Feb 11, 2020

Jess Mason, “Trump slashes foreign aid, cuts safety net programs in new budget proposal,” Reuters, Feb 9, 2020

Cuts to Medicaid, Medicare, disability, and other safety-net programs would total $4.4 trillion over 10 years. In response, will the Dems (1) refuse to succumb to deficit panic; (2) exercise their veto over the runaway war budget; or (3) accept social spending cuts in principle, insist on a little less, then claim they did the best they could?

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Jonathan Cohn, “The Trump Administration is coming for Medicaid again,” HuffPost, Jan 30, 2020

Block grants offer “flexibility” to help states cut coverage and dump beneficiaries, described by the Trump official in charge as “providing better care at a lower cost.” Also includes user fees and lots of talk of “sustainability,” meaning cuts now or cuts later. Plus, states can keep money in block grants not spent on healthcare, so they will have an incentive to grab the cash for other projects.

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Amy Goldstein, “Trump administration’s Medicaid block-grants option touches off ideological fight,” Washington Post, Jan 30, 2020

The Trump block grant proposal targets “able-bodied” beneficiaries, code for nonwhite people who sit around inventing healthcare needs. Broader attacks on other undeserving poor people will follow.

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Doktor Zoom, “Utah flies public employees to Mexico to fill prescription and isn’t that normal?” Wonkette, Jan 06, 2020

RX tourism—expect to hear more about it! “The cold equations mean that it’s literally far cheaper, by thousands of dollars, to fly teachers and office workers—plus a friend!—from Salt Lake City to San Diego, then drive ’em to Hospital Angeles, in a nice upscale part of Tijuana, instead of paying what US pharmaceutical companies would charge.” State of Utah saved $225,000 so far on only ten employee beneficiaries. Next stop: a Vancouver airport pharmacy. This is not excerpted from a science fiction novel.

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CBS NEWS [no byline], “‘You wouldn’t think you’d go to jail over medical bills’: County in rural Kansas is jailing people over unpaid medical debt,” Feb 9, 2020

Local lawyer figured out a new business plan: force medically indebted folks to show up in court every three months for a public shaming, then put them in debtors’ prison if they don’t.

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Dan Primack, “Health care VCs haven’t made plans for a Bernie Sanders win,” Axios, Feb 5, 2020

VC=venture capitalist, the guys who scratch around the economy for quick payouts. They’re not worried since Bernie can’t win.

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Martha E. Gaines, Austin D. Auleta & Donald M. Berwick, “Changing the game of prior authorization: The patient perspective,” JAMA (Journal of the American Medical Association), Feb 3, 2020  

Significant that the AMA is questioning pre-authorization abuse, including the (incredible) “retrospective denials” that saddle patients with bills after they have obtained the go-ahead.

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Megan Messerly, “Culinary Union suggests Sanders, Warren asking union members to trade health plans for ‘promises,’” Nevada Independent, Feb 7, 2020

Union officials say they support the right to healthcare but want to preserve their 130,000 members’ high-end plan, provided “through a special trust fund.” The trust fund must be enormous. Does the union run it in-house? Incidentally, the Nevada Independent is the originator of the tale of the 2016 caucus chair-tossing incident that never happened and marked the onset of the “Bernie Bro” narrative.

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STATE WATCH: GEORGIA

Steven Findlay, “Feds slow down but don’t stop Georgia’s contentious effort to ditch ACA marketplace,” Kaiser Health News, Feb 7, 2020

Georgia proposes to bar residents from the federal Obamacare health insurance exchange in favor of forced enrollment with private companies. Cost savings plan includes the possibility of a waiting list if the pre-set spending cap is reached. Insurers could also sell plans that don’t comply with ACA requirements. “For example, one proposed type of plan could cover just half of a consumer’s costs for care, as opposed to the 80% to 90% levels of ACA’s silver and gold plans. Such a plan would have lower premiums but sharply higher out-of-pocket costs.”

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STATE WATCH: TEXAS

Mitchell Schnurman, “Will voters revolt over health care prices? Texans have plenty of reason to push for change,” Dallas Morning News, Feb 9, 2020

“A growing number of Americans who have health insurance are finding it too expensive to use.” This category (the “underinsured”) is now 25% of all Americans; in Texas it’s almost 50%. “Most Americans are saying they’re ready to give up on the private sector,” said Den Bishop, president of Holmes Murphy, an insurance brokerage and consulting firm. “We’re absolutely at a tipping point.”

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STATE WATCH: OHIO

Cathy Candisky, “Cause for alarm: Thousands more Ohio children have lost health insurance,” Columbus Dispatch, Jan 6, 2020

Rates of uninsured children are creeping up, despite the low unemployment. Reasons are people earning too much to qualify for Medicaid and a “time-consuming and cumbersome” annual renewal process, plus cuts in federal outreach and enrollment assistance.

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STATE WATCH: OHIO

Laura Hancock, “State reveals $1.2 billion Ohio Benefits system riddled with defects a year out from Medicaid work requirements,” cleveland.com, Jan 16, 2020

Another software debacle. System doesn’t work; meanwhile, Ohio is gearing up to add work requirements, guaranteeing further dysfunction.

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STATE WATCH: CALIFORNIA

Melody Gutierrez, “California eyes selling its own brand of generic prescription drugs to battle high costs,Los Angeles Times, Jan 9, 2020

California would become the first state to sell its own brand of generic prescription drugs. The proposal also includes merging all state providers to negotiate drug prices as a bloc.

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STATE WATCH: TENNESSEE

Nathaniel Weixel, “Democrats warn against Tennessee Medicaid block grant,” The Hill, Jan 14, 2020

What are the chances that “vigorous oversight” will happen or be effective in the face of the huge incentive to save Medicaid block-grant money and spend it elsewhere? Block grants are inconsistent with the original Medicaid legislation, but interpretation will depend on Trump-appointed judges.

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STATE WATCH: IOWA

Jeff Stein, “Most Iowa Democratic caucus-goers support a single-payer health-care plan,” Washington Post, Feb 3, 2020

These polls bring in wildly divergent results, usually attributable to differences in phrasing of the question.

Feb 3, 2020

Terri Wilder, “Oral arguments in antitrust case against HIV drug companies began last week. Plaintiff Peter Staley explains the case,” The Body Pro, Jan 28, 2020

This week’s must-read: a lawsuit aims to discover whether Gilead illegally kept generic HIV medications off the market through a secret deal. ACT UP stalwart Staley is a plaintiff, and the article includes background on how activism scored earlier successes against Pharma. Many useful insights.

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Michael Elsen-Rooney, “Queens College professor says he fears financial ruin over cost of crucial HIV drugs under CUNY union’s healthcare plan,” New York Daily News, Nov 13, 2019

Local professor finds that a loophole in his coverage puts him on the hook for tens of thousands of dollars for his HIV medication. “I always thought having a full-time job at a big-time institution meant I had a certain kind of security around things like healthcare,” he said. ACT UP is on this.

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Rachel Cohrs, “Healthcare industry launched lobbying blitz ahead of year-end spending deal,” Modern Healthcare, Jan 24, 2020

Pharma, hospitals, and doctors spent big and scored big. “The Greater New York Hospital Association, an influential force in Senate Minority Leader Chuck Schumer’s (D-N.Y.) home state,” threw in hefty bags of cash. Schumer coincidentally intervened against the surprise billing legislation, which had bipartisan support but tanked at the last minute. Tax repeals amounting to $400 billion of lost revenue did pass, so the companies are getting huge returns on their paltry investments in elected officials.

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Jake Johnson, “Medicare for All ‘is what patients need’: New Harvard study shows even those with private insurance can’t afford care,” Common Dreams, Jan 27, 2020

Sicko by Michael Moore made the same point in 2007. The Harvard study shows financial obstacles among the insured “no improvement in unmet need for physician services.” In fact, their data indicates things have got worse.

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Rachel Cohrs, “States could be next trailblazers for policy regulating hospital costs,” Modern Healthcare, Jan 18, 2020

“The healthcare industry is worried enough that a national coalition has spent six figures advertising against [the Colorado public option] proposal.” State-level fights may be the best tactic for now in the absence of federal action. Note that the ferocious opposition is against a plan that would be run by private insurers, i.e., any change to the status quo will be resisted.

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Luke Darby, “Health-care CEOs made an infuriating amount of money last year,” GQ, Apr 8, 2020

From April, in case we had forgotten: “Last year, 62 CEOs of health-care companies made a combined total of $1.1 billion in compensation.” Or about $17 million each. Or more than the CDC spends on disease control.

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Shannon Brownlee & Judith Garber, “Fragmented health system contributes to medication overload for seniors,” Modern Healthcare, Jan 30, 2020

How overprescribing by specialists not communicating with each other endanger elderly patients.

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Melissa Healy, “US health system costs four times more to run than Canada’s single-payer system,” Los Angeles Times, Jan 8, 2020

Medical admin and insurance company employees “who play no direct role in providing patient care” cost every American man, woman and child an average of $2,497 per year. In Canada, the equivalent cost is $551 per person.

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Sam Finkelstein, “Buttigieg backed by Pharma lobbyist who sought drug price hikes in poor countries,” Sludge, Jan 30, 2020

Touting his seasoned foreign policy team, Mayor Pete failed to vet a top Pharma lobbyist on his list.

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Jake Johnson, “’Cruelty is the point’: Trump takes aim at Medicaid with plan that could harm millions,” Common Dreams, Jan 24, 2020

Trump ramping up the block grant idea to indirectly slash Medicaid.

Jan 22, 2020

Jon Queally, “In historic shift, second largest physicians group in US has new prescription: It’s Medical for All,” Common Dreams, Jan 20, 2020

A huge move toward single-payer from a major group of MDs despite a glaring inconsistency: they simultaneously endorse single-payer AND a public option, which are incompatible.

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Jonathan Cohn, “‘Medicare For All’ has real trade-offs. So does the public option,” Huffington Post, Jan 22, 2020

A fair summary of the current debates although laughably gullible on the “public option” pushed by some candidates, both in terms of its operations and its political viability. The author also slips fully into the canard that taxes must cover federal spending in the face of overwhelming contrary evidence. The conclusion is incoherent.

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Harris Meyer, “Q&A: Kansas Hospital Association CEO praises bipartisan Medicaid expansion deal,” Modern Healthcare, Jan 14, 2020

Red-state Kansas is on the verge of Medicaid expansion after years of official self-harm. “The expansion is expected to ease the rural hospital crisis in his state, where five hospitals have closed since 2010 and another 29 are on the financial brink.” Interestingly, Kansas Republicans did not insist on a punitive work requirement, citing administrative and legal obstacles. But it did include a “work readiness questionnaire” to make sure lazy & undeserving poor people don’t get a free ride.

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Luke Darby, “72 percent of all rural hospital closures are in states that rejected the Medicaid expansion,” GQ Jul 30, 2019

Background from earlier last year. Fun fact: Utah was the only red state to say yes to Medicaid expansion and has had no rural hospital closures.

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Shelby Livingston, “UnitedHealthcare expects big Medicare Advantage gains in 2020,” Modern Healthcare, Jan 15, 2020

For-profit companies eagerly infiltrate Medicare: “Given Medicare Advantage’s rapid growth and support from the federal government, it’s no wonder health insurers are clamoring for a piece of the lucrative market.”

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Dylan Scott, “Taiwan’s single-payer success story — and its lessons for America,” Vox, Jan 13, 2020

“In the 1990s, Taiwan did what has long been considered impossible in the US: The island of 24 million people took a fractured and inequitable health care system and transformed it into something as close to Sen. Bernie Sanders’s vision of Medicare-for-all as anything in the world.” Read in full for the many fascinating details, including problems of physician burnout. “A majority of people in Taiwan disapproved of the single-payer plan when it took effect,” but today, approval is 80%, and spending as a percentage of GDP is flat.

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Rachel Cohrs, “CMS rejects Wyoming plan to lower air ambulance costs,” Modern Healthcare, Jan 16, 2020

The Trump Administration suddenly discovers federal law and finds a way to prevent a state from providing a universal benefit.

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Priyanka Dayal McCluskey, “State seeks to rein in largely unregulated urgent care industry,” Boston Globe, Jan 20, 2020

New for-profit players in the health field dig in their heels against regulation.

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Ana B. Ibarra, “For 2020, California goes big on health care,” California Healthline, Jan 17, 2020

California might take the lead on forcing drug price negotiations and halting surprise bills. Howls of outrage follow.

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Alex Gangitano, “Progressives raise red flags over health insurer donations,” The Hill, Jan 16, 2020

So far in the election cycle: $4.5 million from four companies although the numbers come from not only the industry and its PACs but also “employees and their immediate families.” So it is not the same as lobbyist cash and may reflect the diverse nature of these insurers’ workforces. Nonetheless, the amounts are a reflection of the health industry’s huge role in the overall economy (currently 18% of GDP).

Jan 13, 2020

Michael Kruse, “The great American health care panic,” Politico, Oct 15, 2018

Over a year old, but could have been written yesterday. Healthcare costs are still the #1 issue on people’s (voters’) minds.

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Bryce Covert, “How Medicaid expansion is transforming politics as we know it,” The Nation, Jan 6, 2020

Medicaid expansion, i.e., enrolling people in a simplified, single-payer system without expensive premiums, deductibles, and co-pays, is extremely popular across all political viewpoints. Who knew?

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Michael Brady, “States can do more to make healthcare affordable, report says,” Modern Healthcare, Jan 7, 2020

Oregon has done best in cramming down costs through “efforts to increase price transparency, creating a permanent organization to oversee healthcare spending, establishing all-payer spending benchmarks and building out claims data for all payers.”