Tag: healthcare
Why Medicaid Patients May Not Know Their Health Care Is At Risk

Why Medicaid Patients May Not Know Their Health Care Is At Risk

They go by different names in different states. In Tennessee, it is TennCare. In Ohio it is the Buckeye Health Plan. In California, it is Medi-Cal.

In Florida, it “sounds like an orange juice brand: Simply Healthcare,” wrote N. Adam Brown, an emergency room physician and professor at the University of North Carolina business school, in a commentary posted earlier this week on the MedPage Today website.

What they have in common is that they are Medicaid plans run by private insurance companies. Over the past several decades, 41 states and the District of Columbia have turned over their low-income health insurance programs to what industry jargon refers to as Medicaid managed care organizations or MCOs.

The nation’s 280-plus MCO plans cover an estimated 75 percent of the 85 million people (as of March 2024) on Medicaid, the joint federal-state program targeted for massive cuts by the GOP-run Congress. While many are run by non-profits or government agencies (like CountyCare in Chicago where I live), five for-profit private insurers (Centene, UnitedHealth Group, Elevance, Molina and Aetna/CVS) account for more than half of all Medicaid MCO enrollment, according to the Kaiser Family Foundation.

While the websites of most of these firms indicate their plans are connected to Medicaid, a significant share of their clientele have no idea they are covered by a government-financed program. A recent study published in JAMA found that between 2019 and 2022 when enrollment increased by 5.2 percentage points, surveys that asked where people obtained their health insurance showed only a 1.3 percentage point growth in Medicaid.

“Because Medicaid is not branded as Medicaid, if you tell a patient in South Carolina they might lose Medicaid, their eyes may glaze over,” Brown wrote. “Tell them Healthy Connections is at risk? You have their attention.”

His solution? “In every state, we need to call Medicaid by its real name,” he wrote. Instead of saying “‘Republicans want to reduce Medicaid by $880 billion,’ try ‘If Republicans' Medicaid plans come to fruition, you could lose your Buckeye Health Plan health insurance.’”

Where are the lobbyists?

No one is in better position to call Medicaid by its real name than the private insurers in charge of the program. Yet with the sole exception of Centene, the largest MCO operator, most companies have remained silent in the face of the GOP’s assault on the program.

For instance, I can’t find a single press release or public statement by a private insurer that counters claims contained in a specious hit piece released earlier this month by conservative think tanks that estimated Medicaid made $1.1 trillion in improper payments over the past decade. Since they’re managing at least half the money that flows through Medicaid, they ought to be offended.

The Paragon Health Institute and Economic Policy Innovation Center paper based its claims on eligibility reviews conducted during the last two years of the first Trump administration. It then applied that percentage to all Medicaid spending. However, the government estimated just a five percent improper payment rate or about $31 billion in 2024, which, if eliminated in every year over the next decade, would only save half of what conservatives claim.

Nor have those insurers risen to defend the the 92 percent of adults under 65 who are on Medicaid despite working full or part-time. More than a quarter of all workers in the private sector are not offered health insurance as a benefit, most whom are earning poverty- or near-poverty wages and are eligible for Medicaid, especially in the 41 states that have expanded the program (with 90% federal funding) to cover people earning up to 138 percent of poverty wages.

Even among those offered health insurance on the job, only three-quarters purchase plans. Why? Most can’t afford the premiums being taken out of their paltry paychecks.

So let’s begin describing Medicaid for what it is: A massive subsidy for employers who rely on low-wage labor. This subsidization is necessary because we have what, theoretically at least, is an employment-based health insurance system. Yet the government doesn’t require all employers provide and pay for health insurance.

Of course that’s not what you hearing from Republicans like Rep. Eric Burlison (R-MO). During hearing held earlier this month, he, like the president he slavishly follows, said there would be no cuts to Medicaid. “My definition of cutting does not include getting people who are fraudsters and getting people who are not supposed to be on the list as recipients.”

Democrats should answer with the following: “When we make Florida’s orange growers pay for their orange pickers’ health insurance, we’ll be able to shrink ‘Simply Health’ as much as they shrank the amount of juice put in each bottle.”

Reprinted with permission from Gooz News.

Poll: Massive Voter Rejection Of Medicaid And Food Stamp Cuts

Poll: Massive Voter Rejection Of Medicaid And Food Stamp Cuts

A new Civiqs poll conducted for Daily Kos should give Republicans a serious case of heartburn.

The survey, which was fielded February 28 to March 3, finds that 63 percent of registered voters oppose the idea of cutting programs like Medicaid and food stamps that help low-income Americans. Those are the same two programs Republican lawmakers plan to slash in order to pay for President Donald Trump's tax cuts for the rich. Half of voters (50 percent) strongly oppose cutting those programs.

