For Better Health Outcomes, Investments in Nutrition Matter

By Amanda Swanson Blog

Access to quality, affordable health care is a fundamental part of ensuring that people can live healthy and fulfilling lives. The health care system should be foremost focused on improving health outcomes as shown by indicators like rates of chronic disease, lifespan and economic security. But getting to these outcomes isn’t just about access to medical care. 

In fact, research shows that only about 20% of health outcomes are directly linked to medical care. The remainder are determined by social determinants of health care (SDOH) that include basic conditions of living like homelessness, food insecurity, environmental pollution and patient behaviors. That’s common sense: the conditions in which people live, their livelihoods, the air and water they consume, and the neighborhoods they live in all shape what kind of health a person will experience and how they may use the health care system to stay healthy, manage disease and prevent illness. 

That’s why, to get to better health, we can’t just focus on coverage and affordability in healthcare, we have to improve the overall conditions of people’s lives in order to have a real chance at improving health. The current federal budget debate is a timely opportunity. 

Members of the U.S House and U. S. Senate are currently negotiating a federal budget deal  that will make new cuts in key programs that support housing, nutrition, education, transportation and public safety. Cutting spending on these resources even as the need for services is increasing could have negative health consequences down the line, even if those affected never lose their health coverage. But cutting is just part of the problem: lawmakers should reassess their priorities to invest more in key programs that we know provide essential services rather than continue partisan gridlock that does not serve constituents, whether they voted for Democrats or Republicans. 

The Supplemental Nutrition Program for Women, Children and Infants (WIC) program, for instance, has for decades enjoyed bipartisan support. WIC provides nutrition support to mothers and young children (under 5). These days, the program is more popular than ever since pandemic inflation and the rising cost of food have made it harder to stretch grocery budgets. WIC is there to ensure that moms and their kids get a strong start by ensuring they get the nutritious food they need to develop strong minds and bodies.

Research from Johns Hopkins School of Public Health  shows that WIC has a strong record of preventing children’s health problems and improving their long-term health, growth and development. Childhood WIC participation is correlated to an array of positive health and cognitive outcomes when compared to children who are eligible but not participating in WIC. Not only does that give millions a boost in early life, it saves the rest of us money down the road on more expensive healthcare bills and services. Research shows that every dollar spent on WIC results in $2.48 of future savings in medical, educational, and productivity costs.

It’s clear that Americans get a good return on investments in WIC. And more investment is needed now. 

WIC is facing a $1 billion shortfall this year because of increased demand and cost of food. If Congress doesn’t act soon to fill the gap, millions of Americans could be turned away from WIC even though they are eligible because the program will run out of money. 

In state after state thousands of moms and young kids  could be forced to go without the nutritious food they need, help with breastfeeding support, child immunizations, and other services that parents and kids need because of Congressional inaction. Ultimately, 2 million parents and kids could go without food and other services because of the anticipated shortfall. 

The WIC shortfall is a solvable problem and for the people who are going without the food they need, the problem is urgent. Ultimately, taking action on WIC is a matter of political priorities. It’s time for lawmakers to prioritize basic needs for kids and parents over their own infighting or partisan axe-grinding and pass an increase in funding that will reap big benefits for the future by feeding hungry people now.

Coverage Without Lowering Out-of-Pocket Cost Is Not Enough–It’s Time to Address Affordability

By Amanda Swanson Affordable Healthcare, Blog

President Biden and lawmakers in Congress have made tremendous strides in increasing access to healthcare–both by expanding coverage and by lowering the cost of services like prescription drugs in Medicare. These are fantastic steps that stand in contrast to Republican efforts to repeal or water down coverage, cut Medicare and Medicaid, and loosen up regulations so that insurance corporations can offer more high-cost “junk” plans. 

But it’s not enough. Millions of people who have coverage, whether through their employers or through the Affordable Care Act, can’t afford to use it because of too high out-of-pocket costs that deter people from getting care, drive households into debt, or force families to choose between their healthcare and other routine expenses like housing and groceries. 

Insurance coverage is critical for improving health, but it can only work if people can afford the premiums and the out-of-pocket costs. And both are rising.

The Affordable Care Act (ACA) that HCAN and many other allied groups helped pass in 2010 has survived dozens of political, legislative and legal attacks to now reach record enrollment and majority support from the public. Bigger tax credits over the last two years have reduced premiums for middle-class families saving them an average of $800 annually.  The law also continues to provide critical consumer protections for people with all kinds of insurance by stopping discrimination against pre-existing conditions, ending gender discrimination, eliminating caps and limits on coverage, and many others. The ACA has both expanded coverage and improved the quality of coverage for hundreds of millions Americans. 

