JustCare

Tag: Elizabeth Warren

  • Is Mehmet Oz fit to run Medicare agency?

    Is Mehmet Oz fit to run Medicare agency?

    Last month, Senator Elizabeth Warren, along with six other Democratic Senators, sent a letter to Dr. Mehmet Oz, whom President-elect Donald Trump has named as Administrator-Designate, Centers for Medicare & Medicaid Services (CMS), regarding Dr. Oz’s call for the elimination of traditional Medicare and his lack of qualifications for the CMS Administrator position. If Dr. Oz becomes head of CMS will we be playing with fire?

    Dr. Oz has substantial investments in corporate health insurance companies. He has said that he wants everyone with Medicare in a Medicare Advantage plan, even though Medicare Advantage does not work for large swaths of the population. (People in rural communities who are in Medicare Advantage plans often must travel tens of miles to receive hospital care because their Medicare Advantage plans won’t pay their local hospitals appropriately. People with cancer in Medicare Advantage plans can’t see physicians at cancers centers of excellence because they are all out of network. People who travel and need care in multiple parts of the US can’t get the in-network coverage they need in Medicare Advantage. Amputees and other people needing rehab services too often can only get that care covered if they are in traditional Medicare.)

    Dr. Oz also either does not appear to appreciate or does not care that traditional Medicare is far more cost effective than Medicare Advantage. He either does not know or does not care that Medicare is overpaying corporate health insurers operating Medicare Advantage plans tens of billions of dollars each year.

    MedPAC projects that these insurers will overcharge CMS $83 billion relative to traditional Medicare in 2024 alone. To maximize profits, private insurers make their MA enrollees appear sicker than they actually are. The HHS Office of the Inspector General finds that insurers engage in constant inappropriate delays and denials of needed care and force physicians and hospitals to jump through hoops to deliver needed care. Dr. Oz does not seem to know about or ignores these abuses.

    Dr. Oz also has a financial conflict of interest. He owns more than $550,000 of stock in UnitedHealth, which is under Justice Department investigation for antitrust abuses. But, his desire to eliminate traditional Medicare would double revenue for UnitedHealth to nearly $300 billion.

    Senators Warren, Wyden, Cardin, Merkley, Durbin and Blumenthal ask Dr. Oz for answers to a series of questions by December 23, 2024:

    1. Does he continue to believe traditional Medicare should be eliminated and, if so, why?
    2. Will he commit to protecting Medicare, not privatizing it or cutting benefits?
    3. Does he understand why Medicare Advantage is highly dysfunctional and, if not, what does he think about the upcoding and widespread delays and denials of needed care?
    4. Will he sell off all investments in health insurance companies in order to ensure he has no financial conflicts of interest if he is confirmed as CMS Administrator?

    Here’s more from Just Care:

  • Food prices are soaring as are profits at Walmart and other big food corporations

    Food prices are soaring as are profits at Walmart and other big food corporations

    If you spend any time at the grocery store, you can’t help but notice that prices are going up and up and up. The big corporations, like Pepsi and General Mills, say it’s all about supply chain issues, while their profits soar. Veronica Riccobene reports for the Lever on“What’s going on?”

    In four years, grocery prices are up 25 percent overall, while shareholders with interests in grocery stores have seen $77 billion in distributions.

    In 2022, people typically spent 11 percent of their disposable income on food. The price of a dozen eggs has just about doubled in four years. Food and Water Watch says that an average family of four living thriftily spends 50 percent more today than it did four years ago, $976, up from $654.

    More Americans are going hungry. Three and a half million more people are facing food insecurity since the pandemic. Today, about 28 million adults in the US do not have ongoing access to food. Some are calling on President Biden to step in and keep the food companies from driving up food prices. The marketplace is broken.

    Companies buy back their stocks to drive up their stock prices. Corporate executives and shareholders benefit. Consumers are hurt.

    Tyson Foods’ execs and shareholders are some of the big beneficiaries of stock buybacks. Tyson raised the price of meat nearly 30 percent and saw its profit margins more than double between 2021 and 2022. It’s operating costs rose, but price increases more than offset those costs—by 33 percent.

    According to the Federal Trade Commission,  Walmart, Kroger, and Amazon “used rising costs as an opportunity to further hike prices to increase their profits.” The price of food and drinks rose seven percent more than their costs.

    Walmart raised prices more than 50 percent on some of its generic food brands in the three years between 2020 and 2023. General Mills raised the price of cereal 12 percent in 2023 from the prior year. It also shrunk the amount of cereal in the box to 18.1 ounces from 19.3 ounces.

    In addition to raising prices, companies are shrinking the size of their products. They call it “shrinkflation.”

    As grocery store corporations get larger, they can engage in price fixing. Only about four companies control half the market for nearly 80 percent of groceries sold. Walmart sells nearly 30 percent of all groceries in the US. Costco sells about 7.1 percent of groceries and Kroger sells 5.6 percent. The Federal Trade Commission is now trying to stop a merger between Kroger and Albertsons on antitrust grounds.

    The consolidation is particularly stark among retailers. Just this year, the Federal Trade Commission sued to block a $24.6 billion merger between Kroger and Albertsons, alleging it violates antitrust law.

    Senator Elizabeth Warren is leading the charge in Congress to stop the grocery store price gouging through the Price Gouging Prevention Act. Her bill would make it a federal offense for corporations to price gouge.

    Here’s more from Just Care:

  • Sen. Warren and Rep. Jayapal urge CMS to end Medicare Advantage overpayments, punish bad actors

    Sen. Warren and Rep. Jayapal urge CMS to end Medicare Advantage overpayments, punish bad actors

    Ahead of the Centers for Medicare and Medicaid Services’ (CMS’) release of proposed payment policy for Medicare Advantage plans, Senator Elizabeth Warren and Representative Pramila Jayapal sent a letter to the Centers for Medicare and Medicaid Services detailing ways the administration could wipe out a projected $100 billion in overpayments to MA plans this year alone. Among other things, the letter proposes ending contracts with MA plans that violate their duty to cover Medicare benefits.

    “It is imperative for [Medicare] to rein in these abuses and protect Medicare coverage for the seniors and people with disabilities who rely on it,” say Warren and Jayapal. Last month, Senator Warren wrote CMS to start collecting critical data needed to oversee the Medicare Advantage plans.

    Thirty-one million older adults and people with disabilities are enrolled in Medicare Advantage plans. These health plans cost taxpayers $500 billion last year. But, substantial evidence indicates that the government overpays insurers offering these plans tens of billions of dollars each year; and, some, if not many, of these MA plans inappropriately deny and delay care to their enrollees, especially care for people with complex and costly conditions.

    The Biden administration has taken some steps to end some of the overpayment abuses. But, many experts believe there’s a lot more to be done. Mark Miller, former director of the Medicare Payment Advisory Commission, says “If [the Centers for Medicare and Medicaid Services] backs down … then the beneficiary and taxpayer lose.”

    CMS gave the insurers immunity from overpayments detected over seven years of audits. CMS now plans to conduct more auditing of MA plans’ billing processes. Warren and Jayapal are looking for payment policy changes as well as audits. For example, they want the government to adjust payments to MA plans because their enrollees are healthier than enrollees in Traditional Medicare.

    The five-star quality rating system for MA plans also needs an overhaul. People cannot rely on the star-rating system as an indicator of whether an MA plan inappropriately denies care or has a narrow network that undermines their ability to get good care. Yet, the government pays insurers more for MA plans with a 4 or 5 star-rating.

    Moreover, some data show that some MA plans provide their enrollees fewer benefits than they would get in Traditional Medicare, even though they are legally required to cover the same benefits. CMS has not penalized plans that inappropriately deny care. Warren and Jayapal want CMS to hold them accountable and end their contracts.

    In some instances, UnitedHealth Group has denied rehab care to patients in critical need of rehab, based on computer algorithms, to the detriment of their enrollees’ health and well-being. Even though CMS said it may punish insurers who violate their contracts by wrongly denying care, it has yet to do so.

    CMS has ended contracts with Centene Medicare Advantage plans in Arizona and North Carolina because their star-ratings were three or below for three years running.

    Here’s more from Just Care:

  • Bi-partisan group of Senators call for better Medicare Advantage data to protect enrollees

    Bi-partisan group of Senators call for better Medicare Advantage data to protect enrollees

    In a letter to the CMS Administrator, Senators Elizabeth Warren, Catherine Cortez-Masto, Bill Cassidy and Marsha Blackburn call for better Medicare Advantage data collection and reporting. Lack of good Medicare Advantage data prevents the Centers for Medicare and Medicaid Services (CMS) from effectively overseeing and reforming the Medicare Advantage program and make it impossible for people with Medicare to make a meaningful choice of a Medicare Advantage plan, let alone protect themselves from the bad actor Medicare Advantage plans.

    “[I]n the last few years, federal watchdogs have released numerous reports examining concerning trends in MA… These findings raise important questions about ensuring the integrity and fiscal sustainability of the Medicare Advantage program. Without publicly available plan-level data on prior authorization requests by type of service, timeliness of determinations and reasons for denials; claims and payment requests denied after a service has been provided; beneficiary out-of-pocket spending; and disenrollment patterns, policymakers and regulators are unable to adequately oversee the program and legislate potential reforms,” wrote the senators.

    The Senators have it almost right. All this data is needed. Unfortunately, even if it were realistic to expect that the MA plans would release data of this nature, the data they do release is never complete, accurate or timely, reports the Medicare Payment Advisory Commission. Moreover, because each MA plan is permitted to handle the prior authorization process differently, using proprietary tools, it is impossible for the Centers for Medicare and Medicaid Services to oversee the MA plans effectively. Without a lot more standardization of claims processing in MA plans, the MA plans are free to engage in bad acts, such as denying claims inappropriately, with little chance they will be caught, let alone held to account.

    In sum, people do not have the information they need to choose among Medicare Advantage plans. MA plans have failed to turn over complete and accurate patient encounter data for years, with impunity. Without this data, it is not possible to assess quality of care in Medicare Advantage and how well an MA plan performs, as the Medicare Payment Advisory Commission (MedPAC) has said repeatedly.

    The most important question to ask yourself if you’re in a Medicare Advantage plan or thinking of joining one is: Will I get the care I need when I most need care–be it hospital care, rehab services, cancer treatment, nursing or home care. Do not assume you or your loved ones will. Unfortunately, in Medicare Advantage, there’s no telling. Some Medicare Advantage plans deny high levels of medically necessary care or delay care to the serious detriment of their enrollees. The data is missing to tell you which ones to avoid. And, the government cannot protect you from the bad actors.

    The Senators’ letter to the CMS Administrator explains that the Office of the Inspector General has found widespread inappropriate Medicare Advantage prior authorization denials and payment denials. And, the General Accounting Office has found that people who are in the last year of life are twice as likely to disenroll from a Medicare Advantage plan and switch to traditional Medicare. Most people are locked into a Medicare Advantage plan once they join because the supplemental coverage people need to protect themselves financially in traditional Medicare, which lacks an out-of-pocket cap, tends to be unavailable or unaffordable.

    In their letter. the Senators also note that overpayments to Medicare Advantage plans need fixing. These overpayments have been estimated to be as high as $140 billion this year alone. They are eating into the Medicare Trust Fund and driving up Part B premiums for everyone, significantly. The Committee for a Responsible Federal Budget projects as much as $250 Billion in additional Part B premiums over the next ten years if the overpayments are not corrected.

    In addition to complete encounter data, the Senators are urging CMS to collect and report the following:

    1. Prior authorization requests, denials, and appeals by type of service. Among other things, collecting this data would permit assessment of whether MA plans are covering all Medicare Part A and Part B services, as required.
    2. Justification of prior authorization denials. With this information, CMS could better determine whether denials are appropriate.
    3. Timeliness of prior authorization decisions. 
    4. Utilization of supplemental benefits and associated out-of-pocket costs. Right now, it is not clear who is using these benefits or what they are paying. With this information, CMS could determine whether they have real value.

    CMS collects other data that the Senators want CMS to publicly report, including:

    1. Out-of-pocket costs and provider payment information. 
    2. Disenrollment data broken down into subgroups. This information would help the public understand whether people are leaving MA because of the cost of care or the inability to get needed care.
    3. Plan comparison information in MA and TM, including health outcomes.

