Aug20 by RI ARA

RI ARA Affiliated with the Rhode Island AFL-CIO

“Fighting for the future of our members.” “NOW, more than ever!!!”

August 20, 2017 E-Newsletter

Publication 2017/ Issue 32 Published in house by the RI ARA

White House to pressure McConnell on ObamaCare White House officials are exploring ways to pressure Senate Majority Leader Mitch McConnell (R-Ky.) to return to the controversial issue of ObamaCare repeal when the Senate returns to work in September. President Trump, who has repeatedly criticized McConnell in public, wants to hold the leader’s feet to the fire on the issue, say White House sources. “I have not heard a single voice in the White House say give up on healthcare.

Everyone keeps saying 'let’s keep trying and let’s keep pushing,' ” said one White House source. “We’re definitely not ready to move on and feel members should keep looking for a way to pass the bill. It would be one thing if it had fallen 30 votes short but they were just one vote shy of passing a bill in the Senate,” the source added. One point of leverage the White House may explore is using the looming expiration of reconciliation instructions for fiscal 2017 to argue for one more push. Under the rules, the GOP has until the end

of September to pass ObamaCare repeal legislation under the fast-track rules, which prevent a Democratic filibuster. This means the GOP has just one last chance to defund Planned Parenthood or eliminate the most unpopular elements of ObamaCare, such as the mandate on individuals to purchase insurance. McConnell has made it clear he wants to move on to other priorities: raising the debt ceiling, negotiating a spending deal, passing a defense authorization and reforming the tax code….Read More

Americans Eager For Leaders To Cooperate To Make Health Law Work That’s what most people say Congress and the Trump administration should do after the Senate failed to approve legislation in July to revamp the Affordable Care Act, according to a survey this month. Nearly 8 in 10 Americans say President Donald Trump should be trying to make the health law work, according to poll conducted by the Kaiser Family Foundation. This includes large majorities of Democrats (95 percent) as well as half of Republicans (52 percent) and President Trump’s supporters (51 percent). (Kaiser Health News is an editorially independent program of the foundation.) Almost 6 in 10 people think the Republicans should work with Democrats to improve the health law. Only 17 percent of the public — and 40 percent of Republicans — think the Trump administration should take steps to make the health law fail, the survey said. Trump has threatened to end funding to insurers to cover cost-sharing subsidies that cover the out-of-pocket health expenses for millions of low-income people buying coverage on the Obamacare

exchanges. Insurers say such a move would force them to leave the health law marketplaces or raise premiums. Nearly two-thirds of the public oppose the president’s negotiating tactics, the survey said. Just 21 percent of respondents — but 49 percent of Republicans — want the GOP

to continue working on a plan to repeal and replace Obamacare, the survey said. The GOP-controlled Senate failed to pass a health bill before it left for a summer break last week. The House in May passed a bill to partially repeal the law and drastically cut Medicaid….Read More

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CMS Projects Continued Stability of Part D Premiums in 2018 The Centers for Medicare & Medicaid Services (CMS) recently announced that the average basic premium for a Part D prescription drug plan is estimated to be $33.50 per month in 2018. This projected average premium is a slight decrease from the average monthly premium in 2017 ($34.70) and represents the continued relative stability of Part D premiums. It is important to note that while the average, basic premium is lower in 2018, beneficiary premiums will vary—some increasing and some decreasing next year.

Although Part D premiums remain stable, Part D costs continue to increase faster than other parts of Medicare. According to CMS, this increase is largely due to the high cost of specialty drugs, especially during the catastrophic coverage period. In all Medicare Part D plans, after the enrollee pays a certain amount in out-of-pocket costs (regardless of their total drug costs) for covered drugs, they will reach catastrophic coverage, when they pay a 5% coinsurance for their covered prescriptions. For people with Medicare, they continue to see savings on their out-of-

pocket drug costs due to the Affordable Care Act’s (ACA) closure of the Part D coverage gap, also known as the “donut hole.” Someone in the coverage gap in 2018 will pay 35% out of pocket for most of their brand name drugs and 44% out of pocket for generic drugs. The coverage gap is slowly closing, and will close completely by 2020 when people with Medicare will pay, on average 25% for their drugs after they have met their deductible. Read the CMS announcement.

Climbing Cost Of Decades-Old Drugs Threatens To Break Medicaid Bank Skyrocketing price tags for new drugs to treat rare diseases have stoked outrage nationwide. But hundreds of old, commonly used drugs cost the Medicaid program billions of extra dollars in 2016 vs. 2015, a Kaiser Health News data analysis shows. Eighty of the drugs — some generic and some still carrying brand names — proved more than two decades old. Rising costs for 313 brand-name drugs lifted Medicaid’s spending by as much as $3.2 billion in 2016, the analysis shows. Nine of these brand-name drugs have been on the market since before 1970. In addition, the data reveal that Medicaid outlays for 67 generics and other non-branded drugs cost taxpayers an extra $258 million last year. Even after a medicine has gone generic,

the branded version often remains on the market. Medicaid recipients might choose to purchase it because they’re brand loyalists or because state laws prevent pharmacists from automatically substituting generics. Drugs driving Medicaid spending increases ranged from common asthma medicines like Ventolin to over-the-counter painkillers like the generic form of Aleve to generic antidepressants and heartburn medicines. Among the stark examples:  Ventolin, originally approved in 1981, treats and prevents spasms that constrict patients’ airways and make it difficult to breathe. When a gram of it went from $2.58 to $2.90 on average, Medicaid paid out an extra $54.5 million for the drug.

 Naproxen sodium, a painkiller originally approved in 1994 as brand-name Aleve, went from costing Medicaid an average of $0.72 to $1.70 a pill, an increase of 136 percent. Overall, the change cost the program an extra $10 million in 2016. Generic metformin hydrochloride, an oral Type 2 diabetes drug that’s been around since the 1990s, went from an average 10 cents to 13 cents a pill from 2015 to 2016. Those extra three pennies per pill cost Medicaid a combined $8.3 million in 2016. And cost increases for the extended-release, authorized generic version cost the program another $6.5 million….Read More

Only Half of Eligible Beneficiaries are Receiving Help with Part B Costs This week, a report for the Medicaid and CHIP Payment and Access Commission (MACPAC) examines the enrollment of likely eligible Medicare beneficiaries in Medicaid programs that assist with Medicare Part B premiums and costsharing, known as the Medicaid Savings Programs (MSPs). In 2013, Medicaid paid for approximately 8.8 million beneficiaries to receive assistance with their Medicare costs through

the MSPs, and that historically not everyone eligible for an MSP has actually enrolled. In this new release MACPAC presents data on MSP participation rates, updating prior, dated studies from 2003. Using the most recently available data (2009 and 2010), the analysis shows that participation in the MSPs remains low: only 53% for the Qualified Medicare Beneficiary (QMB) program; 32% for the Specified Low-Income Medicare Beneficiary (SLMB) program; and 15% for the Qualifying Individual (QI) program. The analysis seeks to understand why low enrollment persists

by comparing characteristics of MSP enrollees with those eligible but not enrolled. For example, the authors find that people eligible but not enrolled in the QMB program, compared to those enrolled in QMB, were “more likely to be 65 and older rather than eligible for Medicare due to disability; more likely to be white, nonHispanic; more likely to report excellent or very good health; and less likely to have limitations in activities of daily living (ADLs).” Read the report.

Doctors Warm To Single-Payer Health Care Single-payer health care is still a controversial idea in the U.S., but a majority of physicians are moving to support it, a new survey finds. Fifty-six percent of doctors registered either strong support or were somewhat supportive of a single-payer health system, according to the survey by Merritt Hawkins, a physician recruitment firm. In its 2008 survey, opinions ran the opposite way — 58 percent opposed single-payer. What’s changed? Red tape, doctors tell Merritt Hawkins. Phillip Miller, the firm’s vice president of communications, said that in the thousands of conversations its employees

have with doctors each year, physicians often say they are tired of dealing with billing and paperwork, which takes time away from patients. “Physicians long for the relative clarity and simplicity of single-payer. In their minds, it would create less distractions, taking care of patients — not reimbursement,” Miller said. In a single-payer system, a public entity, such as the government, would pay all the medical bills for a certain population, rather than insurance companies doing that work. A long-term trend away from physicians owning their practices may be another reason that single-payer is winning some over. Last year was the first in which fewer than half of practicing physicians

owned their practice — 47.1 percent — according to the American Medical Association’s surveys in 2012, 2014 and 2016. Many doctors are today employed by hospitals or health care institutions, rather than working for themselves in traditional solo or small-group private practices. Those doctors might be less invested in who pays the invoices, Miller said. There’s also a growing sense of inevitability, Miller said, as more doctors assume single-payer is on the horizon. “I would say there is a sense of frustration, a sense of maybe resignation that we’re moving in that direction, let’s go there and get it over with,” he said….Read More

CBO: Killing Cost-Sharing Subsidies Would Hike Silver Plan Premiums And Deficit If President Donald Trump were to follow through on his threats to cut federal cost-sharing subsidies, health insurance premiums for silver plans would soar by an average of 20 percent next year and the federal deficit would rise by $194 billion over the next decade, the nonpartisan Congressional Budget Office said Tuesday. The change would not be expected to have much long-term effect on the number of uninsured people, according to the analysis. But it could cause a shift in which plans are popular with marketplace customers as insurers realign some of their prices to defray the loss of the federal payments, the CBO said. Surprisingly, some customers might find

better deals by looking at higher-end products. The cost-sharing subsidies are paid directly to insurers to help cover out-ofpocket costs, such as deductibles and copayments, for people who earn between 100 and 250 percent of the federal poverty level and who choose a marketplace silver plan. About 7 million consumers receive the benefit. .These payments are separate from the subsidies offered as tax credits to help consumers pay their marketplace plan premiums, which are available to people earning up to 400 percent of the poverty level. The CBO estimated that the federal government would spend $8 billion on the

cost-sharing subsidies in 2018, if they are continued. The loss of the payments would be expected to have minimal effect on the number of uninsured people over the next decade, CBO said. That is because the CBO predicts that insurers would raise their premiums on silver plans to make up for the loss of the federal payments, which insurers would still need to give to those customers. That price increase would spur a rise in the premium tax credits, too. The higher tax credits would, in turn, make the marketplace plans more attractive for some lowerincome Americans who have not been customers….Read More

Often Missing In The Health Care Debate: Women’s Voices Women, in particular, have a lot at stake in the fight over the future of health care. Not only do many depend on insurance coverage for maternity care and contraception, they are struck more often by such diseases as autoimmune conditions, osteoporosis, breast cancer and depression. They ar e mor e likely to be poor and depend on Medicaid — and to

live longer and depend on Medicare. And it commonly falls to them to plan health care and coverage for the whole family. Yet in recent months, as leaders in Washington discussed the future of American health care, women were not always allowed in the room. To hammer out (behind closed doors) the Senate’s initial version of a bill to replace Obamacare, Majority Leader Mitch McConnell appointed 12 colleagues, all male. Some Congress members made

clear they don’t see issues like childbirth as a male concern. Why, two GOP representativeswondered aloud during the House debate this spring, should men pay for maternity or prenatal coverage? Republican repeal efforts are stalled, for now, but the fate of America’s health care system remains highly uncertain….Read More

RI ARA HealthLink Wellness News

Obesity And Depression Are Entwined, Yet Scientists Don’t Know Why About 15 years ago, Dr. Sue McElroy, a psychiatrist in Mason, Ohio, started noticing a pattern. People came to see her because they were depressed, but they frequently had a more visible ailment as well: They were heavy. McElroy was convinced there had to be a connection. “Many of my [depressed] patients were obese. And they were very upset by obesity,’’ McElroy recalled. ”I looked into the literature, and it said there was no relationship. It didn’t make sense.” That sense of disconnect has started to change, promising new avenues for treatment, but also presenting a puzzle: Just how can you chart the mechanics of what ties the two together? And how can

treatment be linked for two disorders that exist in totally different parts of the health care system? Ingrid Donato, a top official in the federal agency that promotes mental health treatment, says that both conditions are on the rise, heightening the need to unlock the connection and develop treatments that address both conditions simultaneously. “You can’t address obesity in a person that’s struggling with major depression without addressing that major depression,” said Donato, chief of mental health promotion at SAMHSA, the Substance Abuse and Mental Health Services Administration. “When a person’s coming in with depression… or they’re coming in with the struggles on the physical side of obesity, if they’re not having those treated both ways, they’re only going to be having

half a treatment plan.” The relationship between obesity and depression is what researchers call “bidirectional.” Being obese or overweight ups the odds of depression, and vice versa. For example, about 43 percent of people with depression are obese, according to the federal Centers for Disease Control and Prevention, compared with a third of the general population. People who are obese are 55 percent more likely to be depressed, and people with depression 58 percent more likely to develop obesity, according to one 2010 study. “This is a massive public health issue when you have numbers that large,” Donato said. ...Read More

A Long And Winding Road: Kicking Heroin In An Opioid ‘Treatment Desert’ Heather Menzel squirmed in her seat, unable to sleep on the Greyhound bus as it rolled through the early morning darkness toward Bakersfield, in California’s Central Valley. She’d been trapped in transit for three miserable days, stewing in a horrific sickness only a heroin addict can understand. Again, and again, she stumbled down the aisle to the bathroom to vomit. She hadn’t used since Chicago. She told herself that if she could just get through this self-prescribed detox, if she could get to her mother’s house in her hometown of Lake Isabella, Calif., all her problems

would be solved. “I’ve been through a lot of horrible, crazy stuff,” said Menzel, now 34. “I’ve been raped. I’ve been beaten up. I’ve been in prison. But trying to kick heroin on the Greyhound on the way home was the worst experience of my entire life.” When Menzel finally arrived at the Bakersfield bus station at 6 a.m. that day in February 2014, her mother and stepfather were there waiting. The two women hadn’t seen each other in years, not since Menzel stole her mom’s jewelry and fled the area. They didn’t talk much as they drove east though the twisty canyon

on State Route 178 toward Lake Isabella, a two-stoplight town with a population of 3,500, nestled in the golden Sierra Nevada foothills. Menzel hoped that the worst of the withdrawal was over — that a new life without heroin awaited. What she didn’t know was that heroin was now cheap and plentiful in Lake Isabella, as in so many small towns in the U.S., and that her best hope for treatment was far away. ...Read More

Insurers Can Bend Out-Of-Network Rules For Patients Who Need Specific Doctors The Affordable Care Act has so far survived Republican attempts to replace it, but many people still face insurance concerns. Below, I answer three questions from readers. Q: I have a rare disease, and there is literally only one specialist in my area with the expertise needed to treat me. I am self-employed and have to buy my

own insurance. What do I do next year if there are zero insurance plans available that allow me to see my specialist? I cannot “break up” with my sub-specialty oncologist. I must be able to see the doctor that is literally saving my life and keeping me alive. If the plan you pick covers out-of-network providers, you can continue to see your cancer specialist, although you’ll have to pay a higher percentage of the cost than if you were seeing someone in your plan’s

network. But many plans these days don’t provide any out-of-network coverage. This is certainly true of plans sold on the health insurance exchanges. The situation you’re concerned about — that a specialist you consider crucial to your care isn’t in a plan’s provider network — isn’t uncommon, said Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms….Read More

End-Of-Life Advice: More Than 500,000 Chat On Medicare’s Dime The 90-year-old woman in the San Diego-area nursing home was quite clear, said Dr. Karl Steinberg. She didn’t want aggressive measures to prolong her life. If her heart stopped, she didn’t want CPR. But when Steinberg, a palliative care physician, relayed those wishes to the woman’s daughter, the younger woman would have none of it. “She said, ‘I don’t agree with that. My mom is confused,’” Steinberg recalled. “I said, ‘Let’s talk about it.’” Instead of arguing, Steinberg used an increasingly popular tool to resolve the impasse last month. He brought mother and daughter together for an advance-care planning session, an end-of-life

consultation that’s now being paid for by Medicare. In 2016, the first year health care providers were allowed to bill for the service, nearly 575,000 Medicare beneficiaries took part in the conversations, new federal data obtained by Kaiser Health News show. Nearly 23,000 providers submitted about $93 million in charges, including more than $43 million covered by the federal program for seniors and the disabled. Use was much higher than expected, nearly double the 300,000 people the American Medical Association projected would receive the service in the first year. That’s good news to proponents of the sessions, which focus on understanding and documenting treatment preferences for people nearing the end of their lives.

Patients and, often, their families discuss with a doctor or other provider what kind of care they want if they’re unable to make decisions themselves. “I think it’s great that half a million people talked with their doctors last year. That’s a good thing,” said Paul Malley, president of Aging with Dignity, a Florida nonprofit that promotes end-of-life discussions. “Physician practices are learning. My guess is that it will increase each year.” Still, only a fraction of eligible Medicare providers — and patients — have used the benefit, which pays about $86 for the first 30-minute office visit and about $75 for additional sessions….Read More

Seniors citizens, boomers no longer dominate voters Senior citizens are no longer the dominant voice on election day. Baby Boomers and other older Americans are no longer the majority voters in U.S. presidential elections, according to Richard Fry, a senior r esear cher at Pew Research Center, who predicted this result a year ago. Fry writes that Baby Boomers and older generations had cast the vast majority of votes in every presidential election since 1980. Millennials and Generation Xers cast 69.6 million votes in the 2016 general election, a slight majority of the 137.5 million total votes cast, according to a Pew Research Center analysis of Census Bureau data, by Fry. Meanwhile, Boomers and older voters represented fewer than half of all votes for the first time in decades. The shift has occurred as Millennials accounted for a growing share of the electorate and as those in the Silent and Greatest generations aged and died.

Millennials (those ages 18 to 35 in 2016) reported casting 34 million votes last November, a steep rise from the 18.4 million votes they cast in 2008. But, despite the larger size of the Millennial generation, the Millennial vote has yet to eclipse the Gen X vote, as 35.7 million Gen Xers (ages 36 to 51 in 2016) reported voting last year. It is likely, though not certain, that the size of the Millennial vote will surpass the Gen X vote in the 2020 presidential election. The Millennial generation as a whole is larger than Gen X (both in absolute size and in the number of birth years it spans). In addition, the ranks of the nation’s Millennials are growing faster than older generations due to immigration, which is likely to be accompanied by increased naturalizations. As a result, Millennials are likely to be the only adult generation whose number of eligible voters will appreciably increase in the coming years.

In addition, while voter turnout is difficult to predict, the general pattern is that as a generation ages its turnout rate more closely matches that of the next older generation. Consequently, the difference in turnout between Millennials and Gen Xers is expected to narrow in 2020 (63% of Gen X eligible voters reported voting in 2016, versus 49% of Millennials).

Petition Subject: Elimination of the Unfair GPO and WEP Provisions of the Social Security Act