Tagged U.S. Congress

Running Short On Time, Covered California And Insurers Seek Obamacare Answers From GOP

With a deadline looming, California’s health exchange and a major insurer pressed Republican leaders in Washington to clear up confusion over their commitment to key provisions of the Affordable Care Act.

Health insurers participating in the Covered California exchange for individuals and families must submit initial rates for 2018 on Monday. Peter Lee, the exchange’s executive director, warned in a conference call Thursday that rates could jump by more than 40 percent if the Trump administration and Republican-led Congress walk away from crucial elements of the health law.

In the meantime, House Republicans are looking to revive their Obamacare replacement bill and rally more support among moderate lawmakers in hopes of holding a vote soon.

In addition to Covered California, the chief executive of Molina Healthcare, a Long Beach-based insurer, implored Congress and the Trump administration on Thursday to act quickly to stabilize the exchange markets.

At issue are the continued federal funding of subsidies that reduce low-income consumers’ deductibles and copays and the enforcement of the individual mandate to purchase health coverage or pay a penalty.

Use Our Content

Premiums in Covered California plans could increase by 42 percent, on average, if those subsidies aren’t funded and the mandate isn’t enforced, according to an analysis released Thursday by the exchange. Covered California has about 1.3 million customers.

Lee said it is imperative for leaders in Washington to clear up the uncertainty to avoid damaging insurance markets nationwide and hurting consumers. He said statements this week by the Trump administration that it would continue funding the cost-sharing subsidies haven’t specifically addressed whether that applies to all of 2017 or 2018.

“Health plans need to know now what are the rules of the road,” Lee said. “Insurers are considering their participation in the face of unprecedented uncertainty.”

Much of the debate this week in Washington has centered on House Republicans amending their Obamacare replacement bill, the American Health Care Act. But Lee said addressing the current market rules should be a priority ahead of crafting broader legislation.

Lee declined to comment on the latest legislative proposal from House Republicans, but he noted it still faces a long road ahead in Congress before it would win approval. “Health plans need to submit bids for today’s reality. Policymakers need to address that reality,” Lee said.

In a letter to House Speaker Paul Ryan and other congressional leaders, Molina Healthcare CEO J. Mario Molina said the cost-sharing reduction subsidies are essential for making coverage affordable for many consumers. Those subsidies cover out-of-pocket costs for exchange customers with incomes below 250 percent of the federal poverty level. They are separate from the tax credits that subsidize premium costs.

Without that federal funding, Molina wrote, “we will have no choice but to send a notice of default informing the government that we are dropping our contracts for their failure to pay premiums and seek to withdraw from the marketplace immediately.”

Molina said his company currently serves more than 1 million people through insurance exchanges in California and several other states. Molina had nearly 69,000 enrollees in Covered California as of December, state data show.

Anthem, California’s largest for-profit health insurer and a key player on exchanges nationally, issued a similar warning this week. During an earnings conference call on Wednesday, Anthem CEO Joseph Swedish said the insurer may exit some state exchanges or resubmit for higher rates if the fate of the cost-sharing subsidies isn’t resolved by early June.

Anthem has more than 310,000 customers in the California exchange, or nearly 25 percent of the market. Rival Blue Shield of California is the leader in state enrollment with 389,480, or 31 percent market share.

Republican leaders in Congress say they will address these concerns and move quickly to aid consumers by replacing the ACA with a plan that will reduce premiums and expand options for coverage.

The health law “is collapsing,” Ryan said at a news conference Thursday. “The American health care system in the individual market is in peril right now. We have a moral obligation to prevent people from getting hurt, to stop the damage from being continued.”

Many conservative Republicans oppose the Trump administration’s decision to continue to pay the cost-sharing subsidies, calling the subsidies unconstitutional because they lack congressional approval. House Republicans successfully sued to block the payments, but a judge put the ruling on hold while the Obama administration appealed the case. It’s not yet clear how President Donald Trump will handle that appeal.

Amid this political uncertainty, California Insurance Commissioner Dave Jones told insurers this week they could submit two sets of rate filings on Monday for their exchange business. One filing would reflect continued funding of cost-sharing subsidies and enforcement of the individual mandate. A separate filing could assume the opposite.

“In light of all the actions taken by the Trump administration and House leadership to undermine the ACA, I expect that health insurers will consider filing significant rate increases for 2018,” Jones wrote in a bulletin to insurers this week.

For 2017, rates in Covered California rose by 13.2 percent, on average, statewide. The state exchange is one of the few that actively negotiates rates with insurers. Premiums for the next year usually are announced in July.

