Tag Archives: consumers

House GOP health bill jettisons insurance mandate, much of Medicaid expansion

House Republicans unveiled their much anticipated health law replacement plan Monday, slashing the law’s Medicaid expansion and scrapping the mandate that individuals purchase coverage or pay a fine. But they opted to continue providing tax credits to encourage consumers to purchase coverage, although they would configure the program much differently than the current law.

The legislation would keep the health law’s provisions allowing adult children to stay on their parents’ health insurance plan until age 26 and prohibiting insurers from charging people with preexisting medical conditions more for coverage as long as they don’t let their insurance lapse.  If they do, insurers can charge a flat 30 percent late-enrollment surcharge on top of the base premium, under the Republican bill.

In a statement, House Speaker Paul Ryan (R-Wis.) said the proposal would “drive down costs, encourage competition, and give every American access to quality, affordable health insurance. It protects young adults, patients with preexisting conditions, and provides a stable transition so that no one has the rug pulled out from under them.”

The GOP plan, as predicted, kills most of the law’s taxes and fees and would not enforce the so-called employer mandate, which requires certain employers to provide a set level of health coverage to workers or pay a penalty.

Democrats quickly condemned the bill. “Tonight, Republicans revealed a Make America Sick Again bill that hands billionaires a massive new tax break while shifting huge costs and burdens onto working families across American,” House Minority Leader Nancy Pelosi tweeted. “Republican will force tens of millions of families to pay more for worse coverage — and push millions of Americans off of health coverage entirely.”

The legislation has been the focus of intense negotiations among different factions of the Republican Party and the Trump administration since January. The Affordable Care Act passed in 2010 without a single Republican vote, and the party has strongly denounced it ever since, with the House voting more than 60 times to repeal Obamacare. But more than 20 million people have gained coverage under the law, and President Donald Trump and some congressional Republicans have said they don’t want anyone to lose their insurance.

When Republicans took control of both Congress and the White House this year, they did not have an agreement on the path for replacement, with some lawmakers from states that have expanded Medicaid concerned about the effect of repeal and the party’s conservative wing pushing hard to jettison the entire law.

Sen. Rand Paul (R-Ky.), one of those favoring a full repeal, tweeted: “Still have not seen an official version of the House Obamacare replacement bill, but from media reports this sure looks like Obamacare Lite!”

Complicating the effort is the fact that Republicans have only 52 seats in the Senate so they cannot muster the 60 necessary to overcome a Democratic filibuster. That means they must use a complicated legislative strategy called budget reconciliation that allows them to repeal only part of the ACA that affect federal spending.

Beginning in 2020, the GOP plan would provide tax credits to help people pay for health insurance based on household income and age, with a limit of $14,000 per family. Each member of the family would accumulate credits, ranging from $2,000 for an individual under 30 to $4,000 for people ages 60 and higher. The credits would begin to diminish after individuals reached an income of $75,000 — or $150,000 for joint filers.

Consumers also would be allowed to put more money into tax-free health savings accounts and would lift the $2,500 cap on flexible savings accounts beginning in 2018.

The legislation would allow insurers to charge older consumers as much as five times more for coverage than younger people. The health law currently permits a three-to-one ratio.

Community health centers would receive $422 million in additional funding in 2017 under the legislation, which also places a one-year freeze on funding for Planned Parenthood and prohibits the use of tax credits to purchase health insurance that covers abortion.

Both the Energy and Commerce and Ways and Means Committees are scheduled to mark up the legislation Wednesday. The committees do not yet have any Congressional Budget Office analysis of how much the legislation would cost or how many people it would cover.

Party leaders have said they want to have the bill to President Trump next month.

In a statement, senior Democrats on both panels said the measure would charge consumers “more money for less care. It would dramatically drive up health care costs for seniors. And repeal would ration care for more than 70 million Americans, including seniors in nursing homes, pregnant women and children living with disabilities by arbitrarily cutting and capping Medicaid,” said Rep. Frank Pallone of New Jersey and Rep. Richard Neal of Massachusetts.

The House GOP plan makes dramatic changes to Medicaid, the state-federal health insurance program that covers 70 million low-income Americans. The program began in 1965 as an entitlement — which means federal and state funding is ensured regardless of cost and enrollment. But the Republican bill would cap federal funding for Medicaid for the first time.

The federal government picks up between half and 70 percent of Medicaid costs. The percentage varies based on the relative wealth of the state.

Under the GOP plan, federal funding would be based on what the government spent in the fiscal year that ended Sept. 30. Those amounts would be adjusted annually based on a state’s enrollment and medical inflation.

Currently, federal payments to states also take into account how generous the state’s benefits are and what rate it uses to pay providers. That means states like New York and Vermont get higher funding than states like Nevada and New Hampshire and those differences would be locked in for future years.

Republicans have pushed to cap federal funding to states in return for giving them more control in running the program.

The legislation also affects the health law’s expansion of Medicaid, in which the federal government provided enhanced funding to states to widen eligibility. The bill would also end that extra funding for anyone enrolling under the expansion guidelines starting in 2020. But the legislation would let states keep the extra funding Obamacare provided for individuals already in the expansion program who stay enrolled.

About 11 million Americans have gained Medicaid coverage since 2014.

Changing the expansion program is a delicate balance for the Republicans. Four GOP senators from states that took that option said Monday they would oppose any legislation that repealed the expansion.

“We are concerned that any poorly implemented or poorly timed change in the current funding structure in Medicaid could result in a reduction in access to life-saving health care services,” Sens. Rob Portman of Ohio, Shelley Moore Capito of West Virginia, Cory Gardner of Colorado and Lisa Murkowski of Alaska wrote in a letter to Majority Leader Mitch McConnell.

Provided under a creative commons license by Kaiser Health News. Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation

Vowing to jettison Obamacare, Republicans face immediate resistance and risks

The 115th Congress started work Tuesday with Republican majorities in both the House and Senate in agreement on their top priority — to repeal and replace the 2010 health law, the Affordable Care Act, also known as Obamacare.

