JustCare

Tag: Biden administration

  • Millions of adults still carry significant student debt

    Millions of adults still carry significant student debt

    The Biden Administration tried to eliminate some student debt. But, a federal appeals court stopped the Saving on a Valuable Education Plan (SAVE) from moving forward, while it considers its legality. Instead the eight million people who had enrolled in SAVE still face considerable debt. Oyin Adedoyin reports for the Wall Street Journal on the likely future for these people during a second Trump administration.

    Millions of Americans are burdened by student loans, including nearly three million older adults. Older adults also owe more than $54 billion in medical debt. But, relief is nowhere in sight for them or for tens of millions of other Americans with student debt or medical debt.

    People with student debt are at a loss as to what to do. Many are part of a public-service loan forgiveness initiative. They expected the balances on their loans to be eradicated once they had made 120 monthly payments. And, they had planned for that future.

    People who are part of the SAVE program are in limbo at the moment. They need not pay anything on their loans, and they will not be penalized for doing nothing. But, until the lawsuit ends, they are stuck.

    Around a million public-service workers in SAVE thought their monthly loan repayments would come down around $1,000 a year, on average, and, for some, go away entirely. Instead, at least for now, the Biden Administration is only able to help 55,000 public service workers through the Public Service Loan Forgiveness Program.

    Many Republican policymakers in the states challenged the SAVE program on the grounds that it is expensive and illegal. Trump has called the program a “catastrophe.”

    People in SAVE who have worked in public service for at least 120 months, but who have not made 120 loan repayments yet, could be able to “buy back” the right to loan forgiveness. They might have to pay in more. Or, they could sign up for a different repayment plan based on income.

    Here’s more from Just Care:

  • Will the administration step in to curb prices on drugs developed with taxpayer dollars?

    Will the administration step in to curb prices on drugs developed with taxpayer dollars?

    For more than 30 years, the federal government has failed to rely on the Bayh-Dole Act to reduce the cost of prescription drugs developed with taxpayer dollars. US Senator Elizabeth Warren, along with many advocates, is urging the Department of Commerce to finalize a policy that would specify the federal government’s right to seize prescription drug patents funded by the government on drugs with prices deemed to be “too high.” Partrick Wingrove reports for Reuters on where things stand.

    In early December 2023, the Biden administration said it would issue a policy for taking patents from drug manufacturers when their drug prices were excessive. The policy would give the federal government “march-in rights.” Essentially, the government could give other manufacturers the license to manufacture drugs developed with federal dollars, which are priced too high.

    Not surprisingly, the US Chamber of Commerce is trying hard to keep the policy from people implemented. Rather than accepting that the policy would promote innovation and drive competition, it makes the tired argument that the policy will keep pharmaceutical companies from developing new drugs. As a rule, the pharmaceutical companies use their power to make new versions of the same blockbuster drugs rather than to develop new drugs to meet unique and important health care needs. Exceptions are few and far between.

    To determine whether a drug’s price is excessive, the government will look at who can afford it and whether the high price of the drug exploits a health or safety issue.

    Under the new policy, the government would consider a list of factors, including whether only a narrow set of patients can afford the drug, and whether drugmakers are exploiting a health or safety issue by hiking prices.

    Here’s more from Just Care:

  • Want to strengthen Social Security and Medicare, not cut them? Vote Biden

    Want to strengthen Social Security and Medicare, not cut them? Vote Biden

    Paul Krugman explains in a New York Times opinion piece why older adults and people with disabilities who support strengthening Medicare and Social Security need to vote in the upcoming presidential election: Medicare and Social Security are on the ballot. Only Joe Biden stands with them.

    President Biden’s 2025 fiscal budget proposes to increase taxes to protect and strengthen Social Security and Medicare. In stark contrast, former President Donald Trump has been calling for cuts to these programs. Krugman reminds us that Biden’s position is more in keeping with the public than Obama’s.

    In the past, President Obama and some other Democrats have called for limiting Medicare and Social Security spending, without regard to its consequences. Limits to Medicare spending would mean higher health care costs for older adults and people with disabilities. Limits to Social Security spending would mean lower benefits down the road and less retirement income.

    President Biden is proposing higher Social Security benefits and paying for them through higher corporate taxes. Wealthy individuals, who now contribute to Social Security for just a part of the year, unlike everyone else, and who don’t make Social Security contributions on capital gains income, would have to pay their “fair share.”