Categories: California Healthline, Cost and Quality, The Health Law

Tags: , , , ,

Rural Doctors’ Training May Be In Jeopardy

In nearly two years as a medical resident in Meridian, Mississippi, Dr. John Thames has treated car-wreck victims, people with chest pains and malnourished infants. Patients have arrived with lacerations, with burns, or in a disoriented fog after discontinuing their psychiatric medications.

Thames, a small-town Mississippi native, said the East Central Mississippi HealthNet Rural Family Medicine Residency Program has been “exactly what I was looking for.”

Unlike the vast majority of doctors, Thames sought a residency in a rural clinic instead of in a teaching hospital because his ambition is to practice in the sort of place where he grew up, where doctors are scarce. He wants to be able to handle anything that comes through the door, from infections to gunshot wounds to a woman who might deliver a baby any second.

But budget decisions in faraway Washington, D.C., may make it more difficult for Thames and other doctors who want to practice in small towns or underserved cities.

Under the Teaching Health Center Graduate Medical Education program, which is part of the Affordable Care Act, the federal government dispenses grants to community health centers to train medical residents. The goal of the program is to address the shortage of primary care physicians in rural and poor urban areas.

But under current law, the federal government will stop funding the program, which serves nearly 750 primary care residents in 27 states and Washington, D.C., at the end of September. Without congressional action, it might be shut down.

“The program is absolutely doing what it is designed to do, which is to put doctors in underserved areas like ours,” said Darrick Nelson, the director of Hidalgo Medical Services’ teaching health center program, which is training six residents in Lordsburg, New Mexico.

The teaching health centers have received bipartisan support in the past. But supporters worry that because the program is new, relatively small, and not as well-known as other federally funded doctor training programs, it might fall through the federal budgetary cracks.

“The greatest threat to the teaching health centers is the dysfunction in Washington,” said Dan Hawkins, a vice president at the National Association of Community Health Centers, a research and advocacy group.

Earlier Cuts

Bipartisan support didn’t protect the program from earlier cuts. In 2010, Congress allocated $230 million over five years, or about $46 million a year. But when it approved a two-year extension in 2015, it reduced funding to about $43 million a year. That reduction was enough to cause some of the teaching health centers to train fewer residents. Some have closed.

Studies have found that most physicians end up practicing close to where they did their residencies. But most teaching hospitals are located in urban centers, far from rural regions with acute doctor shortages. Poor urban neighborhoods also have difficulty attracting physicians.

The American Association of Teaching Health Centers, a nonprofit advocacy group, said the ACA residency program is having the intended result. According to the organization, 55 percent of teaching health center graduates practice in underserved areas, compared to 26 percent of those who graduate from hospital-based residencies.

“The program is doing exactly what we wanted it to do,” said John Sealey, director of medical education for Authority Health in Detroit. More than 60 percent of residents who graduated from teaching health centers in Detroit go on to practice in medically underserved areas, many of them in Michigan, he said.

Progress in Montana

RiverStone Health, a health care provider in Billings, Montana, was a teaching health center even before the federal program began. RiverStone started training residents in 1998, after partnering with two local hospitals.

“The state was completely reliant on recruiting from other areas, which was clearly not working as well as it should,” said Roxanne Fahrenwald, a RiverStone vice president. Fifty-one out of 56 Montana counties have shortages of primary care doctors, according to the federal government.

With the federal money awarded to it under the ACA, RiverStone has been able to add one medical resident a year to its program, bringing its number of residents to 24. About 70 percent of RiverStone graduates have remained in the state.

Supporters also argue that teaching health centers expose residents to the types of ailments and health disparities, such as higher rates of obesity, diabetes and heart disease, that they are likely to encounter if they practice primary care in underserved areas.

“In a community health center, most of the patients are going to present with conditions or ailments more common to a primary care practice, whereas those in the hospital will be sicker, with more acute needs,” said Shawn Martin, a vice president at the American Academy of Family Physicians.

The residents in teaching health centers do spend some of their time training in hospitals. They must complete hospital rotations in surgery, inpatient care, obstetrics and gynecology.

But health center residents also see what many hospital residents never do. In Washington, D.C., for example, medical residents at Unity Health Care Inc. often work in jails, homeless shelters and HIV/AIDS clinics.

Those receiving care at such sites would bear the brunt of the impact if federal money for the health center residency program disappears.

“I’m very nervous,” said Eleni O’Donovan, director of the teaching health center program at Unity. “The program is not sustainable without that funding.”

Categories: Health Industry, Public Health, The Health Law

Tags: , ,

5 Things To Know About The Health Issue That Could Shut Down The Government

Congress must pass a bill this week to keep most of the government running beyond Friday, when a government spending bill runs out. It won’t be easy.

The debate over a new spending bill focuses on an esoteric issue affecting the Affordable Care Act.