“The Obamacare experience has proven it’s a failure,” House Majority Leader Kevin McCarthy, R-Calif., told reporters at an opening day news conference.

But that may be where the agreement among Republicans ends.

Nearly seven years after its passage, Republicans still have no consensus on how to repeal and replace the measure.

“It is risky business,” said Thomas Miller, a conservative economist and former Capitol Hill aide now at the American Enterprise Institute.

Republicans, he said at a recent AEI forum, are “very good at fire, aim, ready.” But with more than 20 million Americans getting coverage under the law, GOP lawmakers will have to tread carefully, Miller warned. “The hard one is when you’re trying to defuse what’s already been out there, cutting the wires on the bombs sequentially” so as to avoid a messy and destructive explosion.

Republicans are reportedly discussing a range of options for disassembling Obamacare, but analysts who have been involved in the intricacies of health policy for decades warn no replacement strategy will be easy.

The most immediate problem for the GOP is that even with majorities in both chambers of Congress, they do not have the 60 votes needed to overcome Democrats’ objections in the Senate. (There are 52 Republicans in the Senate now.) That means they won’t be able to pass a full repeal of the law on their own and it is unlikely eight Democrats would join to overturn President Barack Obama’s signature legislation.

Even if they did have the votes standing by, they don’t have anything teed up to replace the health law.

“It’s not that Republicans don’t have replace bills. They have a couple dozen,” said Douglas Badger, who oversaw health policy in the White House for President George W. Bush and worked for the Senate GOP leadership prior to that. “The problem is they don’t have consensus,” he said at the AEI forum.

Still, doing nothing, or even waiting, is not an option given that these lawmakers have been vowing to repeal the law almost since the day it passed in 2010.

“You have to pass something,” said Miller, “and whatever you pass you call repeal.”

The leading option under consideration is “repeal and delay.” The idea is to use the budget process to overturn the tax-and-spending parts of the law, but delaying the effective date to buy time for Republicans to agree on a replacement bill.

But there are problems with that strategy. One is political — Democrats are already crying foul.

“It’s not acceptable to repeal the law, throw our health care system into chaos and then leave the hard work for another day,” incoming Senate Minority Leader Charles Schumer, D-N.Y., said Tuesday.

Added Sen. Richard Durbin, D-Ill., “it’s not repeal and delay, it’s repeal and retreat.”

The plan also has raised concerns in the health industry. The goal of delaying the repeal date is to let people who have obtained insurance under the health law keep it while a replacement is formulated. But that is by no means guaranteed.

Insurance analysts have said that any more uncertainty in an already fragile marketplace could easily prompt insurers to leave the individual market, which would put at risk coverage for not just the roughly 10 million people who are purchasing plans there under the health law, but also the roughly 10 million people who previously had individual policies. (Another 10 million people have gained coverage under the health law through an expanded Medicaid program for those with low incomes.)

Without specific help for insurers from Congress, which would likely include insurance payments Republicans have called bailouts, “the market will begin to crumble” quickly, said Robert Reischauer, former president of the Urban Institute.

House Majority Leader McCarthy told reporters Tuesday that “no decisions have been made yet” on how Republicans might want to help stabilize the insurance market while they seek a replacement plan.

The individual insurance market could also be rattled if the incoming Trump administration decides not to appeal a lawsuit brought by congressional Republicans who argued that the Obama administration was illegally using money to pay insurers to subsidize health costs for some low-income customers buying individual plans on the health law’s marketplaces. If the new administration bows out of the suit and those subsidies, insurers would not get reimbursed for the expenses, and some analysts predict it could force companies to leave the market.

On the other hand, attempting to repeal and replace the law in a single bill also could pose problems.

Repealing and replacing together “looks less like repealing than fixing,” said Badger. “That could cause some angst” among the GOP base that wants Obamacare to be fully eliminated.

And Democrats point out that Republicans are equally guilty of overpromising the benefits of overhauling the health care system, albeit in a very different way.

The goals currently being talked about by Republicans — including making health care more affordable, covering more people, reducing government spending and giving states more flexibility — “are impossible to achieve,” within acceptable GOP budget limits, said Reischauer at the AEI event. “There are going to have to be some tradeoffs,” he said, as Democrats found when they tried to accomplish roughly those same goals.

Made available from Kaiser Health News under a creative commons agreement. KHN is a national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.

Doctors, hospitals say ‘show me the money’ before treating patients

Tai Boxley needs a hysterectomy. The 34-year-old single mother has uterine prolapse, a condition that occurs when the muscles and ligaments supporting the uterus weaken, causing severe pain, bleeding and urine leakage.

Boxley and her 13-year-old son have health insurance through her job as an administrative assistant in Tulsa, Oklahoma. But the plan has a deductible of $5,000 apiece, and Boxley’s doctor said he won’t do the surgery until she prepays her share of the cost. His office estimates that will be as much as $2,500. Boxley is worried that the hospital may demand its cut as well before the surgery can be performed.

“I’m so angry,” Boxley said. “If I need medical care I should be able to get it without having to afford it up front.”

At many doctors’ offices and hospitals, a routine part of doing business these days is estimating patients’ out-of-pocket payments and trying to collect it up front.

Eyeing retailers’ practice of keeping credit card information on file, “there’s certainly been a movement by health care providers to store some of this information and be able to access it with patients’ permission,” said Mark Rukavina, a principal at Community Health Advisors in Chestnut Hill, Massachusetts, who works with hospitals on addressing financial barriers to care.

But there’s a big difference between handing over a credit card to cover a $20 copayment versus suddenly being confronted with a $2,000 charge to cover a deductible, an amount that might take months to pay off or exceed a patient’s credit limit. Doctors may refuse to dispense needed care before the payment is made, even as patient health hangs in the balance.

The strategy leaves patients financially vulnerable. Once a charge is on a patient’s credit card, they may have trouble contesting a medical bill. Likewise, a service placed on a credit card represents a consumer’s commitment that the charge was justified, so nonpayment is more likely to harm a credit score.

