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Tag: Medicare

  • The bipartisan battle over capping insulin costs outside Medicare

    The bipartisan battle over capping insulin costs outside Medicare

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    “Our approach reflects our years of working on this issue, and it’s so much broader. It’s so much more comprehensive,” Collins said in a joint interview with Shaheen, the moderate Mainer’s longtime partner on bills ranging from broadband expansion to post-Jan. 6 reform. Shaheen observed that “our proposal is better than theirs” before taking a more diplomatic tack: “It’s more comprehensive. That’s a better way to say it.”

    The disparate duos are fighting for the approval of Senate Majority Leader Chuck Schumer and the Senate health committee’s chair, Bernie Sanders (I-Vt.), both of whom have avoided a firm stance while assembling other pieces of a large drug-pricing measure that could get a vote as soon as this month.

    Assessing the outlook in his typically quotable style, Kennedy said that while Warnock and Shaheen are vying for Schumer’s support, “one’s probably biting on his right ear, and one is probably biting on his left ear.”

    It’s not just Democrats angling for Schumer’s attention. Insulin is important enough to Collins that she’s spoken privately about the issue with Schumer, an intriguing detente after the New Yorker spearheaded 2020’s Democratic spend-a-thon to try to beat the Maine Republican — which caused an icy few months between the two senators.

    “Both Jeanne and I were asked to come talk to him, and we’ve both done that,” Collins said. “I’m always hesitant to characterize Sen. Schumer. But he seemed receptive.”

    But Warnock has held his own meetings with the Democratic leader. The recently reelected Georgian saw his approach to insulin price caps adopted for Medicare patients last year in Democrats’ party-line passage of the Inflation Reduction Act, and he’s betting his juice will extend beyond his successful reelection bid.

    Asked if Schumer committed to moving his bill forward, Warnock said: “I have assurances that my bill to cap the cost of insulin, which is a bipartisan bill introduced by me and Sen. Kennedy, will be a part of any health care package that moves forward.”

    The Warnock-Kennedy effort would offer people with private insurance the IRA’s price cap of a $35 copay for a 30-day supply for a 30-day supply of one of each insulin dosage form — a policy President Joe Biden advocated in his State of the Union Address this year. It also directs the Department of Health and Human Services to set up a program in which the uninsured would have access to the same $35 rate through “qualified entities,” a term that likely refers to federally qualified health centers.

    Democrats pushed to include a $35 cap in the commercial insurance market in their party-line measure but were forced to strip out the provision after the Senate’s nonpartisan rules referee decided that it didn’t qualify for budget rules which evaded the 60-vote threshold. Seven Republicans supported the price cap in that vote, demonstrating the possibility of a deal under the current divided government.

    In contrast, the Collins-Shaheen bill would limit monthly cost-sharing for at least one insulin type and dosage to $35 or 25 percent of the list price, whichever is lower. It would also require pharmacy benefit managers to pass through 100 percent of insulin rebates and discounts from manufacturers to insurance plans.

    Furthermore, it largely limits insurers from imposing prior authorization and medical management on insulin products and seeks to speed up new competition to further reduce costs.

    “We’re not just looking at: How do we address out-of-pocket costs? But also: How do we encourage more competition?” said Shaheen, who has a granddaughter with Type 1 diabetes.

    Schumer is not tipping his hand on a sensitive issue that will alienate some of his members no matter what he does given his close relationships with both Shaheen and Warnock. Schumer spokesperson Alex Nguyen said: “Prescription drug reform and insulin pricing remains a top priority for leader Schumer. He’s committed to getting a $35 insulin bill passed, and the details are still being worked out.”

    The legislative push to again tackle insulin legislation comes despite recent commitments from Eli Lilly, Novo Nordisk and Sanofi to lower the list price of some insulin products this year or next — a decision policy experts say is a response to political headwinds, generic competition and bigger Medicaid rebates set to kick in in 2024.

    Sanders, who introduced his own insulin pricing bill in March to cap the list price of the drug at $20 per vial, is dragging the CEOs of the three major insulin manufacturers before his committee this month. That hearing comes after the committee is slated to act on a drug pricing package this week, which focuses on pharmacy benefit manager practices and generics competition, indicating that tough choices on which insulin legislative approach to take are being deferred.

    “Advocates for lower insulin prices would rightly point out that most of these, aside from Senator Sanders’ bill, focus largely on what insurers charge patients and not what drug companies are paid,” said Stacie Dusetzina, a health policy professor at Vanderbilt University Medical Center. “If you only cap the copayment, then there is a possibility that manufacturers could raise prices.

    The Senate health committee’s May 10 hearing on insulin affordability — which will also include the CEOs of the three major PBMs — is likely to signal whether there is enough Republican support for additional insulin legislation.

    “Obviously, a dramatic change with regard to insulin is already underway, and we’ll see how that plays out,” Sen. Mitt Romney (R-Utah) said. “Whether there’s different additional legislation needed, that’s something we’ll have to evaluate.”

    Sanders predicted a future effort to bring the various insulin bills together, a path to which Warnock appears agreeable.

    “In my view, we’re all on the same team here, we’re trying to get across with insulin,” Warnock said. “There is more than one approach here.”

    But Shaheen and Collins said their legislation is so sweeping compared with the Warnock-Kennedy bill that the two approaches would be nearly impossible to reconcile; Collins described their effort as “so much more comprehensive a bill that it’s difficult to compare.”

    From his vantage point, the twangy Louisianan thinks the four senators — and the majority leader — can put aside the sparring and cut a deal.

    “It seems to me the short way home is to let all four of us come together with Sen. Schumer and work something out in one bill,” Kennedy said. “But having said that, the real issue is how to pay for it. If we can pay for it, I can sell it on my side.”

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    ( With inputs from : www.politico.com )

  • More care at home could save Medicare, lawmakers believe

    More care at home could save Medicare, lawmakers believe

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    The sponsors and industry backers say that by allowing Medicare to pay for at-home care for more patients, Congress can reduce expensive hospitalizations and help stabilize Medicare’s teetering finances. “When you look at the numbers and demands on Medicare in the years on the horizon, we need to innovate,” Smith said.

    The legislation would create a new Medicare benefit allowing certain beneficiaries not eligible for Medicaid to have a home health worker for up to 12 hours a week. It would facilitate house calls by allowing doctors to receive a monthly payment, in place of the existing fee-for-service structure. And it would broaden reimbursement for home-based services, including dialysis, lab tests and infusions.

    The bill would also task the Department of Health and Human Services with studying additional procedures that could move to the home, such as X-rays.

    Consulting firm McKinsey estimated last year that more than $250 billion worth of care in Medicare and Medicare Advantage could shift to the home over three years, including primary care, emergency visits, long-term care, infusions and acute care at home.

    The timing is fortuitous. The pandemic forced providers to move more care to the home and created momentum for a long-term shift. Many elderly people embraced the change. It also spawned innovation in the private sector, as venture capitalists poured money into telehealth and at-home care startups.

    The federal and state governments are “the single-biggest payer of long-term care in this country,” Dingell said. “It’s institutionally focused, period. That’s not where most people want to be. They want to be in the home in their own setting with people they know and love.”

    But even as cash flows into the sector and patient demand for at-home care rises, health economists say it’s not clear this future is imminent.

    ‘Hard to know what the total costs might be’

    While advocates tout potential cost savings, there’s scant data to back up those claims. How much money the changes would cost or save remains a crucial question as lawmakers look to rein in health care spending.

    “There is potential for cost savings,” said Rachel Werner, executive director of the University of Pennsylvania’s Leonard Davis Institute of Health Economics, but Werner also said the package is difficult to assess as a whole.

    “The cost implications probably vary across the different provisions and it’s hard to know what the total costs might be,” she said.

    “Among the proposed programs, the one for which there will be the biggest demand is personal care services, which will be expensive and raises questions about whether there will be overall cost savings,” Werner said.

    Werner expects that personal care services — help with daily activities — would cost, rather than save money, in part because of what economists call the “woodwork effect.” When presented with the opportunity to get at-home help, people who weren’t previously paying for services come out of the woodwork to get it.

    Robert Burke, an associate professor of medicine at the University of Pennsylvania’s Perelman School of Medicine, said he was “intrigued” by personal care services’ inclusion in the bill. Those services could be especially useful for older adults leaving the hospital who need a combination of skilled home care and help with nonmedical needs.

    But while fewer stays at skilled nursing facilities may offset costs, Burke said the 12-hours-a-week of personal care the legislation outlined isn’t likely to work. A better approach would offer more care up front and less support over time, he suggested.

    Supporters of the package argue that expanding payment for personal care services could prevent costly hospital readmissions.

    Beyond cost, Werner, Burke and other analysts questioned whether there are sufficient workers to execute the vision.

    “I am concerned we lack the workforce to do it effectively or to scale the programs to have a meaningful impact,” Werner said.

    The ratio between home care workers and people who need services is worsening, according to a study Werner published this week in Health Affairs. The number of workers per 100 participants in Medicaid’s home and community-based services programs fell by 11.6 percent between 2013 and 2019, a trend that suggests it might be hard for Medicare patients to find home health aides.

    Technology like remote monitoring and telehealth could scale certain services. But others, like labs, diagnostic testing and at-home primary care, need skilled workers to carry out, in person, Burke noted.

    Others said the success of the lawmakers’ vision depends on execution and could be better or worse than existing care models.

    “It could help or exacerbate [workforce shortages],” said Julian Harris, former health care team lead at the White House Office of Management and Budget under former President Barack Obama and CEO of ConcertoCare, which cares for patients with complex conditions in the home. “We will likely have challenges as the Baby Boomers continue to age into Medicare with staffing and care needs of patients who want to receive care in the home with some of our legacy approaches.”

    The legislation would provide grants to organizations like health systems and home health agencies to build the workforce and create a task force for nursing certification standards for home care, which could result in a larger supply of workers. The Biden administration also recently directed HHS to look into regulations and guidance to improve home-care jobs.

    Dingell said paying health care workers more would help address these issues, touting her legislation introduced last month that aims to boost wages via more funding.

    Finally, there’s the question of cost-shifting, and whether moving care into the home will ultimately transfer labor costs to family members as they take on additional hours of informal caretaking.

    “Across most of these, I would expect increased caregiver burden,” Werner said.

    Supporters of the legislation contend that caregivers actually would feel more supported in this model, given the extra technology and supporting staff in the home that wouldn’t otherwise be there.

    ‘The pandemic showed us it is possible’

    While some health economists are skeptical of the House bill’s promises, a growing lineup of health care companies are enthused.

    Moving Health Home, a coalition of tech-enabled home care companies including Best Buy’s Current Health, health system Intermountain and dialysis provider DaVita, has backed the push. It’s a sister organization of the Alliance for Connected Care, a prominent telehealth lobbying group.

    Both groups are led by Krista Drobac, a lobbyist who once worked for the No. 2 Democrat in the Senate, Dick Durbin of Illinois, Sen. Debbie Stabenow (D-Mich.) and the Centers for Medicare and Medicaid Services under Obama.

    Drobac’s groups see moving care into the home as a way to improve patients’ outcomes, reduce costs and bolster access. The organization points to Morning Consult polling commissioned by home health care leaders showing that about three quarters of Democrats and three in five Republicans say the federal government should prioritize boosting access to care in the home.

    “Seniors and their caregivers want the option to stay home. It’s better for overall health and recovery,” said Drobac. “The pandemic showed us it is possible, and we need to build on that.”

    Backers acknowledge that the empirical evidence base for home care needs to be developed more, but point to studies showing that moving care to the home doesn’t compromise patient safety.

    A 2021 meta-review published in BMJ Open on hospital at-home care found that the practice “generally results in similar or improved clinical outcomes” and said expansion should be considered amid spiking health care costs. The Congressional Budget Office scored an extension of hospital at-home care through 2024 as costing $5 million — a drop in the bucket of overall health care spending.

    Meanwhile, the pandemic demonstrated it’s doable and that patients want it, the industry advocates said.

    “The Covid pandemic put lighter fluid on the importance of care delivery in the home and meeting patients where they’re at,” said Kevin Riddleberger, co-founder of coalition member DispatchHealth, which brings lab tests, X-rays and other urgent care into the home.

    At-home testing company ixlayer, which is part of Moving Health Home, hopes bringing lab testing into the home can help treat chronic conditions by making it easier to get tested. Emcara, which provides home-based primary care, has seen 40 percent growth year over year, said Eric Galvin, the company’s CEO, largely driven by demand for care in the home.

    Backers hope that leaning on technology like remote patient monitoring to track patients’ health can help reduce costs by catching issues sooner and forestalling the need for expensive drugs and treatments.

    Cheryl Stanton, chief legal and government affairs officer at home care company BrightStar Care, pointed to a study by Avalere her firm commissioned that found that early intervention with targeted personal care services significantly reduced costs.

    “If you’re in the home and see someone is sluggish and starting to go to the bathroom much more than usual, you can say something is wrong and have them tested early to find a UTI, rather than wait until they’ve gone into crisis and have to be hospitalized,” Stanton said.

    And there’s a ready constituency for that message on Capitol Hill and at the White House, given the Medicare hospital insurance trust fund’s looming insolvency, and the impasse in Washington around another possible solution: raising taxes.

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    ( With inputs from : www.politico.com )

  • Trump ties GOP in knots over Medicare and Social Security

    Trump ties GOP in knots over Medicare and Social Security

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    “It got him elected the first time, and I think it will get him elected the second time,” Iowa Sen. Chuck Grassley, the Budget Committee’s top Republican, said of Trump’s rhetoric. “But it doesn’t do anything for our children and grandchildren that aren’t going to have a program that I’m enjoying right now.”

    Others say the GOP has changed for the better in the past 10 years — finally accepting that the voters aren’t as divided as elected officials over whether to touch the two decades-old programs, as Sen. Josh Hawley (R-Mo.) put it.

    “I distinctly remember somebody basically ran a presidential campaign on this in 2012: the Paul Ryan budget, the austerity budget,” Hawley said, invoking the former GOP vice presidential nominee’s famous fiscal hawkishness. “I don’t recall that ticket performing very well. I personally don’t care to go back to that.”

    Trump’s pugnacious messaging comes at a crossroads for the party internally, as a group of senators quietly meets about possible changes to endorse on Medicare and Social Security. And Trump’s tactics have some Republicans clamming up or endorsing more modest ideas aimed at ensuring the programs don’t go bankrupt, despite projections that both may be headed for insolvency in about a decade.

    Among the alternate GOP suggestions as the party shapes its approach to the upcoming debt-limit fight: targeting fraud and waste; imposing work requirements or raising the eligibility age; and other benefits formula changes. A number of Republicans have also pointed to legislation from Sens. Mitt Romney (R-Utah) and Joe Manchin (D-W.Va.) that would create “rescue committees” aimed at negotiating changes designed to save the programs in the long term.

    It’s enough to send Republican eyes rolling up and down the Capitol.

    “The best thing to do is just ignore him,” Sen. John Cornyn (R-Texas) said of Trump. Sen. Mike Rounds (R-S.D.) called Trump’s attack on DeSantis “very unfortunate.”

    “We need an adult as president who is going to take on the tough challenges, the tough problems, and be prepared to share with the American people how serious it is. That we use facts. And not scare tactics,” said Rounds, a member of the Senate’s working group on entitlements.

    But Trump clearly sees a promise to leave Medicare and Social Security alone as a winning message. He assailed primary opponent Nikki Haley for decade-old comments about even considering entitlement cuts in order to slow the growth of the government.

    Trump’s also broken on the matter with DeSantis, who as a congressman voted on three non-binding budgets that called for gradually raising Medicare’s eligibility age, and his former vice president (Mike Pence said on CNBC recently that Social Security and Medicare should be “on the table in the long term”).

    DeSantis, Pence and Haley aren’t alone in potential vulnerability to attack from Trump over the issue. Other possible presidential candidates, including South Dakota Gov. Kristi Noem, former Secretary of State Mike Pompeo, and Sen. Tim Scott (R-S.C.), have supported entitlement changes.

    As GOP debate over entitlements first stirred last month, Trump delivered a brushback pitch to congressional Republicans in a video warning them not to lay a finger on Social Security or Medicare as part of the debt ceiling showdown. Aides say he will continue to make the issue of entitlement reform a key part of his campaign, despite GOP handwringing.

    “It goes to the broader picture of how this isn’t just Trump against Democrats — it’s Trump against the establishment,” said a Trump adviser who sought anonymity to speak. “This is a defining policy moment for a lot of Republicans.”