The question is whether Congress will pass — and President Donald Trump will sign — a bill that also funds subsidies for lower-income people who purchase health insurance under the law. These “cost-sharing reductions” (CSR) have become a major bargaining point in the negotiations between Republicans and Democrats, because the spending bill will require at least some Democratic votes to pass.

Here are five things to know about these cost-sharing subsidies: 

Use Our Content

How are these subsidies different from the help people get to purchase insurance?

There are two types of financial aid for people who buy insurance from an ACA exchange. People with incomes up to four times the poverty line, or $81,680 for a family of three, are eligible for tax credits to help pay their premiums.

In addition to that help, people with incomes up to two-and-a-half times the poverty line, or $51,050 for a family of three, get additional subsidies to help pay their out-of-pocket costs, including deductibles and copayments for care, as long as they purchase a silver-level plan. Insurance companies are required in their contracts with the government to provide these cost-sharing reductions to eligible people, then get reimbursed by the government.

Why are cost-sharing reductions suddenly front and center?

The fight dates to 2014, when Republicans in the House of Representatives filed suit against the Obama administration, charging that Congress had not specifically appropriated money for the cost-sharing subsidies and therefore the administration was providing the funding illegally.

A year ago, a federal district court judge ruled that the House was correct and ordered the payments stopped. However, she put that ruling on hold while the Obama administration appealed. That’s where things stood when Trump was inaugurated.

If the Trump administration drops the appeal, the funding would cease. However, Congress could also opt to approve funding the payments, which is what Democrats are pushing in the spending bill. 

What would happen if these subsidies are stopped?

At the very least, ending the cost-sharing reductions in the middle of the year would cause a serious disruption in the insurance market. The payments are estimated at $7 billion this year, and $10 billion in 2018. They cover about 7 million people, about 58 percent of those purchasing coverage on the exchanges.

Many experts have predicted that if the subsidies end, some or all insurers might leave their markets entirely, leaving consumers with fewer, or possibly no, choices.

But even if they stay, the Kaiser Family Foundation estimates that insurers would have to raise premiums on the marketplace silver plans by an average of 19 percent in order to offset that loss of government reimbursement. (Kaiser Health News is an editorially independent program of the foundation.)

Ironically, ending the subsidies would actually cost the federal government more money. Premium increases to make up for the lost payments would in turn trigger bigger tax credits for the broader population eligible for help paying their premiums. Those larger tax credits would cost the federal government an estimated $2.3 billion above what it would save on the cost reduction subsidies next year, KFF projected.

Who is pushing Congress to fund the subsidies?

In addition to Democrats in Congress who support the ACA, influential health-related groups are urging lawmakers to fund the cost-sharing reductions.

The coalition, which includes America’s Health Insurance Plans, the American Medical Association, the American Hospital Association and the U.S. Chamber of Commerce, points out that the uncertainty surrounding the future of the promised payments could not only disrupt this year’s insurance market, but next year’s as well.

“The window is quickly closing to properly price individual insurance products for 2018,” the groups wrote to Congress on April 12. Most insurers must decide whether they will participate in the health law’s market in 2018 by late June.

Most Americans don’t support cutting the subsidies as part of a GOP strategy to force Democrats in Congress to help pass a new health law. A recent poll reported 60 percent of those surveyed said the president “should not use negotiating tactics that could disrupt insurance markets and cause people to lose health coverage.” On the other hand, two-thirds of Republicans surveyed said Trump “should use whatever negotiating tactics necessary to win support for a replacement plan.”

What does the Trump administration think about this?

Good question. Trump and senior health officials have offered conflicting positions.

On April 10, unnamed officials told the New York Times and other outlets that the administration “is willing to continue paying subsidies” while the lawsuit remains pending, just as the Obama administration did. The next day, however, a spokeswoman for the Department of Health and Human Services disavowed that statement, saying that “the administration is currently deciding its position on this matter.”

The day after that, Trump himself said in an interview with the Wall Street Journal that he was holding back a decision on the payments as leverage. “I don’t want people to get hurt,” he said. “What I think should happen — and will happen — is the Democrats will start calling me and negotiating.”

By the following week, administration officials were dangling the funding for the cost-sharing reductions in the spending bill as a trade for Trump’s request for funding for a border wall. “We don’t like those [subsidies] very much, but we have offered to open the discussions to give the Democrats something they want in order to get something we want,” budget director Mick Mulvaney said on Fox News Sunday. “We’d offer them $1 of CSR payments for $1 of wall payments.”

Democrats, however, are not buying what the administration is selling. “The White House gambit to hold hostage health care for millions of Americans, in order to force American taxpayers to foot the bill for a wall that the president said would be paid for by Mexico is a complete non-starter,” Senate Minority Leader Chuck Schumer (D-N.Y.) said in a written statement.

Complicating matters further, it is far from clear that Republicans in Congress want to end the cost-sharing payments.