Approximately three-quarters of health care and hospital systems ask for payment at the time services are provided, a practice known as “point-of-service collections,” estimated Richard Gundling, a senior vice president at the Healthcare Financial Management Association, an industry group. He could not say how many were doing so for higher priced services or for patients with high-deductible plans, situations that would likely result in out-of-pocket outlays of hundreds or thousands of dollars.

“For providers, there’s more risk with these higher deductibles, because the chance of being able to collect it later diminishes,” Gundling said.

But the practice leaves many patients resentful.

After arriving by ambulance at the emergency department, Susan Bradshaw lay on a gurney in her hospital gown with a surgical bonnet on her head, waiting to be wheeled into surgery to remove her appendix at a hospital near her home in Maitland, Fla. A woman in street clothes approached her. Identifying herself as the surgeon’s office manager she demanded that Bradshaw make her $1,400 insurance payment before the surgery could proceed.

“I said, ‘You have got to be kidding. I don’t even have a comb,’” Bradshaw, a 68-year-old exhibit designer, told the woman on that night eight years ago. “I don’t have a credit card on me.”

The woman crossed her arms and Bradshaw remembers her saying, “You have to figure it out.”

As providers aim to maximize their collections, many contract with companies that help doctors and hospitals secure payments up front, often providing scripts that prompt staff to talk with patients about their payment obligations and discuss payment scenarios as well as software that can estimate what a patient will owe.

But as hospitals and doctors push for point-of-service payments to reduce bad debt from patients with increasingly high deductibles, the risk is that patients will delay care and end up in the emergency room, Rukavina said. “Patients are essentially paying for their procedures up front,” he said. “It may not be a significant amount compared to their salary, but they don’t necessarily have it available at the time of service.”

The higher their deductible, the less likely patients are to pay what they owe, according to an analysis of 400,000 claims by the Advisory Board, a health care research and consulting firm. While more than two-thirds of patients with a deductible of less than $1,000 were likely to pay at least some portion of what they owe, just 36 percent of those with deductibles of more than $5,000 did so, the analysis found.

Fifty-one percent of workers with insurance through their employer had a deductible of at least $1,000 for single coverage this year, according to the Kaiser Family Foundation’s annual survey of employer health insurance. (KHN is an editorially independent program of the foundation.)

Boxley pays $110 a month for her family plan. She could not afford the premiums on plans with lower deductibles that her employer offered. She plans to talk with the doctor and hospital about setting up a payment plan so she can get the surgery in January.

“I’ll make payments,” Boxley said, although she acknowledged what she could pay monthly would be small. If that doesn’t pan out, she figures she’ll have to use student loan money she got for graduate school to cover what she owes.

Still, experts say that trying to pin patients down for payment in more acute settings, such as the emergency department, may cross a line.

Under the federal Emergency Medical Treatment and Labor Act (EMTALA), a patient who has a health emergency has to be stabilized and treated before any hospital personnel can discuss payment with them. If it’s not an emergency, however, those discussions can occur before treatment, said Dr. Vidor Friedman, an emergency physician who is the secretary-treasurer of American College of Emergency Physicians’ board of directors.

Bradshaw finally got her appendix removed by calling a friend, who read his MasterCard number over the phone. The surgery was uneventful and Bradshaw was home within 24 hours.

“It’s a very murky, unclear situation,” Friedman said of Bradshaw’s experience, noting that a case might be made that her condition wasn’t life threatening. “At the very least it’s poor form, and goes against the intent if not the actual wording of EMTALA.”

Please visit khn.org/columnists to send comments or ideas for future topics for the Insuring Your Health column.

Published courtesy of Kaiser Health News.

Obama administration announces rule to deal with illegal fishing, seafood fraud

The Obama administration on Dec. 8 issued a final rule to implement the Seafood Import Monitoring Program to address illegal fishing and seafood fraud in the United States.

This rule will require imported seafood at risk of illegal fishing and seafood fraud to be traced from the fishing boat or farm to the U.S. border, helping to stop illegally caught and mislabeled seafood from entering the United States.

This is a statement by Oceana senior campaign director Beth Lowell:

Today’s announcement is a groundbreaking step towards more transparency and traceability in the seafood supply chain. We applaud President Obama for his ambitious plan to require traceability for imported seafood ‘at-risk’ of illegal fishing and seafood fraud.

For the first time ever, some imported seafood will now be held to the same standards as domestically caught fish, helping to level the playing field for American fishermen and reducing the risk facing U.S. consumers.

But the problem doesn’t stop here. We must continue to build on this important work and expand seafood traceability to include all seafood sold in the U.S. and extend it throughout the entire supply chain.

Without full-chain traceability for all seafood, consumers will continue to be cheated, hardworking, honest fishermen will continue to be undercut, and the long-term productivity of our oceans will continue to be in jeopardy.

American consumers deserve to know more about their seafood, including what kind of fish it is, and how and where it was caught or farmed. While Oceana celebrates today’s announcement, there’s still more to do in the fight against illegal fishing and seafood fraud.

 

About Oceana…

Oceana’s investigations of fish, shrimp, crab cakes and most recently salmon, in retail markets and restaurants found that, on average, one-third of the seafood examined in these studies was mislabeled — the product listed on the label or menu was different from what the buyer thought they purchased, often a less desirable or lower-priced species. Oceana has observed threatened species being sold as more sustainable, expensive varieties replaced with cheaper alternatives and fish that can cause illness substituted in place of those that are safer to eat.

In September, Oceana released a report detailing the global scale of seafood fraud, finding that on average, one in five of more than 25,000 samples of seafood tested worldwide was mislabeled. In the report, Oceana reviewed more than 200 published studies from 55 countries, on every continent except Antarctica, and found seafood fraud in 99.9 percent of the studies. The studies reviewed also found seafood mislabeling in every sector of the seafood supply chain: retail, wholesale, distribution, import/export, packaging/processing and landing.

The report also highlighted recent developments in the European Union to crack down on illegal fishing and improve transparency and accountability in the seafood supply chain. According to Oceana’s analysis, preliminary data out of the EU suggests that catch documentation, traceability and consumer labeling are feasible and effective at reducing seafood fraud.

