Affording Health Care Tomorrow Depends on Taxing the Rich and Corporations Now

By jfoster Blog, Tax Fairness

Millions of Americans will finish and file their taxes in the next few days, joining their family, neighbors and co-workers in fulfilling a basic responsibility that all Americans share. 

Although a lot of us don’t love paying taxes, we should at least recognize that everyone paying their fair share is the reason the American way of life exists. After all, American taxpayers are the reason we have roads, bridges, fire and police departments, trash removal, public schools, community health centers and a plethora of other services including much of our healthcare system. The nation’s most reliable healthcare programs–Medicare, Medicaid, the Department of Veterans Affairs, the Children’s Health Insurance Program (CHIP)–all are supported with taxpayer funds.

A reliable social safety net is well worth paying taxes to support, but the truth is that in the coming decades we’ll need more revenue to accommodate the changing needs of our population, including the massive challenge created by the rapid aging of the population.  More than 11,000 Americans will turn 65 every day in 2024 and in every year through 2027. The older population also grew five times faster than the total population between 2010 and 2020. The number of Americans ages 65 and older will more than double over the next 40 years, reaching 80 million in 2040. 

Relative to peer countries, the United States will still be on the younger end and given the wealth in our nation, is well positioned if we plan now to accommodate the investments needed to ensure millions of people age with the healthcare and dignity they deserve over the coming years. That’s where President Biden’s commitment to taxing the wealthy and corporations more fairly comes in. The President supports raising revenue to deal with the nation’s fiscal challenges by closing tax loopholes that let the richest households and big corporations avoid paying taxes, which drains money from the economy and away from investments in healthcare and other services. 

For most of us, our tax bills increase when our income increases. The American tax system is supposed to be progressive so that those who make more also pay more. Over the years, however, the system has gotten more and more skewed so that those who have the most– millionaires and billionaires–pay less than the rest of us. Thanks to an antiquated and increasingly two-tiered tax system, the super rich get taxed according to one set of rules while the rest of us are subject to a different set – helping the rich to get richer while the rest of us pay more. 

New data from the federal reserve shows that the cumulative wealth of the richest 1%  of Americans just hit a record high – $44.6 trillion at the end of 2023. The Fed defines the top 1% as people whose wealth exceeds $11 million. The total net worth of the top 1% increased by $2 trillion with all gains coming from stock holdings that are largely concentrated in the hands of the wealthy. In fact, 87% of all individually owned stocks are owned by the richest 10% . The top 1% own over half of all individual stocks. Plus, the wealthy aren’t taxed on stocks unless they sell them. That means they can collect increased wealth from stocks going up in value – and even borrow against that wealth – while paying nothing more in taxes.

A recent tax reform–the Trump tax law of 2017–has also helped America’s billionaires get richer over the last several years by cutting their taxes and keeping in place loopholes that help them avoid paying their fair share. Billionaire wealth has nearly doubled—up $2.9 trillion—since enactment in late 2017 of the Trump-GOP tax law. Under current rules, none of that nearly $3 trillion in wealth gain–the main form of income for the ultra-wealthy–may ever be taxed.

Under the Trump tax law, the top 1% of taxpayers got an average annual tax cut of $61,000 a year while the bottom 60% of American households only received about $500. Those big tax cuts for the wealthy cost the rest of us, adding over $2 trillion to the national debt. Now, leading Republicans in Congress are insisting on cuts to federal programs. services and benefits because of the mounting debt. 

Yet despite Congressional hand-wringing about the debt, many Republicans are urging an extension of the Trump tax cuts that would lavish even more money on the wealthy in the coming decade. Congressional Republicans have already introduced the TCJA Permanency Act to make permanent parts of the Trump law that would otherwise expire at the end of 2025. The bill would cost $288.5 billion in 2026 alone and heap more benefits onto the wealthiest Americans while continuing to offer very little that benefits the rest of us. 