The subsidies are “a commitment made by the government to the insurers and the people,” House Energy and Commerce Committee Chairman Greg Walden (R-Ore.) said at a town hall meeting in his district, according to The Washington Post. “That needs to happen.”

Categories: Health Care Costs, Insurance, Repeal And Replace Watch, The Health Law

Tags: , ,

Health Care Worries Pull Crowd To Conservative Ohio Rep’s Town Hall

LIMA, Ohio — Speaking over constituents’ often-hostile shouts and angry murmurs, one of Congress’ most conservative Republicans told a tense town hall meeting here Monday that less government regulation — not more — is the solution to their rising health care premiums.

“What we want to do is make sure we have the best health care system in the world and bring back affordable insurance plain and simple. That’s what I’m trying to do. That’s what we continue to focus on,” said Rep. Jim Jordan, the co-founder of the House’s conservative Freedom Caucus. Its firm opposition to the GOP’s plan to replace the Affordable Care Act forced party leaders last month to yank their bill from a vote on the House floor.

But on the eve of Congress’ return to Washington after a two-week Easter recess, Jordan offered no clues to his party’s next move on a health care bill or the prospects for a government shutdown if Congress fails to agree before the Friday deadline on a bill to provide short-term funding to keep it operating.

Use Our Content

More than 200 people attended the Ohio congressman’s 2 1/2-hour meeting, mostly pummeling him with questions and personal stories about their health care. Jordan heard from constituents with sick children, veterans who couldn’t access Veterans Affairs’ care and nervous families who feared what could happen to them if federal Medicaid funding is cut, among others.

Seated on black folding chairs in a windowless hall of the Lima Veterans Civic Center, many in the audience followed a practice that’s been common this year at congressional members’ town hall meetings — holding up red signs when they disagreed with Jordan and, less frequently, green signs when they agreed. Jordan, unruffled by opposition, drew laughs once when he referred to a woman in the crowd as “gentlelady,” in the formal way that male members of Congress sometimes address female members when the House is in session.

Tobias Buckell told the congressman the ACA’s mandate that insurers cover preexisting conditions had made it possible for both his wife, Emily, and him to have careers as freelancers — he as a science fiction writer and Emily as an e-book designer. Buckell, the father of twin 8-year-old daughters, told Jordan the only way he could risk that career choice was because he was able to buy insurance through the law’s exchanges. He has a genetic heart condition that he said had made him virtually uninsurable before.

“We’re going to be moved to a high risk pool, we’ll pay three times as much our current rate … how will that help me?” asked Buckell, 38.

Though the most vocal members of the crowd were largely in disagreement with Jordan’s views, a quiet minority in the front of the room shook their heads and waved green signs in agreement when the congressman responded to a question by saying he did not believe health care is a universal right.

(Rachel Bluth/KHN)

“I do not believe health care is a right. Rights are not given to us by the government, rights come from God, although Jim acknowledged that the American people have come to accept it as a right,” said Linda Gentry, a 66-year old constituent who works for an insurance company.

Of the 17 questions Jordan was asked, 13 related to health care. Lisa Robeson, the event’s moderator, estimated that around half of the 45 questions submitted in advance focused on the topic.

Jordan’s comments on the federal government’s role in solving the opioid crisis brought what might have been his audience’s most negative reaction of the night.

Ohio has been especially hard hit in recent years. It led the nation in opioid overdose deaths in 2015, according to the Kaiser Family Foundation, while Dayton, just an hour and a half south of Lima, topped a criminal justice group’s national ranking of America’s most drugged-out cities last year.

“I’m not convinced the federal government giving more money will solve the problem,” Jordan said. Instead of a “grand scheme” handed down from Washington, he suggested churches, schools and families are best equipped to handle the opioid epidemic – a remark that raised a sea of red signs across the room.

Jordan’s 4th District touches the northern part of the state near Lake Erie, and includes rural areas and suburbs of Columbus, the state capitol. He has been the district’s congressman since 2007 and he has little reason to be alarmed by contentious town halls. Jordan was reelected last November with more than 68 percent of the vote.

By the end of Monday’s town hall, some of Jordan’s constituents were divided on whether they’d heard what they came to find out.

“It’s clear to me that there is sort of a vague idea what the Republican replacement would be, and I don’t think we got a statement about that,” said Robert Kemp, 62, a health care economist that also rose to speak in favor of universal health care.

Barbara Mayer, 81, a retired teacher, didn’t mind the lack of specificity. She said it was unfair for people to demand comment on a measure that hasn’t been finalized yet.

“They’re quoting things about what Trump’s bringing out and it isn’t even public yet,” Mayer said. “People aren’t giving the new Congress a fair trial.”

