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Beware the Camel’s Nose

Published by Thair Phillips

There’s and old expression, “don’t let the camel’s nose into the tent,” It is in reference to an old tale about an Arab master who let his camel stick his nose under his tent flap to get warm and pretty soon found that the camel had slowly moved completely into the tent and pushed him out. The moral is, don’t let something start that is wrong, no matter how small or innocuous, because it will soon grow large, much to your detriment. I heard this term used in Washington when I began working in public policy in 1996. It was a way for a partisan party or administration to start the process of passing an untenable change to public policy by passing a small seemingly harmless bill and then slowly building on this approach until it only takes a small step to pass the final ultimate legislative goal. I argued 12 years ago that letting an unelected, judicially exempt government panel decide how to ration healthcare in Medicare was dangerous. It was letting the camel’s nose into the tent that would ultimately result in government-controlled healthcare. I think we are seeing this tactic used again.

Lately, our government has begun sticking its nose into our healthcare in ways that scare me. There has been legislation proposed and, in some cases, signed into law, that inserts the government into our healthcare in unprecedented ways. Here are three examples of what I’m talking about.

The recently passed Inflation Reduction Act (IRA) contains some very dangerous precedents. It allows the government’s health agency, Centers for Medicare & Medicaid Services (CMS), to set the price of selected prescription drugs. This is certainly a step toward government control of our healthcare. The law gives CMS no flexibility on which drugs to select, because there is a very stringent method that leaves no agency discretion on which drugs are selected, while expressly denying any judicial review of their actions . . . does this sound familiar? The legislation grants CMS a huge budget increase to add government workers to support the new oversight. This certainly doesn’t sound like a reduction in government control. The nose has found its way into the tent.

There has been a lot of talk about the new Alzheimer’s drug Aduhelm. It was approved by the FDA for broad use and then the Department of Health and Human Services (HHS) restricted the use to only those participating in a trial, which greatly reduced access to the drug. This seemingly innocuous move to save money was a precedent setting move by a government agency, overriding the approval of the FDA, the world’s gold standard in ensuring the safety and efficacy of prescription drugs, to arbitrarily ration your and my access to this approved drug. The Biden administration had the audacity to claim credit for the expected reduction in next year’s Part B premium price, a reduction that was paid for by their denying our access to an FDA approved Alzheimer’s drug. This government rationing was on just one drug but is clearly the first move into the tent.

My last example is a waiver request Oregon submitted to HHS. This request would allow Oregon to deny Medicaid patients access to selected drugs that were approved under the FDA’s accelerated-approval program. By law, states must allow access to all FDA approved drugs, but this precedent setting waiver would change that requirement. In their request Oregon stated that “it will only exclude accelerated-approval drugs with limited or inadequate evidence of clinical efficacy, as determined by state review.” So, the state of Oregon, with all its legions of medical experts, would “wisely” determine if Oregon citizens would have access to an FDA approved drug. This means that, if this waiver was in affect two years ago, Oregon could have denied access to the COVID-19 vaccines, since they were approved under the accelerated approval program. It seems that this waiver request represented not just a nose into the tent but half the body. I’m a champion of states’ rights, but this seems to be a clear over stepping of powers and would be a dangerous precedent. I expect this part of the waiver to be withdrawn, since I would hope that HHS would not approve of this exclusion, but the mere fact that it was included in the waiver request in the first place scares me.

These examples should be red flags to all of us. Is this the camel we want sharing our tent? Do we want more government involvement in our healthcare? While the Oregon accelerated-approval part of the waiver will likely be withdrawn, it will lessen the shock the next time something like this is proposed. Soon, this approach won’t shock us, and we won’t think it’s so bad when they propose that they limit access to a small portion of accelerated-approved drugs, maybe like in the IRA, where it is 10 drugs for the first year and then adding 15 more and then . . .

It is impossible not to see that the government, both at the state and federal level, is moving toward more involvement and more control of our healthcare. We need more competition in all facets of our healthcare not more government oversight and regulations. I’ll continue to stay up-to-date and strive to inform you on the things that impact your healthcare. I hope you realize that you can have an impact if you take the time to stay informed and active as an advocate. Together we can make a difference.

