Officials in states across the U.S. showed little interest for years about looking into the black box of pharmacy benefit managers, the pharmacy supply-chain middlemen who have been shrouded in secrecy as they pour billions of dollars worth of prescription drug rebates into state coffers.

According to a new NPR-IBM Watson Health Poll, about one in five people said they have delayed or canceled some kind of health care service, such as a doctor’s appointment or medical procedure, because of cost in the preceding three months. The proportion of people who said cost had deterred them from getting care varied by age, with a third of people under 35 saying it had been a problem compared with only 8% of people 65 and older. The cost of prescriptions also appeared to be a bigger concern for younger people, with 38% of those under 35 saying they had difficulty paying for their medicine. Only 9% of people 65 and older said they had the same problem.

Spending on prescription drugs was nearly flat during President Trump’s first year in office, according to the latest report from nonpartisan government actuaries.

In 2017, drug spending rose by 0.4 percent to $333.4 billion, the Office of the Actuaries at the Centers for Medicare and Medicaid Services reported Thursday. That was the lowest rate of growth in prescription drug spending since 2012, when it was 0.2 percent.

The slowdown in drug spending had begun in 2016, during former President Barack Obama’s final year, after rapid growth during the two previous years.

When the Medicaid expansion under the Affordable Care Act (ACA) added healthy, able-bodied adults without dependent children to the list of beneficiaries, policymakers overlooked the substantial price paid by these recipients who, as the Congressional Budget Office once forecasted, forego hourly wages and earnings in order to maintain their Medicaid eligibility. Without a work requirement for able-bodied adults to receive Medicaid, studies have shown that the program tacitly encourages such recipients to stay home and not go to work. And, as it turns out, Medicaid’s non-work incentive has some not-so-healthy consequences.

Representative-elect Alexandria Ocasio-Cortez (D-NY) supports expanding Medicare to people under 65, what’s known as single-payer or Medicare-for-all. But the big question is how to pay for all that health care. Ocasio-Cortez claimed on Twitter that $21 trillion in “Pentagon accounting errors” could have paid for 66 percent of the Medicare-for-all proposal.

 

However, that $21 trillion is not one big pot of dormant money collecting dust somewhere. It’s the sum of all transactions — both inflows and outflows — for which the Defense Department did not have adequate documentation. This means the same dollar could be accounted for many times. For this, the Washington Post gave Ocasio-Cortez four Pinocchios.

Louisiana’s legislative auditor wanted to know how the state’s expansion of Medicaid under Obamacare was doing, so he picked 100 people who were deemed eligible under the rules.

He found that 82 of them made so much money that they shouldn’t have qualified for the benefits they received.

Auditor Daryl G. Purpera, who issued his findings last month to little fanfare outside of Louisiana, figured if those statistics hold true for the rest of the expanded Medicaid population in his state, then the losses to ineligible beneficiaries could be as high as $85 million.

As health care spending continues to rise, Americans are not receiving the commensurate benefit of living longer, healthier lives. Health care bills are too complex, choices are too restrained, and insurance premiums and out-of-pocket costs are climbing faster than wages and tax revenue. Health care markets could work more efficiently and Americans could receive more effective, high-value care if we remove and revise certain federal and state regulations and policies that inhibit choice and competition.

The Trump administration on Monday urged states to scale back their certificate-of-need laws and scope of practice rules, as the executive branch promised to push back against hospital consolidations. In a sweeping 120-page report encompassing more than 50 policy recommendations, the White House blamed government and commercial insurance for putting up barriers to patients and hurting price transparency.

The Trump administration has made important progress in loosening the federal government’s grip on private health insurance, freeing up more options for affordable health insurance. But the administration has veered off this free-market track with its  recent proposal to, among other things, slap a form of imported price controls on a specific class of prescription drugs in Medicare.