gobbles a pot brownie.

And parents who find out their teen is getting baked — which remains illegal — are urged to “stay calm. Overreacting may lead youth to rebel, feel resentment or take greater risks,” the state advises.

The website has a resource page specifically for youth, but Legaspi doesn’t think it will be the first stop for curious teens and young adults.

“You ask your friends first, then Google,” he said. “I think we’ve been exposed to it for a while. … We know almost everything there is to know about it.”

Still, there are things that some young adults want to see on the website. Aatiqah Murdoc, 22, is Legaspi’s friend. She wants information about possible ingredients in marijuana products, such as brownies and candies.

The site doesn’t offer that. But it does warn that “edibles may have higher concentrations of tetrahydrocannabinol (THC). If you eat too much, too fast you are at higher risk for poisoning.”

THC is the chemical responsible for providing marijuana’s high.

Tamara Cross, who works at Broham Smoke Shop in Sacramento, said she might share the website link with customers who walk in with questions, mostly around legality.

“I have a lot of questions myself, so it’s good to know this exists,” Cross, 24, said. Some customers already ask her when they’ll be able to buy marijuana for recreational use, or whether their access to medical pot will change with the new law.

Sharon Duplechan says education about the risks of cannabis should have been more widespread when the measure to legalize recreational marijuana was on the ballot last year. (Ana B. Ibarra/California Healthline)

Sharon Duplechan, 65, who helps care for four of her grandchildren, voted against legalization last year, she said.

As she watched her grandchildren play at a Sacramento park, she said she wishes that the precautions offered on the state website had been more widely available when Californians were deciding how to vote. Now she worries that her grandchildren are growing up in an era when pot is more available and accepted.

“The warnings are a little late,” she said. “You don’t put the cart before the horse.”

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

Categories: California Healthline, Public Health, States

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