    Here’s more from Just Care:

  • Lilly breaks its promise to offer lower-cost insulin

    Lilly breaks its promise to offer lower-cost insulin

    Eli Lilly may be talking the right talk when it comes to insulin prices, but it is not walking the walk, according to a report by Senators Richard Blumenthal and Elizabeth Warren. Eli Lilly’s new generic version of Humalog, Lispro, which it promised to sell at lower cost, tends to be out of stock at pharmacies. And, when surveyed, many pharmacies did not know it was even available.

    Senators Blumenthal and Warren surveyed 190 chain pharmacies and 196 independent pharmacies across the US about the availability of lower-cost insulin over a five-month period in 2019. And, it found that lower-cost insulin is hard to find. Only 17 percent of pharmacies had it in stock.

    What’s worse, the pharmacies that did stock Lispro were not telling their customers about it.  And, nearly seven in ten pharmacies that did not carry Lispro reported that they could not order it. Instead, prices for insulin are sky high.

    It’s not clear why insurers have not been informing their members to use Lispro. Stat News reports that many insurers do not even include Lispro on their formulary. Rather, insurers are driving up costs for people with diabetes.

    Warren and Blumenthal believe that it’s time that Congress took action to rein in high drug prices. In the meantime, they want Lilly to deliver on its promise and lower the price of insulin. It charges far lower prices abroad for Humalog.

    Some 30 million Americans have diabetes, more than one in every nine people. The price of insulin should be very low, given that it was discovered 100 years ago. Instead, its cost has more than tripled in the last 20 years. The cost of a 10 ml vial of Humalog is nearly seven times what it was in 2001, $275 today as compared with $35 in 2001. A typical person with diabetes uses between two and four vials a month at a cost of about $1,000.

    Of course, people with drug coverage typically pay only a small fraction of the cost at the pharmacy. But, everyone with insurance pays high premiums because the cost of drugs are so high. If insurers are not covering the generic version, they’re likely also making money off the higher cost.

    Given their findings, Senators Blumenthal and Warren question whether generics can deliver Americans the low prices people assume they deliver. They offer several recommendations to address the high cost of insulin and other critical and life-saving drugs. First and foremost, they say that Congress must act to reduce the price of drugs across the US, including for people with Medicare. Congress should also allow safe importation of drugs. And, it should allow the federal government to develop generic drugs, including insulin, when the market is not producing them as it should.

    Here’s more from Just Care:

  • What would Warren do to improve access to health care through executive power?

    What would Warren do to improve access to health care through executive power?

    If elected President, Medicare for All will only become law if both the US House of Representatives and the Senate pass Medicare for All legislation. If that does not happen, Presidents can use their executive powers to improve access to health care. Margot Sanger-Katz reports for the New York Times on how Elizabeth Warren says she would use that power.

    Warren‘s first priority is limiting corporate influence over Congress. That takes legislation. She says she would pursue anti-corruption reforms against health insurers and pharmaceutical companies. She wants to tax “excessive lobbying” by these companies and restrict their ability to effectively bribe members of Congress through campaign contributions. She would also use her power to protect people with pre-existing conditions.

    With her executive authority, Warren would undo many of President Trump’s executive actions on health care. She would strengthen the Affordable Care Act and she would expand premium tax credits to help people buy insurance coverage. She would restore funding to Planned Parenthood. She would end work requirements for people with Medicaid. And, she would limit corporate health insurance companies’ ability to sell health plans that do not cover all essential health benefits, “short-term health plans.”

    People with health insurance would have greater benefits and protections. Warren would cover dental care for people with Medicare. And, states would have the ability to expand Medicaid coverage. Warren would also expand mental health and substance abuse coverage.

    Warren would give more people help to pay for their health insurance, such as families of working people and legal immigrants who are not citizens. Transgender people and women who had had abortions would regain civil rights protections.

    To lower the cost of prescription drugs, Warren would use her executive authority to have HHS cancel pharmaceutical company patents on drugs developed with government funding. And, in the case of public health emergencies, she would use federal authority to have the government manufacture some prescription drugs, including insulin, antibiotics and hepatitis C medicines.

    Here’s more from Just Care:

  • Would a public option reduce your out-of-pocket health care costs?

    Would a public option reduce your out-of-pocket health care costs?

    Democratic presidential candidates’ health care reform proposals are designed to improve upon your current coverage. But, how? Would a public option reduce out-of-pocket health care costs and guarantee Americans access to affordable health care?