As President Biden has pointed out, there are better ways to deal with the debt. Biden has proposed letting the Trump tax cuts expire on time, raising taxes on price-gouging corporations and the wealthy that have for too long avoided paying federal taxes, as well as closing the loopholes that unfairly privilege the wealthy. Already, the President is implementing a law that enables the Internal Revenue Service (IRS) to finally enforce tax payments from wealthy tax cheats making over $400,000 a year and enacting a corporate minimum tax so that billion-dollar companies can’t get away with paying $0 in Federal income taxes anymore. 

These measures make the tax system more fair and ensure that the wealthiest Americans are contributing more toward supporting the economy that made them so rich to begin with. Paying taxes is everyone’s responsibility and we all benefit from the investments that tax dollars support. It’s time that those prospering the most from our economy and society–billionaires, millionaires, and large corporations–start paying their fair share.

14 Features to Celebrate on the ACA’s 14th Anniversary

By jfoster Affordable Healthcare, Blog, Medicaid, Reproductive Healthcare

March 23, 2024 marks the 14th anniversary of the passage of the landmark Affordable Care Act, the most significant and comprehensive healthcare reform since the 1960s passage of Medicare and Medicaid. The law took two years to pass, over a decade to implement and countless resources to defend from attacks in the courts, in legislatures and in Congress. Today, the Affordable Care Act is supported by a majority of Americans and has reached record enrollment thanks to powerful consumer protections, comprehensive coverage and new premium tax credits that President Biden renewed under the 2022 Inflation Reduction Act. 

There are hundreds of reasons to celebrate the ACA, but on the law’s 14th birthday, here’s HCANEF’s top 14:

  1. The ACA reduced the number of uninsured people in the United States to record lows. Before the ACA, the rate of uninsurance was about 16%–one of the highest rates in the developed world. Today, the rate of uninsurance is just under 8%.
  2. The ACA improved the quality of insurance for over 150 million people who already had coverage by creating new rules for insurance companies that stopped them from discriminating against people with pre-existing conditions by denying them coverage, charging them more, capping services and setting arbitrary limits on coverage.
  3. The ACA for the first time created standards for health insurance that requires every insurance policy sold on the individual and small group market to cover basic Essential Health Benefits like mental health, birth control, and pediatric care. These services were often excluded from plans before the ACA.
  4. The ACA made it illegal to discriminate against women: insurance companies can no longer charge women more than men for the same policy or treat pregnancy and the potential to get pregnant as pre-existing conditions to charge women more for insurance.
  5. The ACA made it possible for states to vastly expand coverage through Medicaid, the health insurance program with the lowest administrative costs and greatest reach, by funding the full cost of Medicaid coverage for the expanded population – bringing billions of dollars of new revenue into states to support coverage, rural hospitals and providers, and local economies.
  6. The ACA saves millions of people of all ages money by making preventive care free under all health plans. Annual check ups, Pap smears, colonoscopies, and other procedures that identify disease early are now provided at no cost to people under private insurance, Medicaid and Medicare.
  7. The ACA also made no cost birth control available to millions more Americans as part of the no-cost preventive care provisions. Before the ACA, many policies had no coverage for birth control and people had to pay out of pocket.
  8. The ACA provided more than $11 billion in funding to bolster and expand community health centers: nearly 1,400 of these health centers operate more than 14,000 service delivery sites that provide comprehensive and preventive health care to nearly 29 million people – 1 in 11 nationwide – in every corner of the country. 
  9. The ACA closed the Medicare Part D “donut hole” coverage gap that forced millions of seniors to pay the full price of their prescriptions out of pocket.
  10. The ACA expanded home-care options for aging people and people with disabilities by rebalancing the funding between institutional care and home-based care and expanding the amount provided for people who want to receive services and support in their homes rather than in an institution or facility setting.
  11. The ACA reduced racial health disparities by providing affordable coverage to Latino, Black and Native American people who were most likely to lack coverage before passage of the law as well as by establishing the Offices of Minority Health within six agencies at HHS to dedicate attention, support and data tracking for health disparities information. 
  12. The ACA also for the first time explicitly prohibited discrimination on the basis of race, color, national origin, age, disability, or sex (including pregnancy, sexual orientation, and gender identity), in covered health programs, activities, and health insurance.
  13.  The ACA expanded coverage for young people by enabling for the first time parents to keep children on their insurance plans until age 26. 
  14. The ACA provided all these benefits while lowering overall health care costs and paid for the improvements with taxes on wealthy households making over $200,000, on providers, insurers, medical device manufacturers and pharmaceutical corporations. 