Best, Thair

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Our Legislative Focus

Published by SSO

As summer wanes and fall begins to come into focus, it’s time to look ahead to the healthcare legislative issues that could come into play. With campaigns heating up and the debates beginning, you can guarantee that promises will be made and accusations leveled concerning your healthcare. Some of the issues that will be brought up might have a small chance of actually being implemented, but this doesn’t mean that we shouldn’t pay attention. In the past, seemingly long shot proposals have become late night trading fodder when politicians make deals on far reaching legislation. Many of the issues I’ll talk about today were thought to be not-starters a few years ago and now they are political realities. What I will do is offer a simple explanation of each issue, give you an idea on how it could affect you and how likely I think it will be to be implemented. I’ve written an earlier blog about many of these issues. You can look through recent posts to get a more detailed explanation of some of the issues.

International Pricing Index/Favored Nation Pricing

Background – In an effort to lower drug costs some in Washington (most recently the President) have proposed that we fix the cost of a drug to the lowest price a “favored nation” paid. As I’ve explained before, price fixing has never been a long-term solution to any cost problem. There are better ways to have other nations share in the costly research and development that goes into discovering and manufacturing prescription drugs.

Impact – If this approach is implemented the supply line safety that we have enjoyed over the years will be jeopardized with no guarantee that any savings will make its way to you.

Chance of Implementation – While this idea has been around for at least a couple of years, its chances of becoming a reality have gone up. It would be difficult to implement and the chance of unintended consequences high. This makes its implementation politically unpopular but a great thing to talk about during debates.

Importation

Background – This issue has some of the same characteristics as the international pricing index. The goal is again to lower drug prices by allowing importation of these drugs from Canada. I talked about this proposal in my earlier blog explaining how it bypasses the safety net we now enjoy without any proof that the patient will see any savings while counting on Canada to implement a program that they have already said they can’t support.

Impact – While you or someone you know has gone across either our southern or northern boarders to purchase medicine at a lower price, this is not what this proposal is about. This importation proposal is at a much higher-level involving suppliers and transporters and large volumes. Some states have passed laws allowing importation but none of them have been implemented.

Chance of Implementation – This approach has been around for many years and no one yet has found a way to safely implement it. A pilot program of some sort may be started but it will take some real political will to make it happen.  Canadian officials have indicated they will not support it. However, the chances of it happening are much more likely than they were just a few years ago. This is one of those solutions that may gain some traction.

Changes to Medicare Part B

Background – The price of drugs administered and paid for under Medicare Part B have increased substantially. These are drugs that are often injected at a doctor’s office for serious diseases like cancer and many types of autoimmune diseases. A proposal to fix the cost of these medicines has been put forth. This approach would go against the market-based approach that is now in place. It would impact many of the doctors who perform these services and upend and regulate this vitally important portion of our healthcare. Again, fixing prices has never been and efficient, long range solution.

Impact – If implemented, this approach would change the economics of this vital service. Any savings to the patient has been hard to quantify but it would most certainly put pressure on already pressured neighborhood practices. Losing these close, more accessible, services would have serious consequences.

Chance of Implementation – Part B drug prices have become a focal point for people seeking solutions to increased costs. We need to correct the underlying parts of the system rather than using a sledgehammer to bludgeon one part of the business.

Part D Cap

Background – Almost all of us, either in private insurance or Medicare or Medicare supplemental insurance, have experienced caps on our healthcare out-of-pocket costs. It helped us budget our money, we even decided what type of insurance to buy based on the yearly cost caps. Medicare Part D has no such caps. Depending on what prescription drugs, we need we may have out-of-pocket costs that balloon to the tens of thousands a year.

Impact – While we have been against the other proposed changes, a Medicare Part D cap would have a huge impact on those of us who are already retired and everyone younger as they plan for their retirement. I’ve known people, maybe you have also, who were living comfortably until an illness struck and their drug costs forced them to tap into their retirement. The peace of mind that a cap on our drug costs would give all of us, whether planning for or already retired, would be immense. This a change that is worth fighting for.

Chance of Implementation – This change is gaining some traction. While it probably won’t be something that is done on its own, it is a change that could be incorporated in some larger legislation as a balance or concession to reach final approval on the bigger legislation. It would be a most welcome change.

It is guaranteed that there will be other changes to our healthcare put forth as we near election day. We will keep you up to date on each one, explaining in simple terms what the change is and its impact on you. There is one over all criteria that I would like you to consider. Making short term, knee jerk, politically popular, changes is not the answer. Trying to band aid or quick fix a broken process never ends well. We need to fix the underlying problem, simplify the process, and let the free market drive us to the most effective, cost efficient solution. I believe the reduction of administrative overhead and regulations is a big step toward this goal. Measure each change to see if it offers simplicity and transparency in its solution.