But affordable premiums for insurance coverage are just the first step in accessing healthcare. Actually using the coverage when you are sick to pay for services that are beyond preventive care often proves more challenging. Deductibles, co-pays, and other out-of-pocket “cost-sharing” expenses may render coverage moot when patients can’t afford their share of the cost or when they have to shell out thousands before their insurance plan starts to pay for treatment. 

For example, deductibles, the amount a patient must pay toward the cost of in-network covered services before the insurance plan will start paying, have risen substantially from 2014 to 2024 in ACA plans with combined medical and prescription drug deductibles. 

The problem isn’t exclusive to the ACA: millions with employer sponsored plans are also facing increased deductibles as well as skyrocketing premiums. The number of employer plans that require patients to pay a deductible is rising as the number of employers offering high deductive plans grows.

High Deductible Health Plans (HDHPs) typically have reduced premiums but leave people at greater risk of being underinsured and at increased risk for medical debt.  In fact, these plans are intended to reduce overall usage of health care by increasing the burden on patients.

While people with ACA premiums are getting more affordable coverage because of President Biden’s commitment to increased premium assistance, the overall cost of healthcare continues to rise and the more generous premium assistance isn’t permanent.  The average cost of workplace health insurance premiums for family coverage reached nearly $24,000  in 2023, jumping 7.0% from 2022, according to KFF’s latest survey of employer-sponsored coverage. These increases are outpacing wage growth: while premiums for family coverage rose 7.0% in 2023, wages grew about 5.2% and inflation rose 5.8%.  Costs for employer coverage are expected to increase 6.5% for 2024. Affordable Care Act coverage will increase by around 6.0% in 2024. These increases are the largest in a decade.

Health insurance companies made record profits during the pandemic because many fewer people used their healthcare plans, resulting in fewer claims to pay. But big profits continue as the pandemic has receded. In 2023, the seven big for-profit health insurers alone made more than $40 billion in profits on revenues in just the first six months of the year. Profits were up 8.1% compared to the year before. Given the soaring premiums in 2024, we can expect to see similar profits this year even as medical debt continues to soar and families struggle to afford the basics. 

The anxiety that millions of Americans feel about the state of the economy despite low unemployment and improvements in inflation is no mystery: affordable healthcare is a constant worry in a system where profit trumps affordability or health outcomes. That’s why more action is needed to increase competition among insurers, reduce premium and out-of-pocket costs, and also to reduce drug prices, which is a key driver of overall health care costs. 

Reforming PBMs Puts Money In Patients’ Pockets

By Amanda Swanson Blog, Lower Drug Prices

When it comes to lowering drug prices and making medicines more affordable, lawmakers have many opportunities for interventions that save patients money. We’re already seeing positive impacts from last year’s historic Inflation Reduction Act (IRA), which has capped insulin prices, saved taxpayers billions on price-gouging from drug corporations and eliminated all out of pocket costs on vaccines for Medicare beneficiaries. But the IRA is just a first step. Provisions like inflationary caps to stop drug corporations from raising prices faster than negotiations, negotiated prices on drugs, and cost caps on drugs like insulin should be expanded to benefit even more people in Medicare as well as people with other kinds of insurance or with no insurance at all. After all, people of all ages and incomes are struggling with healthcare affordability, regardless of what kind of coverage they have. Unless more action is taken, hundreds of millions of Americans will continue to be at the mercy of drug corporations and their relentless profiteering.

But drug corporations aren’t the only ones profiting from jacking up our prescription drug prices. Pharmacy Benefit Managers (PBMs), sometimes called “middle-men,” are key players in the prescription drug distribution chain who influence affordability. PBMs negotiate and manage prescription drug benefits on behalf of health insurers, Medicare Part D plans, large employers, and other payers. They play an important behind-the-scenes role in determining drug costs by developing formularies and negotiating rebates and discounts between drug corporations and pharmacies. PBMs collect rebates that are a percentage of the manufacturer’s list price. These rebates and assorted other questionable practices are increasing scrutiny in Congress over how PBMs may contribute to rising prescription drug costs.

Drug corporations relentlessly insist that PBM rebates are forcing higher prices while the PBMs claim that a larger and larger share of the rebate is actually being passed along to insurers. Since rebates aren’t disclosed, there’s no way to resolve the argument without increasing transparency. A recent study found that the share of rebates PBMs passed through to insurers and payers increased from 78 percent in 2012 to 91 percent in 2016.5 But many small insurers and employers say they do not receive this share of savings.

PBMs also practice “spread pricing,” whereby PBMs are reimbursed at a higher price for generic drugs than what the PBMs actually pay pharmacies for these drugs. The PBMs keep the difference but quantifying the amount that accrues to PBMs is hard because of lack of reporting and transparency and because there’s limited consideration of value versus price in the system. 

Although voters are much more animated at the prospect of taking on drug corporations than PBMs, bipartisan support for PBM reforms is growing in Congress and numerous proposals have emerged to increase transparency and accountability in this murky system. 