The ACA provides all these benefits and many more and the law is just getting better under President Biden’s leadership. This year, over 21 million people enrolled in ACA marketplace plans–the largest number of all time and that number will grow as long as the ACA remains the law of the land. But that’s not guaranteed: despite the law’s many successes, ACA opponents like former President Trump continue to threaten the law, vowing to end it before its next birthday. 

President’s SOTU Speech Brims With Common Sense and Optimism–Now Congress Must Act

By jfoster Blog, Lower Drug Prices

More than 6 in 10 Americans who watched President Biden’s State of the Union speech had a positive reaction to the President’s remarks and with reason: President Biden communicated plainly and succinctly about what his administration has accomplished, what plans he has for tackling today’s toughest issues and what we’re going to as a nation to build on our best legacies. Certainly chief among these is the tremendous gains we’ve made in every area of healthcare except for reproductive health, where anti-abortion extremists have turned back the clock fifty years. 

The President celebrated recent actions to lower the price of Affordable Care Act coverage that has led to record low uninsured rates and Medicare reforms that are lowering prescription drug costs for seniors and people with disabilities with good reason. For two decades, politicians of all stripes have been promising to rein in Big Pharma price-gouging and make medicines affordable–including Biden’s predecessor who promised to make drug corporations “negotiate like crazy” but then reversed course. 

Instead it was President Biden who delivered on the promise of more affordable medicines and on holding drug corporations accountable for price-gouging and raising prices faster than inflation year after year. The Inflation Reduction Act (IRA) that Democrats passed without one single Republican vote and that President Biden signed into law will lower prices on some of the most expensive medicines in Medicare by requiring negotiated prices rather than letting drug corporations decide alone. Not only did the President tout this provision, he actually proposed that Congress expand it to include many more drugs–up to 500 drugs in Medicare. He also urged that the lower negotiated prices be extended to millions of people with other kinds of coverage.

That’s a great idea since polls reveal that people of all ages, not just seniors in Medicare, struggle to afford prescriptions. Two thirds of American adults take at least one prescription and one in three can’t afford their medicines because of the high cost of prescriptions. The expanded reforms that President Biden proposed would go a long way toward ensuring that millions more Americans have access to the medicines they need to take care of themselves and their families. 

Even those who don’t take prescriptions would benefit since prescription drug prices contribute to overall healthcare costs for employers, patients and taxpayers. For example, the Medicare negotiations provisions in the IRA will save Medicare, a taxpayer funded program, nearly $100 billion over ten years. The provisions that penalize drug corporations for raising rates faster than inflation save another $101 billion over this period. This is savings on top of what individual patients save on prices and out of pocket costs thanks to the new law. 

People with all kinds of insurance, of all ages and incomes deserve the same opportunity for savings. Americans pay 2 to 3 times more for brand name drugs than people in other countries pay for the exact same drug, driving up premiums and putting higher burdens on US consumers who need treatments for everything from diabetes and heart disease and more complex conditions like cancer and mental health disorders. In our country, even people with insurance worry incessantly that they won’t be able to afford treatments they need, that their insurance won’t cover the full cost, that they will incur debt or that they will have to forgo treatment. Putting the President’s plan to make ACA coverage more affordable permanently and to expand prescription drug reforms to cover millions more people would provide the peace of mind we all deserve when it comes to our health. 

But, as the President also noted, that peace of mind won’t be complete until people have not just the coverage and affordability we need, but also the right to make their own health care decisions about reproduction and when to start a family. 

The President called on Congress to restore the right to abortion because the decision about when and if to have a child is fundamentally about having the power to control our own bodies and destinies. And he couldn’t be more right: denying women the right to decide for themselves whether to have an abortion or continue a pregnancy has dire health and economic consequences that can last a lifetime. The President has provided a path forward with wisdom, encouragement and optimism that America can succeed, as we always have in the past, in making progress. It’s time for Congress to take it.

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.