    If you have traditional Medicare or a Medicare Advantage plan, Vice President Joe Biden and Pete Buttigieg‘s public option proposals offer little guarantee of reducing your health care costs. They are largely designed to provide more options to working people and people without insurance today. Health care reforms proposed by Senators Elizabeth Warren and Bernie Sanders, in stark contrast, would reduce your costs substantially, ending Medicare premiums, deductibles and coinsurance and adding important benefits, including vision, hearing, dental coverage as well as home and community-based care.

    If you have employer coverage, Biden and Buttigieg offer you a Medicare-like option. You could get your health insurance through a Medicare-like system rather than a corporate health insurer if you chose. Would that help?

    Biden’s and Buttigieg’s public option proposals could help some people afford insurance coverage they cannot afford today. But, it’s not at all clear their plans would help with out-of-pocket costs. Shefali Luthra reports for Kaiser Health News that a recent Kaiser Family Foundation poll reveals that about four in ten people with employer health coverage have trouble paying medical bills. About 50 percent of them delay or forego care because they can’t afford it. And, about one in six of them have to make “difficult sacrifices” to pay for their care.

    Except at the margins, Biden’s and Buttigieg’s public option proposals appear to be of little help to people with employer coverage who struggle to afford their care. They do not fill gaps in people’s coverage; they still require you to pay a lot for your health care. And, they do not offer people additional benefits that many need, such as dental, vision, hearing and home care.

    In short, the key advantage of their public option proposals is that Americans can choose not to rely on corporate insurers or employer health plans for their coverage; they give people a choice of a public plan. But, public option proposals are not likely to save Americans any money or ensure they can afford their care. Only Medicare for All proposals significantly reduce the cost of care for working people and guarantee its affordability.

    People say they prefer the public option to Medicare for All. But, most do not know that their health care costs will continue to rise under public option proposals. Once people understand that the public option does little to make health care affordable, Medicare for All should garner their support.

    Here’s more from Just Care:

  • Top Democratic presidential candidates support strengthening Social Security

    Top Democratic presidential candidates support strengthening Social Security

    The top four Democratic presidential candidates may be split on health care reform, two favor the public option and two favor Medicare for All. But, Nancy Altman writes in Forbes that all four top candidates, Bernie Sanders, Elizabeth Warren, Joe Biden and Pete Buttigieg, support strengthening and expanding Social Security. No matter who becomes the Democratic candidate, if you support expanding Social Security, it will be critical to vote.

    Social Security is a national treasure that virtually all Democratic members of Congress support expanding. In fact, nine out of ten members of the House of Representatives support Congressman John Larson’s Social Security 2100 Act. If enacted, Social Security benefits would rise, and its Trust Fund would be strong for many many decades.

    Increasing Social Security benefits would  help older Americans in retirement. Today, a large portion of older adults struggle to afford their basic needs. Few people can rely on pensions or retirement savings. Many rely almost exclusively or heavily on Social Security for their income. Social Security income is guaranteed and cost-effective, unlike Wall Street stock investments and 401(k) plans.

    Most Republicans in Congress would like to cut Social Security benefits even though their constituents overwhelmingly support Social Security. They strive to create a wedge between older adults and younger Americans. In fact, young Americans need Social Security both when they retire and, now, to help support their parents and grandparents. Without adequate Social Security benefits, young Americans would be left worrying even more about their parents’ financial well-being.
    Social Security is social insurance, meaning that everyone contributes to it and everyone who contributes benefits. It builds social solidarity. Americans all count on it for themselves and their families. Social Security is an earned benefit, unlike other federal and state social programs that are for particular populations in need. For our personal and collective security, we must ensure its continued well-being.
    Social Security benefits need to be coupled with coverage for home and community-based care. Medicare for All, which Senators Sanders and Warren support, covers these long-term services. Buttigieg proposes giving people $90 a day to help with these costs, which is far more than the US guarantees older adults today. But, his plan does not come close to providing the most vulnerable Americans with adequate coverage.
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  • Senator Warren details strategy for passing Medicare for all

    Senator Warren details strategy for passing Medicare for all

    Senator Elizabeth Warren is doubling down on her plan to guarantee everyone in America good affordable health care. The New York Times reports that Warren has designed a strategy for passing Medicare for All over three years that involves a two-step process. She is seeking support for her plan from pundits like New York Times opinion writer Paul Krugman and policymakers like Representative Pramila Jayapal.

    Early on in her career, Elizabeth Warren saw that more Americans were filing for bankruptcy as a result of health conditions that gave rise to medical debt. She recognized that improved Medicare for everyone was the “most obvious” way to prevent these bankruptcies. But, until recently, she did not think it was practical.

    Now, she has designed a plan to pay for Medicare for All almost exclusively through employer contributions and taxes on the wealthiest Americans and corporations.

    Some Democratic presidential candidates who do not support Medicare for all argue that Warren’s policy is not viable because the public does not accept it. But, Warren and Sanders remain two of the top Democratic presidential candidates in the polls, even though they are ardent advocates of Medicare for All.

    Senator Warren, like Senator Sanders, appreciates that she needs to advocate for what she believe to be the best policies. It makes no sense to advocate for policies because you think the public will support them if you don’t think they will deliver what is needed, in this case, guaranteed access to affordable health care. As Warren says,  “You don’t get what you don’t fight for.”

    Unlike Senator Sanders, Warren appears to believe the pragmatic approach is to enact Medicare for All in two phases. In phase one of her health care reform strategy, she supports giving Medicare for All for free to children from birth to 18 and to all individuals earning less than twice the federal poverty rate. And, she supports giving people over 50 the choice to buy into it.  By year three of her presidency, Warren plans to have Congress pass Medicare for All for everyone. In her first 100 days, Warren also will push campaign finance reform, to get money out of politics.

    Here’s more from Just Care:

  • Warren’s health care financing plan puts health care costs back in people’s pockets

    Warren’s health care financing plan puts health care costs back in people’s pockets

    Senator Elizabeth Warren’s health care financing plan puts health care costs back in people’s pockets. It guarantees Americans the ability to see the doctors and get the care we want without having to worry about whether it’s affordable.

    Warren’s plan would spend the same $52 trillion over ten years that we spend today, but covers everyone, imposes virtually no out-of-pocket costs, and expands benefits, including long-term care, vision, hearing and dental, without adding to national health care spending. And, it requires just $20.5 trillion in new federal spending (as opposed to private spending) over ten years. How? It cuts a lot of waste from our system and establishes fair provider rates and prescription drug prices.

    Warren’s plan eliminates $350 billion a year–12 percent of premiums–that insurance companies put towards administration and profits. Medicare for all spends 2.3 percent on administration. Hospitals today spend $210 billion a year—8.5 percent of revenue–and doctors spend about 10 percent of revenue on administrative costs.

    There’s no reason we should be paying $897 for a CT scan when it costs $97 in Canada, or $75,000 for heart bypass surgery when it costs $16,000 in the Netherlands. Primary care physicians in the US deserve higher rates; some specialists are paid too much.

    Warren plans to cut brand-name drug prices by 70 percent and generic drug prices by 30 percent. No drug price should be more than 110 percent of the average international market price. Today, insurers’ incentive is to deny coverage for long-term treatments because they expect people to switch coverage. Medicare for All, in sharp contrast, will make long-term investments in people’s care the smart way to go.

    Who should pay for health care? Warren wants federal and state governments as well as employers to continue to contribute what they contribute today towards the cost of health care. Though, under her plan, employers would save about $200 billion–2 percent–over ten years. Individuals spend $11 trillion today but would spend close to zero under Warren’s plan. Warren puts the money that comes out of their paychecks for insurance premiums back in their pockets. People with Medicare would be able to use the money they spend today on premiums as well deductibles, coinsurance and non-covered medical services, on other needs.

    Workers would get back in salary the amount they currently contribute to health insurance premiums. Instead, financial firms, giant corporations, and Americans in the top 1 percent financially would pay more. The top 1 percent of Americans would pay $3 trillion more over ten years. The financing system would be phased in over time for a smooth transition.

    Warren also expects an additional $2.3 trillion to come from enforcing existing tax laws. And, she projects $800 billion over ten years from a one tenth of one percent tax on financial transactions.

    If you support Medicare for all, please let Congress know. Please sign this petition.

    Here’s more from Just Care: