#medicare policy

[dontmean2bepoliticalbut]

[deadpresidents]

"I'm going to get [John F.] Kennedy's tax cut out of the Senate Finance Committee, and we're going to get this economy humming again. Then I'm going to pass Kennedy's civil rights bill, which has been hung up too long in Congress. And I'm going to pass it without changing a single comma or a word. After that we'll pass legislation that allows everyone in this country to vote, with all the barriers down. And that's not all. We're going to get a law that says every boy and girl in this country, no matter how poor, or the color of their skin, or the region they come from, is going to be able to get all the education they can take by loan, scholarship, or grant, right from the federal government. And I aim to pass Harry Truman's medical insurance bill (which ultimately became Medicare and Medicaid) that got nowhere before."

-- President Lyndon B. Johnson, on his immediate domestic policy goals, to aides Jack Valenti, Bill Moyers, and Cliff Carter, as they sat with him in his bedroom before he went to sleep at 4:00 AM on November 23, 1963 -- just hours after being sworn in as President following John F. Kennedy's assassination. LBJ achieved each of those goals -- basically in the exact order he mentioned -- during his first two years as President.

[justinspoliticalcorner]

Jonathan Cohn at HuffPost:

The first-ever negotiations between the federal government and pharmaceutical companies have led to agreements that will lower the prices of 10 treatments, reducing costs for the Medicare program and for some individual seniors, the Biden administration announced early Thursday morning. This round of negotiations began in 2023 and took place because of the Inflation Reduction Act, the law that Democrats in Congress passed on a party-line vote and that President Joe Biden signed two years ago. The new prices are for drugs covering a variety of conditions, including diabetes and inflammatory illnesses, and are set to take effect in January 2026. The negotiation process is going to happen each year, with a new set of drugs each time. If all goes to plan, that means the scope of drugs subject to negotiated prices will grow each year, while the savings will accumulate.

“When these lower prices go into effect, people on Medicare will save $1.5 billion in out-of-pocket costs for their prescription drugs and Medicare will save $6 billion in the first year alone,” Biden said in a prepared statement, citing figures that analysts at the U.S. Department of Health and Human Services calculated and published on Thursday. “It’s a relief for the millions of seniors that take these drugs to treat everything from heart failure, blood clots, diabetes, arthritis, Crohn’s disease, and more ― and it’s a relief for American taxpayers.” Of course, those numbers refer to aggregate savings on drug spending. Figuring out what they will mean for individual Medicare beneficiaries is difficult, because so much depends on people’s individual circumstances ― like which drugs they take, or which options for prescription coverage they use. It also depends on knowing the actual, real prices for these drugs today, after taking into account the discounts that private insurers managing Medicare drug plans extract from manufacturers. Those discounts are proprietary information that the federal government cannot release.

Great news: The Biden Administration, pharmaceutical companies, and Medicare have negotiated hefty price reductions for 10 high-cost drugs, including Januvia, FIASP, and Entresto.

[ivygorgon]

AN OPEN LETTER to THE U.S. HOUSE OF REPRESENTATIVES

Pass H.R. 6270, the State-Based Universal Health Care Act!

371 so far! Help us get to 500 signers!

I strongly urge the Congressmember to support and help pass H.R. 6270, the State-Based Universal Health Care Act, introduced by Rep. Ro Khanna of California. This bill helps states test universal health plans that could be a model for a national plan - a Universal, Simple, and Affordable (USA) plan. A USA plan will drastically reduce administrative overhead, freeing billions of dollars for our health care and general welfare. With your support, states can save money and provide health care for all their residents. How H.R. 6270 moves us toward health care that is universal, simple, and affordable (USA): Mandates that participating states guarantee healthcare coverage for at least 95% of residents in the first 5 years, thus reducing the uninsured and underinsured populations to less than 5% (currently 30% in most states). Requires any state-based plan to have benefits equal to or greater than those received by beneficiaries of federal healthcare programs. Allows states to cooperate on multi-state plans. Section 1332 of the ACA does not. Enables states to integrate Medicare funds into a state plan. Section 1332 does not. This is critically important for equity. Please work to pass this bill, and then get to work passing Medicare For All. Nothing else will fully solve our healthcare crisis.