Categories: Cost and Quality, Insurance, Repeal And Replace Watch, The Health Law

Tags: ,

Drugmakers Dramatically Boosted Lobbying Spending In Trump’s First Quarter

Eight pharmaceutical companies more than doubled their lobbying spending in the first three months of 2017, when the Affordable Care Act was on the chopping block and high drug prices were clearly in the crosshairs of Congress and President Donald Trump.

Congressional records show those eight, including Celgene and Mylan, kicked in an extra $4.42 million versus that quarter last year. Industry giant Teva Pharmaceutical Industries spent $2.67 million, up 115 percent from a year ago as several companies embroiled in controversies raised their outlays significantly.

“It’s certainly a rare event” when lobbying dollars double, noted Timothy LaPira, an associate professor of political science at James Madison University. “These spikes are usually timed when Congress in particular is going to be really hammering home on a particular issue. Right now, that’s health care and taxes.”

Trump has come down hard on drugmakers, stating in a press conference before his inauguration that the industry is “getting away with murder.” He has promised to lower drug prices and increase competition with faster approvals and fewer regulations. Sens. Bernie Sanders (I-Vt.) and John McCain (R-Ariz.), and Rep. Elijah E. Cummings (D-Md.) have introduced bills to allow lower-cost drug imports from Canada or other countries.

Use Our Content

Lobbyists weren’t expecting much by way of big policy changes during the comparatively sleepy end of the Obama administration this time last year, but with a surprise Trump administration and a Republican-controlled House and Senate, trade groups and companies are probably “going all in,” LaPira said.

Thirty-eight major drugmakers and trade groups spent a total of $50.9 million, up $10.1 million from the first quarter of last year, according to a Kaiser Health News analysis. They deployed 600 lobbyists in all.

PhRMA, the drug industry’s largest trade group, spent $7.98 million during the quarter —more than in any single quarter in almost a decade, congressional records show, topping even its quarterly lobbying ahead of the Affordable Care Act’s passage in 2010.

In their congressional disclosures, companies listed Medicare price negotiation, the American Health Care Act, drug importation and the orphan drug program as issues they were lobbying for or against. They do not have to disclose on which side of an issue they lobbied.

When Medicare prices are on the table, it should come as no surprise that pharmaceutical companies are interested in influencing congress.

“It’s quite literally hitting their bottom line,” LaPira said.

Drugmakers under fire more than doubled their lobbying dollars. Mylan spent $1.45 million during the quarter, up from $610,000 last year. The company’s CEO faced a congressional hearing in the fall when it raised the price of EpiPen to over $600.

Marathon Pharmaceuticals spent $230,000, which was $120,000 more than last year. Marathon was criticized in February after setting the price of Emflaza, a steroid to treat Duchenne muscular dystrophy, at $89,000 a year. That angered advocates, Congress and patients who had been importing the same drug for as little as $1,000 a year. Marathon has since sold the drug to another company, and the price may come down.

Teva and Shire also more than doubled their spending. Teva was accused as part of an alleged generic price-fixing scheme in December, and the Federal Trade Commission sued Shire because one of its recently acquired companies allegedly filed “sham” petitions with the Food and Drug Administration to stave off generics.

Companies that make drugs for rare diseases also more than doubled lobbying dollars as congressional leaders and the Government Accountability Office work to determine whether the Orphan Drug Act is being abused. Those firms include BioMarin, Celgene and Vertex Pharmaceuticals. Celgene, which makes a rare cancer drug, more than tripled its first quarter lobbying to more than $1 million.

Despite efforts to make good on campaign promises to repeal the Affordable Care Act, House Republicans canceled a floor vote on the American Health Care Act in March after multiple studies estimated that millions of people would lose coverage if it passed, and neither Democrats nor ultra-conservatives lined up in opposition to the bill’s provisions. Drug prices weren’t a key part of the package.

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, Medicare, Pharmaceuticals

Tags: , ,

Trump Set To Extend Flawed ‘Fix’ For VA Health Scandals

It was a “fix” that didn’t fix much — but Veterans Choice is expected to be extended anyway, with a stroke of President Donald Trump’s pen that could come as early as Wednesday.

Veterans Choice is a $10 billion response to the 2014 scandal in which Veterans Affairs health facilities altered records to hide months-long waits for care in Phoenix and elsewhere. The troubled Choice program pays for private-sector health care for veterans and was set to expire in August, but the VA and some of the program’s harshest critics in Congress have agreed to extend it, with a few changes, until January. They said that will give the VA time to propose a more comprehensive package of reforms — fixes for the fix.

Montana Democratic Sen. Jon Tester authored the extension bill, which won bipartisan support in the House and Senate this month. It will become law when Trump signs it.

