Photo by Marc Nozell

We are in the beginnings of an election year in the United States and the first primary votes to determine the Democratic nominee will be cast in the coming weeks. Healthcare costs remain a top concern for voters, and candidates have developed varying proposals to improve healthcare, reform the current system, and reduce healthcare costs in the U.S.   Independent Senator from Vermont and 2016 Democratic Presidential Candidate Bernie Sanders has long championed the ideal of single payer healthcare, often referred to as Medicare for All in the U.S. In a single payer system, the federal government fully covers every service and procedure, including dental, vision, long-term care and abortion, with no out-of-pocket charge to patients. Bernie Sanders has often claimed Medicare for All is the

only way to address deeper problems in the United States healthcare system, from medical bankruptcies to high maternal mortality rates, especially among poor and minority women. Senator Sanders has proposed allowing importing medication from abroad at lower costs and the creation of a government bureau to set drug prices based on their costs in countries like Canada, United Kingdom, and Japan. That bureau would also consider a drug’s research and development costs and federal investments that contributed to its development; if companies don't comply with the price, the government could let other companies produce the drug. Massachusetts Senator Elizabeth Warren joins Sanders in supporting a single-payer healthcare system, though has indicated that she would wait until later in her term to make such a…

President Donald Trump gave a speech about pharmaceutical drug prices last month. During his presidential campaign and leading up to his inauguration, he accused pharmaceutical companies with “getting away with murder” for what they charge patients for prescriptions and promised to enact reforms to lower drug prices. After sixteen months in office, his speech last month consisted of few proposals as opposed to proposing meaningful legislation or guidelines that could have an immediate effect on prescription costs and actually led to pharmaceutical stocks rising.   Trump took aim at Pharmacy Benefit Managers (PBMs) who he referred to as “middlemen” who implement “gag rules” that forbid pharmacists from telling patients they are spending more than they need to on a prescription (you can read our blog on the laws proposed

to combat PBM gag rules here). He also touched on other popular proposals such as removing barriers to generic medications and biosimilars from entering the market and encouraging lower prices through competition, as well as granting Medicare Part D more flexibility to negotiate prices with manufacturers.   Some new ideas did emerge from Trump’s speech: price transparency by encouraging pharmaceutical companies to include the list price of their drug in advertisements; and to somehow make foreign nations (many of which buy U.S.-made medications through direct negotiations between their governments and pharmaceutical companies) pay more. There is little evidence to support transparency in pricing will impact prescription prices; it follows a pattern of attempting to “shame” pharmaceutical companies, as the Food and…

Medicaid is the United States’ public health insurance program for people with low incomes and chronic health conditions. Medicaid covers one in five Americans; mostly children, people with disabilities, and the elderly. The Affordable Care Act (ACA; aka Obamacare) expanded Medicaid coverage to include the working poor (those who make 138% of the Federal Poverty Level or below) who do not typically have access to affordable care. Thirty-two states have implemented the ACA’s Medicaid expansion. Some states, along with the Trump administration, have pushed for imposing a work requirement for Medicaid recipients.   Of the 25 million affected by the Medicaid expansion nearly 80% live in working families, many of whom are self-employed. Close to half of working Medicaid enrollees work for small businesses which

often do not offer health coverage. Most of those who are not working report inability to work due to illness, disability, or caregiving responsibilities.   Kentucky is the first state to have the work requirement waiver approved by the Trump administration. Kentucky’s HEALTH (Helping to Engage and Achieve Long Term Health) program requires 80 hours of work, job training, or other qualified “community engagement” per month. Going to school or taking care of a child or elderly relative exempt Medicaid recipients from the new mandate. Those who do not pay their premiums for sixty days subsequently lose their coverage for six months, only to be reinstated after payment along with taking a health and financial literacy course. Under Kentucky’s HEALTH program, Medicaid enrollees pay between…

Health care in America was a constant subject of conversations in public venues and political forums in 2017. There has been confusion about health insurance, failed legislation, Executive Orders reversing Obamacare guidelines, tax plans affecting healthcare costs, and the failure to fund healthcare programs that cover millions of low-income Americans. People in the United States continue to count healthcare costs as a major concern. We at NeedyMeds prefer to remain apolitical, but it is difficult to avoid the partisan nature of the changes in health care in America since the Trump administration’s inauguration last year. Donald Trump ran on the platform of repealing the Affordable Care Act (aka ACA; Obamacare), saying it would be “so easy.” He claimed his Obamacare replacement would have “insurance for everybody” and that “Everybody’s

going to be taken care of much better than they’re taken care of now.” In practice, all “Trumpcare” bills failed to pass through Congress due to bipartisan disagreement over the destabilization they would cause in millions of Americans to losing insurance and the expected increase in premium costs.   Meaningful legislation did not affect Obamacare until Executive Orders allowing insurers to offer low-benefit insurance plans and ending subsidies to insurance companies that help cover low-income Americans. The ACA was also impacted by the tax bill passed late December 2017 that included an end to the individual mandate—a rule requiring most Americans to have health coverage designed to ensure that not only sick people buy insurance, thereby lowering premiums for everyone. Those…

This year we have been tracking the evolution of healthcare in the United States under the Trump administration, from the American Health Care Act (AHCA) and the Better Care Reconciliation Act (BCRA) bills failing to pass through Congress, the expiration of the Children’s Health Insurance Plan (CHIP) which covers 9 million children—many of whom have chronic health conditions—to Executive Orders undermining the Affordable Care Act (ACA; aka Obamacare) to the effect of destabalizing the insurance markets, causing confusion among consumers and higher premiums and out-of-pocket costs. More recently the U.S. Congress has been focused on tax reform, though critics have described efforts as a healthcare repeal disguised as a tax bill. This week the nonpartisan Congressional Budget Office (CBO) has scored the Senate’s Tax Cuts and Jobs Act bill that, if

passed, could take effect on January 1, 2018.   For those concerned with America’s growing debt, the CBO analysis finds the $1.4 trillion would be added to the federal deficit over the next decade. Critics decry raising taxes for lower-income families while lowering taxes for those who make over $100,000 annually. The primary concern to poor Americans comes from the tax bill’s effect on health care. The Senate’s tax bill repeals the Obamacare individual mandate that requires almost all Americans to have health insurance or else pay a penalty. As with all previous attempts to repeal the Affordable Care Act, the CBO has calculated that the change would cause insurance premiums to rise leading to millions losing their insurance in the…