▶ Created on April 8 by Jess Craven

📱 Text SIGN PEUMEL to 50409

🤯 Liked it? Text FOLLOW JESSCRAVEN101 to 50409

[dontmeantobepoliticalbut]

After The White House and Republicans in Congress reached a tentative agreement on the debt ceiling, House Speaker Kevin McCarthy went on Fox News Sunday to boast about making struggling Americans work in order to continue receiving food aid.

Although precise details have not been released, the deal will increase the maximum age at which adults must work in order to receive Supplemental Nutrition Assistance Program (SNAP) food stamps from age 50 to 54. There are exceptions, however, for veterans, unhoused individuals, and those with dependents. The deal also includes changes to Temporary Assistance for Needy Families (TANF) but those details have not been made public.

“We finally were able to cut spending. We’re the first Congress to vote for cutting spending year over year,” McCarthy boasted Sunday on Fox. “So, you cut that back. You fully fund the veterans. You fully fund defense. But you take that non-defense spending all the way back to 2022 levels. Now you get work requirements for TANF and SNAP. The Democrats said that was a red line.”

At another point in the interview, McCarthy claimed that “We’re going to get America working again,” and that the deal includes “work requirements to help people out of poverty into jobs.” At this, host Shannon Bream pushed back on McCarthy, arguing that the work requirements are not tough enough for the most extreme members of the GOP caucus.

"We're gonna get America working again … When Republicans had the Presidency, the Senate and the House, did they ever cut spending? No, they increased it."

“The White House, that’s an area where they’re celebrating,” Bream said of the work requirements. “They say there are no changes to Medicaid. You referenced SNAP and TANF. So basically, SNAP includes an expansion for veterans and people who are homeless. So there’s an expansion there to some extent… and the changes that you did get will lift the age and the requirements and those kinds of things, but they sunset. So they don’t last for very long.”

It should be noted, though, that the vast majority of Americans are working. Unemployment remains extremely low at 3.4% as of this April.

McCarthy also bragged about cutting funding to the Centers for Disease Control and Prevention (CDC). “This is the largest recision in American history,” McCarthy said. “You can add up all the recisions from all the other Congresses. This is greater. And what are we pulling back? CDC’s Global Health Fund. So no longer are we sending $400 million of American taxpayers’ money to China.”

According to the CDC, the Global Health Fund supports HIV/AIDS prevention and care, immunizations, and global disease detection and emergency response. On the heels of a global pandemic, cutting this funding seems dangerous, but after seeing their response to COVID, it’s not surprising that Republicans in Congress don’t take global health seriously.

Returning to the topic of work requirements, McCarthy said, “At the end of the day, it saves more money, ’cause what does a work requirement do? It’s only on able-bodied people with no dependents. Instead of borrowing money from China to pay somebody to sit on the couch, we now give them the process to go get a job. Every study has shown when you do that, it puts people to work. And when they work, what happens? More people are paying into social security and Medicare.”

Sure, it may “save” some money in food aid, but at what cost?

[davidzoltan]

Accountability.

What all the pageantry and the celebrities and the big names are supposed to distract you from is that our primary job as voters during election season is accountability. Indeed, the mood being set was one of bringing “joy” to this election so as not to highlight the deficiencies in real answers. Or for where real answers were provided that didn’t stack up.

Vice President Kamala Harris, in her historic acceptance as the first Black woman and first person of Asian descent nominated for the presidency from a major political US party, spoke to her commitment “for the people”. The rest of her speech with its scant details makes one continue to question though, “Which people?” and the answers so far do not all point in the right directions.

Most glaringly perhaps, at least to be stated boldly out loud, was a promise to have the “strongest, most lethal fighting force in the world”. Which people are asking for this? Indeed, how does one make a military that is exponentially larger than all the other militaries in the world stronger and even more lethal? Who benefits from this statement?

The obvious answer is the military industrial complex. But let’s name names which is important. The top 10 defense contractors as of last year included: Lockheed Martin, Raytheon, General Dynamics, Pfizer, Boeing, Northrop Grumman, Humana, HII, L3Harris, and BAE Systems.

And while those certainly represent jobs which put food on the table for many thousands of families, it is incumbent upon us to ask if the capacity for destruction, direct or indirect, that these companies create is not better spent, those jobs better assigned to production that benefits the people in a broader sense, for a better world for all.