Veterans Choice is designed to allow veterans who have waited more than 30 days for an appointment at a VA facility, or who live more than 40 miles from one, instead to get care from private providers, who then bill the VA. But it has been plagued with problems. Many vets complain that Choice actually makes getting care more difficult and time-consuming, and some health care providers have dropped out due to slow payments or administrative hassles.

The bigger reforms the VA wants following this extension bill will be aimed at fixing more than a half-dozen other systems the VA has for purchasing care from the private sector.

“The idea of having seven, eight ways of doing the same thing is part of the problem, because it’s confusing to veterans, it’s confusing to the community providers,” said VA Deputy Undersecretary Dr. Baligh Yehia.

Yehia said the VA has issued a request for proposals to streamline how it buys care from non-VA providers across the board. It expects to receive those proposals this summer.

VA leaders have said a big reason Veterans Choice foundered is because Congress provided only 90 days to set it up. The VA invited 57 companies to bid on running Choice, but only two responded, given the short timeline. Those two companies, Health Net Federal Services and TriWest, have struggled to make it work.

Tester, the ranking Democrat on the Senate Veterans’ Affairs committee, said he hopes to have draft legislation incorporating private-sector reform proposals ready in the fall.

Tester said his goal is to “cut the red tape and make sure it’s easy to work with for the providers. And I think we’ll get more providers jumping on board, and we’ll get more veterans using it, if the time to set up those appointments is reduced dramatically.”

Tester says he’ll defend the VA from those who “don’t want the government involved in health care at all.”

“I think it’s idealism versus realism,” Tester said. “We have folks that have borne the wounds of battle, and I think the VA is best suited to take care of those folks. So that VA needs to be there, and then we need to have a private sector that fills in the gaps around that VA.”

That’s particularly important in rural states like Tester’s Montana, where VA facilities are an important part of a generally understaffed health care landscape. They provide vital services, but rely on partnerships with private-sector doctors, clinics and hospitals to provide specialty care, or appointments that don’t require hours of driving.

This story is part of a reporting partnership with Montana Public Radio, NPR and Kaiser Health News.

Categories: Mental Health, Public Health, States

Tags: , ,

Non-Profit Linked To PhRMA Rolls Out Campaign To Block Drug Imports

A nonprofit organization that has orchestrated a wide-reaching campaign against foreign drug imports has deep ties to the Pharmaceutical Research and Manufacturers of America, or PhRMA, the powerhouse lobbying group that includes Eli Lilly, Pfizer and Bayer.

A PhRMA senior vice president, Scott LaGanga, for 10 years led the Partnership for Safe Medicines, a nonprofit that has recently emerged as a leading voice against Senate bills that would allow drug importation from Canada. LaGanga was responsible for PhRMA alliances with patient advocacy groups and served until recently as the nonprofit’s principal officer, according to the partnership’s tax forms.

In February, LaGanga moved to a senior role at PhRMA and stepped down as executive director of the Partnership for Safe Medicines — just as the group’s campaign to stop import legislation was revving up.

Both PhRMA and the partnership have gone to great lengths to show that drugmakers are not driving what they describe as a “grass-roots” effort to fight imports — including an expensive advertising blitz and an event last week that featured high-profile former FBI officers and a former Food and Drug Administration commissioner.

The partnership’s new executive director, Shabbir Safdar, said LaGanga resigned from the group to avoid the appearance of a conflict of interest.

“That’s why Scott’s not executive director anymore,” he said. PhRMA declined to make LaGanga available for an interview.

A Kaiser Health News analysis of groups involved in the partnership shows more than one-third have received PhRMA funding or are local chapters of groups that have received PhRMA funding, according to PhRMA tax disclosures from 2013 to 2015. Forty-seven of the organizations listed in the ads appear to be advocacy organizations that received no money from PhRMA in those years.

The Senate push to allow Americans to buy pharmaceuticals from Canada comes as more patients balk at filling prescriptions because of soaring drug prices. Prescription medicines purchased in the U.S. can run three times what they cost in Canada, data from the company PharmacyChecker.com show. In 2016, about 19 million Americans purchased pharmaceuticals illegally from foreign sources through online pharmacies or while traveling, according to a Kaiser Family Foundation poll; many survey respondents cited pricing disparities as the reason.

The U.S. drug industry has strongly opposed efforts to open the borders to drug imports, but PhRMA is not mentioned in the partnership’s recent advertising blitz. The nonprofit said its grass-roots effort is supported by 170 members, including professional organizations and trade groups.

The nonprofit describes PhRMA as a dues-paying member with no larger role in shaping the group’s activities. Partnership spokeswoman Clare Krusing would not say how much each member contributes. PhRMA spokeswoman Allyson Funk declined to say whether PhRMA funds the partnership.

“PhRMA engages with stakeholders across the health care system to hear their perspectives and priorities,” Funk said. “We work with many organizations with which we have both agreements and disagreements on public policy issues, and believe engagement and dialogue are critical.”