    To strengthen Medicare, President Biden proposes that people with annual incomes above $400,000 would pay a slightly higher Medicare tax rate. Their Medicare tax rate on earned and unearned income would increase from 3.8 percent to 5 percent. A majority of voters have always supported raising taxes on the wealthy to strengthen Medicare and Social Security.

    In stark contrast, here’s what Trump says:  “There is a lot you can do in terms of entitlements, in terms of cutting and in terms of also the theft and the bad management of entitlements.”  The Trump campaign insists that Trump did not actually mean “cutting.”

    Here’s more from Just Care:

  • Will the Biden administration rein in Medicare Advantage overpayments in 2025?

    Will the Biden administration rein in Medicare Advantage overpayments in 2025?

    Each year, the Centers for Medicare and Medicaid Services (CMS) proposes the payment rate for insurers offering Medicare Advantage plans for the following year. Right now, payments to Medicare Advantage plans are projected to be $88 billion more than they should be, driving up Medicare premiums and threatening Medicare’s long-term sustainability. Will the Biden administration rein in Medicare Advantage payments?

    Excessive Medicare Advantage payments take a dangerous toll on the Medicare Trust Fund, rapidly eating into it and threatening its solvency. Moreover, excessive Medicare Advantage payments drive up people’s Medicare premiums. According to the Committee for a Responsible Federal Budget, people with Medicare will spend $260 billion more in Medicare premiums in the ten years between 2023 and 2033 than they would have if CMS stopped overpaying Medicare Advantage plans.

    In addition, Medicare Advantage overpayments are likely to lead to the death of traditional Medicare, the government administered alternative to Medicare Advantage. The overpayments enable the insurers offering Medicare Advantage to  lure people away from Traditional Medicare through offers of dental and hearing benefits.

    Last week, CMS proposed a continuation of its Medicare Advantage rate proposal from last year, which would result in about a 0.2 percent decrease in Medicare Advantage payments for 2025. CMS says it will also result in a 2.45 percent reduction in revenue.

    Overall, for other reasons, their revenue will increase about 3.7 percent. CMS is changing the way it determines whether it will pay more for enrollees who have a variety of different health conditions.

    The insurers, of course, are already starting to say that the proposed rate will hurt their bottom line. But, it should not affect people’s Medicare Advantage benefits because the MA plans will still be overpaid tens of billions of dollars.

    Here’s more from Just Care:

  • Biden administration should do more to lower drug costs

    Biden administration should do more to lower drug costs

    In an opinon piece for Scientific American, James Love, Director of Knowledge Ecology International, explains how the Biden administration could do more to lower the cost of prescription drugs in the US. You might not know this but the federal government has the authority to drive competition in the brand-name prescription drug market for brand-name drugs developed with taxpayer support. Many brand-name drugs are developed with your tax dollars.

    Federal agencies can grant licenses to pharmaceutical companies to manufacture drugs that compete with patented drugs with high prices, if the patented drugs were developed with taxpayer dollars. Of course, these are licenses that the pharmaceutical companies that developed the patented drugs do not expect or want to be issued. And, historically, the government has not issued them.

    The federal government has what are called “march-in” rights. It can issue licenses to develop drugs whenever it believes it is necessary to fix a pharmaceutical company’s “abuse or nonuse” of a patented drug. New draft federal guidance clarifies that an excessively high drug price can be considered abusive.

    These “march-in” rights were first established in the Bayh-Dole Act of 1980. Their goal is to ensure that the public benefits from drugs that that are patented, if public dollars contributed to their development. But, over four decades, the federal government has never exercised “march-in” rights, even when pharmaceutical companies set unconscionable prices for their drugs.

    The Biden administration’s new take on the law is significant but still limits the government’s use of its march-in rights and still allows the pharmaceutical companies to set excessively high prices for drugs that were developed with taxpayer dollars. The administration does not suggest that pharmaceutical companies have an obligation to set their drug prices no higher than levels citizens of other wealthy countries pay for the same drugs when US taxpayer dollars funded their development. Right now, we often pay five to ten times more than people in other wealthy countries for the same drugs, developed with our tax money.

    There are not that many new drugs developed with federal funding. And, some of those drugs include patents that were not developed with federal funding. In the administration’s draft, timing, including a patent’s life, could mean that march-in is not a good tack for the federal government to take.

    Moreover, pharmaceutical companies can appeal the federal government’s exercise of march-in rights, which would freeze government action. Essentially, pharmaceutical companies can slow down the march-in process for years, until their drugs lose their patents. And, for obscure reasons, sometimes pharmaceutical companies do not disclose government funding, as in the case of Gleevec, a cancer drug that has generated billions in revenue for Novartis.

    But march-in rights are not the federal government’s only tool for lowering drug prices. Our government has “worldwide royalty-free licenses for a taxpayer-funded invention, and a separate statute allows government use of any patent with compensation—zero for government-funded inventions—set by a judge.” There’s no reason our government should not be using all these rights to ensure Americans can afford the medications they need, especially for Americans in federal programs like Medicare and Medicaid.

    [Editor’s note: I continue to believe that the simplest and swiftest way to pressure the pharmaceutical companies to lower drug prices in the US is to open our borders to prescription drugs from verified pharmacies abroad and require insurers to cover them just as they cover drugs from pharmacies in the US. The Biden administration is now allowing some states to import drugs from Canada, which is another small step in the right direction.]

    Here’s more from Just Care:

  • Biden administration finalizes Medicare Advantage prior authorization rule

    Biden administration finalizes Medicare Advantage prior authorization rule

    Last week, the Biden administration finalized a prior authorization rule that, among other things, will require insurers offering Medicare Advantage plans to use an electronic prior authorization process, approve requests more speedily, and report on their prior authorization denials. But, the rule does not take effect for three years and still leaves people with urgent health care needs at risk of not getting timely care and suffering serious harm in Medicare Advantage.

    (If you’re enrolled in Medicare Advantage, you should take advantage of the Medicare Advantage Open Enrollment Period, which end at the end of March, and study your Medicare options. Traditional Medicare has no prior authorization requirements, and you are covered for care anywhere in the US. Traditional Medicare also has no out-of-pocket cap, so it’s good to get supplemental coverage if you don’t have Medicaid. Supplemental plans K and L are lower cost.)

    The Centers for Medicare and Medicaid Services’ (“CMS”) final prior authorization rule does not dictate when or how often insurers can use prior authorization, nor does it require insurers to disclose this information. And, it still allows insurers to take a week to make a determination on a standard  prior authorization request and 72 hours on an urgent request. When people urgently need care, a 72-hour wait could literally kill them.

    Moreover, the new prior authorization rule doesn’t apply to prescription drug coverage. Right now, some Medicare Advantage plans require people with diabetes to go through a prior authorization process each time they need a continuous glucose monitor, even though it is standard treatment.

    Given that many insurers impose prior authorization rules that are not evidence-based and that can lead to serious harm to the most vulnerable patients, CMS should be establishing a standard set of prior authorization rules that Medicare Advantage plans can use. Standardizing prior authorization also would be a step towards helping people understand their Medicare options; people should know how often the MA plans will force them to go through prior authorization hoops when choosing between Traditional Medicare and Medicare Advantage as well as when choosing among Medicare Advantage plans.

    Today, people choose Medicare Advantage plans with blindfolds on. The government does not allow them to meaningfully distinguish among plans, let alone protect them from plans that are bad actors. Denial rates in some MA plans are more than 25 percent, but no one knows which deny care inappropriately at high rates and which allow enrollees to get the care they need.

    In sum, people can’t  know whether a particular Medicare Advantage plan will make them go through mega hoops before they can receive urgently needed care or whether it will inappropriately deny critically needed care. Even with these prior authorization final rules in effect, they can’t know. That’s not meaningful choice, that’s Russian Roulette.

    Here’s more from Just Care:

  • FDA is confiscating some imported life-saving prescription drugs

    FDA is confiscating some imported life-saving prescription drugs

    NBC News reports on the Food and Drug Administration’s efforts to block importation of prescription drugs. The FDA is helping the pharmaceutical industry and harming Americans who can’t afford to buy the life-saving drugs they need in the US. Allegedly the FDA is trying to keep fentanyl and opioids from being shipped into the US. Really? The FDA found just 33 packages of these controlled substances out of 53,000 it intercepted in 2022.

    The quickest way to ensure drug prices in the US are fair and not two to four times higher than what people in other wealthy nations pay is to open our borders to drug imports from verified pharmacies abroad.  The pharmaceutical industry uses its considerable influence to prevent drug importation, claiming safety risks.

    There are always risks to importing prescription drugs from abroad, just as there are risks to importing food from abroad. But, on a risk benefit analysis, the danger of being harmed from a drug imported abroad–for which there are no reported cases–is far outweighed by the danger of preventing people from getting the drugs they need because they cannot afford them.

    If the FDA’s goal is keeping opioids from entering the US, its current strategy of seizing packages with drugs from abroad is misplaced. The data show that few opioids are in the shipments the FDA intercepts. Almost all of the drugs in these seized shipments were prescription drugs people had ordered from abroad for personal use. The FDA confiscated mostly drugs to treat asthma, diabetes, cancer and HIV, as well as a lot of drugs that treat erectile dysfunction.