For more information about Oceana’s campaign to stop seafood fraud, please visit www.oceana.org/fraud.

Costs of widely prescribed drugs jumped up to 5,241 percent in recent years

Jess Franz-Christensen did not realize the seriousness of her son’s Type 1 diabetes diagnosis until staff in the doctor’s office offered to call an ambulance to take him to the hospital.

Her next shock: The cost of Jack’s medicines.

The drugs, administered through an insulin pump, cost $1,200 a month.

“We’re really fortunate. We’re able to pay for stuff,” said Franz-Christensen, whose husband, Scott, is a physicist, while she stays home to care for Jack, 8, and their daughter, Kendall, 11.

“But there are people who are making decisions whether to feed their kid or get test strips — whether to pay rent or get a vial of insulin. It’s heart-breaking.”

Prices for insulin products have nearly doubled in recent years, including Lantus SoloSTAR — one of the drugs that Medicaid and Medicare spent the most on in 2015. Its price increased by 81.5 percent between 2011 and 2014, according to data analyzed by the Wisconsin Center for Investigative Journalism. The data were provided by California-based First Databank, a supplier of U.S. commercial drug pricing information.

The costs of seven widely prescribed antibiotics, cancer drugs, arthritis medications and other prescriptions have escalated between 29 percent and 5,241 percent in recent years, according to a joint investigation by the Wisconsin Center for Investigative Journalism, Wisconsin Health News and Wisconsin Public Radio.

The investigation examined the impacts of and reasons behind the overall rise in prescription costs, including drug price increases since 2011, using proprietary First Databank data.

Overall, the price of insulin nearly tripled between 2002 and 2013, prompting calls this month for a federal investigation by former Democratic presidential candidate Sen. Bernie Sanders from Vermont.

“They (drug companies) are making billions and billions of dollars on people who literally can’t afford it,” said Franz-Christensen, who has joined #MyLifeIsNotForProfit, a national grassroots parent movement.

Recent nationwide news coverage has focused on the rising cost of EpiPens, which counteract potentially fatal allergic reactions to peanuts, bee stings and other triggers. But the $600 cost for a two-pack of that medicine is just one example of lifesaving drugs with skyrocketing prices.

Synthroid, which is used to treat hypothyroidism, is the most commonly prescribed medication in the United States and has been on the market for more than 60 years. In just the past six years, it has nearly doubled in price, according to the Center’s analysis. The generic version of Synthroid, levothyroxine, has gone from 14 cents to 46 cents per pill, an increase of 231 percent between 2011 and 2016, the analysis shows.

A single two-week dose for Humira, a medication that treats conditions including rheumatoid arthritis, has increased 129 percent since 2011, to $2,000, according to First Databank data analyzed by the Center.

The price increases, which continue to mount, place economic and emotional pressure on patients and their families, squeeze the budgets of health care providers and raise costs for taxpayers in Wisconsin and nationwide, the joint investigation found.

Lack of competition raises costs

Spending on medications is rising for a variety of reasons:

  • Some pharmaceutical companies have taken action to extend the patent protections on their products, blocking cheaper generic versions from being developed.
  • As some companies stop making certain low-cost drugs, other companies gain monopolies over the market.
  • Companies are introducing more high-cost “speciality” drugs that treat lifelong conditions.
  • As the nation’s population ages, the demand for prescription drugs increases; more than half of Americans now use them.

In one practice known as “product hopping,” a company makes changes to a drug to extend its patent protections, keeping others from entering the market with cheaper alternatives.

Wisconsin Attorney General Brad Schimel filed an antitrust lawsuit in September alleging that the makers of Suboxone, a drug used to treat opiate addiction, changed the product from a tablet to a film that dissolves in the mouth to block alternatives and “maintain monopoly profits.”

Drug maker Indivior said it takes “these allegations seriously” and “intends to defend this and other related actions.”

“As long as drugs are on patent protection, manufacturers at that point have monopoly pricing ability and they can price their products at levels that the market will bear,” said Chuck Shih, who leads Pew Charitable Trusts’ specialty drugs research initiative.

In addition, as competitors drop out of the market, the remaining companies are “raising prices significantly and earning substantial profits,” said Larry Levitt, senior vice president for special initiatives at the California-based Kaiser Family Foundation.

The price jumps have caught the attention of Congress, which held hearings after Turing Pharmaceuticals increased the price of a drug that treats toxoplasmosis — an illness that can cause brain damage, blindness, miscarriage or birth defects — by 5,000 percent shortly after acquiring it.

The increase in the price of EpiPens has also drawn congressional scrutiny. Between 2010 and 2016, the price has more than quadrupled, according to data from First Databank.

Seventeen senators, including Democratic Wisconsin Sen. Tammy Baldwin, sent a letter to EpiPen maker Mylan in early November asking for more pricing information. The senators said the skyrocketing prices were raising costs for taxpayers and jacking up insurance premiums.

Lawmakers on the state and federal level are calling for new regulations to rein in drug prices. A dozen states have enacted laws requiring greater transparency in drug pricing and other measures, but no state has enacted price controls.

California voters rejected a proposal earlier this month to implement their own price control system, which would require state agencies to pay the same rates negotiated by the U.S. Department of Veterans Affairs. The two sides poured more than $100 million into the effort, most of it from pharmaceutical companies opposed to the measure.

Holly Campbell, spokeswoman for the Pharmaceutical Research and Manufacturers of America, attributed the increase in EpiPen prices to a U.S. Food and Drug Administration backlog in approving new generics and a “lack of competition” in the market.

Working poor hit hard

For those without insurance or who cannot afford their share, the rising cost of medications has left them facing hard choices.

Kathryn Drexler, a registered nurse and certified diabetic educator at the free Living Healthy Community Clinic in Oshkosh, said some of her patients ration their insulin. So many are asking the clinic for medication help “that it’s draining our budget,” she said.

“I think it’s hitting the working poor the hardest,” Drexler said. “They can’t afford their co-pays, and they can’t afford insulin out of pocket.”

Free clinics provide care and drugs to the roughly 323,000 people, or 5.7 percent of state residents who lack insurance, as well as some people who are underinsured. And while drug companies offer free prescriptions to certain low-income people with no insurance, generic medications — which comprise eight out of every 10 prescriptions — do not qualify.

University of Wisconsin pediatric endocrinologist Dr. Ellen Connor said the price increases have thrown some of her patients into despair.

“Families — this is what they agonize over,” Connor said. “They lose sleep over it. I have parents sobbing in the office over this. They feel like failures because they had lost jobs and couldn’t afford $500 of medications a month. It breaks your heart.”

For the insured, drug price hikes have contributed to higher deductibles and co-pays, said Dr. Tim Bartholow, chief medical officer for the not-for-profit insurer WEA Trust in Madison.

The price increases are hitting hospitals too, costing University of Wisconsin Hospitals and Clinics an additional $14 million in the past year, according to Steve Rough, pharmacy director.

Rough noted large increases among generic drugs with no competitors.

“I call it generic price-jacking, where companies purchase the rights to a low-cost generic drug that is routinely used in the care of many patients, just for the sole purpose of raising the price to make money, because they can,” he said.

Taxpayers left with hefty tab

Prescription drugs are a growing portion of health care spending nationwide, accounting for 16.7 percent or $457 billion of total U.S. health care spending in 2015 — about double the percentage from the 1990s, according to a report released in March.

The U.S. Department of Health and Human Services report found the number of prescriptions is rising, but most of the spending growth is due to rising prices and a shift toward more expensive medications.

The state’s Medicaid program — which receives both federal and state funding — spent $329.4 million in the fiscal year between July 2011 and June 2012 on prescription drugs, according to the Legislative Fiscal Bureau. By July 1 of this year, annual spending had grown to $427.7 million — a 30 percent increase. The amount can vary year to year because of rebates the program receives from drug manufacturers.

Elizabeth Goodsitt, Wisconsin Department of Health Services spokeswoman, said the program has taken numerous steps to address growing costs, such as requiring patients to get prior approval before receiving more expensive medications.

Meanwhile, a September poll from the Kaiser Family Foundation found that 55 percent of Americans nationwide reported taking prescription drugs. About 26 percent of them — or 14 percent of the U.S. population — found it somewhat or very difficult to pay the cost of their prescription medication.

Even generics now too expensive

Paul Hoffmann, manager of the Bread of Healing Clinic in Milwaukee, said his free clinic can no longer afford to provide some generic medications.

“I’ve been a pharmacist for 35 years, and this is a phenomenon that we never saw,” Hoffmann said. “All these long-standing generics that have been generic for some 20, 30 years are going up in astronomical prices.”

He cited doxycycline, used to treat infections. First Databank figures show the price skyrocketed by 12,024 percent from 2011 to early 2013 because of drug shortages. The price has dropped, but the antibiotic is still 5,240 percent higher than in 2011 — or more than 50 times more expensive.

Lawmakers eye transparency initiatives

Some state lawmakers are looking for ways to curb drug prices. Rep. Debra Kolste, D-Janesville, plans to introduce legislation next year requiring the Office of the Commissioner of Insurance to collect information about the cost of drugs to public health care programs and develop a strategy to reduce prices.

Meanwhile, Baldwin has co-authored a bill at the federal level requiring pharmaceutical companies to submit a report to the federal government a month before increasing a product’s price by 10 percent or more.

PhRMA spokeswoman Campbell called the proposal “a thinly veiled attempt to build a case for government price setting.”

But observers say the conversation around drug pricing has changed.

“You have these very high profile seemingly outrageous price hikes that have focused the attention of policymakers in a way that I haven’t seen before,” said Levitt, of the Kaiser Family Foundation. “There’s a window where we could see some policy changes.”

Franz-Christensen hopes Congress will fix the problem.

“The people that can’t afford it, they’re so overwhelmed,” she said. “They can’t fight. … If it’s hard for us, people who have everything, imagine the people who don’t.”

Cara Lombardo and Andrew Hahn of the Wisconsin Center for Investigative Journalism contributed to this report.

Sean Kirkby reports for Wisconsin Health News, an independent, nonpartisan, online news organization serving Wisconsin health care professionals and decision makers. Dee J. Hall is managing editor of the Wisconsin Center for Investigative Journalism. Bridgit Bowden is a reporter for Wisconsin Public Radio. The nonprofit Center (www.WisconsinWatch.org) collaborates with WPR, Wisconsin Public Television, other news media and the University of Wisconsin-Madison journalism school. All works created, published, posted or disseminated by the Center do not necessarily reflect the views or opinions of UW-Madison or any of its affiliates.

Farmers, consumers want new management of organic program

Wisconsin-based Cornucopia Institute delivered to the USDA more than 5,000 letters from farmers and consumers calling for new management of the National Organic Program.

The food and farm policy research group collected the letters from concerned organic advocates across the country.

“This is one more indication of the growing dissatisfaction with deputy Administrator Miles McEvoy’s direction and oversight of the rapidly growing organic industry,” said Mark Kastel, Cornucopia’s senior farm policy analyst.

The Cornucopia Institute, along with many other public interest groups, has been critical of what they describe as a “corporate takeover” of the regulatory process that Congress designed specifically to protect organic rulemaking from the influence of agribusiness lobbyists.

“Under the direction of deputy Administrator McEvoy, the independence of the National Organic Standards Board, an expert policy panel convened by Congress to act as a buffer between lobbyists, like the powerful Organic Trade Association, and USDA policymakers has been seriously undermined,” said Dr. Barry Flamm, a Montana farmer, scientist and past chairperson of the NOSB.

In the cover letter to USDA Secretary Tom Vilsack, the organization cited several areas where it says the USDA management is failing. These include:

A lack of enforcement activities on major fraud and alleged violations of organic regulations occurring with “factory farm” livestock activities — all cloaked in secrecy.

Ignoring the questionable authenticity of the flood of organic imports coming into this country from China, India, a number of former Soviet Bloc states and Central America that have effectively shut American organic grain farmers out of the U.S. market.

Allowing, in violation of the law, giant industrial-scale soilless production of organic produce (hydroponic and other management systems), along with ignoring NOSB prohibitions on nanotechnology, using conventional livestock on organic dairies, and other issues.

Usurpation of NOSB governance and authority by USDA/NOP staff and other violations of the Organic Foods Production Act (Cornucopia has a federal lawsuit being adjudicated that charges the USDA with appointing agribusiness executives to the NOSB in seats Congress had specifically earmarked for stakeholders who “own or operate an organic farm”).

Unilateral changes to the Sunset review process for synthetic and non-organic materials, making it difficult for unnecessary or harmful substances to be removed from organics when agribusinesses lobby for them (the USDA is currently involved in litigation with Cornucopia and other stakeholders on this Sunset issue).

“We want organics to live up to the true meaning envisioned by the founders of this movement,” Kastel said. “For both organic farmers and organic consumers, that means sound environmental stewardship, humane animal husbandry, wholesome and nutritious food derived from excellent soil fertility, and economic justice for those who produce our food. The USDA needs to act to preserve consumer trust in the organic label.”

Due in part to the issues that Cornucopia is spotlighting, Consumer Reports has downgraded the credibility of the USDA organic label from its previous top-tier ranking.

 

Congress fights for consumers’ right to leave negative reviews

Congress is defending your right to Yelp.

Legislation in Congress would ensure that customers who want to post negative reviews on websites like Yelp or TripAdvisor can do so without legal repercussions. That’s in response to some businesses that have made customers sign non-disparagement clauses and then sued if a bad review showed up.

Supporters say the legislation is needed to ensure freedom of speech in a growing online economy.

“A lot of Americans, particularly in my generation, use those reviews,” says 35-year-old Rep. Joe Kennedy, D-Mass. “You look at good reviews and you look at bad reviews and both of those are very important.”

In one case, a Dallas couple was sued by a pet-sitting company for up to $1 million after giving the company a one-star review on Yelp and complaining that their fish had been overfed. The case was dismissed last month.

The bipartisan legislation, which the House passed last week, was sponsored by Kennedy and Republican Rep. Leonard Lance of New Jersey. Kennedy, who represents Needham, Mass.-based TripAdvisor, says fair reviews are important to build the strength of the so-called “sharing economy” that allows consumers to exchange products, services and ideas.

Laurent Crenshaw, director of Public Policy for San Francisco-based Yelp, says the company has been trying to advocate for better protection for its users, including efforts to avert negative reviews with non-disparagement clauses.

“Unfortunately, some have decided to try to intimidate and silence negative speech,” says Crenshaw. He says the bill “will give consumers all across the country clarity that they are protected from these types of clauses.”

A Senate version of the legislation passed last year, and it is similar but not identical to the House bill, so the two will have to be reconciled before it heads to the president’s desk. Both bills would ban business contracts for goods or services that don’t allow negative or truthful reviews and give the Federal Trade Commission enforcement over the issue.

South Dakota Sen. John Thune, the Republican chairman of the Senate Commerce Committee, said he hopes that they can move soon on the bill.

“We’re close to ending unfair gag clauses that can intimidate consumers away from telling the truth about their purchase experiences,” Thune said.

Ellen Schrantz of the Internet Association, a trade group that represents companies like Yelp, TripAdvisor and Amazon, says it’s impossible to know how many people have been penalized by businesses for negative reviews after unknowingly signing contracts that banned them. She says reviews are necessary so average businesses can connect and grow.

“Without protecting that you’re not only looking at free speech issues, but massive economic issues,” she said.

In a related matter in California, Yelp is asking the state Supreme Court to overturn a lower court’s ruling that asked the company to remove some negative reviews of a law firm, saying it could set a precedent for the removal of other negative reviews and leave consumers with a skewed assessment of restaurants and other businesses. The firm has said the reviews are defamatory.

While the non-disparagement clauses are still legal, Yelp is trying to let users know about them. The company is now tagging some companies’ Yelp pages with a warning: “This business may be trying to abuse the legal system in an effort to stifle free speech, including issuing questionable legal threats against reviewers. As a reminder, reviewers who share their experiences have a First Amendment right to express their opinions on Yelp.”

 

Greenpeace: Majority of consumers think manufacturers should recycle mobiles

Consumers say mobile phone manufacturers are releasing too many new models, according to a survey Greenpeace commissioned across six countries.

In all countries surveyed, consumers were most likely to say that mobile phone manufacturers should be responsible for providing people with the means to recycle their phones, while four in five surveyed said that it was important that a new smartphone can be easily repaired if damaged.

“The humble smartphone puts enormous strain on our environment from the moment they are produced — often with hazardous chemicals — to the moment they are disposed of in huge e-waste sites,” said Chih An Lee, Global IT Campaigner at Greenpeace East Asia.

“Over half of respondents across the countries surveyed agree that manufacturers are releasing too many new models, many designed to only last a few years. In fact, most users actually want their phones to be more easily dismantled, repaired and recycled.”

Mobile phones are some of the most frequently replaced of all small electronics products.

A United Nations University report in 2014 showed that up to 3 million metric tonnes of e-waste is generated from small IT products, such as mobile phones and personal computers. This represents a massive waste of resources and a source of contamination from hazardous chemicals.

Key findings from the survey:

  • Chinese (66 percent) and South Korean respondents (64 percent) are more likely to have ever had their phones repaired, compared to those in the US (28 percent) and Germany (23 percent).

  • Nearly half surveyed believe that mobile phone manufacturers should be most responsible for making recycling accessible. This sentiment was strongest in Germany (61 percent).

  • Except in Germany (86 percent), over 90 percent of respondents surveyed in all countries said that “designed to last” is an important feature of a new smartphone.

  • Four in five respondents consider it important that a new smartphone is not produced using hazardous chemicals.

  • Four in five respondents believe it is important for a new smartphone to be easily repaired if damaged.This rises to as high as 95 percent in China, 94 percent in Mexico and 92 percent in South Korea.

  • Apart from respondents in South Korea, the most common reason for replacing their last phone was the desire for a more up-to-date device.

“We believe true innovation means gadgets designed to last, to be repaired and recycled. It is time for tech leaders to rethink the way they make our electronics so that they are as innovative for our planet as they are for our lives,” said Lee.

“If tech brands want to lead us into the future, they need to move towards closed-loop production and embrace the circular economy; something that can be good for their profits, for people and for the planet.”

Greenpeace East Asia conducted the survey as part of its True Innovation campaign, which challenges the technology sector to embrace innovation to protect our environment and our future.

Pop or fizzle: Are soda taxes gaining steam?

A sip of soda will become more expensive next year in Philadelphia, which recently became the second city in the United States to pass a tax on sugary beverages — after Berkeley voters passed one in 2014.

The Philadelphia measure, approved by the City Council in June, could lend momentum to efforts by public health advocates to get similar taxes enacted elsewhere around the nation.

Voters in three Northern California cities — San Francisco, Oakland and Albany — will decide in November whether to approve such taxes. A soda tax initiative in San Francisco in 2014 failed to get the two-thirds vote needed to pass.

Several states also have tried and failed to pass soda taxes. In California, a bill to do so died this spring.

Outside of the United States, Mexico, England and France also tax sugar-laden beverages.

Advocates of taxing these drinks say that they contribute to high rates of obesity and diabetes, and that putting a bigger price tag on them can reduce consumption and improve people’s health. Critics argue the taxes are unpopular and that it is discriminatory to single out one item in the grocery cart.

The American Beverage Association, one of the staunchest opponents of soda taxes, has funded successful opposition campaigns throughout the United States, including in California.

The association has spent $64.6 million since 2009 fighting such initiatives — including more than $9 million just to defeat the proposed San Francisco tax in 2014, according to a report last year by the Center for Science in the Public Interest, a Washington, D.C.-based advocacy group. Coca-Cola and Pepsi have also been big contributors to the opposition.

Lauren Kane, a spokeswoman for the beverage trade group, said there is no evidence that soda taxes make anyone healthier. “Obesity has been rising … while soft drink consumption has been declining,” she said. “It would defy logic to say that soft drink consumption is driving obesity.”

Overall, soda sales dropped 1.2 percent in 2015, according to Beverage Digest, which tracks the industry, continuing a downward trend.

Kane added that taxing any grocery item is a “slippery slope” that makes other groceries vulnerable to taxation.

To hear more about the campaigns for soda taxes, we spoke with Harold Goldstein, executive director of California-based Public Health Advocates, who has played an active role in some of these efforts. A transcript of the conversation below has been edited for clarity and space.

Q: What are the health and medical effects of drinking too many sugar-sweetened beverages?

It is now proven that sugary beverages are a leading contributor to obesity, diabetes and heart disease. When we consume liquid sugar, the body converts much of that sugar to fat in the liver, causing fatty liver disease. We now have an epidemic in this country of fatty liver disease.

There are studies showing, for example, if you drink two sodas a day for just two weeks, that your unhealthy cholesterol, your LDL cholesterol, will go up 20 percent and that your triglycerides will go up 20 percent. If you drink that amount for six months, the amount of fat in your liver will go up 150 percent. This is a dramatic impact in a short period of time because our bodies are not designed to consume liquid sugar.

Q: How big is the problem of obesity and diabetes in the U.S.?

The obesity and diabetes epidemics are among the most fundamental public health problems facing our country today. They impact every demographic group. At the same time, they are a particular problem in low-income communities and communities of color, in large part because it’s in those communities where there is the least access to healthy food and the least access to opportunities to be physically active.

We know that diabetes rates are going to increase by 80 percent in the next five years, costing the state $15 billion more in direct health care costs. With that kind of money on the table … it is imperative that we invest in diabetes prevention. Whether it is through a soda tax, through the state legislature or state general funds, it is time to establish a major statewide diabetes prevention campaign in California.

Q: A recent report by your organization and the UCLA Center for Health Policy Research found that more than half of Californians have either diabetes or prediabetes. Aside from sugar-sweetened beverages, what else is causing this?

We have created a world that is designed for diabetes. We have fast food outlets on every corner. We have staggering portion sizes of sugary beverages and restaurant meals and everything from bagels to burgers. We have gotten rid of [physical education] in schools. We allow unregulated advertising of unhealthy products to children.

Q: Why target sugary beverages and not other junk food?

A: If you eat a candy bar, it takes hours to digest it. The liquid sugar is just floating sugar molecules and we absorb that sugar in as little as 30 minutes. The research is continuing to show that sugar itself is a particular problem, and perhaps the biggest problem. We know that the body turns sugar into fat. [Soda] is the right place to start. It represents half of the sugar in the food supply, it is the largest source of sugar and our body treats it differently.

Q: In Philadelphia, the mayor argued for the new tax based on the revenue it would bring in, rather than the health risks of soda. Do you think that helped get it approved?

I think different communities are going to support soda taxes for different reasons, in large part based on what the funds are going to be used for. In Berkeley, the revenues go into the general fund. City council members wanted that money to be dedicated to obesity and diabetes prevention efforts, as they have done. That was something clearly important to voters in Berkeley. In Philadelphia, the funds are dedicated to a variety of things, especially pre-K [education] in low-income communities and parks and rec programs. It is important that through this democratic process, residents get to decide how they want to use the revenues raised by such a tax.

Q: The effort to pass a soda tax in California died in committee this spring. Can you explain what the bill would have done and what happened to it?

The bill would have established a 2 penny-per-ounce fee on sugary beverages. As a fee, it would have required that all the revenues raised be dedicated to mitigating harm caused by those products. As has happened now five times in the state legislature, the beverage industry put their corporate might behind their lobbying efforts and successfully killed the bill.

Q: How difficult is it to overcome opposition by the soda industry?

What we are learning is that it’s far easier to enact soda taxes at the local level than at the state level in California. The beverage industry has enormous power in the state Legislature. And getting it passed in California requires a two-thirds vote in the legislature, which is a big hurdle. Other states don’t have that hurdle. There are a number of states that are currently working on it in one way or another.

Q: Critics say that soda taxes won’t reduce obesity rates and give government too much control over consumer choice. What do you think about the argument that this might not be the best way to address diabetes and obesity?

Soda taxes are one way to address the diabetes and obesity epidemic. What has been shown in Berkeley and Mexico, where the tax has now been in effect for quite some time, is that those taxes reduce consumption of sugary beverages, which we know are a leading contributor to the epidemic.

At the same time, those taxes provide funds to pay for much needed programs in communities. Soda taxes aren’t the end-all and be-all of obesity and diabetes prevention. There is a lot more that can and needs to be done to address the epidemic.

Q: As public health advocates like yourself work to reduce access to these beverages, what sort of alternatives are you promoting?

The biggest solution is to encourage and support people to drink water instead of sugar. It is the simplest, easiest change that any of us can make to reduce our chance of getting diabetes. Sixteen teaspoons of sugar in every 20-ounce beverage is way more than our body can handle and still be healthy.

Q: Will there be another try to get a statewide tax in California?

I am sure there will be, with Philadelphia passing theirs. One or more of the soda taxes in the Bay Area are likely to pass. I think that in the coming years, states around the country will also establish soda taxes.

Published from Kaiser Health News under a creative commons license. KHN is a national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.

After firing, popular Wal-Mart checker becomes star

A month ago, Frank Swanson was a checker, pretty much a lifer, at Wal-Mart in West Plains, Missouri.

He’s 52, disabled and long known for smiles and hugs. Shoppers loved him. They would purposely get in his line because they wanted to visit with Frank.

But then came April 2, the day of the gallon jug of Red Diamond Sweet Tea and the end of Frank the checkout guy.

Turned out all those hugs and a keen memory for grocery prices made for a volatile cocktail. At least in the way the big-box corporate world played out in this small Ozarks town.

Frank got fired that day. Since then, 800 or so people have attended a rally for him in the store’s parking lot, his name has bounced around social media all over the world, somebody held up a sign with Frank’s name at an Atlanta Braves baseball game, and Jimmy Fallon gave him a shoutout on “The Tonight Show.”

Frank’s termination could be headed to court, and Wal-Mart had to issue a statement explaining to West Plains what happened to the town’s favorite checker.

All this because a woman in Frank’s line that day wanted to buy a gallon of the sweet tea. She told Frank a store in a neighboring town had a sale price that Wal-Mart was supposed to match.

She didn’t have the ad, as required, but she didn’t need it with Frank. He’d always made it a point to keep up with prices at other stores, so he let her have it at the sale price.

That got Frank called in and fired after nearly 20 years.

“The bosses said I made up an imaginary price,” he said.

Frank went to Willow Springs and got an issue of a local paper that showed he was right about the price of tea.

For the record, the other store had the tea on special for $1.98. Wal-Mart’s price: $2.78.

Frank has always had a knack for remembering things. Like the day as a boy when he fell out the back of his grandpa’s pickup after cutting a load of firewood. He suffered paralysis and brain damage.

“Sometimes grandpa would go slow, and sometimes he would go fast,” Frank said.

He said he had stopped hugging customers after he was told to do so. But then people asked if they could hug him.

Wal-Mart issued this statement about Frank:

“Letting an associate go is never easy. It is important to note that we have a progressive discipline policy where performance issues move an associate to the next step. For this associate, point-of-sale policies had not been followed in some instances. A recent violation of those policies moved the associate to the final step of our discipline process, resulting in his dismissal.”

That didn’t satisfy Frank’s fans. They started a Facebook page called “Hugs for Frank” that encouraged people to flood Wal-Mart headquarters in nearby Bentonville, Arkansas, with complaints.

Various accounts had people talking about how Frank cheered their days. One story told how Frank was known to reach into his own pocket to help somebody who came up short.

“They were lucky to have you, Frank,” a woman wrote. “More people should be like you, but sadly, it’s all about the almighty dollar instead of the people. I wish you the very best!! (( HUGS )))

Another: “Hugs for Frank and he needs his job back and the Walmart head bosses need to be fired. He needs his job back and Sam Walmart (Walton) wouldn’t of fired him.”

Frank didn’t want ugliness. He told people that the workers at Wal-Mart — bosses, too — were his friends, and he didn’t want to hear anything mean about them. He has even shopped there since.

So the town threw a party for him. Music, food and, of course, a lot of hugs. Frank signed T-shirts.

On a YouTube video of the event, his brother said most people’s legacies aren’t known until they die.

“Frank can see his today,” Drexel Swanson said.

Customers came from all over. There’s just something about a guy who knew to never put ice cream and sugar in the same bag.

“Makes the sugar hard,” Frank said.

Springfield lawyer Benjamin Stringer said Frank intends to challenge his termination under the Missouri Human Rights Act, which prevents employers from discriminating against or firing employees because of disabilities.

Frank must first file a charge of discrimination with the Missouri Commission on Human Rights, which will conduct an investigation into Frank’s allegations. Then, if issued a “right-to-sue” letter, Frank intends to pursue the matter vigorously, Stringer said.

“Frank was singled out and fired without cause,” Stringer said.

Meanwhile, Frank has a new job at Ramey supermarket, a couple of miles away. He doesn’t make as much there, but he’s happy. His new bosses like him to be up front to greet people when they come through the door.

So while West Plains may claim Dick Van Dyke, Porter Wagoner and baseball pitcher Preacher Roe, right now the big name in town is Frank Swanson.

“Everybody’s been picking on me about being famous,” he said shyly.

One of the many recent comments written about him said: “Went to Ramey’s twice today, and yep got me a hug from Frank. He has made everyone smile. I think he got more hugs this past month than he ever had. lol.”

This is an AP Member Exchange shared by The Kansas City Star.