LaGanga is listed as the nonprofit’s executive director on each of the partnership’s annual tax filings since 2007, the earliest year for which they are available from ProPublica’s Nonprofit Explorer.

LaGanga wrote a 2011 article about the partnership’s origins. Published in the Journal of Commercial Biotechnology, it described “public-private partnerships in addressing counterfeit medicines.” His PhRMA job was not disclosed.

From 2010 to 2014, the organization hosted a conference called the Partnership for Safe Medicines Interchange. At a 2013 event posted to YouTube, LaGanga thanks pharmaceutical companies for sponsoring the event, most of them PhRMA members.

The partnership recently launched its ambitious ad campaign — including television commercials, promoted search results on Google and a full-page print ad in The Washington Post and The Hill. The group’s YouTube page shows recent commercials targeted to viewers in 13 states.

“We don’t disclose specific ad figures, but the campaign is in the high six figures,” Safdar said.

The campaign warns against the alleged dangers of legalizing Canadian drug imports. The commercials ask voters to urge their senators to “oppose dangerous drug importation legislation.”

The newspaper ad reads, “Keep the nation’s prescription drug supply safe. Urge the Senate to reject drug importation measures.” Its splash headline declares that “170 healthcare advocacy groups oppose drug importation,” touting a letter to Congress signed by its many members. It lists 160, and PhRMA’s name is not included.

“Having a big membership allows the coalition to present what looks like a unified show of grass-roots support … but it does raise questions about which members of the coalition are really driving and funding the group’s policymaking,” said Matthew McCoy, a postdoctoral fellow at the University of Pennsylvania who studies patient advocacy groups.

The list of “grass-roots groups” includes at least 64 trade organizations representing the biomedical industry, professional associations representing pharmacists, a private research company and two insurance companies.

One group that signed the letter, the “Citrus Council, National Kidney Foundation of Florida Inc,” represents a single volunteer, according to an email from the group. A spokesman for the National Kidney of Foundation of Florida said the volunteer’s views contradict the position of the umbrella group, and said the foundation supports “any sort of drug importation that allows our patients to have access to drugs at the best price.”

Two of the hepatitis advocacy groups listed — the National Association of Hepatitis Task Forces and the California Hepatitis C Task Force — are run by the same person: Bill Remak. Remak said the groups receive small amounts of PhRMA funding.

“I don’t enjoy having to take this extreme position of saying we shouldn’t import at all, but until we have some oversight regime, some way of protecting consumers, it’s a really tough call,” he said in an interview.

“Current drug importation proposals do not appear to have equal safety and chain-of-custody accountability laid out adequately for patient safety concerns,” said William Arnold, president of the Community Access National Network, an advocacy and support group for people living with HIV/AIDS or hepatitis in Washington, D.C. His group did not accept money from PhRMA from 2013 to 2015.

Last week, the partnership hosted a panel at the National Press Club featuring former FBI director Louis Freeh and former FDA commissioner Dr. Andrew von Eschenbach. The discussion focused on the health and legal dangers of online pharmacies.

“You can talk about lowering prices, but if a drug comes with a high probability of toxicity and death, that comes at a high cost to the patient,” von Eschenbach said. “That’s what’s at issue with drug importation.”

Each speaker argued that the bill co-sponsored by Sen. Bernie Sanders (I-Vt.) would be harmful to patients. That legislation would provide a mechanism for Canadian drug manufacturers to sell to U.S. consumers and pharmacies. Sanders introduced the bill in February. Around the same time, the partnership sent emails to member organizations seeking help to stop such a measure.

In the House, Rep. Elijah Cummings (D-Md.) introduced a similar bill to Sanders’, along with 23 other Democrats. In January, Sens. John McCain (R-Ariz.) and Amy Klobuchar (D-Minn.) also introduced a bill to allow drug imports from Canada.

Speakers at the partnership event claimed importation would lead to a flood of counterfeit medicines laced with arsenic, fentanyl and lead paint.

“These drugs are manufactured in jungles, in tin drums, in basements … those are the sort of sanitary conditions we’re talking about here,” said George Karavetsos, a former director of the FDA’s Office of Criminal Investigations.

Josh Miller-Lewis, Sanders’ deputy director of communications, refuted those arguments in an interview. He said Canadian drugmakers can apply for licenses, and all drugs would have to come from FDA-inspected plants.

Both von Eschenbach and Karavetsos have ties to the pharmaceutical industry: Von Eschenbach left the FDA in 2009 to join Greenleaf Health, which counsels pharmaceutical clients, before starting his own consulting company; and Karavetsos counsels pharmaceutical clients at DLA Piper, a Washington, D.C., law firm.