The GOP budget blueprint, which passed the House last week with only Republican votes, would require hundreds of billions in cuts to Medicaid and food stamps in order to just partly pay for the GOP's plan to extend the tax cuts they passed in 2017, which overwhelmingly benefit the highest-earning taxpayers.

The new poll finds that nearly every demographic group opposes making cuts to Medicaid and food stamps, which help 72 million Americans afford health care and 42 million Americans put food on the table, respectively.

The cuts are opposed by an overwhelming share of female voters (68 percent), male voters (57 percent), non-college-educated voters (60 percent), college-educated voters (67 percent), urban voters (74 percent), suburban voters (62 percent), rural voters (56 percent), and every age group.

The only major group surveyed that supports the cuts are Republicans, 55 percent of whom support making cuts to those programs. However, that is weak support from a group that usually eats up everything Trump wants.

The poll's results provide insight into why Republicans are lying about the kind of cuts their budget necessitates.

“The word Medicaid is not even in this bill,” Republican Rep. Steve Scalise of Louisiana said at a news conference on Capitol Hill last week, as he sought to convince his own members to support the budget. “Democrats are lying about … what’s in the bill.”

But Democrats are not lying about the fact that the budget would make steep cuts to Medicaid.

"Their resolution calls for at least, as a floor, $880 billion to be cut by what is under the purview of the Energy and Commerce Committee,” Democratic Rep. Brendan Boyle of Pennsylvania, ranking member of the House Budget Committee, explained. “If Energy and Commerce Committee said, 'We don't want to cut Medicaid. Instead, we will cut literally everything else we possibly can, 100 percent,' that only gets you about halfway to the $880 billion. So by definition, they have to, at a minimum, cut hundreds of billions of dollars from Medicaid.”

Experts say cuts that steep would leave many at risk of losing their Medicaid coverage.

Indeed, heavily Republican states such as West Virginia, Louisiana, Kentucky, and Arkansas have some of the highest percentages of state residents on Medicaid, according to data from KFF, a nonpartisan organization focused on health policy.

“Everyone who relies on Medicaid would be at risk,” Edwin Park, a research professor at the McCourt School of Public Policy at Georgetown University, told NBC News. “Specifics of the proposal will matter—each state will be hit, and how hard they’ll be hit will vary—but certainly they’re all at risk.”

Protests have cropped up across the country as voters try to convince Republicans not to slash the programs. Over the weekend, people in Alaska, Colorado, New York, and Wisconsin gathered to slam their Republican lawmakers for voting for the bill that necessitates cuts to Medicaid.

Republicans were also met at town halls by angry constituents who oppose Medicaid cuts.

But whether Republicans will listen to voters is another story.

Trump has blessed the GOP proposal with his endorsement, saying, "We need both Chambers to pass the House Budget to ‘kickstart’ the Reconciliation process, and move all of our priorities to the concept of, 'ONE BIG BEAUTIFUL BILL.' It will, without question, MAKE AMERICA GREAT AGAIN!"

And Republicans have shown time and again that if Trump says jump, they say how high.

Reprinted with permission from Daily Kos.

RFK Jr. And Trump Risk Health Of 9/11 Heroes With Callous Staffing Cutbacks

RFK Jr. And Trump Risk Health Of 9/11 Heroes With Callous Staffing Cutbacks

New York Sens. Chuck Schumer and Kirsten Gillibrand wrote a letter to newly appointed Health and Human Services Secretary Robert F. Kennedy Jr. on Monday, condemning the recent “nonsensical and dangerous” 20% staffing cuts to the World Trade Center Health Program. The cuts jeopardize the ability to deliver health care to those suffering from 9/11-related health conditions, including respiratory ailments and cancers.

The letter urges Kennedy to reverse the staffing cuts and requests a briefing from the HHS and the CDC on the changes made to the WTCHP and their direct impact on the program's capacity to serve enrollees. The letter also called out Kennedy’s hypocrisy, citing a former conversation he had with the senators before his confirmation where he vowed to protect 9/11 access to care.

One of the first responders, John Feal, whose organization FealGood Foundation helps 9/11 responders access financial aid programs and treatment for 9/11-induced illnesses, appeared on New York’s News 12 on Sunday to speak out against the mass firing. Feal called the cuts “inhumane.”

"The World Trade Center Health Program is a lifeline to 137,000 people—9/11 heroes, volunteers, and those who lived, and worked and went to school in Lower Manhattan," Feal said. "And these people now who are dealing with severe respiratory illnesses, severe cancers—there's over 30,000 people with a certified cancer. That means when those people are cut and no longer work for the federal government, they cut 20% of that staff. That staff is responsible for certifying people's illnesses, that staff is responsible to ensure that there’s no fraud, that staff is responsible to ensure that research continues."

Feal added that he and a group of first responders and political leaders will head to Washington, D.C., next week to lobby for the $3 billion needed to fund the WTCHP through 2090.

Schumer took to X on Tuesday to tell his constituents he’s fighting on their behalf.

“The Trump HHS is breaking the sacred promise to always stand by our 9/11 heroes by slashing funding and vital staffing for their healthcare in the World Trade Center Health Program,” he said. “It’s unacceptable. I’m fighting to get Secretary Kennedy to reverse these cuts and firings NOW to provide for those who answered the call of duty on 9/11.”

This comes as Kennedy, under the direction of the White House and Elon Musk’s chaotic Department of Government Efficiency, fired an estimated 3,600 public health employees across the National Institutes of Health, CDC and Food and Drug Administration over the weekend, prompting employees to call it the “Valentine’s Day massacre.”

DOGE has taken it upon itself to gut the federal government. In less than a month, it has conducted mass firings or buyouts of government agency employees at the United States Agency of International Development, the Federal Aviation Administration, the Department of Education, the FBI, and the CIA.

Whether it’s hypocrisy or pathetic fealty to Trump, courageous Americans who risked their lives to save others on 9/11 deserve the care they now need—not to be cast aside by a president and his billionaire ally intent on dismantling human decency.

Reprinted with permission from Daily Kos.

Drug Prices

Democrats Should Pick A Fight With Trump Over Drug Prices

Donald Trump is executing a shock and awe strategy, burying the public in a smoky cloud of flamboyant proposals. Some, like ending birthright citizenship, are quickly slapped down in the courts. Some, like threatening to invade Greenland, are dismissed as moronic. But all are radical enough to provide news media with easy entertainment.

The problem for Democrats is that these flashbangs distract from plans that would hit Americans, in Bill Clinton's words, "where they live." Democrats need to focus.

Start with actions to weaken Biden-era programs to restrain the prices drugmakers may charge for their products. His first day back in office, Trump canceled the Biden order to test new models for lowering drug costs.

When Trump ran for president in 2016, he promised to have Medicare negotiate drug prices. Why? It was a very popular idea. Upon election, the vow promptly vanished. Trump named Alex Azar, a top executive at Eli Lilly, to head Health and Human Services. (Under Azar, Eli Lilly tripled the price of its top-selling insulin drug.)

But Joe Biden's Inflation Reduction Act did follow through. As a result, 10 popular drugs covered under Medicare Part D (the prescription drug benefit) were selected for price reductions by 2026. They include such popular medications as Jardiance (diabetes), Enbrel (rheumatoid arthritis) and Eliquis (blood clots).

In its last days, the Biden administration targeted another 15 Part D drugs for price negotiations. They include Trelegy Ellipta (asthma, COPD) and three big-name drugs for weight loss, diabetes and heart disease: Rybelsus, Ozempic and Wegovy. These negotiations would have to be implemented by the Trump administration. Don't bet the farm on much relief.

Novo Nordisk, maker of Ozempic and Wegovy, has been charging Americans outlandish prices for these blockbusters. Wegovy's list price in the U.S. is over $1,300 for a month's supply. It is five times the price in Canada ($265) and 14 times the price in Britain ($92).

The right-wing argues, as Project 2025 puts it, that government negotiations on Medicare drugs amount to "price controls" that will reduce patient access to new medication. That's news to the citizens of just about every other advanced country. And no, other countries don't let drugmakers charge their people whatever they want.

In Novo Nordisk's home country of Denmark, Wegovy costs only $186 a month. It should surprise no one that 72% of the company's sales come from the United States. We are the land of suckers.

Thanks to Biden, the catastrophic coverage tier for Part D begins when a beneficiary's out-of-pocket spending reaches $2,000. Project 2025 calls for "eliminating the coverage gap in Part D, reducing the government share in the catastrophic tier, and requiring manufacturers to bear a larger share." (You may laugh at the "requiring manufacturers" part.)

It's true that Trump has yet to reverse the caps already in place on seniors' drug costs, and so beneficiaries won't notice much change right off. He's certainly too clever to mess with the $35 limit on the monthly price of insulin, one of Biden's marquee achievements. Doing so might break through the smoke.

However, Project 2025 has its own ideas, and Trump is stocking his administration with Project 2025 folk. Furthermore, as Republicans comb through the budget for ways to pay for tax cuts, Medicare would seem a ripe place to slash spending. Trump did vow to leave Medicare alone. Then again, he vowed to have Medicare negotiate drug prices.

Why would Trump be OK with forcing Americans to pay more than the rest of the world for their drugs? The answer is simple: Because the drug companies want them to.

Democrats, step around some of those rabbit-hole distractions. You have an issue.

Reprinted with permission from Creators.

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