Let’s stay informed as we approach this critical election. Get involved, tell those in Washington how you feel. Also, get registered to vote and then vote! It’s one of the most powerful things we can do.

Thair

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Tell Congress to Reject Cuts to Medicare Part D!

Published by SSO

There is a rumored proposal in the works that could harm Medicare Part D and the seniors that rely on this critical program. This proposal would harm Medicare by applying a government-imposed inflation rebate on Part D medications that could negatively affect the program’s successful market-based structure.

By unnecessarily inserting government-imposed inflation rebates, this policy would violate the spirit of the non-interference clause, which has allowed competition between Part D plans to hold down costs and has been key to Part D’s success since its inception. This penalty could also raise premiums for beneficiaries, as this type of change has the potential to eliminate the privately negotiated price protection rebates that are currently used to subsidize premiums.

Not only would this type of proposal undermine the success of the Part D program, but it could also reduce the incentive for future innovation in health care. Inflicting such a policy on Part D medications could have the harmful consequence of discouraging future investment in medical research, harming beneficiaries, especially those with chronic or complex conditions who rely on the program to access new break-through cures.

There are numerous proposals that, if enacted, would serve to meet the needs of seniors. This is not one of them. It is critical that you act NOW to tell your Member of Congress that these cuts to Medicare through government-imposed inflation rebates are the wrong way to lower Part D costs. Join us TODAY in making our voices heard by clicking here!

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Back to Basics: Medicare Part D

Published by SSO

It’s summer already, and the year seems to be flying by! Before we know it, the fall open enrollment period will be here for the Medicare Part D prescription drug benefit as well as Medicare Part C, better known as Medicare Advantage. It’s important that beneficiaries know about the Medicare program and how we can utilize its resources, particularly access to prescription drug coverage that comes through Medicare Part D as well as most Medicare Advantage plans. A great way to get an easy refresher on the Medicare program overall is by watching this short clip here, which provides a brief overview of these important benefits. Arming yourself with the most comprehensive knowledge about Medicare is critical, especially for those of you who are turning 65 this year, or have friends or relatives that are becoming eligible.

Today, let’s go back to basics with an easy primer on one of the parts of Medicare—Medicare Part D!

Medicare Part D is the part of Medicare that covers prescription medications. One thing that differentiates Part D from other parts of Medicare is that the program is optional. Beneficiaries are automatically enrolled in parts A and B of Medicare when they reach age 65, however, beneficiaries must choose to opt-in to the Medicare Part D program and are not automatically enrolled.

Unlike other parts of Medicare, which are administered by the federal government, Medicare Part D coverage is provided through private insurers. Under the program drug manufacturers and private plans negotiate drug prices directly, allowing for a wider variety of treatment options and medication choices for beneficiaries.

This unique structure allows for and encourages increased competition among insurers, which aids beneficiaries by allowing individuals to shop around for the best-tailored plan for their unique health care needs. You can watch a quick video about how this competitive structure drives down the overall cost of Medicare Part D plans here.

There are a variety of Medicare Part D plans to choose from, each with different prescription drug formularies, coverage options, and costs. An easy way to find a plan that works for you is to use this interactive tool, which can help provide easy access to information about uniquely-tailored plans that could work for you.

Open enrollment will be here before we know it, and it is imperative that beneficiaries are equipped with the information we need to make smart decisions for our health. Opting in to Medicare Part D is an important part of maintaining a healthy lifestyle, so make sure you utilize these resources to keep up-to-speed on all things Part D!

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Have You Checked Your Plan Recently?

Published by SSO

We have recently discussed a number of different proposals that could alter seniors’ access to the medicines through the Medicare programs we rely on to stay healthy. It is critical that we, as seniors, are our own best advocates and that includes making sure we are up-to-speed on the provisions of our personal Medicare plans.

Health insurance can be complicated, which is why we are here to provide guidance for seniors so we can make the best decisions for our personalized needs. As we have discussed, Medicare Parts A and B, the parts that cover hospital and medical insurance, are included in your Medicare coverage as soon as you turn 65 years old. However, Medicare Part D, which is an optional add-on service, covers many of the prescription medications that we rely on every day.

Although Medicare Part D is optional, an overwhelming majority of seniors choose to add this important part of health coverage to their plans. In fact, out of the 60 million American Medicare beneficiaries, 43 million were also enrolled in Part D coverage as of May 2018—showing just how important this part of the program is to seniors’ overall quality of life.

It is critical that we keep on top of our Medicare plans to make sure they are working for us and our needs. The fall open enrollment season may seem far away now, but it is right around the corner! Make sure you are checking your coverage options, and stay informed, empowered, and independent!

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What is the International Pricing Index?

Published by SSO

You may be hearing a lot about prescription drug prices in the news recently, with many of these discussions surrounding proposals from the Administration and members of Congress about ways to change Medicare. Although proposals to improve the Medicare system are always welcome, one recent method of choice for Part B, international referencing pricing, could harm seniors.

Part B is the part of Medicare that covers physician-administered treatments and outpatient hospital care, as well as other services. This is a very important part of the Medicare program and one that we want to preserve in order to protect seniors’ access to a full range of care options.

International referencing pricing proposals, including the Administration’s proposed International Pricing Index, would use the prices of medications in different countries to set the prices and reimbursement rates of Part B medications here in the United States. This may sound workable in theory, but in practice, history shows it could significantly undermine incentives in our healthcare system that increase access and patient choice.

In fact, many of the countries that would be used under this proposal – countries that have implemented reference pricing, already experience access issues.

If these types of policies are implemented, our current treatment plans, plans that we have carefully created with our doctors, could be disrupted in favor of more generalized treatment plans that value cost-saving over value-based care.

As seniors, it is critical that we advocate for the ability to receive the treatments that we know work best for our unique needs. International reference pricing could increase government involvement in our personalized health care plans, limit patient choice, and reduce seniors’ access to the variety of health care options we deserve!

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It’s Time for a Springtime Medicare Refresher!

Published by SSO

The lingering cold weather is slowly warming up, which can only mean one thing: Spring has sprung! Spring is a great time to reset physically and mentally, so we have prepared some easy explanatory Medicare materials for you to review to make sure you are informed throughout the rest of the year. Staying informed about your health is a year-round responsibility, and as we age it is important for us to educate ourselves on the programs and care options we can utilize.

As you may know, Medicare is a federal health insurance program that provides coverage for seniors aged 65 and older, as well as for certain individuals with disabilities. Medicare, through the years, has incorporated certain updates and changes to ensure that it is consistently working to promote the health of seniors as impactfully as possible, including the addition of different aspects, or “parts” to the program. Making sure you are knowledgeable about the Medicare program is important, as it can help you make decisions about which plan is right for you. Many people have heard about Medicare Parts A, B, C, and D, but don’t know what they necessarily mean. Medicare Today’s helpful infographic, provided below, highlights each fundamental aspect of the Medicare program and what each part of the program does.

Another helpful resource we want to highlight for seniors is a Medicare 101 informative video, which you can watch here, and see below. Take a minute to watch this short video, which gives a helpful snapshot of the Medicare program, what it does, and how it works. Warmer weather usually means busier schedules, and helpful explainer videos can be a great resource for getting the information you need quickly and efficiently. For more Medicare related video content click here.

Before we know it, the fall open enrollment period will be here, and it will be time to make changes or adjustments to our Medicare plans. Planning early and choosing the right plan for you based on your needs is very important, and brushing up on Medicare resources is a helpful way to prepare. You can enter the Spring season with an extra pep in your step knowing you are informed about the Medicare program!

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Do You Know About These Threats to Medicare?

Published by SSO

As seniors, we know just how important Medicare programs are to our health and wellbeing. Unfortunately, there are currently some government proposals that would affect Medicare’s ability to provide accessible, affordable care for seniors. We have outlined some of the major threats below, because the first step in making a difference is being informed!

First, there have been various proposals to repeal the non-interference (NI) clause of the Medicare Part D program. This clause prohibits the government from interfering in negotiations between manufacturers and insurers that result in rebates and discounts. The proposals seek to repeal that clause and allow the government to negotiate medicine prices under Medicare Part D, but studies have shown the only way the government could negotiated lower prices is if they severely restricted access to medicines. As seniors, it is vital that we support protecting Part D’s private marketplace structure that is in place to keep medications accessible and affordable. You can find an informative video about this issue here.

Another recent proposal that could threaten Medicare Part D relates to coverage of medicines within the six protected classes. Currently, Medicare Part D plans are required to cover “all or substantially all” medicines within these six classes—which include medicines that help those suffering with mental illnesses, HIV, cancer, and organ transplant rejection. The Centers for Medicare and Medicaid Services (CMS) has proposed making changes to these protections, which could harm some of America’s most vulnerable patients. Ensuring that seniors are able to receive the specific medications our doctors prescribe us is very important, and this proposal could threaten that ability.

Finally, another threat to Part D is the upcoming out-of-pocket cliff. This explainer video provides more information about this issue, as does this informative graphic from Medicare Today. If not addressed, the dollar value necessary to reach catastrophic coverage, which helps cover prescription medications for seniors once they have already spent a substantial amount out of pocket, is set to increase in 2020. It is vital that we advocate for seniors’ health by urging Congress to address this impending out-of-pocket cliff, and ultimately help patients save more money at the pharmacy counter.

In addition to Part D threats, the Administration has recently proposed some changes to Medicare Part B, the program within Medicare that covers outpatient physician-administered medicines, as well as outpatient services like doctor visits and ambulance services. The Department of Health and Human Services’ (HHS) International Pricing Index proposal could harm seniors and patients with chronic conditions by inserting middlemen into the doctor-patient relationship, which will create new administrative barriers that could hinder a doctor’s ability to provide care. The proposal would also open U.S. borders to price controls from socialized health care systems and could severely limit access to existing and new treatment options.

The American health care landscape is always changing, so it is critical that we keep informed about current proposals and challenges facing Medicare—a program that provides us with so many benefits and reliable, affordable access to care. The more we know as seniors, the better we can advocate for our friends, our families, and ourselves.

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Last Call for Open Enrollment!

Published by SSO

As we enter the most wonderful time of the year, we may be focused primarily on spending time with family and friends, exchanging gifts, and indulging in decadent holiday treats. However, we cannot overlook the fact that it is another wonderful time of year, as well—Medicare open enrollment!

The open enrollment period for new and existing Medicare beneficiaries to select or alter their plans runs from October 15th to December 7th. We have previously discussed the importance of taking a good look at your plan and making any necessary changes, and it’s not too late!

For those of you turning 65, now is a great time to take a close look at your options and select a Medicare plan that matches your needs based on the medications you take and treatments you use. For those of you already enrolled, you may not know that you are able to alter your plan every year during open enrollment. So, whether your needs have changed, you have switched medications, or have been diagnosed with a new illness, open enrollment season is an important time for you to take a close look at your plan and make any necessary changes.

Remember, you know your health best—so make sure you are taking charge of your treatment options by enrolling in a Medicare plan that best fits your goals, budget, and lifestyle. There are numerous tools that you can use to find information about different options, including information about plans based on where you live. Click here for an easy-to-use tool that can help you identify potential matches, and here to learn even more about just how important it is to utilize the open enrollment period.

Time is ticking on your chance to make changes to your health care plans! We all know time flies when you are having fun, so make sure to take a quick look at your options during these last few days of Medicare open enrollment. The holidays will be here before we know it!

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Happy Birthday Medicare!

Published by SSO

On July 30, 1965, President Lyndon B. Johnson signed the Social Security Amendments of 1965, officially creating what we now call Medicare. Now celebrating its 53rd birthday, Medicare has helped seniors across the nation to better afford the care and medications they need.

In honor of Medicare’s birthday, Seniors Speak Out wanted to provide a brief overview of Medicare’s four parts for those who may be unfamiliar with the program or may be preparing to sign up for Medicare for the first time this year. Below you’ll find a brief explanation of each part, as well as a handy graphic that you can keep on hand for reference. You can also learn more by clicking the links to Medicare.gov’s web pages on each of the four parts.

Medicare Part A: Part A was created as part of the original Medicare law and helps provide a variety of services, including hospital stays, hospice care, and nursing home care.

Medicare Part B: Part B was also created as part of the original Medicare law and covers outpatient services like doctor visits, ambulance services, and mental health services as well as preventative services like vaccines.

Medicare Part C: Also called “Medicare Advantage Plans,” Part C is coverage offered by Medicare-approved private companies. Advantage Plans cover all your original Medicare services, but can also extend to prescriptions, dental, vision, and other types of coverage.

Medicare Part D: Part D is the newest part of Medicare and covers prescription drug medications. To receive Part D coverage, you must opt in for a plan when you turn 65 by using one of these two options.

With each part covering such important aspects of care, it’s clear that Medicare is instrumental in helping seniors acquire the medical services they need without being overburdened by costs. As we celebrate another year of this important program, we’d love to hear how Medicare has helped you! Feel free to reach out to us over Facebook and Twitter to share your Medicare story!