    Still, the FDA continues its efforts, at a huge cost to the health and well-being to the Americans who need the drugs they import. The FDA has the right to confiscate drugs without US labeling or packaging.

    While it is technically not legal to import prescription drugs from abroad, millions of Americans do so every year. No one has ever been prosecuted for doing so.  What’s particularly interesting is that both Republican and Democratic governors in Florida, Colorado, New Hampshire and New Mexico want to allow drug importation.

    The Biden administration has not yet approved state applications to import drugs. It’s unclear why not. Pharma has tried through a lawsuit, and failed, to block this Trump administration initiative.

    Why is Congress giving the FDA $10 million to intercept controlled substances from abroad, when the vast majority of the drugs it intercepts are for personal use, to keep people alive? “The nation’s fentanyl import crisis should not be conflated with safe personal drug importation,” argues Gabe Levitt of PharmacyChecker.com. PharmacyChecker.com reports prices from verified pharmacies in dozens of countries for a wide range of drugs.

    In December, Congress told the FDA that it should focus on intercepting controlled and counterfeit drugs from abroad and drugs that pose “a significant threat to public health.” That alone is not likely to stop the FDA from confiscating drugs that Americans are importing to treat their cancer, asthma and heart drugs. As Koontz of the FDA said, “Importing drugs from abroad simply for cost savings is not a good enough reason to expose yourself to the additional risks,” he said. “The drug may be fine, but we don’t know, so we assume it is not.”

    The FDA claims, based on Pharma-supported congressional testimony, that imported drugs have an eight to ten percent chance of being counterfeit. It’s not at all clear this is accurate. And, based on the evidence, it is not at all accurate when it comes to drugs bought from verified pharmacies around the world. The  U.S. Customs and Border Protection data show that it found just 365 counterfeits out of  more than 30,000 drugs it inspected in 2022.

    So, is it safe to import drugs from verified pharmacies abroad? If you hear ads from the Partnership for Safe Medicines about the dangers of drug importation, ignore them. The Partnership for Safe Medicines is a pharmaceutical industry front group. The ads are paid for by Pharma, whose profits depend on keeping drug importation illegal.

    “We have never seen a rash of deaths or harm from prescription drugs that people bring across the border from verified pharmacies, because these are the same drugs that people buy in American pharmacies,” said Alex Lawson, executive director of Social Security Works. “The pharmaceutical industry is using the FDA to protect their price monopoly to keep their prices high.”

    Here’s more from Just Care:

  • Medicare might cover more dental services in a limited way

    Medicare might cover more dental services in a limited way

    For years, Democrats in Congress have tried to add a dental benefit to Medicare without success. But, now, Susan Jaffe reports for Kaiser Health News that the Biden administration is proposing to change Medicare rules so that more people receive Medicare-covered dental services. However, Medicare is only planning to cover a limited suite of dental benefits for a small cohort of additional people.

    Today, Medicare’s coverage of dental benefits is limited to services that are necessary for treatment of another health condition. Those services include wiring teeth in connection with surgery to fix a broken jaw as well as removal of infected teeth in advance of a kidney transplant or radiation treatment for people with cancer in their neck or head.

    The Biden administration is proposing to expand the number of conditions for which dental services would be needed. For example, it might cover medically necessary removal of infected teeth for people with breast cancer who receive chemotherapy and radiation. Or, Medicare might cover services to treat a dental infection for people needing organ transplants beyond kidney transplants.

    It appears that the government’s goal is to expand dental coverage for people being treated for health conditions  in which dental services could substantially help their health outcomes. People getting hip and knee replacements, for example, might receive dental services if their teeth are infected. That said, Medicare would not cover medically necessary follow-up dental care.

    Also, for unknown reasons, the Centers for Medicare and Medicaid Services (CMS) does not appear to be considering covering dental services for the large cohort of people with Medicare who have diabetes. Medicare covers insulin, diabetic supplies and a range of services for these 16 million people. Dental care to address periodontal disease could help lower their blood sugar levels. One recent report from the National Institutes of Health found that nearly 6o percent of people with Medicare have periodontal or gum disease.

    If CMS expands dental benefits, coverage would begin in 2023. It is not clear how much CMS would pay for these dental services.

    Here’s more from Just Care:

  • Millions could lose health insurance when the public health emergency ends

    Millions could lose health insurance when the public health emergency ends

    When the COVID pandemic hit, the Biden administration declared a public health emergency which, among other things, extended Medicaid coverage to millions of people. For the vast majority of them, that coverage is a lifeline. As of now, the public health emergency could end as early as mid July. What happens to people with Medicaid then?

    The Biden administration needs to act thoughtfully and deliberately before declaring an end to the public health emergency. Since it was declared, Medicaid enrollment is up 12 percent and 25 percent of Americans now get their coverage through Medicaid. Taking Medicaid away from them because they are no longer eligible will have dire consequences.

    With the end of the public health emergency and the federal Medicaid funding that goes with it, as many as 15 million low and middle-income Americans could end up losing their health insurance. As of now, states are forbidden from kicking people off of Medicaid and have received additional funds to cover Medicaid’s cost. But, states will need to ensure all Medicaid enrollees remain eligible once the emergency is over.

    Many people who should have Medicaid coverage could lose it. A lot of people with Medicaid who remain eligible for Medicaid might not have the ability to undertake their state’s complex renewal application process. Other people with Medicaid might no longer qualify because their income is a little too high, or they might have moved to another state. Many of them likely have no clue that their coverage could end once the public health emergency ends and will only find out when they are told by their doctor’s office, their hospital or their pharmacy.

    As it is, the uninsured no longer have access to free Covid-19 testing and treatment. That protection ended last month. There are no funds to pay for it. Free vaccines are also about to end.

    It is not unreasonable for the Biden administration to end mask mandates and the like, as Covid’s threat to the public health appears to be waning. But, ending Medicaid protections is another story. Covid-19 has not gone away. Without insurance, many Americans will be hard-pressed to afford needed care, be it for Covid or something else.

    This year, people who lose Medicaid can still enroll in a state health insurance exchange plan. Because Congressional funding of Affordable Care Act subsidies for people with low and middle incomes lasts through the end of this year, their insurance premiums will cost very little, if anything. But, in 2023, they will be at risk of being uninsured again.

    Our dysfunctional fragmented and costly health care system affords few among us a way to address a public health emergency, let alone a complex disease. Costs are just too high, even with insurance. As a start, the Biden administration should extend Medicaid protections at least through the end of the year, even if it ends other protections that came with the declaration of a public health emergency.

    And, if it wants to ensure that Americans are prepared for the next public health emergency or simply to safeguard people’s health and well-being, Congress should pass legislation that guarantees health care for all; it should pass Medicare for all.

    Here’s more from Just Care:

  • Biden administration overlooks importance of informal caregivers for nursing home residents

    Biden administration overlooks importance of informal caregivers for nursing home residents

    Back in February, the Biden administration proposed a series of nursing home reforms, many of which could help significantly to improve nursing home quality. But, shockingly, the administration does not address the need for nursing home residents to have informal caregivers by their side. Judith Graham reports for Kaiser Health News on the often critical role that informal caregivers play for nursing home residents and why nursing homes should not be able to keep informal caregivers away, even in a pandemic.

    In theory, better staffing at nursing homes, better oversight of nursing homes, and better information about particular nursing homes could be a huge step forward in ensuring nursing home residents are safe and well cared for. But, the rights of residents to be with family members are as important, yet most family members were prevented from spending time with loved ones in nursing homes during the pandemic. The consequent isolation many residents felt took a toll on their mental and emotional health.

    Without the support of family and friends, nursing home residents suffer. Many of them rely on these informal caregivers to help them with personal care, cleaning and other basic activities. Sometimes these informal caregivers are their principal ongoing contact with the outside world.

    But, support from informal caregivers vanished for many of them during Covid. Most nursing homes ended visitation privileges, even from close family and friends. And, the fear is that, now, nursing homes will cut those privileges whenever they deem appropriate, without regard to residents’ essential needs.

    Keep in mind that not all nursing homes are alike. Some are far better than others at caring for patients. Do your homework before choosing a nursing home and don’t trust Medicare star-ratings of nursing homes. Stay away from chain nursing homes. Look into Green Houses, smaller nursing homes that are not-for-profit. And, also look into non-profit PACE programs, which allow you to remain in your home and community as you age.

    Advocates are now calling for additional protections for nursing home residents, including the right to designate two people who will always have access to them in their nursing homes so long as they comply with the same safety policies that staffers must comply with.

    Caregivers are not staff, but they should participate in the care planning process. They should be supported. They can offer love that staff generally never offer, as well as ongoing attention to their loved ones’ care needs.

    Here’s more from Just Care: