Tag: Policy

FDA requires companies to show amount of added sugars in processed foods

For the first time since nutrition labels appeared on processed foods back in 1994, these labels will have a new look and improved nutrition information. Among other things, the Food and Drug Administration is requiring companies to show on the nutrition label the amount of added sugars in processed foods. In addition, the serving size listed on the package will be more in sync with the average amount people eat and the calorie information will be easier to see.

Until now, the FDA has allowed companies simply to list the total amount of sugar in a product, without distinguishing between natural sugars and added sugars. It also had not required companies to list the recommended daily percent of sugar intake.

The FDA’s new policy requires companies to list the “percent daily value” for sugars, so that people know the amount of sugar in a product in relation to how much they should be consuming. The FDA recommends no more than 10 percent of daily calorie intake come from added sugars, which is about 200 calories or 50 grams. Research shows increased risk of heart disease when added sugar represents more than 15 percent of your caloric intake.

Companies must also state the percent daily value of vitamin D, calcium, iron and potassium as well as the actual amount. You can learn more from John Oliver on the risks of eating too much sugar here.

Most companies must comply with the new requirements no later than July 2018.

Here’s the old label on the left and the new one on the right

May 25, 2016
Trump now supports Social Security and Medicare cuts
If you watched a Republican debate or attended a Donald Trump rally, you would not think that Trump supports Social Security cuts. Indeed, his position on Social Security distinguished him from his Republican rivals and put him in the same camp as the 83 percent of Republicans who oppose cuts to Social Security. But, as I write in the Huffington Post, now that Trump has clinched the Republican nomination and needs support from the party, he is ready to dismantle Social Security and Medicare.

From Social Security’s birth in 1935, Republicans have opposed the program. They tried to persuade President Eisenhower to abolish it in 1953, but he would not do so. In a private letter, Eisenhower wrote to his brother about those wanting to kill Social Security: “Their number is negligible and they are stupid.”

Who knows where Trump will stand on Social Security in the coming months as he works to curry favor with the electorate. But, chances are, unfortunately, that if elected he will support Paul Ryan and the Congressional Republicans in their desire to dismantle Social Security.

In sharp contrast, both Hillary Clinton and Bernie Sanders are on record as supporting an expansion of Social Security. And, the vast majority of Americans (72 percent) stand with them, along with 75 percent of House Democrats and 90 percent of Senate Democrats. They represent the interest of older adults and their families. This election, with a platform that supports expanding Social Security, the Democratic nominee is likely to get the older adult vote.

Here’s more from Just Care:
May 23, 2016
How to address the doctor shortage in the U.S.
A new report by the Association of American Medical Colleges (AAMC) projects a doctor shortage over the next ten years of between 61,700 and 94,700, with a primary care doctor shortage of between 15,000 and 35,600. To address the doctor shortage, AAMC recommends a multi-pronged approach, including federal support of 15,000 more residency positions over the next five years as well as support for new care-delivery models and technologies.

The rise in demand for doctors stems largely from a projected 41 percent increase in the number of people over 65 in the next ten years. The projected shortfall in doctors results as well from the fact that more than one in three doctors will be over 65 in 2025 and many will retire. Today, about 37 percent of doctors are between 55 and 75. The impact of the Affordable Care Act and the higher number of insured Americans on the doctor shortage is less than expected at 1.2 percent.

Currently, medical schools are expanding their classes to enroll more students, but these students often struggle to find residency programs. The federal government caps enrollment in residency positions, limiting access. Under the Balanced Budget Act of 1997, Medicare cannot spend more than $9.5 billion a year on residency programs, and it is the largest funder of these programs.

In the last 20 years, there are 20 more medical schools–175 total–and hundreds more students graduating from them. Five hundred students could not secure residencies in 2013. Many residency programs and states are taking matters into their own hands, finding money to increase residency slots. But, that is no small feat since each slot is estimated to cost $150,000.

At the same time, there is a need to ensure that more doctors deliver primary care. Yet, the percentage of doctors going into primary care is lower than ever before. The cost of medical schools and residency programs drives doctors into specialty care that helps ensure that they can pay off loans. Thousands of prospective doctors are drowning in debt. The National Health Service Corps and other loan repayment programs can encourage doctors to enter primary care medicine and to practice in underserved communities.