House leaders combined bills from the Energy and Commerce, Ways and Means, and Education and the Workforce committees to produce the Lower Costs More Transparency Act of 2023 which passed out of the E&C Committee last week. 

Meanwhile, in the Senate, the Health, Education, Labor and Pensions (HELP) Committee passed the Pharmacy Benefit Manager Reform Act of 2023 and the Senate Finance Committee passed the Modernizing and Ensuring PBM Accountability Act (MEPA), legislation that would bring more transparency, accountability and competition to pharmacy benefit manager practices in the drug supply chain, helping to lower out-of-pocket costs for patients. 

All the proposals include transparency provisions that would require PBMs to disclose, at different levels,  how much they pay for drugs, how much money they retain and what costs and savings get passed along to health plan sponsors and patients. Under the current rules, this information is largely obscured. Also all the measures feature some restrictions on spread pricing, the practice of charging insurers more for drugs than the PBMs paid. The Senate bill would bar PBMs from linking compensation to drug formularies, a practice that lawmakers and many advocates say incentivizes higher prices. These legislative efforts coincide with an ongoing Federal Trade Commission (FTC)  investigation into PBM business practices and follow up on earlier administrative action that also is intended to increase transparency and accountability. 

Across the political spectrum, lawmakers are eager to make progress on regulating PBMs to lower drug costs for consumers, so despite a very polarized legislative context, PBM reform has a good chance at passage. And it’s about time. Rooting out waste, grift, and inefficiency in every stage of the prescription drug process and system can only help with savings and access that will benefit millions.

Lackluster support for Bidenomics reflects Americans’ continued struggle with health care costs

By Amanda Swanson Affordable Healthcare, Blog

In recent years, the United States has made huge strides in healthcare access. Not only is the  rate of uninsured people lower than ever before thanks partially to record Affordable Care Act enrollment, but recent reforms aimed at lowering prescription drug costs by taking on Big Pharma price-gouging in Medicare will continue to improve affordability for seniors and people with disabilities who often struggle the most with health costs. 

But despite expansions in coverage and some progress on lowering costs, a new study from the Commonwealth Fund confirms that far too many Americans are still struggling to afford healthcare in today’s economy despite having insurance, which is supposed to make health care accessible. Over half of people with Medicare coverage struggle to afford it as do over half of people with ACA marketplace or individual coverage. Nearly half–45%–of people in Medicaid say healthcare is difficult to afford and even 43% of people with employer sponsored coverage say the same. Naturally, for the nation’s remaining uninsured population, things are even worse.

A key factor in the affordability problem is rising premiums. A new KFF report shows that the average cost of workplace health insurance premiums for family coverage reached nearly $24,000 this year, a 7% jump from 2022. Meanwhile, wages grew about on average 5.2% and inflation rose 5.8% last year. Plus, the cost of everything else including housing and groceries is also rising. Given these conditions, it’s easy to see why “Bidenomics” isn’t hitting home for many voters.

Currently, 2 in 5 patients report delaying getting care or skipping it all together because of affordability concerns including incurring medical debt. Nearly a third of adults reported having medical or dental debt, and nearly half of them said it’s at least $2,000. That’s a significant sum for seniors in Medicare on a fixed income or for low-wage working families. Currently, Medicare doesn’t cover dental, vision, or hearing and many private insurance policies also omit coverage for these services as well as for comprehensive mental health treatment. 

Clearly, there’s more work to be done to put healthcare in reach even for people who now have coverage and much more to do for people without coverage. The number of uninsured people is also rising because of the end of Medicaid coverage following the Public Health Emergency connected to covid. In the last year, over 10 million people have lost Medicaid coverage. Some of these people will be able to get insurance during the current ACA open enrollment period and some will not be able to afford coverage, even with improved affordability on the ACA exchanges. 

Without more progress reining in corporate price-gouging to reduce profits in healthcare, there’s little hope when it comes to bringing down costs for consumers. Policy-makers at every level should make this a top priority. It’s not just essential to the economic stability of families, it’s also politically popular.  

Lowering drug prices is the tip of the spear for reining in healthcare costs more broadly given that prescription drug price gouging drives increases in premiums and contributes to medical debt. A recent poll from Hart Research showed that 96% of Americans agree that lowering drug prices and the cost of prescriptions is an important way to help people afford the cost of living and nearly three-quarters of Americans favor Biden and Democrats in Congress passing Medicare negotiations

Appetite for lowering drug prices isn’t limited to Medicare enrollees: 7-in -10 voting age adults in the U.S. support lowering drug prices. Regardless of political affiliation, Americans want their lawmakers to lower drug prices and take on Big Pharma greed.  That’s why Democrats in Congress are forging forward to build on the success of the Inflation Reduction Act. New Jersey Congressman Frank Pallone, a key architect of the original reforms that were included in the IRA has already filed a bill to expand negotiations, the insulin cap and accountability for drug corporation price gouging in the 118th Congress. If passed, that bill could lower costs for millions more people in Medicare and for hundreds of millions with private coverage.

Pallone’s leadership stands in stark contrast to some of his colleagues in the US House of Representatives who are actively trying to repeal the modest reforms in the existing law just one year after its passage. Led by Tennessee Republican Andrew Ogles, 23 GOP Members of the House are pushing a bill to repeal the law as their allies in Big Pharma file lawsuits to overturn Medicare negotiations. Johnson & Johnson, Astellas, Bristol Myers Squibb, and Merck joined the U.S. Chamber of Commerce and industry lobby group PhRMA to stop Medicare negotiations. Plus, GOP House Speaker Mike Johnson just hired former Pharma lobbyist Dan Ziegler, a former lobbyist for the drug corporations as his Policy Director. 

Americans need healthcare they can depend on, but despite progress, we’re not there yet. The time is now for lawmakers to address what every poll is telling them: it’s time to lower profits, rein in price-gouging, and make healthcare truly affordable in our country.

More Staff Equals Better Quality Care for Nursing Home Patients

By Amanda Swanson Affordable Healthcare, Blog

There are over 1.5 million Americans in long-term care nursing facilities today. That number is projected to grow as the elderly population explodes over the coming two decades. In fact, people 65 and older are the fastest growing age segment in the United States population, yet despite the coming tidal wave of aging people, there is very little attention paid to how the nation will provide for the increased demand for health and personal care services. 

Whether an aging person receives services in their home or in a long-term care facility, the care provided should be high quality, meet the individual’s needs, and enhance their quality of life. But all too often, we fail to meet this standard despite billions of dollars of investment that both tap public resources and deplete people’s lifetime savings and assets.

As we saw during the most intense periods of the COVID pandemic, the crisis is acute in nursing homes and long-term facilitated where more than 200,000 nursing home residents and workers died—around one-fifth of all COVID-19 deaths in the United States—because of short-staffing, poor protocol, and lack of attention to the real time needs of the residents. The phenomenon of short-staffing in nursing facilities didn’t start with COVID, but the tremendous loss of life during the pandemic put a spotlight on problems with the lack of oversight, accountability and consistent standards that characterize this sector. 

Despite the fact that the nursing home industry receives nearly $100 billion from American taxpayers every year, far too many facilities continue to provide substandard care. During this year’s State of the Union address, President Biden committed to improving the quality of long-term care in nursing homes with federal minimum staffing requirements, increased oversight and enforcement, and expanded workforce initiatives to recruit and retain staff. These improvements would offer much needed support for health care workers, improved care for residents and better protection for both. 

The Department of Health and Human Services (HHS) recently proposed new regulations that would take a critical step in finally addressing the needs of nursing home residents and their families. These new regulations would create a federal floor for staffing, ensuring that nursing home owners could no longer slash staffing to unsafe levels. The proposal would also require every facility to have a registered nurse on site 24/7, to have a minimum number of registered nurses and nurse aides to help provide routine care, and to staff according to patient needs based on a robust assessment of the facility’s residents. These proposals don’t go nearly far enough, but given that currently no minimum standard exists and that nursing home operators answer to no one on staffing, it would be a huge improvement and lay the foundation for even more.

Under the new HHS rules, residents would receive a minimum of 0.55 hours of care from a registered nurse per resident per day, and 2.45 hours of care from a nurse aide per resident per day, exceeding existing standards in nearly all states. According to the Centers for Medicare & Medicaid Services (CMS), 75% of nursing home facilities would need to hire more nurses and nurse aides to meet even this very modest requirement. Additional analysis from KFF Health News indicates that number could be even higher, over 80%.

These new rules are long overdue. Not only does short staffing hurt patients, it increases the risk of injury for workers and drives more and more people out of care-giving professions. Providing care to elderly patients or people with disabilities who have mobility challenges, chronic disease, cognitive decline, dementia, or other common conditions requires patience, skill and physical dexterity. Workers should be fairly compensated, have safe working conditions and basic protections, including whistle-blower protections that also help patients. 

The for-profit nursing home industry vociferously opposes these minimum staffing standards, insisting there’s no way to meet them. But the reality is that the non-profit nursing home industry is, on average, providing staffing that already exceeds CMS proposed staffing levels. This raises the question of whether for-profit nursing homes could, in fact, meet the new standard if they spent more money on staffing and less on profits. 

Right now, any member of the public has an opportunity to weigh in on this debate because CMS is accepting comments on the proposed rules until the November 6th deadline. Anyone–residents in nursing homes, health care workers, family members, concerned advocates, service providers can submit a comment that describes why they support this important first step. Remember that once a comment is submitted, it will become part of the public record. 

