JustCare

Tag: Donald Trump

  • Trump reelected: What happens to health care?

    Trump reelected: What happens to health care?

    With Donald Trump on his way back to the White House, we can be sure that our health care system will change dramatically over the next four years. Sarah Owermohle reports for StatNews on ways in which Trump could restructure US health care.

    As Trump said in his victory speech, Robert F. Kennedy Jr. is likely to be in charge of “mak[ing] America health again.” It’s not at all clear what that means. Americans appeared less focused on health care this election and more focused on the economy. However, health care costs are part of the economy and have always been a large concern for Americans.

    This go round, Trump claims he won’t try to end the Affordable Care Act. He says he simply wants to reduce costs. That could mean lower costs for healthy people and higher costs for people who need care. It could also mean health insurance options that are not comprehensive, for example, insurance that does not cover prescription drugs.

    Tax credits that help people with low incomes afford insurance premiums could not be extended at the close of 2025, when they expire. Republicans in Congress don’t support them.

    Trump says he will not support a law that bans abortion in American. He intends to prevent funding for gender-affirming care and prohibit it for minors entirely. He will protect employers’ right to refuse to cover birth control based on their religion.

    What will Trump do with Medicare? During his last presidency he ultimately decided not to support lower drug prices. Will he try to undo Medicare drug price negotiation for high-cost drugs?

    Both Medicare and Medicaid are on the table. He might try to do away with traditional Medicare. Although Medicare Advantage has cost the Medicare program significantly more than traditional Medicare, Republicans in Congress still look to the corporate insurers offering Medicare Advantage plans to contain costs. Trump left open the possibility that he would cut spending on Medicare and Medicaid. In his first presidency, he gave states permission to put work requirements on some people with Medicaid.

    Trump says he wants a commission to look at the growth of chronic illnesses in America. Who knows what that will lead to. To date, he has not embraced RFK Jr.’s notion that vaccines are responsible for chronic diseases. RFK Jr. will not lead the Department of Health and Human Services, according to a Trump spokesperson, but he still could have significant authority over recommended vaccines.

    On a brighter note, Trump has said he will ensure access and insurance coverage of in vitro fertilization.

    Trump says he supports tax credits to help with the costs of  America’s 53 million plus caregivers. He has yet to offer details as to what that would look like. Health savings accounts, which tend to be of little help to people when they need costly care, is one way he might go.

    Here’s more from Just Care:

  • What happens to Medicare if Trump wins?

    What happens to Medicare if Trump wins?

    Older adults and people with disabilities have no warning to avoid enrolling in Medicare Advantage plans–plans run by corporate health insurers–that likely will deny them care. And, they have no good protections. If Donald Trump becomes President again, everyone could be forced into a Medicare Advantage plan, reports Jessica Glenza for The Guardian.

    Today, traditional Medicare, the government-administered alternative to Medicare Advantage, has become a luxury for the wealthy. People enroll in Medicare Advantage because the upfront costs are lower. And, they are then locked in. They can’t switch to traditional Medicare because it lacks an out-of-pocket cap, and they can’t afford supplemental insurance to protect themselves against catastrophic costs.

    Problems abound in Medicare Advantage for people who get sick and need costly care. Millions of people in Medicare Advantage struggle to figure out how they are going to stay with their treating physicians because their Medicare Advantage plan is leaving their area or their physicians are leaving their Medicare Advantage plan networks. Or, they wonder how they will travel tens of miles to get the care they need because their local hospital is no longer in-network. Or, they struggle to deal with Medicare Advantage denials of care their treating physicians says they need.

    Joe Namath and William Shatner might tell you how much they like Medicare Advantage, but dollars to donuts, they are in traditional Medicare. Traditional Medicare is a luxury for the wealthy because it actually covers the care you need from the physicians and hospitals you want to use.

    Trump and his supporters in Congress want to privatize Medicare and end traditional Medicare. They want you to believe that you will have all the choices you need in Medicare Advantage. The fact is that you will have a bunch of meaningless choices because you won’t be guaranteed the choice of a Medicare Advantage plan that will meet your needs if you are in an accident or are diagnosed with cancer or heart disease. Only traditional Medicare guarantees you coverage for all your needs.

    The ten big insurers offering Medicare Advantage have been charged with fraud many times. In 2022, eight of them were defending themselves in court.

    While Medicare Advantage plans might not meet your needs, they meet the needs of the biggest health insurers, who are able to profit wildly. Nearly half of United Healthcare’s total revenue came from Medicare Advantage. But, Medicare Advantage enrollees represent only 15 percent of all its enrollees, according to Accountable.US.