This isn’t Sanders’ first attempt to legalize importation. But Politico reported in October that PhRMA is bolstering its war chest by another $100 million a year, suggesting to many industry watchers that drugmakers are gearing up for a ferocious fight.

“I think it’s safe to say pharmaceutical corporations are prepared to spend some fraction of their multibillion-dollar profits to fight drug importation and any other policy that might end the plague of overpriced medicine,” said Rick Claypool, research director for Public Citizen, a watchdog group critical of the drug industry.

Categories: Health Industry, Pharmaceuticals

Tags: , , ,

Florida Congressman Draws Jeers At Home For Backing Failed GOP Health Care Plan

LOXAHATCHEE, Fla. — A Republican congressman who in 2010 lost both legs after stepping on a roadside bomb in Afghanistan told an occasionally raucous town hall meeting here that he supports his party’s push to repeal the Affordable Care Act because Americans should be free to go without health care if they so choose.

“There are positives and negatives” in the health law known as Obamacare, said Rep. Brian Mast, who noted he gets his health care from the Veterans Health Administration. “I’m not going to pretend this is the easiest thing to work through.”

That was clear Saturday morning in the high school auditorium where about 150 constituents from Mast’s South Florida district west and north of West Palm Beach sometimes booed the congressman during the two-hour meeting. They held up red placards when they didn’t like what they heard and, less often, green ones when they did. Roughly half of the 35 questions that Mast took concerned health care.

No one spoke in favor of the GOP health bill that Mast was prepared to vote for last month. It was pulled by House leaders before a vote because of lack of support.

Use Our Content

Party leaders and the Trump administration are negotiating elements for a new plan to bring to Congress. At the same time, some Republicans back in their home districts for the Easter recess have endured similarly heated town hall meetings with constituents.

After his meeting, Mast told Kaiser Health News that his constituents’ lack of support for the GOP health bill shows the proposal needs more work before a vote. But he offered no solutions.

Many people at Saturday’s meeting asked why Mast wanted to gut the federal health law that helped them survive serious illnesses and sought to defund Planned Parenthood.

Susan Stutz, 48, of Port St. Lucie, said her health coverage under Obamacare is affordable and it has helped her and her sister get vital regular screenings for breast and cervical cancer. Both are at high risk for the diseases.

“If you take away the ACA without a realistic plan to replace it and defund Planned Parenthood, you take away my ability to know every six months if I have cancer,” she told Mast. “What am I supposed to do to stay alive?”

Rep. Brian Mast, who lost both legs while serving in the Army in Afghanistan, chats with Randi Solomon, a constituent who worries about losing her Obamacare coverage, at a town hall meeting in Loxahatchee, Fla. (Phil Galewitz/KHN)

Randi Solomon, 56, of Royal Palm Beach, said Obamacare coverage has helped her obtain back surgery and afford medications for asthma and high blood pressure. “I am really worried,” Solomon said.

Several women at the meeting asked Mast why he wanted to defund Planned Parenthood since federal law already banned federal funding of abortions. Mast replied that the nonprofit provides 300,000 abortions a year and that his concern is preserving the rights of unborn children.

Mast, 36, said he strongly supported retaining the health law provision that prohibits insurers from charging higher rates to people with preexisting illnesses. Unlike the current law, the GOP health plan would allow that benefit only for people who continuously maintain coverage.

“Preexisting conditions is something that I live with. … [It] touches our lives in personal ways, and that is never something lost on me,” said Mast, who has two prosthetic legs and spent the entire meeting in one spot leaning on a cane.

Even constituents who opposed Mast’s ACA opinions Saturday saluted his courageous service in the Army.

Mast was elected to represent the state’s 18th Congressional District after the two-term Democratic incumbent Patrick Murphy vacated the seat to run unsuccessfully for the U.S. Senate against Marco Rubio. The large district includes the wealthy haven of Jupiter Island and impoverished rural towns along Lake Okeechobee. Along with its many retirees, the region counts on tourism and agriculture as mainstays of its economy.

The town hall meeting took place about 15 miles northwest of where President Donald Trump spent the day at his West Palm Beach golf course.

Mast gained national publicity in March when he delivered an impassioned plea to his House GOP colleagues to unite to pass the GOP health plan, likening the effort to his military unit working together to beat the enemy combatants in Afghanistan.

Scott Webber, 62, of Hobe Sound told Mast that Obamacare provided affordable coverage for him and his wife and asked Mast how he could support the GOP bill when it received so little support in public polls.

Mast responded that Obamacare premiums are in a “death spiral” because too few young, healthy people have signed up, which has forced up prices. “I hope we can get to a point so you can have lower deductibles and lower premiums,” he said.

Categories: Insurance, Repeal And Replace Watch, The Health Law

Tags: , , , ,