California will become the first state to pay for some adults living in the country illegally to have full health benefits as the solidly liberal bastion continues to distance itself from President Donald Trump’s administration.
Democrats in the state Legislature reached an agreement Sunday afternoon as part of a broader plan to spend $213 billion of state and federal tax money over the next year. The legislature is expected to approve the deal this week. The agreement means low-income adults between the ages of 19 and 25 living in California illegally would be eligible for California’s Medicaid program, the joint state and federal health insurance program for the poor and disabled.
In one case, an insurer prevented a woman from getting a CT scan her doctor ordered. In another, a mother couldn’t afford the full regimen of special bags needed to clear her cancer-stricken daughter’s lungs. In a third case, a woman lost her health insurance and could not afford end-of-life chemotherapy.
These examples come from National Nurses United, the country’s largest nurses’ union. To prevent further incidents like these, the union favors a universal, government-run health care system. A lead editorial in the New York Times last week appeared to endorse their thinking.
If any state can serve as the poster child for the problems associated with ObamaCare’s Medicaid expansion, it’s Louisiana, which joined the expansion in 2016, after Democrat John Bel Edwards became governor. An audit released last year exposed ineligible Medicaid beneficiaries, including at least 1,672 people who made more than $100,000. But Louisiana’s Medicaid expansion has revealed another waste of taxpayer funds, both in the Pelican State and nationwide: the money spent providing coverage to people who already had health insurance.
People new to Medicare can receive their Medicare benefits through either traditional Medicare or private plans, such as HMOs or PPOs, known as Medicare Advantage plans. Older adults and younger beneficiaries with disabilities have said that they make this choice based on premiums and out-of-pocket costs, access to desired providers, the reputation of the company offering the plan, ads and other marketing materials, and the advice of brokers, family members and friends.
Transparency, though essential, is not sufficient to bring down health care costs. Nor does it always need to be legislated. Laws aren’t required to force sellers of food, computers or clothing to post prices. That information is driven by consumers who actively seek value for their money. The most compelling motivation for doctors and hospitals to post prices would be the awareness that they’re competing for price-conscious patients.
A recent study published in Health Affairs reached a controversial conclusion, that the United States should adopt socialist price schemes to reduce drug prices.
The study, “Using External Reference Pricing In Medicare Part D To Reduce Drug Price Differentials With Other Countries” argues that by matching prices with those in other countries, the United States can reduce spending in Medicare.
The proposal is not new, but it is dangerous.
The Department of Veterans Affairs on Thursday will begin allowing a broad section of its nine million enrollees to seek medical care outside of traditional V.A. hospitals, the biggest shift in the American health care system since the passage of the Affordable Care Act nearly a decade ago.
While department officials say they are ready, veterans groups and lawmakers on Capitol Hill have expressed concerns about the V.A., which has been dogged for years by problems with its computer systems. They worry that the department is not fully prepared to begin its new policy, which Congress adopted last year to streamline and expand the way veterans get care.
The Medicaid Drug Rebate Program (MDRP) was created by Congress nearly 30 years ago. It requires drug manufacturers to pay a rebate for all out-patient drugs dispensed to Medicaid beneficiaries. The percentage for this rebate varies by type of drug, with brand-name drugs requiring the greatest rebate and generics the least. In addition, the rebate must rise until it ensures that the net (of rebate) price of the drug matches the best price available to anyone in the private market. (MDRP is often referred to as the Medicaid “best price” policy.) Finally, there is an inflation penalty — an additional rebate equal to the amount by which the price increase exceeds the rate of inflation, measured by the Consumer Price Index for All Urban Consumers (CPI-U).
Two efforts are underway in the Senate to compile bipartisan packages aimed at lowering and bringing transparency to health care costs, with the goal of merging them on the Senate floor this summer:
- Senate Finance Committee Chairman Chuck Grassley (R-IA) and his Democrat counterpart, Ron Wyden (D-OR), are poised to release a drug pricing proposal by the end of the month.
- The other top health care committee — Health, Education, Labor and Pensions — is preparing for a hearing on a health care pricing package recently released by its leaders, Chairman Lamar Alexander R-TN) and Patty Murray (D-WA).
Neither package will include one singular big thing to lower health care costs for consumers. Instead, they’ll be full of smaller proposals that legislators say together could help move the needle on prices.
President Trump is expected to issue an executive order soon that could require insurers and hospitals to disclose the prices they’ve negotiated for various services. He hopes such transparency will increase competition and drive down health spending.
The health care industry is less supportive. The nation’s top health insurance lobby, for instance, claims the president’s plan is “bad transparency” that could actually cause prices to go up.