To be sure, addressing doctor shortfalls in underserved communities presents a challenge; it likely means establishing more residency slots in these communities. One study found that only 48 of more than 1,390 residency programs and training sites in family medicine (4 percent) and only 48 of 936 in internal medicine (5 percent) are in rural or community-based settings. Exposure to these settings is more likely to lead doctors to practice in these settings, so the researchers recommend more residency programs in these settings.

Congressmen Joseph Crowley (D-NY) and Charles Boustany, Jr., M.D. (R-LA) have introduced H.R. 2124 the Resident Physician Shortage Reduction Act of 2015, which supports 3,000 more Medicare direct graduate medical education and indirect medical education residency positions each year for five years beginning in 2017.

Stateline

Here’s more from Just Care:
April 27, 2016
New White House rules help promote retirement security, but you should still beware

Earlier this month, the U.S. Labor Department finalized rules for financial advisers regarding retirement investments, which are intended to promote retirement security in America. The rules impose a fiduciary duty on investment advisers towards their clients’ retirement accounts and help ensure that retirement advice serves the best interests of people. But, you should still beware of advice from financial advisers.

Shockingly, the old rules permitted advisers to recommend retirement investments that served their financial interests even when the investments may not have been in the best interest of their clients. Financial advisers have been able to steer clients rolling over their 401(k) accounts to retirement products for which the advisers were paid to promote the products.

The White House study of the issue determined that Americans lose up to $17 billion a year from conflicted retirement advice, “tens of thousands of dollars” a household. In particular, middle and working class Americans see an average loss of one percent in returns on retirement savings each year resulting from the conflicted advice their financial advisers provide them. Now, most advisers will need to meet a fiduciary standard, putting their clients’ interests ahead of their own and can be sued if they do not.

However, even once these new rules take effect, financial advisers still can receive commissions from the companies whose investment products they promote, creating a conflict of interest. To address this conflict, they must simply disclose their financial interest to their clients.

The White House analysis suggests that a worker who moves 401(k) funds into an IRA at age 45 typically loses about 17 percent in income in that account over the next 20 years because of conflicted advice. Put differently, $100,000 in retirement savings at age 45 only grows to an average of $179,000 over 20 years because of conflicted advice; with the new rules in place, it would grow to an estimated $216,000, $37,000 more.

The rule is a long time coming because of massive opposition from the financial industry and from some members in Congress, including House Speaker Paul Ryan. Arguments against the rule suggest that it will hurt the financial industry and access to “expert” advice for people with fewer assets. Of course, if the advice is not in people’s financial interest, it’s likely to have negative value.

As Labor Secretary Thomas Perez said to opponents of the new rule, “Are you for consumers, putting their best interests first, or do you think that the only way financial advisers can provide advice is to put their financial interests first?” The Consumer Federation of America considers this a big win for consumers.

The new rules do not go fully into effect until 2018. But most people pay too high fees for financial products, even if their adviser is not conflicted. So, even when the rules go into effect, it’s wise to invest in index funds as well as to ask any prospective financial advisers if their personal income depends on the decisions you make about your investments. If the answer is yes, the prospective adviser is conflicted and getting commissions from the retirement investment advice you receive.

April 21, 2016
What becomes of Medicare and Medicaid after the presidential election?
In an opinion piece for the Wall Street Journal, Drew Altman, president of the Kaiser Family Foundation discusses the possible consequences of House Speaker Paul Ryan choosing not to run for president. Altman makes the case that Ryan is likely to rally Republicans around further privatizing Medicare and Medicaid. And, it’s a compelling argument.

Republicans have long been fighting to privatize Medicare and Medicaid in ways that would cap federal spending on these programs and shift more costs onto older adults and people with disabilities. These programs now cover 121 million people and represent 23 percent of federal budget. And, that will only grow as the population ages.

Altman notes that Republicans have already come a long way in privatizing Medicare and Medicaid. Today, nearly one in three people with Medicare are enrolled in a Medicare Advantage plan. And, more than one in two are in a private Medicaid managed care plan.