    Republicans have long struggled to trim popular programs, from former President George W. Bush’s failed Social Security privatization plan to the GOP’s bids to repeal Obamacare and scale back its Medicaid expansion. Party leaders are currently vowing to stay away from entitlements as they pursue still-unspecified spending cuts in exchange for agreeing to raise the debt ceiling, harmonizing with Trump.

    Speaker Kevin McCarthy said last month that Social Security and Medicare cuts are “completely off the table.”

    Sen. Kevin Cramer (R-N.D.) said while Trump is “gifted at making the complex simple,” he is irked by the former president’s “intellectually dishonest” campaign rhetoric on entitlements. Trump’s allies see it differently, calling out a party they say focused too much on trimming or changing the eligibility age for some of the government’s most popular programs.

    Sen. J.D. Vance (R-Ohio) said talking about entitlement cuts is “politically stupid.”

    “I really don’t like the political attitude that so many people take where they will take a set of programs that are wildly popular and very beneficial for Republican voters, and point to all of the other things that are more important than them,” said Vance, who has endorsed Trump.

    Notably, Trump’s past budgets haven’t exactly aligned with his argument against cutting entitlements. His fiscal 2021 budget, for example, sought steep safety net cuts, including tens of billions of dollars in reductions to Social Security benefits for disabled workers and Medicare changes designed to yield about $500 billion in savings without reducing benefits.

    Democrats have shown little interest in uniting around any proposed entitlement changes of their own despite dire projections for the programs’ fiscal future. But they see an advantage in the GOP split.

    Republican division on the matter “shows a lack of discipline,” said Sen. Mark Warner (D-Va.). “You would not think it’s a group of individuals that have an organized plan on how we deal with our budget, debt and deficit over a long period of time.”

    And the top Democrat on the House Budget Committee gave Trump begrudging credit for resonating with his base.

    “I give the devil his due,” Rep. Brendan Boyle (D-Pa.) said. “I think he has a better finger on the pulse of the Republican primary electorate than the Romney-Ryan wing.”

    Exploiting their opponents’ internal feud could also help Democrats after a midterm campaign that left Republicans acknowledging the success of entitlement-themed attacks on GOP Senate candidates. Last year’s Arizona Senate nominee Blake Masters, toyed with the idea of privatizing Social Security before backtracking.

    “Telling old folk … that Blake Masters wants to privatize Social Security is probably going to scare them a little bit,” Arizona-based GOP strategist Barrett Marson said of Masters, who’s considering another run in 2024.

    Meridith McGraw and Holly Otterbein contributed to this report.

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    ( With inputs from : www.politico.com )

  • Biden on Republicans: ‘Their dream is to cut Social Security and Medicare’

    Biden on Republicans: ‘Their dream is to cut Social Security and Medicare’

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    After running through his usual economic talking points, Biden capitalized on his handling of a tense exchange the previous night with Republicans for wanting “Medicare and Social Security to sunset.” While Biden didn’t name Sen. Rick Scott during his State of the Union speech, he did so on Wednesday, pulling out the Florida Republican’s “Rescue America” pamphlet that calls for all federal legislation to include such a provision.

    Then the president quoted Sen. Ron Johnson’s (R-Wis.) stance on the issue, prompting the crowd to boo.

    “They sure didn’t like me calling them on it,” Biden said, noting that Rep. Marjorie Taylor Green (R-Ga.) stood up and called him a “liar” during Tuesday night’s speech. “Look, a lot of Republicans — their dream is to cut Social Security and Medicare. Well, let me just say this. It’s your dream, but I’m going to use my veto pen and make it a nightmare.”

    A post-State of the Union barnstorming swing has become a traditional part of the calendar for modern presidents, with great thought put into the location for a visit inherently bound to receive more media attention than an average trip.

    For the Biden White House, it was always going to be Wisconsin. White House aides suggested that a lot of the year ahead will look just like this day. They believe that a message of blue collar populism works for the president, saying he is the first Democratic standard bearer in decades to successfully chase a demographic drifting steadily toward Republicans.

    A labor hall filled with union workers was considered a perfect backdrop for this particular president. Biden aides said they hoped to fill his schedule with events like this one — and like last week’s twin infrastructure events in Maryland and New York — to showcase the president’s record in creating jobs and tangible, real-world projects.

    Wisconsin, in many ways, has become the preeminent swing state. It was one of the trio of Great Lakes states — along with Michigan and Pennsylvania — that Biden won back from Donald Trump in 2020. And while the president may still be a month or more from announcing his reelection plans, most paths for a Biden second term run right through the same three states.

    Michigan and Pennsylvania trended more toward the Democrats in the 2022 midterms than did Wisconsin, which reelected a Democratic governor but also a Republican senator in Johnson. Biden’s margin of victory in Wisconsin in 2020 was fewer than 21,000 votes — his smallest advantage of the three former “Blue Wall” states — but his advisers believe that his pro-union and manufacturing message will continue to play well in the state.

    Moreover, Biden advisers are looking at the electoral map and see limited options. Many in the party believe that Florida — which has dramatically trended rightward in recent years and is home to the GOP’s two top leading 2024 candidates — is a lost cause. Still, Biden will make a stop there Thursday. But even the most bullish Biden advisers concede Florida is an uphill climb, and a loss there, if combined with defeats in Georgia and Arizona — two states Biden barely captured two years ago — would make his path to victory very narrow. It also would make Wisconsin essential.

    Biden has been to Michigan and Pennsylvania more often to this point in his term, and aides said to expect travel to Wisconsin to ramp up. It’s been decided by less than a percentage point in four of the last six presidential races, including in 2016 and 2020.

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    ( With inputs from : www.politico.com )

  • Trump to GOP: Don’t touch Medicare or Social Security in debt ceiling fight

    Trump to GOP: Don’t touch Medicare or Social Security in debt ceiling fight

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    Republicans have vowed not to raise the federal government’s borrowing capacity unless Biden makes steep cuts to federal spending, potentially impacting social insurance programs like Social Security and Medicare. Trump’s video is a warning to his fellow party members not to go there. Instead, he suggests targeting foreign aid, cracking down on migration, ending “left wing gender programs from our military,” and “billions being spent on climate extremism.”

    “Cut waste, fraud and abuse everywhere that we can find it and there is plenty there’s plenty of it,” Trump says. “But do not cut the benefits our seniors worked for and paid for their entire lives. Save Social Security, don’t destroy it.”

    The video message was shared in advance of its release with POLITICO.

    Trump’s position echoes his long-held, albeit unorthodox, conviction that the Republican Party should stay away from attaching themselves to entitlement reform. Prior to being elected president, Trump was highly critical of then-Rep. Paul Ryan (R-Wis.) for pushing austerity budgets during the Obama years. As a candidate for president, he insisted he would preserve both Medicare and Social Security. There was never any serious discussion of doing so during his time in office, though he obliquely hinted he may consider it in a second term.

    Nevertheless, in issuing his statement now, Trump places his fellow Republicans in a political corner. Several of them have openly discussed using the looming debt ceiling standoff to extract cuts in non-discretionary spending, though party leadership has not fully embraced such a demand.

    Over the last few months Trump himself has insisted that congressional Republicans use the debt ceiling as a leverage point to achieve policy objectives, despite having done no such thing during any of the times the debt ceiling was lifted when he was president. But his statement makes clear he views certain pursuits as off limits. And it puts him at least partially on the same page as Biden, who has not only insisted he won’t cut Social Security or Medicare but excoriated Republicans for suggesting they would.

    The statement is among a series of policy-specific videos Trump has released since formally launching his third bid for the White House. And it suggests that the ex-president is looking to enhance his footprint on the current political landscape following weeks of criticisms that his campaign was off to a sluggish start.

    Trump is slated to be in South Carolina next Saturday to make announcements related to campaign hires at an event his aides have described not as a rally but a more “intimate” gathering. Since announcing his third presidential run, Trump has not held any rallies and has remained at his properties in South Florida.

    But Trump’s team has said they are at work behind the scenes from the campaign headquarters in West Palm Beach, and the ex-president will soon start making more public appearances, including a speech at the upcoming CPAC conference outside Washington, D.C.

    Trump’s team has also asked Facebook to allow him back on the platform after he was thrown off of it following the Jan. 6 insurrection he helped foment. The social media platform has played an important role in fundraising and voter outreach, according to aides, and Meta is set to decide if it will lift Trump’s suspension this month.

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    ( With inputs from : www.politico.com )