“Every gun that is made, every warship launched, every rocket signifies, in the final sense, a theft from those who hunger and are not fed, those who are cold and are not clothed.” - President and former 4-star General Dwight D. Eisenhower (R) 

Indeed, a recent study has proposed that we could have all our human and civil rights met with but 30% of our current production power if that production were directed towards the needs of the people. If we weren’t stealing from the poor for the benefit of the rich and powerful, we could make marvels.

While I do not deny the need in this current world as it stands that there is a need for a standing military, even that being an admission that some of my fellow leftists would consider grotesque but that I consider sadly realistic, we need a strong military that is used incredibly selectively, in coalition with other nations, and only where the human and civil rights of the people of the world are endangered. A military that spends a TENTH of what we do at present would better serve us all. A military that pays its servicepeople a living wage and that ensures that after they serve they enter a country that has Medicare for All to cover their medical needs and a VA with proper funding that serves the additional supports that their service in the military must address. A military that can’t potentially be turned against its own people should an authoritarian ever actually ascend once more to the Oval Office with a plan like Project 2025 that could truly initiate a full fascist government rather than the proto-fascist one we have in place now.

All of this, of course, also turns our attention to the great injustice of the genocide in Gaza. I am careful to lead with calling it a genocide, because that word, genocide, was carefully editted out, one might even use the word censored nearly appropriately here given the context of this spectacle being part of our governmental process, for better of for worse,of any and all speeches given inside the convention. Even as protesters diligently spoke of the genocide outside the walls of the United Center, it was demurely called simply a “war” within them.

Wars are acceptable. We can fund wars. We can supply weapons from those companies mentioned above and hundreds more to a war. Profiteering off of war is quite nearly as old as humanity itself. It’s how kings and queens and billionaires are made.

But we have laws against supporting genocide, and as long as that word isn’t uttered in the halls of power, a gentleman’s, and now gentlewoman’s, understanding can be made that all is normal. All is good.

That can’t be further from the truth. In the Talmud, we are taught as Jews that to save a single life is to save the entire world. At least 40,000 worlds have already been snuffed out by this genocide. The killing is not indiscriminate as the Israeli army has the most sophisticated American technology allowing them precise control over who lives and who dies. Hospitals, schools, refugee camps obliterated with the press of a button. Palestinians used as human shields. Children, babies even, not given even a chance for life, a chance for peace.

It must stop. An arms embargo is the very least we must do. A funding embargo should also be put in place. Until Israel ends its genocide and its aggressions into other war footing, we cannot continue to enable them. Period.

Harris spoke of the right for Israel to defend itself and went so far as to promise to arm them to do so in open defiance of the calls for an arms embargo. Let’s set aside if a colonialist project can ever be said to be defending rather than, by its very nature, continuing an offensive that started with Theodore Herzl inventing Zionism in the first place in 1897. But what is defense truly? We call our war machine the “Department of Defense”, but when was the United States last on the defensive in a conflict not of our own making?

My example of defense comes from the stories of my grandmother who was a freedom fighter in Budapest in the Shoah. She did not fight with guns. She helped run an underground cell of Jews, moving from building to building, protecting each other and keeping each other alive. She spoke of using the skills she learned in her village in Ukraine from her family, cooking, sewing, healing, caring for one another, holding each other as bombs exploded overhead and guns fired in the streets outside. She won against the Nazis because they survived.

Where is this kind of defense for the Israeli people? Indeed, most of the families of the hostages realized long ago that their loved ones were being used by Bibi to hold onto power. They are not being defended with care and compassion. They are pawns for power, and they’ve spoken out against it. Former Israeli Defense Forces members that retired their military careers in protest have confirmed this from their own experiences while still in the IDF and from sources they have still inside. What we have enabled as the US through our war machine is not defense but a human rights disaster.

This alone is enough to call Harris to account in her bid for the presidency. Not only on moral grounds, but on the grounds that this is going to be an incredibly close race, scarily so given what the other party is offering, and standing on the wrong side of these issues of enabling genocide and fueling the military industrial complex will absolutely keep people from coming out to vote. Votes that Harris needs desperately.

Votes that could desperately use her message of what she calls an “Opportunity Economy” that is being lost under the sounds of bombs. There is little doubt that despite propaganda by the rich suggesting falsely that the economy does worse under Democrats, the people could benefit from many of the proposals that Harris suggests. Depending, of course, on how it is done.

Expanding Medicare negotiations on drug prices beyond the 10 already done would be excellent, and that work shouldn’t stop until it covers every drug and medical device. That’s work that would be necessary even under Medicare for All, though we’d have even far more leverage if M4A was in place than we already have with just Medicare, so it is small-p progressive work to be certain.

Passing a federal law enshrining Roe v. Wade is essential to personal liberties. Full stop.

Going after grocery companies gouging prices is good. We’ve all seen the charts showing the virtual monopolies that have developed in most sectors, food chains included. Breaking down price gouging and possibly even breaking up those monopolies would do some real good there.

Passing the John Lewis Voting Rights Act (Rest in Power, legend) and the Freedom to Vote Act would prevent real abuses by white supremacists that especially Black and Brown voters are facing right now.

All that said though, even some of her rosier sounding domestic projects require accountability. Not just needing more details which the campaign still has not released in any way, especially by punting on the national platform by just passing what was planned under a Biden presidency. We must truly examine how we transform our broken-on-purpose system to a government whose first goal truly is one of enabling and ensuring our human and civil rights. A government founded on compassion and care.

Let’s start, perhaps predictably for me, with housing.

The solutions that got us into this housing crisis cannot get us out of it. When every major city has a glut of vacant housing, enough to house the entire unhoused population many times over, the call to build starts to sound like exactly what it is. A solution to benefit the real estate industry, not the people in desperate need of alternatives.

We don’t have a housing supply problem. We have a landlord greed problem.

The primary public policy need for building is to ensure affordable accessible housing which accounts for less than one percent of current housing. There are a few, especially rural communities, that also need actual units for the populations they serve, need for sustainability, or simply to accommodate people that wish to live there and be part of that community, but that have been stymied by NIMBYism and disinvestment, just another form of that landlord greed problem.

But fundamentally, putting our human right to housing in the hands of the landed gentry (the continued use of the title of land-lord is not an aberration) and tying it to financialization, all a modern form of the feudalism that white men brought with them to these shores, have completely distorted housing in America and in many places abroad as well. A standard that has infected the nonprofit “affordable housing” sector as much as any other, indeed creating some of the most prolific slumlords in practice. An alternative is needed, and it must be pursued aggressively.

That starts with supporting Rep. Delia Ramirez’s bill to repeal the Faircloth Amendment. Since 1998, the federal government has been prohibited from direct investment of funding to building additional public housing and placed limits on what individual local housing authorities could create. Of course with no federal funding coming for nearly three decades, local housing authorities are far from pushing those limits. Quite the opposite, in fact.

Public housing has been divested, privatized, and largely neglected. This was by design, of course, so that private real estate could maximize profits, and now we stand at a time where more than half of renters are paying more than 30% of their income in rent and rent expenses, also known as rent-burdened.

Moreover, finding the next evolution of what public housing can look like, has been stymied as well. That evolution, called social housing for its emphasis on community control, can be found in most other nations, the gold standard being in Vienna, Austria. This takes public funding of housing and expands upon it to make it permanently affordable, community-owned and tenant-governed. That means largely out of the control of politicians and bureaucrats, and, most especially, fully out of the control of landlords, vesting that control in the communities and especially the residents of the housing itself. And as it is publicly funded and community focused, it also is designed to meet our chief public policy goals of meeting accessibility needs and green infrastructure needs.

American experiments towards this end are underway already in Seattle and Hawaii with Chicago already having starting funding in place and getting ready to get started soon as well. Montgomery County, MD has something adjacent to social housing too. Seattle and Chicago are hoping to be inspired by the Vienna model while Hawaii is looking to the Hong Kong model. California and other states and local governments continue to study social housing too, and they hope to move forward soon.

But until the coffers at the federal level open up, this will all be difficult at best to pursue. Harris should be talking about these alternatives to the privatization model that got us in this mess, not creating more tax incentives to build millions more of the same.

The venerable Rep. Maxine Waters (D-CA), Ranking Member of the House Financial Services Committee in the US House that oversees housing matters, even remarked that she is now “basically opposed to tax incentives because I think that all it does is give rich people, the builders and the developers, more money than they should have when they claim that they’re building affordable housing.” I agree fully, and I would go further to say that those tax incentives and “public/private partnerships” that evolved as a result of federal policy in the wake of Faircloth have created a scenario that encourages slumlords as landlords are more dependent on government money than tenant rents for their revenues (profits by a non-profit name) that enrich executives, salaries and incentives sometimes reaching upward of millions of dollars, and given that the government is not a tenant nor enforces its own laws properly, there is no reason for landlords to keep their properties in habitable conditions.

Which brings us, of course, to immigration, and especially the influx of migrants from countries like Venezuela that US foreign policy has created.

We talk a whole lot about “border security” but not nearly enough about the roles of the CIA and foreign policy in general that created the influx of people to our borders. To Harris’s credit, she seemingly takes a position that immigration on the whole is good. Under certain conditions. If you do it exactly the way she proscribes.

To that end, Harris proposes passing the “bipartisan border security bill”, but this bill would increase funding to ICE and concentration camps on US soil. Not ok.

She proposes reforming the immigration system and creating an “earned” pathway to citizenship, but she provides no details nor justification for why citizenship must be earned for immigrants now when our country’s original sins of colonialism and slavery certainly didn’t require earning that citizenship for white people or the Black slaves they brought to serve them. If, as Harris implies, America is better off with immigration and certainly the studies confirm that we are, then what more must be earned than a desire to be here and to add to the vitality of our communities?

Indeed, most immigrants even pay taxes into our national, state, and local coffers without many of the benefits that come with citizenship, so what more would we ask of them on that basis alone?

Meanwhile, holding Harris to account on her tax proposals in general is key. She proposes a sweeping and vague tax cut on the poorly defined and some would say divisive group she calls the “middle class” that would touch 100 million people. To damn her with faint praise again, it is indeed better than Trump’s additional tax cuts for the wealthy which we know never works, but without details, that’s the best that can be said of the proposal.

And what about the poor? A part of the working class that has been growing by the day. She has mentioned in other speeches made recently bringing back and expanding the child tax credit which has been one of the most expansive poverty measures in recent years and done some real good. But it is far from enough, especially for all the families out there that have made the decision not to bring a child into the world under poverty conditions.

And while we are reducing the price of groceries, let’s also talk about expanding SNAP benefits too to put more food on the table for those in need. SNAP is consistently one of the best poverty measures, helps create more demand for farmers’ products, and has one of the highest velocities of money for any government program as it’s putting the money in the hands of the people directly and circulating through every level of the economy. Putting more money in the hands of more people by raising federal funding to the states for SNAP to both expand benefits for current users and raising the caps on the current means testing to include more people and allow beneficiaries to earn more without losing access to food would help a tremendous number of people.

Harris speaks of protecting Social Security and Medicare, but protecting is not the same as expanding to ensure that it meets the real needs of lifting people out of poverty conditions. We need not just a Living Wage for workers, but we also need a Living Wage for Social Security. This would be a feasible part of the discussion if Harris were willing to commit to ending the cap on Social Security taxes and even proposing a progressive taxation to reduce the burden on the working class and greatly expand what the wealthiest earners contribute to the program.

And, obviously, passing and enacting the Improved Medicare for All bill as she once promised to do as a senator before becoming a presidential candidate.

Indeed, that’s not all to talk about where taxes are concerned as it has become increasingly obvious that there is a great need to not just capture the wealth of the most wealthy to compensate for our broken systems that create billionaires through exploitation or inheritance. Where is talk of not just reducing the tax burden on the working class but increasing the tax burden on those that can handle it with ease and that use that wealth to unduly influence power?

We need a wealth tax. I’d like to see a 100% wealth tax on estates worth more than $1 billion with a progressive system on excessive wealth below that, but I’d settle for something closer to Spain’s 1.7-3.5% to start with. Indeed, Massachusetts has already brought in $1,8 billion just this year alone with their 4% surtax on income over a million dollars.

While we rework the tax code, Harris seeks to send capital to small business owners and entrepreneurs and founders. Certainly, promoting small businesses should be a major priority. Community businesses that serve their communities in various ways deserve funding, and innovation comes from small business far more often than from large ones who seek more to protect their turf and suck up competition to maintain their profits for investors.

But that very difference highlights the vast problems in our current tax code that provides endless loopholes and subsidies and benefits for some of the largest and most profitable industries on the planet, often involving corporations that are also the most exploitative of our natural resources and labor. If we’re going to actually refocus on small businesses, let’s go all in.

Start by cutting off the fossil fuel industries completely. Then keep going from there until we’re sending out money to small businesses alone or as nearly so as national priorities allow. And as these industries will no doubt try to raise prices, put more dollars into working class family pockets, tax those corporations more, and keep them honest especially through antitrust actions and going after retaliatory price hikes with legal resources and using the bully pulpit to call them out for trying to keep the profits flowing to investors and executive pockets rather than prioritizing their customers. All while starting to fund the small businesses with even a fraction of that money saved to create the future competitors that will challenge the monopoly or cartel power they have.

While we’re at it, we can end the preferential treatment that investment money has currently as well as other abuses of the system that the rich and powerful have carved out for themselves in investment circles. We can strengthen the inheritance tax once again to prevent massive fortunes from giving some people opportunities at the expense of others and extending the wealth disparities down the generations.

And we can talk about reparations. Long, long overdue reparations for slavery. If we really want to talk about accountability, that must be on the table as well as land back to Indigenous people. We must be accountable as a nation for our original sins, and that leadership should be coming from the White House. How is our potentially second Black president not talking about these incredibly important issues as she touts her civil rights cred on stage?

Now let me be accountable to you, the reader, for just a moment about myself. I am not a member of the Democratic Party now, nor have I been for a very long time. I have no obligation to vote for Democrats, but as a leftist, our current voting system forces me to do so. But that is one of many reasons that I do work as a human rights activist that specializes as an expert in housing and disability policy. To change the system. To keep it accountable as much as I can and to put pressure on it in the hopes that eventually there will be a party that will represent me and my ideals.

In truth, voting is the start of democracy. Far from the totality of it. You must engage further than just showing up to vote. Organizing for justice is essential.

When the change from Biden to Harris happened, I, like many out there, were excited. Change was needed, and we all saw it. We organized for it and finally won. I was ready to throw down in the hopes that the message was heard, and that Harris would offer a new path, especially on the genocide. She proved last week that that wasn’t the case, even doubling down on the war footing. Plus, her policy platform remains largely an elusive, amorphous, largely undefined moving target.

I will vote for Harris because the alternative is truly horrific on all counts. We’ve seen their policy. In great detail. I know I would die or have to flee the country if Trump wins. Harris at least keeps me in the fight here in the US. But my ability to actively support her, to do work of my own accord, to spend spoons for her has been nullified completely, just as it was for Biden. I have to vote for her, but I won’t work on behalf of genocide.

There will be others that can’t even bring themselves to vote for her without a tremendous push in the direction I outline above. The joy is gone. For especially our Palestinian brothers, sisters, and non-binary family, despair has set in, and all the promises taste like the ash that covers Gaza. I can’t blame them.

A better world is possible if we reach for it. We can have a government grounded in compassion and care if we demand it. Ensuring that every single person in this country has their human and civil rights is absolutely feasible if we hold our elected officials accountable for it.

Or in the words of Chairman Fred Hampton, “Peace to you if you’re willing to fight for it.”

[intelligentchristianlady]

If you have time for one long read this holiday weekend, make it this one.

[coverageguru]

Affordable Health Insurance

Health insurance is a type of insurance that helps cover the cost of medical expenses. It can be provided by an employer or purchased individually from an insurance company. Health insurance plans typically have different levels of coverage, ranging from basic to comprehensive, and they often come with different costs, such as premiums, deductibles, and co-pays.

Before signing up for a health insurance plan, it's important to understand your specific healthcare needs and budget. You should consider factors such as your age, health status, and any pre-existing conditions you may have. You should also research the various affordable health insurance plans available to you and compare their costs and benefits.

Some common types of health insurance plans include HMOs, PPOs, and EPOs. HMOs typically have lower out-of-pocket costs but limit you to a specific network of healthcare providers. PPOs offer more flexibility in choosing healthcare providers but may have higher out-of-pocket costs. EPOs are a hybrid of HMOs and PPOs, offering some of the benefits of both.

Ultimately, choosing the right health insurance plan for you and your family requires careful consideration and research. By understanding your healthcare needs and the different options available to you, you can make an informed decision that best meets your needs and budget.

[mariacallous]

god, so many fucking things will be overturned/withdrawn/cut back under a gop administration...

[grrlscientist]

Republicans say they would side with Big Pharma & gut the Biden-Harris law that lets Medicare negotiate lower drug prices

They are openly supporting MUCH higher Drug Prices - why would any sane person vote rethuglican?

[thoughtportal]

Opinion Here’s how to get free Paxlovid as many times as you need it

When the public health emergency around covid-19 ended, vaccines and treatments became commercial products, meaning companies could charge for them as they do other pharmaceuticals. Paxlovid, the highly effective antiviral pill that can prevent covid from becoming severe, now has a list price of nearly $1,400 for a five-day treatment course.

Thanks to an innovative agreement between the Biden administration and the drug’s manufacturer, Pfizer, Americans can still access the medication free or at very low cost through a program called Paxcess. The problem is that too few people — including pharmacists — are aware of it.

I learned of Paxcess only after readers wrote that pharmacies were charging them hundreds of dollars — or even the full list price — to fill their Paxlovid prescription. This shouldn’t be happening. A representative from Pfizer, which runs the program, explained to me that patients on Medicare and Medicaid or who are uninsured should get free Paxlovid. They need to sign up by going to paxlovid.iassist.com or by calling 877-219-7225. “We wanted to make enrollment as easy and as quick as possible,” the representative said.

Indeed, the process is straightforward. I clicked through the web form myself, and there are only three sets of information required. Patients first enter their name, date of birth and address. They then input their prescriber’s name and address and select their insurance type.

All this should take less than five minutes and can be done at home or at the pharmacy. A physician or pharmacist can fill it out on behalf of the patient, too. Importantly, this form does not ask for medical history, proof of a positive coronavirus test, income verification, citizenship status or other potentially sensitive and time-consuming information.

But there is one key requirement people need to be aware of: Patients must have a prescription for Paxlovid to start the enrollment process. It is not possible to pre-enroll. (Though, in a sense, people on Medicare or Medicaid are already pre-enrolled.)

Once the questionnaire is complete, the website generates a voucher within seconds. People can print it or email it themselves, and then they can exchange it for a free course of Paxlovid at most pharmacies.

Pfizer’s representative tells me that more than 57,000 pharmacies are contracted to participate in this program, including major chain drugstores such as CVS and Walgreens and large retail chains such as Walmart, Kroger and Costco. For those unable to go in person, a mail-order option is available, too.

The program works a little differently for patients with commercial insurance. Some insurance plans already cover Paxlovid without a co-pay. Anyone who is told there will be a charge should sign up for Paxcess, which would further bring down their co-pay and might even cover the entire cost.

Several readers have attested that Paxcess’s process was fast and seamless. I was also glad to learn that there is basically no limit to the number of times someone could use it. A person who contracts the coronavirus three times in a year could access Paxlovid free or at low cost each time.

Unfortunately, readers informed me of one major glitch: Though the Paxcess voucher is honored when presented, some pharmacies are not offering the program proactively. As a result, many patients are still being charged high co-pays even if they could have gotten the medication at no cost.

This is incredibly frustrating. However, after interviewing multiple people involved in the process, including representatives of major pharmacy chains and Biden administration officials, I believe everyone is sincere in trying to make things right. As we saw in the early days of the coronavirus vaccine rollout, it’s hard to get a new program off the ground. Policies that look good on paper run into multiple barriers during implementation.

Those involved are actively identifying and addressing these problems. For instance, a Walgreens representative explained to me that in addition to educating pharmacists and pharmacy techs about the program, the company learned it also had to make system changes to account for a different workflow. Normally, when pharmacists process a prescription, they inform patients of the co-pay and dispense the medication. But with Paxlovid, the system needs to stop them if there is a co-pay, so they can prompt patients to sign up for Paxcess.

Here is where patients and consumers must take a proactive role. That might not feel fair; after all, if someone is ill, people expect that the system will work to help them. But that’s not our reality. While pharmacies work to fix their system glitches, patients need to be their own best advocates. That means signing up for Paxcess as soon as they receive a Paxlovid prescription and helping spread the word so that others can get the antiviral at little or no cost, too.

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[kdkeenan]

Project 2025: What's All the Fuss About?

What is Project 2025? Project 2025 is a blueprint for actions the Trump administration should take once it regains power. Trump has tried to distance himself, but he can’t. The name “Trump” is mentioned approximately 201 times in the text, not counting footnotes or author bios. The people who wrote Project 2025 are all Trump adherents and colleagues. More than 140 people who formerly worked for…

[hislop3]

Regulation Monday: SNF Staffing Mandate and Medicaid Access Rule

Just announced this morning, CMS has finalized two hotly debated proposed rules into final rules. The final rules involve the SNF staffing mandate proposed last year and the Medicaid Access Rule, requiring 80% of payments for Medicaid HCBS programs go to compensation for direct care workers. The Medicaid Rule follows the original proposed rule while the staffing mandate INCREASES the number of…

[dontmeantobepoliticalbut]

Americans’ Social Security checks will get a lot smaller in 2034 if lawmakers don’t act to address the pending shortfall, according to an annual report released Friday by the Social Security trustees.