    Trump and his supporters in Congress appear to prefer a Medicare program in which health insurers have the financial incentive to stint on care and profit wildly at taxpayer expense, to a more cost-effective world in which people can get the care they need and the government is in charge.

    Here’s more from Just Care:

  • Project 2025 would push everyone with Medicare into Medicare Advantage

    Project 2025 would push everyone with Medicare into Medicare Advantage

    Project 2025 is the brainchild of The Heritage Foundation and a roadmap for the Republicans if Donald Trump is elected President. If implemented, Project 2025 would push everyone with Medicare into Medicare Advantage, with restricted access to care, instead of enrolling them in Traditional Medicare and allowing them to decide whether they want to enroll in Medicare Advantage. Project 2025 would likely privatize Medicare and endanger the health and well-being of more than 65 million older adults and people with disabilities.

    For a start, if President Trump becomes President and he carries out the Medicare goals of Project 2025, people who sign up for Medicare will be enrolled automatically in a Medicare Advantage plan–a corporate health plan the government pays to provide Medicare benefits and rewards for denying care. Who knows if that plan would cover the doctors and hospitals they want to use or provide them with the care they need. So many Medicare Advantage plans are engaged in widespread inappropriate delays and denials of care.

    Yes, people would still have the right to switch to Traditional Medicare, the government-administered program that provides coverage from virtually any doctor or hospital anywhere in the United States. But, would they know they could disenroll from Medicare Advantage? Or, would they be locked in, unable to enroll in Traditional Medicare as millions of people in Medicare Advantage are today?

    Project 2025 would aggravate health inequalities. As it is, Traditional Medicare is not affordable to most people with Medicare. Because Traditional Medicare lacks an out-of-pocket cap, people also have supplemental coverage to protect themselves financially. But, supplemental coverage is both expensive and not guaranteed. So, until Congress reforms Traditional Medicare to include an out-of-pocket maximum, most people with Medicare have no choice but to enroll in a Medicare Advantage plan.

    If conservatives prevail, the for-profit corporate health insurers will take over Medicare entirely before long. It’s a cash cow for them. They have the money, the power and the mission to drain the Medicare Trust Fund and drive up their profits. Health care costs for people with Medicare will soar. Those with complex and costly conditions likely will face untold challenges getting the care they need.

  • Insulin costs: Biden v. Trump

    Insulin costs: Biden v. Trump

    If you are looking for our next president to lower your health care costs, there are multiple reasons to support President Biden over Donald Trump. One is insulin. Though Trump would like you to think otherwise, Juliette Cubanski and Tricia Neuman explain in a KFF report that Donald Trump did far less to contain the cost of insulin than President Biden.

    To be clear, both President Biden and Donald Trump have lowered the cost of insulin for people with Medicare and for no other cohort of the population. But, access to lower-cost insulin for people with Medicare is far greater under President Biden than it was under President Trump.

    Under President Biden, all 6,000 Medicare Part D prescription drug plans are required to keep the insulin copay at no more than $35 a month. President Trump did not require the Part D plans to charge a copay of no more than $35 a month; he made it voluntary. So, only 38 percent of Part D plans participated when he was president.

    As a result, the Trump administration only helped 800,000 people with Medicare needing insulin. The Biden Administration is helping all 3.3 million people with Medicare needing insulin.

    Under President Biden, all insulin products are covered. Donald Trump only required a subset of insulin products to be covered–one of each dosage form (vial, pen) and insulin type (rapid-acting, short-acting, intermediate-acting, and long-acting).

    Under President Biden, the insulin cap applies to drugs under Medicare Part D and Part B. The Trump administration only applied the cap to Medicare Part D and not to insulin drugs administered by a physician under Part B.

    President Biden is now proposing to ensure that everyone with commercial insurance also enjoys the $35 a month out-of-pocket cap on insulin. In fact, President Biden’s proposal was in the Inflation Reduction Act, but the Republicans took it out before it passed. And, Republicans in Congress want to repeal the Inflation Reduction Act, which would end the $35 out-of-pocket insulin cap, though Trump has not yet commented on this.

    N.B. Rachel Cohrs Zhang reports for Stat that the idea for the $35 insulin cap came from Eli Lilly. The cap likely helps Lilly’s profits since it boosts insulin sales significantly, as more people can afford it. The cap doesn’t affect the price of the drug. So, everyone with Medicare ends up absorbing insulin’s lower out-of-pocket cost through higher premiums.

