From Kaiser Health News

New Health Plans Expose the Insured to More Risk

March 13, 2019

One health plan from a well-known insurer promises lower premiums but warns that consumers may need to file their own claims and negotiate over charges from hospitals and doctors. Another does away with annual deductibles but requires policyholders to pay extra if they need certain surgeries and procedures.

Both are among the latest efforts in a seemingly endless quest by employers, consumers and insurers for the holy grail: less expensive coverage.

One health plan from a well-known insurer promises lower premiums but warns that consumers may need to file their own claims and negotiate over charges from hospitals and doctors. Another does away with annual deductibles but requires policyholders to pay extra if they need certain surgeries and procedures.

Both are among the latest efforts in a seemingly endless quest by employers, consumers and insurers for the holy grail: less expensive coverage.

Premiums are 15 to 30 percent lower than conventional offerings, but the plans put a larger burden on consumers to be savvy shoppers. Even with those concerns, the offerings tap into a common underlying frustration….

Read the full Kaiser Health News article

Big Pharma Gave Money To Patient Advocacy Groups Opposing Medicare Changes

March 4, 2019

Dozens of patient advocacy groups, like the Bonnie J. Addario Lung Cancer Foundation and the National Coalition for Cancer Survivorship, recently appeared in national advertisements objecting to a Trump administration proposal that could limit drugs covered by Medicare providers.

But a Kaiser Health News analysis found that about half of the groups representing patients have received funding from the pharmaceutical industry.

Dozens of patient advocacy groups, like the Bonnie J. Addario Lung Cancer Foundation and the National Coalition for Cancer Survivorship, recently appeared in national advertisements objecting to a Trump administration proposal that could limit drugs covered by Medicare providers.

But a Kaiser Health News analysis found that about half of the groups representing patients have received funding from the pharmaceutical industry.

Drugmakers funneled more than $58 million to the groups in 2015 alone, according to financial disclosures in KHN’s “Pre$cription for Power” database, which tracks the little-publicized ties between patient advocacy groups and drugmakers. As patient organizations gain ground lobbying Congress and the administration, experts have begun to question whether their financial ties could push them to put drugmakers’ interests ahead of the patients they represent….

Read the full Kaiser Health News article

Congress Squares Off With Pharma CEOs In Showdown Over High Drug Prices

February 26, 2019

Expect sparks to fly Tuesday as senators get a rare chance to grill the heads of seven major pharmaceutical companies under oath about the budget-busting prices of prescription drugs.

Expect to hear more from this committee in the coming months, including inquiries to pharmacy benefits managers, as lawmakers seek legislation to ease health care costs. But first, here’s what you should know before the hearing.

Expect sparks to fly Tuesday as senators get a rare chance to grill the heads of seven major pharmaceutical companies under oath about the budget-busting prices of prescription drugs.

Expect to hear more from this committee in the coming months, including inquiries to pharmacy benefits managers, as lawmakers seek legislation to ease health care costs. But first, here’s what you should know before the hearing.

1. Most lawmakers have taken money from drugmakers — including the senators on this committee.

The Senate Finance Committee will host executives from Pfizer, Merck, AbbVie and other drugmakers. Sen. Chuck Grassley (R-Iowa), the chairman, said he hopes the hearing will pull back the curtain on how drugmakers set prices — and how they justify the culture of secrecy surrounding those decisions….

Read the full Kaiser Health News article

For 2020 Dem Hopefuls, ‘Medicare-For-All’ Is A Defining Issue, However They Define It

February 19, 2019

Democrats with 2020 presidential aspirations are courting the party’s increasingly influential progressive wing and staking out ambitious policy platforms.

Front and center are three words: Medicare. For. All.

Democrats with 2020 presidential aspirations are courting the party’s increasingly influential progressive wing and staking out ambitious policy platforms.

Front and center are three words: Medicare. For. All.

That simple phrase is loaded with political baggage, and often accompanied by vague promises and complex jargon. Different candidates use it to target different voter blocs, leading to sometimes divergent, even contradictory ideas.

“People are talking about this as a goal, as a commitment, as a value as much as a specific program,” said Celinda Lake, a Democratic pollster….

Read the full Kaiser Health News article

Utah’s Novel Plan For Medicaid Expansion Opens Door To Spending Caps Sought By GOP

February 14, 2019

Utah this week became the 35th state to approve expanding Medicaid under the Affordable Care Act, but advocates for the poor worry its unusual financing could set a dangerous precedent and lead to millions of people losing coverage across the country.

That’s because the plan includes unprecedented annual limits on federal and state spending.

Utah this week became the 35th state to approve expanding Medicaid under the Affordable Care Act, but advocates for the poor worry its unusual financing could set a dangerous precedent and lead to millions of people losing coverage across the country.

That’s because the plan includes unprecedented annual limits on federal and state spending.

Those restrictions would be a radical change for Medicaid. Since it began in 1966, the state-federal health program for low-income residents has been an open-ended entitlement for anyone who meets eligibility criteria. State and federal spending must keep pace with enrollment.

Joan Alker, executive director of the Georgetown University Center for Children and Families, is concerned that the state and federal Medicaid funding caps can limit how many people are enrolled and what services they receive. She said no state has before tried to cap its own funding….

Read the full Kaiser Health News article