To be clear, privatization not only is likely to shift more costs onto older adults and people with disabilities, but it also brings a lack of transparency to Medicare and Medicaid; commercial health plans are prone to claim that the bulk of their data is proprietary. Privatization also makes it harder for the federal government to drive large scale system change to improve health care value.

And, at least with Medicare, privatization has meant higher per capita health care costs. Commercial insurers offering Medicare Advantage plans have not been able to negotiate as good rates with providers as the Centers for Medicare and Medicaid Services and their administrative costs are far higher than the government’s.

In sum, Speaker Ryan will determine the nature of the Republican Medicare and Medicaid agendas, as well as whether Republicans will continue to try to repeal and replace the Affordable Care Act. But, so long as the President is a Democrat, Republicans should not be able to move their agenda. And, any attempts to undo traditional Medicare and impose higher costs on older adults could shift support of older adults away from Republicans.

Here’s more from Just Care:
And, this, Medicare and Commercial Health Insurance: The Fundamental Difference, which I authored with Theodore Marmor, on the Health Affairs Blog
April 20, 2016
If your doctor leaves your Medicare Advantage plan mid-year, you may be able to switch plans
There are reasons you should not trust your health plan’s provider directory, and you can read about them on Just Care here. One reason is that health plans have the right to change their network of doctors and hospitals at any time during the year and, until recently, there was little members could do about it. Beginning this year, if your doctor leaves your Medicare Advantage plan mid-year, you may be able to switch plans.

At the end of last year, the Centers for Medicare and Medicaid Services issued a new protection for people in Medicare Advantage plans whose doctors leave the network mid-year. Under the new policy, CMS may grant members of a Medicare Advantage plan the right to switch plans as a result of a “significant” change in the provider network. CMS does not define “significant.” But, according to Kaiser Health News, it has been granting this right to some health plan members who have seen changes in their networks.

If your network doctors leave your Medicare Advantage plan, and you want to switch plans, contact your local state health insurance program for help. You may have the right to switch to another Medicare Advantage plan or to traditional Medicare.

Even if CMS does not notify you of a right to switch, it still might offer you the right to switch as a special protection. You may need to be persistent and explain why it’s important you continue care with your current doctors.

For other situations in which CMS allows Medicare Advantage members to switch plans, click here.

For more from Just Care:
April 12, 2016
American Savings Act would help promote retirement security
Nearly 70 million Americans do not have access to a retirement savings plan through work. But, every federal employee, including every member of Congress, has access to the Thrift Savings Plan, to promote retirement savings and ensure their retirement security. What if everyone had access to the Thrift Savings Plan? The American Savings Act, a bill in Congress sponsored by Senator Merkley, would promote “a more secure retirement future” for everyone without a retirement savings plan.

Federal employees are automatically enrolled in the Thrift Savings Plan, which has low fees and clear and simple investment options. So, most of them have retirement savings. But, one in three working-age Americans report having no retirement savings whatsoever.

To help encourage everyone in America to save for retirement, the American Savings Act would automatically enroll everyone without an employer retirement savings plan. Employees can decide how much to set aside for retirement up to $18,000 a year.

The American Savings Act would give everyone access to universal, simple, portable American Savings Accounts, personal retirement savings plans. To read the full bill, click here.

Here’s more from Just Care on retirement security:
- MyRA , a new retirement savings option from the U.S. Treasury
- What’s a Guaranteed Retirement Account?
- Is it fair to say we have a retirement crisis?
- Three ways government could help promote retirement security
- Beware of reverse mortgages
- “Money Smart for Older Adults,” advice on how to protect yourself from financial scams from the Consumer Financial Protection Bureau
March 31, 2016
When does “old age” begin and should it matter?
For decades, we have used 65 as the age at which government health and retirement benefits kick in and, for that reason, as a proxy for old age. Now, recent research suggests that old age does not begin until later–at least for some. And, some policymakers argue that 65 is too early an eligibility age for Medicare and Social Security.

Population experts at the International Institute for Applied Systems Analysis say that people today are aging more slowly as they live longer. They look at age not as the number of years lived but relative to the amount of time people have left to live. In their view, old age begins when people have 15 or fewer years left to live.

From that perspective, one could argue that the population is aging more slowly. At 65, overall, people are in better health and more independent than they were 50 years ago. But, the average life expectancy in the United States is still only 78.8 years, making 65 an appropriate marker for the beginning of old age for the typical American.

Of note, the average life expectancy does not reflect the tremendous chasm in life expectancy between the wealthy and the poor. While I could not find any good data in the U.S., the London Health Observatory found a 25 year difference in London. The affect of income on life expectancy is clear.

Also, the average life expectancy (77 years) was 10 years longer than the average healthy life expectancy (67 years) in the Americas in 2013, according to the World Health Organization. Healthy life expectancy reflects life in less than full health as a result of disease or disability.

So, what should this mean for retirement benefits? The fairest way to address these disparities in life expectancy is through our federal tax system, not by penalizing people with lower incomes whose life expectancy has not increased in a meaningful way. Raise taxes on the wealthiest Americans, those among us who are expected to live the longest overall. And, lift the cap on Social Security contributions so that the wealthy pay their fair share.

Here’s more from Just Care:
- Here’s what your Social Security benefits will be when you retire.
- And, here’s why you want to avoid claiming Social Security benefits early if at all possible.
- Here’s some information on out-of-pocket health care costs for people with Medicare.
- Here are six tips for keeping your drug costs down if you have Medicare.
March 18, 2016
Sanders’ and Clinton’s plans to rein in drug prices

Addressing high drug prices is a top national priority for the overwhelming majority of Americans, Republicans and Democrats alike. And both Hillary Clinton and Bernie Sanders call for lifting the Congressional ban that keeps Medicare from negotiating drug prices as a way to rein in drug prices for older adults and people with disabilities. Controlling drug prices is particularly important given that per person drug spending in Medicare Part D is expected to rise 6.5 percent a year for the next 10 years.

The Centers for Medicare and Medicaid Services could save people with Medicare and taxpayers a substantial amount of money through drug price negotiation. But, the devil is in the details. A new report from the Kaiser Family Foundation suggests that some forms of drug price negotiation might not lead to lower drug prices, relying in part on a Congressional Budget Office projections.

The CBO projections turn on a narrow definition of negotiation. All you need do is see that every other advanced country reins in drug prices successfully for their citizens to know that negotiated drug prices in the United States can bring down drug prices. And, you don’t need a formulary for the government to do so successfully. If CMS simply negotiated for drug prices that the Veterans’ Administration secures or Medicaid or Canada, prices in the U.S. would fall sharply.

The pharmaceutical industry would likely threaten reducing their research. But, as it is, drug companies spend far more on marketing than on research. And, there are huge costs to allowing drug companies to set exorbitant prices for critical medications. Millions of Americans cannot afford the drugs they need.

Surprisingly, neither Clinton nor Sanders calls for negotiated drug prices for all Americans, which is the only way to ensure drugs are easily affordable and accessible for everyone. Sanders proposes letting people import from Canada, which would reduce prices for everyone. But, why make people go through that hassle? Clinton proposes some marketplace fixes to rein in prices. But, that’s wishful thinking given the monopoly power drug companies too often hold and the lack of price and effectiveness transparency in the drug marketplace, which does not allow for meaningful competition.

For a brief history of proposals to allow Medicare to negotiate drug prices, read this report from the Kaiser Family Foundation.

For information from Just Care on ways to keep your drug costs down, click here.

February 18, 2016
FDA backlog keeps generics from coming to market

In October 2015, there were as many as 3,000 generic drugs waiting to be approved by the Food and Drug Administration. FDA underfunding may explain it in part. So might incomplete information on applications by their manufacturers as the FDA claims. But, whatever the reason, the result is that we end up paying high drug prices, (though some generic drug prices are sky high.)

Generics can cost as little as 20 percent of what brand-name drugs cost; they can also cost a lot more. Around 8 out of 10 prescriptions are for generic drugs but they account for less than 30 percent of our drug spending.

The 2012 Generic Drug User Fee Amendments now require drug makers to help offset the cost of FDA review. In exchange, the FDA is supposed to speed up approval of these applications. And, the FDA says it has. However, it also says that the application process is often slowed down because of faulty applications, which may fail to address negative side effects of inactive ingredients or other important information.

Here are four things you may not know about generic drugs and, if you’re interested, a short primer on how federal policy promotes high drug prices.

January 19, 2016