    Here’s more from Just Care:

  • Trump’s health care plan could be a winning ticket for Biden

    Trump’s health care plan could be a winning ticket for Biden

    Jonathan Cohn reports for the Huffington Post on what Donald Trump claims is his health insurance proposal for Americans. Trump’s proposal would effectively end the Affordable Care Act and offer no viable alternative; it could turn Medicare into a voucher program that drives up costs for older adults and people with disabilities.

    Trump is proposing “less expensive” health coverage than the Affordable Care Act, which effectively would enable insurers to sell junk coverage that won’t meet people’s needs. Trump also would once again allow insurers to stop covering people with pre-existing conditions. And, he would eliminate Medicare’s authority to negotiate prescription drug prices.

    Last November, Trump wrote: “The cost of Obamacare is out of control, plus, it’s not good Healthcare. I’m seriously looking at alternatives.” Don’t hold your breath.

    While Trump no longer talks of “repealing” the Affordable Care Act, his message is otherwise the same. He knows that Americans don’t want him to repeal the Affordable Care Act, and that Republicans lost control of the House of Representatives and the presidency in part because of their threat to repeal the ACA. Forty-five million Americans now rely on the Affordable Care Act for their health care coverage.

    Not surprisingly, Ronald Brownstein writes for the Atlantic that health care could be a winning issue for the Democrats. It is one major issue that voters trust Biden to address better than Trump. The Republican Study Committee, which represents 80 percent of the House Republicans, has recently said that it would repeal the ACA and restructure Medicare.

    Today less than eight percent of the US population is uninsured as a result of the Affordable Care Act. While that still leaves nearly 30 million Americans without health care coverage, that number is lower than in years past.

    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:

  • President Biden drafts a package of health care reforms for his second term

    President Biden drafts a package of health care reforms for his second term

    President Joe Biden is assembling a package of health care reform proposals for his second term, including a proposal to bring down the price of prescription drugs, reports CNN. It’s a smart move given that health care affordability is the second most important issue for Americans, after inflation.

    At the same time as President Biden looks to enhance people’s health care benefits, former President Donald Trump is calling to repeal the Affordable Care Act (ACA). President Biden wants to keep federal subsidies for people receiving care through the ACA and do more to reduce drug prices for people with Medicare and all other Americans. Biden’s goals are modest given the state of health care in the US and we need to push him to call for affordable health care for all, but his goals are far better than Trump’s.

    The ACA not only gives 10 million more Americans health insurance through the state health insurance exchanges, it expanded Medicaid to cover more Americans. People with incomes up to 135 percent of the federal poverty level are Medicaid-eligible. President Biden is looking into ways to ensure that the three and a half million people in the 10 states that opted against expanding Medicaid have Medicaid coverage.

    President Biden is again calling for a public health insurance option. In theory, such an option could remove the private insurer middlemen and all the waste and increased costs they bring. But, it’s not at all clear, based on Medicare Advantage and traditional Medicare (the public option) that a public health insurance option would bring down costs. The devil is in the design.

    Right now, the Centers for Medicare and Medicaid Services (CMS), which oversees Medicare, is focused on bringing down the price of ten drugs that cost the Medicare program the most, as required by the Inflation Reduction Act. That’s both the camel’s nose under the tent for lower drug prices and small potatoes. The swiftest and easiest way to bring down drug prices is to allow people to import drugs from abroad and require insurers to cover those far less costly drugs.

    The Inflation Reduction Act also penalizes drug companies for raising drug prices more than the rate of inflation. This measure should keep drug prices from going up at obscene rates. But, it is also small potatoes, given how high drug prices are in the US–often four times higher than in France.

    Here’s more from Just Care:

  • Drug prices: Biden v. Trump

    Drug prices: Biden v. Trump

    Heather Landi reports for Fierce Healthcare on how Donald Trump’s former Secretary of Health and Human Services, Alex Azar, and Joe Biden’s current Secretary of Health and Human Services (HHS), Xavier Becerra, would address high drug prices. Not surprisingly, their views differ significantly.

    Azar does not recognize that pharmaceutical companies in the US engage in price fixing. Or, that the pharmaceutical companies often delay the release of new drugs in order to maximize profits on older drugs, hampering innovation. Or, that it’s much easier for people in France to fill their prescriptions than people in the United States because out-of-pocket costs in the US are so high.

    Azar does recognize the power of pharmacy benefit managers, PBMs, to drive up people’s out-of-pocket costs, but does not suggest a plan to fix that issue,. For example, he does not propose removing PBMs from the process of deciding which drugs are covered and at what price to patients.

