Anyone ElseTerrified about Repeal of ACA Bill
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murfy...say we ask to document our undocumented illegal immigrants for the sake of letting them buy health insurance.....is that possible?Do you see the push back that our President is getting by trying to ask on the Census if people are citizens? When health plans are put together, pricing reflects the proposed number of people who will sign up for the plan. They also need to calculate the age and health of the people. How are the insurers, whether they be the government or private, supposed to figure out that info when many illegals are in the shadows......I have yet to see an accurate count of the number of illegal immigrants living in the US. I have seen the number of 11.5 million illegal immigrants, but I also have seen the number higher than double of that number. I have tried to get a handle of the number and never been comfortable with the sources...
So, to the point....unless we document the number of illegals, we will never know how to price the health insurance plans...
Anyone care to step up to the plate and encourage documentation.....
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This may be a helpful resource for those interested in advocacy:
Doctors for America invites members and the public to listen to health policy experts and policymakers on current issues facing our health care system.
Topics presented include:
How to be more effective on social media
Learn the ABCs on how to write an effective eye-catching Op-Ed and get it published
Prescription Drug Affordability
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Federal Court Rules Against Trump Administration's New Hampshire Medicaid Waiver Project
A federal judge has once again vacated the U.S. Department of Health and Human Services' approval of a section 1115 Medicaid waiver project that would drastically cut Medicaid coverage, this time in New Hampshire. As in a handful of other states, the federal government had given New Hampshire permission to condition Medicaid coverage on work requirements and to eliminate 3-months' retroactive coverage. "In short, we have all seen this movie before," stated Judge James E. Boasberg, who has vacated similar projects in Arkansas and Kentucky.
https://healthlaw.org/wp-content/uploads/2019/07/47.-Mem-Opin.pdf
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Earlier this month California signed legislation becoming the first state to provide tax-payer backed healthcare insurance to undocumented immigrants aged 19-25 through MediCal (the state Medicare program). The first-year estimate is 100,000 people (some estimates are 138,000) at a cost of $98 million. Not sure how they got those numbers because that works out to only $980 per person for the year and my premium per month is more than that. To help offset the cost, the state has restored the individual mandate which fines any citizen who cannot afford to purchase health insurance. California has provided MediCal coverage to undocumented children under age 18 since 2016.
Undocumented immigrants in California are NOT eligible to purchase healthcare insurance under Covered California (ACA), they are only eligible for free coverage under MediCal.
I have to admit, it's a hard pill to swallow having my tax dollars go to provide free healthcare to citizens of other countries who came here illegally while I'm struggling to pay premiums that now exceed $23,000 per year, plus high co-pays that bring my total out of pocket cost over $30,000 annually (and I'm no longer working, so we're down to one income). I have panic attacks every January when my out-of-pocket max resets and I have to figure out how to come up with almost $14,000 to cover just the first 3 months of the year.
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Drug Importation Plan Announced
The Department of Health and Human Services (HHS) announced Wednesday an action plan for the "safe importation" of drugs. The plan has two parts. First, HHS would undertake a rulemaking process to establish a system for states and other entities to engage in drug importation from Canada. The second part of the effort would be to establish a pathway at the Food and Drug Administration (FDA) for manufacturers to import versions of drugs that they currently sell in foreign countries.
Although many in the cancer community believe importation would not have a major impact on cancer drug access or pricing, the Trump Administration specifically mentions "cancer" in the second part of the plan.https://www.statnews.com/2019/07/31/trump-importation-plan/?mc_cid=f55efe8fef&mc_eid=12d673e585
{Wa Po article may require subscription.}
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Senate Drug Pricing Package
Last week, the Senate Finance Committee approved a drug pricing bill by a vote of 19 to 9. However, the bill continues to face several serious challenges according to several reports. Republican Senators expressed concerns about the bill. The pharmaceutical industry lobbied aggressively against it on Capitol Hill this week. Democrats pledged that they would agree to floor action on the bill only if there is a vote on protecting pre-existing conditions and a vote on allowing Medicare to negotiate drug prices during consideration of the bill. The bill's fate is far from certain.{Wa Po article may requite log-in or subscription.}
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'Leaving billions of dollars on the table'
Rural hospitals foundering in states that declined Obamacare
More than half of all rural hospitals in Mississippi, South Carolina, Georgia and Oklahoma lost money from 2011 through 2017. In Kansas...two out of three rural hospitals ...operated in the red during the seven year period. Five were forced to shut down. What these states also have in common is that legislators voted against expanding Medicaid under the Affordable Care Act, which would have provided coverage for hundreds of thousands of uninsured residents and bolstered rural hospital bottom lines.
"The irony to me," said John Henderson, who heads The Texas Organization of Rural & Community Hospitals and supports Medicaid expansion, "is that we're paying federal income taxes to expand coverage in other states. We're exporting our coverage and leaving billions of dollars on the table."
While hospitals in most states that declined to expand Medicaid are struggling, Utah provides a notable exception.
"But I don't know of any hospital that's opposed to Medicaid expansion. It's good from a financial standpoint. But more importantly, it provides access to health care for vulnerable people."
http://gatehousenews.com/ruralhospitals/financialtroubles/?mc_cid=17db56531e&mc_eid=12d673e585
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Study: the US could have averted about 15,600 deaths if every state expanded Medicaid
The real impact of ...rejection of Medicaid expansion ...
{This article discusses a recent study that shows the ACA's impact on mortality more generally}
"...a 2012 Supreme Court ruling ... allow{ed} states to reject the expanded program. As of 2019, 14 {states} have not ...adopted the Medicaid expansion... A new working paper published by the National Bureau of Economic Research details the... results....{of a } study {of} what happened to people's health outcomes in states that expanded the program compared to those that did not.
"[The researchers] found that by the fourth year of Medicaid expansion, mortality rates in states that expanded the program were 0.2 percentage points lower than in states that did not. ...they estimate that states' refusal to expand the program led to 15,600 additional deaths. Medicaid recipients have also report having an easier time paying medical bills and carry less debt."
The President's 2020 budget proposal included Medicaid cuts, including a repeal of Obamacare's Medicaid expansion....The proposed cuts rounded out to about $777 billion, which could leave millions more uninsured.
{Voraciousreader points out that Vox is widely regarded to be a left-leaning media source.}
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Thank you, Lumpie, for continuing to follow through and post this valuable information. I, and I would imagine many others, greatly appreciate your efforts.
Trish
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Thank you, Trish! There is a lot of info out there. It's hard to keep up. I hope that sharing highlights will help us all stay informed.
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https://www.allsides.com/news-source/vox-news-media-bias
Vox, is one example of a very partisan source.... Ezra Klein, who founded Vox, worked for the Washington Post, which Lumpie, you choose to frequently quote, is also quite partisan.
I am not saying these are poor choices to use as sources to enlighten people to healthcare issues...You know the saying...There are two sides to a story and somewhere in the middle is the truth...maybe some other sources could be linked so people can judge more fairly...
Here’s one source that isfrom the far side of the moon...
https://www.nationalreview.com/2019/08/democratic-candidates-health-care-plans-canadian-system/
And I think, Lori and Melissa’s stories should bring pause to this contentious issue....
I will repeat what I have previously said...the current system is unsustainable. When Obamacare was passed, most people knew it would be unsustainable sooner than later. Sooner has become much sooner. And offering coverage to illegals? Even President Obama knew better than to include them in his plan if he ever expected it to pass the House. And, I would love to know who the actuaries were in California who came up with their number of illegals and how much it would cost to insure them...
And lastly, despite what you read or what DeBlasio said during the debate that there are approximately 11 million illegals in the US, that number has been repeatedly challenged. No one knows AT ALL the approximate number....
Anyone who says there are 11 million is either not telling the truth, misinformed, or worse, a liar.
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How One PBM Claws Back Pharmacy Cash
Express Scripts, which manages pharmacy benefits for roughly 100 million people, claws back millions of dollars per year from pharmacies after prescriptions go out the doors, according to a contract obtained by Axios.
Even high-quality pharmacies have to pay back some of their revenues to Express Scripts. That arrangement highlights pharmacy benefit managers' power over the supply chain and helps explain why pharmacies have intensified their acrimony toward PBMs lately.
There's little transparency into how pharmacies are scored, pharmacies don't have any control over the terms, and even high-quality pharmacies are penalized. 99% have to write checks back to Express Scripts, according to the contract.
The practice of recouping money from pharmacies is rampant in Medicare.
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old story...however....one way to be a better shopper is to use this website...
I never head over to the pharmacy until I have checked the Goodrx website. Furthermore, when you ask the pharmacy is this the best price, they are obligated to answer. And, when all else fails and the price is still too high, you can directly contact the pharmaceutical maker and ask them how you can go about getting a better price. Often, they will accommodate.
You would think that because you have insurance, you will get the best price on your drugs. This has not been the case for many, many years.
And lastly, when all else fails...ask your physician for samples. You’d be surprised how many samples physicians’ offices have!
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GoodRx.com is legit. There is no charge to "join"/use their services. We often used to call around to various pharmacies for patients to help them find the best price. The GoodRx card often helped get the best price. Another tip: if you take multiple meds and really need to get the best price, call several pharmacies. I found that the price could vary drastically and it was impossible to predict where you were going to get the best price on any individual drug.
A few other thoughts:
Some pharmacies have a $4, $5 or $10 medication list. Many common, off patent medications can be purchased at a fairly nominal charge. Be sure to ask at several pharmacies. Sometimes these lists are published online. Again, prices can vary dramatically from pharmacy to pharmacy. This article has a link to several such drug lists and some other tips for getting the best deal:
https://www.goodrx.com/blog/what-happened-to-4-generics/
There are a few other companies out there that function in a similar manner. If they do not charge a membership fee, they may be worth trying.
Does anyone have experience with AARP's Rx card?
Alas, I don't think that any of these are cancer drugs but one must economize where it is least offensive (and most possible)!
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Voraciousreader: It crossed my mind to footnote my post from Vox to indicate that it is widely regarded to be a left-leaning media source. I have now done so. Of course, many centrist or even right-leaning governors and legislatures have determined that participating in the expanded Medicaid system is an advantage for their states, i.e.: Kentucky, Arkansas and Virginia. I am loathe to wade to far into the weeds of the healthcare debate. I was hoping that this forum could provide a ready source of factual information. People have myriad positions and I tend to think that there are a number of solutions/models that might be viable. I wish there were more substantive sources of meaningful proposals from the moderate right. I thought I had found one once only to realize, to my horror, that their primary means of seeking to control costs was to institute a lifetime limit of $1 million. I suspect that that would not be popular with readers of this web site. To say that it "would not work" for me is an understatement. With regard to the National Review piece, regrettably, they offer no solutions...not even in outline form. It is true that the debates hardly offer a suitable forum for delving into the details of plans, should one be inclined to do so. The author of the National Review article it extremely critical of the Canadian healthcare system. I'm sure that she could offer a number of fair criticisms of the Canadian healthcare system, instead, her primary criticism is that there are unreasonable/unsafe wait times in the Canadian system. Numerous other sources state that time-sensitive care is rarely or never delayed. She characterizes this as "rationing." Of course, there is rationing in the U.S. system, too. Care is rationed based on whether your insurance will pay for it and/or whether you are able to pay for it out of pocket. Other countries spend considerably less per participant with equal or, usually, better health outcomes. It is hard for me to believe that we Americans lack the vision and ingenuity to create and deliver a system that is as effective as that in other parts of the developed world. Which leads me to believe that self-serving influences are creating a substantial hazard to public health and well-being. I think that we need to be prodding our representative to deliver solutions and not merely criticisms and inaction.
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Lumpie, I also want to say how much I appreciate your important and highly informed contribution to this important topic.
And FWIW, I definitely do not consider Washington Post to be a left leaning periodical. Not sure about VOX, but I'll take your word for it.
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Hi Pupmom,
It does not get much more left leaning than the Washington Post. Sad that most of our news sources obviously lean one way or the other.
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Sorry Simone, but I definitely do not agree about WP.
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I’m always amazed that when a news source speaks in facts it’s labeled as left wing. That way it can be dismissed as partisan
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"The author of the National Review article it extremely critical of the Canadian healthcare system. I'm sure that she could offer a number of fair criticisms of the Canadian healthcare system, instead, her primary criticism is that there are unreasonable/unsafe wait times in the Canadian system. Numerous other sources state that time-sensitive care is rarely or never delayed. She characterizes this as "rationing.""
Canadian here.
I have my own issues with Bernie's comparison of Medicare for All to the Canadian healthcare system, but I won't get into that here. What I will say is that "rationing" is not the best word to describe the Canadian system. The better word is that our health care is "triaged". In other words, patients are treated based on an assessment of urgency. If I need an MRI because of a cancer diagnosis (as has been the case), I will get that MRI very quickly. If I need an MRI for standard screening (as has been the case), I will have to wait (but I know this so I ensure that my doctor gets the requisition in a couple of months before I want the MRI, so I end up getting it exactly when I want it). If I have just been diagnosed with breast cancer and want to see a PS who specializes in breast reconstruction at a cancer hospital, I will get in within a few days. If I am just looking for a reconstruction consult with no medical condition driving the need, it might take a year (but there are many other less specialized Plastic Surgeons that I can see much more quickly).
As for media bias, I like to read news and opinions from all sides so that I can figure out where the truth lies (usually in the middle or a combination of what's said on both sides). I also like to know the bias of my sources so that I can apply that to my assessment of what they are saying. I use two guides:
Media Bias Ratings AllSides This is their chart; I've highlighted Vox, The Washington Post, and National Review.
And Media Bias Fact Check, which includes Vox as Left Bias, The Washington Post as Left-Centre Bias and The National Review as Right Bias.
Edited to add: I read/watch a lot of the media listed on this chart - in every column - and pretty much agree with where they are all placed.
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As an American I like the idea of triaged medicine
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Love the chart, Beesie! I too read from many areas of the chart as well. Nice to get perspective from many sources as there is obviously a lot of opinion in news now. Was just talking to my nephew about news in the old days when the family gathered around the TV for the airing of the evening news. If you missed it you had to wait for the newspaper the following day. He was appalled;-).
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Bessie: Thanks for the "all sides" and bias check references. Those are helpful. A few surprised me a bit - but not too much. This looks like a good resource.
Simone: your note re the old days of news made me grin.
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Trump Administration's Plan to Lower Healthcare Costs
Kevin Campbell, MD, offers his insight on the two controversial proposals
Kevin Campbell, MD, takes a look at the bottom line of these proposals. The opinions expressed in this commentary are those of the author. Video commentary with transcript.
This past week, President Trump proposed his plan to reduce healthcare costs through executive orders and rulings out of the Department of Health and Human Services. One legislative change will allow the importation of drugs from Canadian pharmacies via a newly proposed state-by-state pilot program. Additionally, his administration proposed new rules that would provide consumers more detail about the actual prices that hospitals charge insurers.
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President to Unveil "Elaborate" Health Care Plan in September
The 2020 presidential race is well underway and will only heat up further this fall. There were rumors circling that President Trump wants to introduce health care initiatives that Republicans can use on the trail. Health care issues played a significant role in Democrats winning control of the House of Representatives in the 2018 elections. Those rumors appear to be true, as Bloomberg reports the president will announce an "elaborate" plan in a September speech.0 -
Well if he does that I will start hoping he gets a really painful, deadly type of cancer, like Pancreatic. Are lives are NOT talking points for a bunch of brainless politicians to start sponging for brownie points from likeminded cheapskates who don't care if we die. SHAME ON THEM.
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Insurers Win and Patients Lose… Again
While insurers grow more powerful, patients and doctors are losing control of medicine, says Kevin Campbell, MD
The country's biggest health insurers earned more than $11 billion in profit in Q2 this year, and Kevin Campbell, MD, has had enough of the industry continuing to grow without a fight from patients and physicians.
"we must act NOW. We must demand more from our nation's leaders in Washington. There must be more oversight and we must limit the ability of large insurers to hold both doctors and patients prisoner -- all while lining their own pockets.
"We must fight to preserve competition and allow both doctors and patients to have more choice in how, when, and where high-quality medical care is delivered...."
{Video op ed + transcription}
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Congress Likely to Take on Surprise Billing, Drug Pricing
Issues on the fall agenda have broad consensus, but also many versions of legislation
August 29, 2019
Drug pricing and surprise billing are two likely healthcare agenda items when Congress returns next week from its August recess, health policy experts said Wednesday.
There is a broad consensus that consumers should be held harmless when they -- through no fault of their own -- receive bills from physicians that turn out to be out of network even though they work at in-network hospitals
"...the drug pricing issue ... is a problem and consumers are very frustrated and find these prices to be unaffordable, particularly for those who are uninsured, but even [some of] the insured population has postponed or foregone prescriptions because they can't afford it. It's an issue where the consumer is really driving the interest in this debate."
Another ACA-related issue to watch will be the Texas v. Azar case, in which a federal appeals court is expected to decide this fall on whether all or part -- or none -- of the ACA should be struck down.
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Trump Promises 'Phenomenal' Health Plan. What Might That Mean?
Kaiser Health News article examines what a Trump plan may, or may not, include.
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Lumpie, it means ZIP. Oh, and for example, how about that hurricane threat for Alabama?
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