Currently, the nursing home industry is weighing in very heavily against the proposed rules in an effort to protect the current status quo where nursing homes don’t have to meet any staffing standard. It’s up to all of us to keep fighting for better care and urge HHS and CMS to forge forward on the new rule. 

It’s Hispanic Heritage Month. We Still Have Work to Do for Hispanic Families.

By Amanda Swanson Blog, Lower Drug Prices, Reproductive Healthcare

From September 15th through October 15th, we mark Hispanic Heritage Month. During this period, the U.S. celebrates the countless contributions of more than 60 million Hispanic and Latino Americans to the culture, economy and society of our country. Hispanic and Latino people have made great progress on many fronts over the years, but there’s still work to do to reach full equity with their white counterparts and to ensure that every Latino and Hispanic person has the opportunity to reach their full potential. And, though the Affordable Care Act expanded access to affordable coverage to more Latinos than ever before in history, ensuring consistent, affordable access for everyone who needs it remains an unfulfilled goal. 

The cost of healthcare and prescription drugs is a huge challenge for millions, but access is harder for some people than others and so is the need for routine and acute medical care. Latino and Hispanic Americans are more likely to suffer from chronic health conditions like diabetes, asthma and obesity, but less likely than whites to have health insurance or to be able to afford prescription drugs they need to manage their health conditions.

The Inflation Reduction Act (IRA) that President Biden signed in August of 2022 made great historic improvements to health care that lowered costs and increased access for the people who need it most.  The IRA made coverage under the Affordable Care Act more affordable for people across all incomes, saving the average individual about $800 a year on their premiums. To date, 2.5 million Latinos are enrolled in health insurance through the Affordable Care Act, an increase of more than 50 percent since 2020. Before the passage of the ACA, Latino and Hispanic people made up the largest share of the uninsured population. 

The IRA also lowered drug costs for people in Medicare, including both seniors and people with disabilities who get prescriptions under Part D. Around 5.59 million Latinos get their health coverage through Medicare, nearly 10% of the entire program. Latinos in Medicare are disproportionately likely to have diabetes, which makes the new law especially valuable since it caps the monthly cost of insulin at $35/month. Latino families that are 1.7 times more likely than non-Hispanic white adults to have been diagnosed with diabetes.

But the IRA doesn’t stop at insulin. Once the law is fully implemented, Medicare enrollees will see caps on all out-of-pocket costs, finally limiting what they have to pay at the pharmacy annually for their medicines. The new law also lowers prices–what the drug corporations can charge–on medicines. For the first time, drug corporations that raise their prices faster than inflation will have to pay a rebate back to Medicare for their overcharged amount. In another historic move, Medicare will finally be able to negotiate prices on some of the most high price drugs in Part D. The federal government recently announced the first ten prescription drugs that will have lower negotiated prices, and all of the Big Pharma corporations who manufacture those drugs have agreed to come to the negotiating table

These developments are good news for Latino and Hispanic people in our country, but in some states, not all the news is so good. While we’re expanding access to some kinds of healthcare, we’re denying access to other fundamental aspects of healthcare that millions of people need. 

After the Supreme Court struck down Roe v. Wade in June of 2022, 21 states have enacted complete or partial abortion bans with legislation in 5 more states being blocked or challenged in the courts. Now, new research from the National Partnership for Women and Families and the Latina Institute shows that 6.7 million Latinas – 43 percent of all Latinas ages 15-49 – live in states that have or are likely to implement abortion bans. In fact, Latinas represent the largest group of women of color impacted by current or likely state bans. More than 3 million of the Latinas in these states are economically insecure, making it more difficult or outright impossible to access abortion care by traveling across state lines. This restriction to a safe and necessary healthcare procedure puts Latinas at risk, especially given the disparities Hispanic communities already face when it comes to accessing basic health care, including contraception. 

Moreover, denying people access to abortion has lifelong negative consequences for their economic security, their health and the health of their other children. Latinas, who are more likely to work in low-wage jobs, more likely to lack health coverage and more likely to face complications in birth and to have chronic disease, need better access to the full range of reproductive health options, not restrictions and bans that take away control over their own destinies and put health at risk. 

This Labor Day, Historic Announcements Celebrate Progress for Workers

By Amanda Swanson Blog, Lower Drug Prices

Labor Day was created to honor and celebrate American workers, the backbone of the economy and the engine of our democracy. Working people today continue to face a massive array of barriers to balancing work with family responsibilities, earning wages that keep up with cost of living, and affording healthcare that they can count on when they need it. But they are also making progress under the current Administration thanks to President Biden’s commitment to lowering costs, creating more jobs, and providing every worker with an opportunity to join a union in their workplace. 

It’s been a big week for workers. First, a new National Labor Relations Board (NLRB) ruling made it a lot harder for employers to union-bust by intimidating, threatening, and misleading workers with misinformation about the benefits of unions. For decades, the deck has been stacked against workers who want to organize to negotiate their wages and benefits on the job because of antiquated labor laws that made organizing unions nearly impossible and gave employers license to violate workers’ rights.

In a historic move, this week the NLRB announced a new framework for worker rights that will enable workers to form unions through a more simple process if they can show majority support. The new rules stop bosses from obstructing free and fair union elections to gain representation on the job, which they do routinely and without penalty in order to stop workers from gaining rights at work. Legal recognition for a union is a critical step to improving wages and working conditions: it gives workers the right to bargain a contract that often results in better treatment, higher pay, and more affordable healthcare. 

More affordable healthcare is a leading reason why many workers form and join unions. Health care premiums are rising and basic costs–like the price of prescription drugs–are increasing faster than inflation. Millions of average working Americans can’t afford the health care they need even though they have insurance at work.

But the Biden Administration is making progress on that front too. Last week President Biden announced the first ten prescription drugs that, for the first time, will have lower prices through Medicare negotiations. Retirees and people with disabilities will finally be able to get some of the most expensive and widely used prescriptions in Medicare at a reasonable price they can afford thanks to the new law that enables Medicare to negotiate and lowers out of pocket costs on everything from insulin to cancer drugs. Working Americans who pay taxes to fund Medicare will save tens of billions over the next decade thanks to price negotiations.

Medicare negotiation to lower prices is also great news for seniors who, after a lifetime of work, should not have to ration medicine, go into debt or for other basic needs to afford medicines. 

But older Americans aren’t the only ones struggling: millions of people under age 65 who have private insurance are also struggling with drug prices and need relief. That’s why even as we implement drug pricing improvements in Medicare, we are working with key leaders like Congressman Pallone of New Jersey to expand these cost-cutting reforms to private insurance plans as well.

Meanwhile, the nation’s biggest drug corporations who have reaped billions in profit from decades of price-gouging are fighting to stop lower prices. A new analysis from Accountable.US found that the Pharma companies that are suing Medicare to stop Medicare negotiations (Merck, AstraZeneca, Novo Nordisk, Bristol Myers Squibb, AMGEN, Novartis, and Janssen) boasted $38.7 billion in profits in 2022 alone.

But no matter how hard the drug corporations and their Republican allies in Congress try to stop lower drug prices, seniors, people with disabilities, and working Americans will fight back harder so everyone can have lower drug prices. We have no choice: unless we tackle the drug corporations’ monopoly power to price-gouge, prescription drug costs will eat up more and more of our paychecks and our health premium dollars. People of all ages need access to affordable medicines. 

On Labor Day, people will come together to honor the myriad contributions American workers make to every facet of our lives. As we take a moment to celebrate the victories of the last year, we’re ready to keep fighting for even more – because no one, no matter their insurance plan, zip code, or age, should have to worry whether they can afford the medication they need.

On the Inflation Reduction Act’s First Anniversary, Celebrate Progress as We Countdown to Lower Drug Costs

By Amanda Swanson Blog, Lower Drug Prices

On August 16, 2022, President Joe Biden signed the Inflation Reduction Act (IRA) into law. In addition to historic measures on tax fairness and climate change, the IRA made major improvements to the Medicare program: capping insulin costs at $35/month, making recommended vaccines free for seniors, instituting a $2,000 annual out-of-pocket prescription cost cap, forcing Big Pharma to pay a fine if they raise the price of medication faster than the rate of inflation, and finally enabling Medicare to negotiate directly for lower drug prices. 

The new law is already saving millions of dollars in Medicare and lowering costs for seniors and people with disabilities who have struggled with affordability on everything from insulin to cancer drugs. Once it’s fully implemented, the law’s centerpiece, Medicare negotiations, will save 5 to 7 million seniors money on some of the most expensive medicines covered under Medicare. 

Not only is this progress on prescription affordability worthy of celebration, it’s also ripe for expansion. Medicare is the nation’s largest purchaser of prescriptions, but by no means are Medicare patients alone in struggling to afford prescription medicines. In fact, people of all ages have to ration, skip doses, go into debt or forgo other necessities to afford drugs because the drug corporations have monopoly power to set prices and raise them anytime. We need a national solution that addresses the fact that Americans pay two to three times more than people in other countries for the same medicines.

Yet, while some lawmakers in Congress are forging forward to build on the success of the Inflation Reduction Act, all too many are trying to repeal or roll back the new law before it’s even implemented. NJ Congressman Frank Pallone, a key architect of the original reforms that were included in the IRA has already filed a new bill to expand negotiations, the insulin cap and accountability for drug corporation price gouging in the 118th Congress. If passed, that bill could lower costs for millions more people in Medicare and for hundreds of billions with private coverage who don’t yet qualify for Medicare. 

Pallone’s leadership stands in stark contrast to some of his colleagues in the US House of Representatives who are actively trying to repeal the modest reforms in the existing law just one year after its passage. Led by Tennessee Republican Andrew Ogles, 23 GOP Members of the House are pushing a bill to repeal the law as their allies in Big Pharma file lawsuits to overturn Medicare negotiations. Johnson & Johnson, Astellas, Bristol Myers Squibb, and Merck joined the U.S. Chamber of Commerce and industry lobby group PhRMA to sue Medicare in an attempt to block their new negotiating power. 

This comes as no surprise given the massive profits that drug corporations have made by exercising monopoly power over prices.. According to new reporting from AARP, the 25 drugs responsible for the highest Medicare Part D spending have nearly tripled in price since their introduction. In 2021, the program paid nearly $81 billion on these medications alone, some of which are relied upon by millions of patients. Bristol Myers Squibb’s Eliquis, for example, a blood thinner prescribed to more than 3 million Americans, has increased in price by 124% since it was first introduced. Given the profit to be made off of drugs like Eliquis, Big Pharma is working overtime to hold onto their monopoly price-setting power.

One year after its signing, seniors and people with disabilities who get their health coverage through Medicare are seeing the benefits of the Inflation Reduction Act. Insulin costs, which have historically been prohibitive for so many patients, are capped at $35 per month, making pharmacy trips far cheaper for millions. More than 3.4 million people will benefit from the law’s free vaccine provision, meaning better health overall. 

Experts predict that Medicare negotiations will make medicines more affordable for 5-7 million seniors across the country and save taxpayers $237 million over 10 years. The Inflation Reduction Act’s redesign of Medicare Part D, including the $2,000 out-of-pocket cap, is expected to lower out-of-pocket spending by about $7.4 billion annually among more than 18.7 million enrollees (36 percent of Part D enrollees) in 2025. That’s a savings of nearly $400 per person. 

Today, we celebrate the historic progress of the IRA while at the same calling out Big Pharma’s attempts to protect their profits and shining a spotlight on their allies in Congress who support keeping prices high. We’re on a Countdown to Lower Drug Costs as we push for full implementation of the law that will finally make medicines more affordable for millions of Medicare patients who have already waited too long.

On the Anniversary of Medicare and Medicaid, We’re Counting Down to Lower Drug Costs

By Amanda Swanson Blog, Lower Drug Prices

On July 30th, 1965, President Lyndon B. Johnson signed Medicare into law, creating the nation’s most beloved healthcare program, which provides care to 66 million seniors and people with disabilities. Over the years more improvements have been made to the program to increase access and affordability for enrollees, including the Inflation Reduction Act of 2022 (IRA), which made long-overdue improvements to prescription drug benefits in Medicare. 

Under this new law, seniors, people with disabilities, and their families will save millions on the cost of prescription medicines thanks to common-sense reforms that Big Pharma companies have fought against for decades. These reforms include allowing Medicare to negotiate lower prescription drug prices, capping the cost of insulin at $35, creating the first-ever out-of-pocket cost cap on Part D medicines, making recommended vaccines free for Medicare beneficiaries, and requiring prescription drug companies to pay rebates to Medicare if they raise their prices faster than the rate of inflation. Some parts of the law have already been implemented and some will be implemented over the next several years.

These improvements in Medicare will save taxpayers over $98 billion over the next ten years and make medicines more affordable for millions of seniors who have struggled to afford everything from insulin to cancer drugs. The new law stops drug-corporations from using their monopoly power to price gouge,which inflates their profits at our expense. 

But drug corporations won’t give up their power easily. Big Pharma corporations, industry lobbyists, and Republican allies in Congress are fighting tooth and nail to halt these new reforms and allow Pharma companies to retain their monopoly price-setting power.

 And it’s no wonder why: Eli Lilly, Johnson & Johnson, Merck, AbbVie and Pfizer, the 5 largest Pharma companies by market cap, reported combined earnings of $81.9 billion last year – an $8 billion increase from 2021. Two of those companies (Merck and Johnson & Johnson) have joined fellow Pharma corporations Bristol-Myers Squibb and Astellas, as well as the U.S. Chamber of Commerce and the industry lobby group the Pharmaceutical Research and Manufacturers of America (PhRMA) to sue Medicare in an effort to stop negotiations for lower prices before they even start. 

These lawsuits are outrageous, Americans pay more than 2.5 times more for some brand-name drugs than people in 32 other comparable countries. Aging Americans and people with disabilities and chronic health conditions bear the brunt of these excessive prices. No one should have to go into debt, go without life-saving medicines, or choose between prescriptions and other basic needs like groceries and rent. Yet millions across this nation do. 

We know that the Inflation Reduction Act is already helping people and will only do more in the coming years. A new report shows that 3.4 million people with Medicare would have saved $234 million in out-of-pocket costs in 2021 on vaccines–or about $70 per person if this law had been in place in 2021. Diabetics in Medicare who use insulin would have saved about $500 a year on insulin last year if the law had been in place. Medicare recipients have these savings and much more to look forward to as the law is implemented piece by piece between now and 2026. 

And we’re just getting started: on September 1, Medicare will announce the first ten prescription drugs that will have negotiated prices for the first time, a historic event that will ultimately benefit millions of Medicare enrollees. The Biden Administration is working hard to implement the Medicare negotiations and Democrats in Congress have already introduced a new bill to expand the number of drugs that can lower prices through negotiations and to stop drug corporations from raising prices for people with private coverage faster than inflation.

It’s up to advocates, impacted people, families, providers and others to stop the opponents of lowering drug prices through Medicare negotiations from taking away long-overdue lower prices that will enable millions more people to get the medicines they need. We can’t let them turn back the clock on progress.

Let the countdown to lower drug costs begin!

Assault on Abortion Rights Hurts Health Care Access for Everyone

By Amanda Swanson Blog, Reproductive Healthcare

It’s now been one year since the Supreme Court’s Dobbs decision ended Constitutional abortion rights for millions of people in America, taking away a legal protection that was in place for nearly 50 years. In just over a year, more than 73 million Americans have been stripped of abortion access thanks to abortion bans and restrictions that have been enacted in 14 states. The aftermath of this extreme decision is manifesting across the country. 

But anti-abortion crusaders have made it clear that they have no intention of stopping at state abortion bans. In fact, the anti-abortion extremists are working on taking access from even more patients by once again leveraging the courts to overturn past precedence. Right now, the Fifth Circuit Court is considering revoking the FDA approval of Mifepristone, one of two drugs used in medication abortion, after anti-abortion extremists in Texas challenged its approval even though the drug has been in use for decade and despite the fact that medication abortion is the safest form of abortion and widely used in both the United States and the world. 

The anti-abortion onslaught shows no signs of slowing even though two thirds of Americans continue to support legal, safe abortion in most cases and few people support total bans.

Most recently, a new ban has passed in Iowa. Governor Kim Reynolds called a marathon one-day special session wherein both bodies of the Iowa Legislature met to approve legislation that would ban abortion care in the state after 6 weeks. This was despite the fact that in March, a Des Moines Register/Mediacom Iowa Poll found that “61% of Iowans say abortion should be legal in all or most cases, while 35% say abortion should be illegal in all or most cases.” Clearly, this rush to pass an abortion ban was done so the people of Iowa would not have time to weigh in. Amy Bingaman, a Broadlawn OB-GYN, said that passing this law will mean Iowa “will lose well-qualified providers from our community…Take away our ability to practice full-spectrum health care, and providers will choose to practice in another state, and many will leave Iowa.”

It’s becoming more common for patients and providers to flee increasingly common anti-abortion laws as doctors and medical students elsewhere to work or train because of the potential collateral consequences of providing services to people either exploring abortion or actively seeking it. Abortion restrictions have broad health care impacts beyond denying some people abortion. In fact, millions more people may face reduced access because of bans that close clinics and drive providers away. After the closure of the only maternity ward in Bonner County, Idaho, for example, expectant mothers will be forced to drive 45 minutes to give birth in the next closest hospital.

The impact of abortion bans will be worse in rural states where there are already significant challenges in accessing healthcare due to distance, poverty, and limited provider availability. Patients in emergency situations are forced to the brink of death before a doctor can legally intervene. Mothers may even be forced to watch their babies die from severe birth defects after being denied abortions.

Yet, despite these consequences, many of the most extreme abortion opponents are forging recklessly ahead to curtail access for as many people as possible. Just last week, Congressional Republicans voted for the National Defense Authorization Act, the annual bill that provides funding to the Department of Defense (DOD), with the inclusion of a new abortion restriction that makes abortion access harder for military personnel and that also restricts care for transgender people in the military.

Senator Tommy Tuberville (R-AL), who championed the anti-abortion measure, has spent months stalling high-profile military nominations in protest of the DOD’s abortion policy. Because of this foot-dragging, the Marine Corps has been left without a Congressionally-appointed commandant for the first time in 164 years. This is yet another example of how abortion restrictions hurt many people beyond those who may be seeking abortions. 

The truth is that every American has a stake in protecting access to abortion access and in stopping attacks on reproductive freedom that spill into the healthcare system more broadly. Whether it’s reducing access to birth control, outlawing medicines that are used for a variety of reasons in the healthcare system, threatening doctors and providers with criminal consequences, or forcing people to move out of state to seek all kinds of basic care, the attack on abortion rights hurts everyone.