That’s because the combined Social Security trust funds – which help support payouts for the elderly, survivors and disabled – are projected to run dry that year. At that time, the funds’ reserves will be depleted, and the program’s continuing income will only cover 80% of benefits owed.

The estimate is one year earlier than the trustees projected last year. About 66 million Americans received Social Security benefits in 2022.

Medicare, meanwhile, is in a more critical financial condition. Its hospital insurance trust fund, known as Medicare Part A, will only be able to pay scheduled benefits in full until 2031, according to its trustees’ annual report, which was also released Friday.

At that time, Medicare, which covered 65 million senior citizens and people with disabilities in 2022, will only be able to cover 89% of total scheduled benefits. Last year, Medicare’s trustees projected that the hospital trust fund’s reserves would be depleted in 2028.

LONG-STANDING FISCAL TROUBLES

Immensely popular but long troubled, Social Security and Medicare are on shaky financial ground in large part because of the aging of the American population. Fewer workers are paying into the program and supporting the ballooning number of beneficiaries, who are also living longer. Also, health care is becoming increasingly expensive.

Social Security has two trust funds – one for retirees and survivors and another for Americans with disabilities.

Looking at them separately, the Old-Age and Survivors Insurance Trust Fund is projected to run dry in 2033, at which time Social Security could pay only 77% of benefits, primarily using income from payroll taxes. The date is one year earlier than estimated last year.

The Disability Insurance Trust Fund is expected to be able to pay full benefits through at least 2097, the last year of the trustees’ projection period.

Merging the two trust funds would require Congress to act, but the combined projection is often used to show the overall status of the entitlement.

Social Security’s projected long-term health worsened over the past year because the trustees revised downward their expectations for the economy and labor productivity, taking into account updated data on inflation and economic output.

However, the long-term projection for Medicare’s hospital trust fund’s finances improved, mainly due to lowered estimates for health care spending after the height of the COVID-19 pandemic. Also, the program is projected to take in more income because the trustees estimate the number of covered workers and average wages will be higher.

ADDED PRESSURE ON CONGRESS

The trustees’ reports are the latest warnings to Congress that they will have to deal with the massive entitlement programs’ fiscal problems at some point soon. But addressing their issues is politically challenging. Elected officials are hesitant to suggest any changes that could lead to benefit cuts, even though that could reduce their options in the future.

“With each year that lawmakers do not act, the public has less time to prepare for the changes,” the trustees warned in a fact sheet.

The programs’ shortfalls are back in the spotlight this year as President Joe Biden and House Republicans battle over how to address the nation’s debt ceiling drama and mounting budget deficits. GOP lawmakers want to cut spending in exchange for resolving the borrowing limit, while the White House has said it will not negotiate.

In a memorable moment in his State of the Union address in February, Biden garnered public acknowledgment from congressional Republicans about keeping Social Security and Medicare out of the debt discussions.

But “not touching” Social Security means a hefty cut in benefits within a decade or so.

“Change is inevitable because without changes to current law, both Social Security and Medicare Hospital Insurance would go insolvent, subjecting program participants to sudden and severe payment cuts,” said Charles Blahous, senior research strategist at the Mercatus Center at George Mason University and former Social Security and Medicare trustee. “The outstanding question is whether change will be tolerably gradual, or instead highly damaging because it is too long delayed.”

Though Biden has repeatedly vowed to protect Social Security, his latest budget proposal did not include a plan to stabilize its finances.

However, his proposal did call for extending Medicare’s solvency by 25 years or more by raising taxes on those earning more than $400,000 a year and by allowing the program to negotiate prices for even more drugs.

Spending on the entitlement programs is also projected to soar and exert increased pressure on the federal budget in coming years.

Mandatory spending – driven by Social Security and Medicare – and interest costs are expected to outpace the growth of revenue and the economy, according to a Congressional Budget Office outlook released in mid-February.