    Last year, Congress passed the Inflation Reduction Act or IRA, giving Medicare drug price negotiating power for 10 drugs in 2025; the Centers for Medicare and Medicaid Services have chosent the 10 drugs, based on which cost the Medicare program the most. The IRA also capped out-of-pocket costs for each insulin product people with diabetes use at $35 a month. And, it imposed an out-of-pocket limit of $2,000 for drugs covered by Medicare Part D plans beginning in 2025.

    President Joe Biden’s HHS Secretary Becerra touts Medicare’s drug price negotiation power as an effective way to lower drug costs, pointing out that the IRA now caps the cost of insulin at $35 per month for seniors who have Medicare.

    Of note, the Trump administration had proposed that Part B drug prices–for inpatient drugs–be tied to prices paid abroad for these drugs. That sounds to me as if it would have been a smart move. But, the Biden administration rescinded that proposal, likely under pressure from the pharmaceutical industry.

    Here’s more from Just Care:

  • Trump advises Republicans not to cut Social Security and Medicare

    Trump advises Republicans not to cut Social Security and Medicare

    Surprise, surprise. Donald Trump is advising Republicans that “under no circumstances should Republicans vote to cut a single penny from Medicare or Social Security.” Time will tell whether he would favor raising the age of eligibility for those programs or whether he would support cuts that happen down the road. Regardless, it’s not at all clear that Kevin McCarthy and the Republican House will heed Trump’s advice; what is clear is that they have never supported lifting the cap on Social Security contributions, the fair way to strengthen Social Security.  

    For now, Trump’s message is direct. Republicans should focus on cutting foreign aid and initiatives to support a healthier climate. He also advises cutting “waste, fraud and abuse,” which Republicans like to talk about doing but only do selectively. (For example, they seem to have little to no interest in reducing massive overpayments to Medicare Advantage plans, which would save tens of billions of dollars a year.) Trump also suggests Republicans limit their cuts to issues like foreign aid and climate investments.

    What is motivating Trump to say he opposes cuts to Social Security and Medicare? For sure it’s smart politics. It might also be a way for him to distinguish himself from Ron DeSantis, his adversary and nemesis. No question that DeSantis wants cuts to these programs; he has made his views perfectly clear. 

    Of course, Trump’s expressed views are likely of no consequence for many Republicans. We know that Bill Cassidy and Angus King, moderates, are working on a plan that would weaken Social Security, while claiming it would help ensure the Trust Fund is solvent.

    The smart way to strengthen Social Security is to end the Social Security tax break for the rich. Congress should eliminate the cap on Social Security so that all Americans pay in their fair share throughout the course of the year.

    Here’s more from Just Care:

  • Trump pardons several Medicare fraudsters

    Trump pardons several Medicare fraudsters

    Fred Schulte of Kaiser Health News reports that Donald Trump, on his way out of office, granted pardons or commutations to several Medicare fraudsters. Many of these convicts were serving long jail sentences for major crimes. Who knows what Trump received in exchange for giving these serious criminals their freedom back.

    One man was allegedly responsible for thousands of questionable spinal surgeries. Another man allegedly ripped off Medicare and Medicaid to the tune of $1 billion taken from senior care facilities. All of those pardoned put the lives of vulnerable older adults at risk and ripped off taxpayers.

    Trump said that Senator Robert Menendez of New Jersey and Congressman Mario Diaz-Balart of Florida supported his decision to pardon Salomon Melgen. Melgen was an eye doctor in Florida convicted of defrauding the government of $100 million. He was charged with giving unnecessary treatments to his patients and compromising their health. Trump’s stated rationale: “Numerous patients and friends testify to his generosity in treating all patients, especially those unable to pay or unable to afford healthcare insurance.”

    Trump also pardoned a former doctor and who was an owner of Pacific Hospital of Long Beach, serving a 15-month prison sentence. He was found to have been paying thousands of dollars in kickbacks to doctors who sent patients to Pacific Hospital of Long Beach for unnecessary surgeries.

    Sholam Weiss received a pardon from Trump. He was sentenced to 835 years in federal prison for what some say is the longest sentence every for racketeering, wire fraud, money laundering and obstruction of justice. Trump said that time served–18 years of prison–was enough.

    Trump pardoned John Davis for his crime of accepting over three-quarters of a million dollars in illegal bribes linked to fraudulent Medicare bills of $4.6 million. In Trump’s view, the former CEO of Comprehensive Pain Specialists, a chain of pain management clinics in Tennessee, committed a single crime that did not lead anyone to suffer financially. He belonged home with his three young children after serving four months in jail.

    Here’s more from Just Care: