Volume 393, Number 10175
9 March 2019
WORLD REPORT A committee brought together Senators and drug company representatives to discuss why drug pricing in the USA is so high, but little progress was made, Susan Jaffe reports.
Author: Jaffe.KHN@gmail.com
CMS lost $84M in two years for ineligible nursing home stays
IG investigators said such improper payments are accumulating year after year.
By Susan Jaffe | Modern Healthcare | February 20, 2019
The CMS pays millions of dollars a year to nursing homes for taking care of older adults who don’t qualify for coverage, according to an investigation by HHS’ inspector general.
The IG’s report, released Wednesday, includes steps the CMS should take to fix the problem; but in a written response, CMS Administrator Seema Verma rejected some key recommendations. [Continued here.]…
USA sets goal to end the HIV epidemic in a decade
Volume 393, Number 10172
16 February 2019
WORLD REPORT The unexpected announcement in the State of the Union address could set the start of a realistic agenda to end HIV/AIDS in the USA, provided funds are secured. Susan Jaffe reports.
Nearly an hour into his 90 min State of the Union address, President Donald Trump called for a government-run health-care programme “to eliminate the HIV epidemic in the United States within 10 years”.
Although the president has promised to get rid of the Affordable Care Act (ACA) along with its health insurance marketplaces and Medicaid expansion, these and other policies did not appear to dampen his enthusiasm. [Continued here.]…
House Drug Price Hearing Takes Aim at Industry
By Susan Jaffe | Contributing Writer | MedPageToday | January 30, 2019
WASHINGTON — Pharmaceutical companies were pummeled during Tuesday’s hearing of the House Committee on Oversight and Reform. The panel’s first hearing of the 116th Congress examined the reasons for rising drug prices and follows committee chairman Elijah Cummings’ (D-Md.) launch of an aggressive investigation into pharmaceutical pricing issues.
“For the past decade I’ve been trying to investigate the actions of drug companies for all sorts of drugs — old and new, generic and brand name,” Cummings said. “We have seen time after time drug companies make money hand over fist by raising the prices of their drugs often without justification…” [Continued at MedPageToday]
NYC guarantees health care to all
Volume 393, Number 10169
26 January 2019
WORLD REPORT The mayor of New York City is not counting on Congress for solutions to its health-care problems, Susan Jaffe reports.
By encouraging patients to seek primary and preventive care instead of more expensive emergency care, city officials expect to save money and keep people healthy.
“From this moment on, in New York City, everyone is guaranteed the right to health care—everyone”, declared New York City Mayor Bill de Blasio as he unveiled his so-called NYC Care plan this month. People who cannot pay or are ineligible for health insurance—including undocumented immigrants—will be able to get the most comprehensive and affordable health coverage in the country, at little or no cost, the mayor said, speaking in both English and Spanish. “This is a way of getting people health care here and now, regardless of what happens on the state or the federal level”. [Continued here.]
… Profile: Leana Wen, President of Planned Parenthood
Volume 393, Number 10168
19 January 2019
“If there is one thing that I can accomplish as the President of Planned Parenthood, it’s to make clear that reproductive health care is standard health care, that women’s health care is standard health care and that we must view all aspects of health care as a fundamental human right”, said Wen. [Continued here.]…
State exemptions to the Affordable Care Act expanded
Volume 392, Number 10164
15 December 2018
WORLD REPORT In its latest blow to the ACA, the Trump administration provides guidance on how states can circumvent the health law. Susan Jaffe, The Lancet‘s Washington correspondent, reports.
In its most far-reaching move yet, the Trump administration has reinterpreted a provision of the landmark Affordable Care Act so that states can apply for exemptions to some requirements of the health law for states. [Continued here.]
… Trumpeted New Medicare Advantage Benefits Will Be Hard For Seniors To Find
By Susan Jaffe | Kaiser Health News | November 9, 2018 | This KHN story also ran on 
For some older adults, private Medicare Advantage plans next year will offer a host of new benefits, such as transportation to medical appointments, home-delivered meals, wheelchair ramps, bathroom grab bars or air conditioners for asthma sufferers.
But the new benefits will not be widely available, and they won’t be easy to find.
Of the 3,700 plans across the country next year, only 273 in 21 states will offer at least one. About 7 percent of Advantage members — 1.5 million people — will have access, Medicare officials estimate.
That means even for the savviest shoppers it will be a challenge to figure out which plans offer the new benefits and who qualifies for them.
Medicare officials have touted the expansion as historic and an innovative way to keep seniors healthy and independent. Despite that enthusiasm, a full listing of the new services is not available on the web-based “Medicare Plan Finder,” the government tool used by beneficiaries, counselors and insurance agents to sort through dozens of plan options. [Continued at Kaiser Health News, NPR and CNN]…
Prospects for health after the US mid-terms
Volume 392, Number 10161
24 November 2018
WORLD REPORT After the mid-term elections, Susan Jaffe, The Lancet‘s Washington correspondent, looks at the consequences for health-care legislation in the USA.
In the first national election since Donald Trump won the presidency promising, among other things, to repeal the Affordable Care Act (ACA), Americans went to the polls this month still concerned about health care. It was the most important issue for 75% of Democrats and 23% of Republicans who voted in the Nov 6 elections, according to exit polls. But, unlike in 2016, voters handed Democrats—the party responsible for the ACA—their largest victory since Republican Richard Nixon resigned as president after the Watergate scandal….
“Health care was on the ballot and health care won”, said the House of Representatives’ Democratic minority leader Nancy Pelosi of California, who is expected to become speaker of the house when the new Congress convenes in January. [Continued here.]
… No More Secrets: Congress Bans Pharmacist ‘Gag Orders’ On Drug Prices
Update: After this article was posted Oct. 10th, the President signed the legislation into law later that day.
By Susan Jaffe | Kaiser Health News | October 10, 2018 | This KHN story also ran on 
For years, most pharmacists couldn’t give customers even a clue about an easy way to save money on prescription drugs. But the restraints are coming off.
When the cash price for a prescription is less than what you would pay using your insurance plan, pharmacists will no longer have to keep that a secret.
…But there’s a catch: Under the new legislation, pharmacists will not be required to tell patients about the lower cost option. If they don’t, it’s up to the customer to ask. [Continued at Kaiser Health News and at NBC News]
…Funding redirected to pay for immigrant detention centres
Volume 392, Number 10157
27 October 2018
WORLD REPORT A plan to expand immigrant children detention centres requires money from medical research and
health programmes. Susan Jaffe, The Lancet‘s Washington correspondent, reports.
Trump administration officials told congressional leaders last month it will transfer as much as US$466 million from cancer research, meals for older adults, preschool for toddlers, HIV/AIDS prevention, and other initiatives that are central to the agency’s mission to protect Americans’ health. “These transfers are only a temporary solution to the sad consequence of a broken immigration system”, said HHS Deputy Secretary Eric Hargan. [Continued here.]
… New Medicare Advantage Tool To Lower Drug Prices Puts Crimp In Patients’ Choices
Some physicians and patient advocates are concerned that the pursuit of lower Part B drug prices could endanger very sick Medicare Advantage patients if they can’t be treated promptly with the medicine that was their doctor’s first choice.
By Susan Jaffe | Kaiser Health News | September 17, 2018 | This KHN story also ran on
Starting next year, Medicare Advantage plans will be able to add restrictions on expensive, injectable drugs administered by doctors to treat cancer, rheumatoid arthritis, macular degeneration and other serious diseases.
Under the new rules from Medicare, these private Medicare insurance plans could require patients to try cheaper drugs first. If those are not 
effective, then the patients could receive the more expensive medication prescribed by their doctors.
Insurers use such “step therapy” to control drug costs in the employer-based insurance market as well as in Medicare’s stand-alone Part D prescription drug benefit, which generally covers medicine purchased at retail pharmacies or through the mail. The new option allows the private Medicare plans — an alternative to traditional, government-run Medicare — to extend that cost-control strategy to these physician-administered drugs.
…Critics of the new policy, part of the administration’s efforts to fulfill President Donald Trump’s promise to cut drug prices, say it lacks some crucial details, including how to determine when a less expensive drug isn’t effective. [Continued at Kaiser Health News and NPR]
…
Prospects for US single-payer national health care
Volume 392, Number 10149
1 September 2018
WORLD REPORT The single-payer national health-care bill, so-called Medicare for All, is gaining momentum with the public but is stalling in Congress. Susan Jaffe, The Lancet‘s Washington correspondent, reports.
Instead of fading away into legislative oblivion, some Democrats campaigning for congressional seats and candidates for state offices are supporting the Medicare for All bill—or some variation thereof—as the November election approaches. They are not alone: a Morning Consult/Politico national poll in June found that 63% of Americans support “a Medicare for All healthcare system, where all Americans would get their health insurance from the government”. [Continued here.]
…
Trump’s second Supreme Court nominee, Brett Kavanaugh
Volume 392, Number 10144
28 July 2018
WORLD REPORT If confirmed, Kavanaugh could tilt the court toward the president’s views on US public health policy. Susan Jaffe, The Lancet‘s Washington correspondent, reports.
Before Republicans chose Donald Trump as their party’s candidate for president in 
2016, some doubted whether the New York real-estate developer seeking political office for the first time was truly conservative. To shore up his conservative credentials, Trump produced a list of judges with help from the conservative Heritage Foundation and Federalist Society that he promised to choose from to fill a vacancy on the Supreme Court should an opening occur during his presidency....
Health-care issues are expected to dominate the debate over [Judge Brett] Kavanaugh’s nomination in the US Senate, which will decide if he should join the court. Several cases involving the Affordable Care Act (ACA) and reproductive rights are working their way through the legal system. …If Kavanaugh, aged 53 years, is approved, his lifetime position on the court means his vote could be a deciding factor in cases for several decades. [Continued here.]
…
Trump Administration’s Medicaid work rules hit a snag
Susan Jaffe | Washington Correspondent for The Lancet | 10th July 2018
After winning a federal court decision to stop Kentucky from requiring some Medicaid patients find paid or volunteer work to keep their coverage, beneficiary advocates are considering legal challenges to stop similar efforts in other states.
The victory may expose a major flaw in the Trump Administration’s effort to reshape the Medicaid program, advocates say. But others claim the flaw is in the court decision. [Continued here.]…
Looking For Lower Medicare Drug Costs? Ask Your Pharmacist For The Cash Price.
Sometimes a drug plan’s copay is higher than the cash, but insurers’ “gag orders” keep pharmacists from telling Medicare beneficiaries. A little-known Medicare rule requires pharmacists to divulge the lower cash price if patients ask.
By Susan Jaffe | Kaiser Health News | May 30, 2018 | This KHN story also ran on
As part of President Donald Trump’s blueprint to bring down prescription costs, Medicare officials have warned insurers that “gag orders”
Scott Olson/Getty Images
keeping pharmacists from alerting seniors that they could save money by paying cash — rather than using their insurance — are “unacceptable and contrary” to the government’s effort to promote price transparency.
But the agency stopped short of requiring insurers to lift such restrictions on pharmacists.
That doesn’t mean people with Medicare drug coverage are destined to overpay for prescriptions. Under a little-known Medicare rule, they can pay a lower cash price for prescriptions instead of using their insurance. But first, they must ask the pharmacist about that option…. [Continued at Kaiser Health News, NPR and CNN Money]…
Gun violence research in the USA: the CDC’s impasse
Volume 391, Number 10139
23 June 2018
WORLD REPORT Months after the Trump Administration said that there is no ban on gun violence studies, the CDC still lacks the funding to proceed. Susan Jaffe, The Lancet‘s Washington correspondent, reports.
…Appeals for immediate federal action to make schools and communities safer have so far largely gone unanswered. And legislative efforts languish in Congress, as the chairman of a key congressional committee that oversees federal health programmes has so far resisted requests by its Democratic members to hold hearings on preventing gun violence [continued here].…
Trump unveils plan to cut drug prices
Volume 391, Number 10136
2 June 2018
WORLD REPORT The president’s wide-ranging plan to reduce prescription drug prices won’t be easy to achieve, experts say. Susan Jaffe, The Lancet’s Washington correspondent, reports.
“We will have tougher negotiation, more competition, and much lower prices at the pharmacy counter. And it will start to take effect very soon“, said President Donald Trump.
How soon will depend on what steps the administration takes on its own, through regulations and other mandates, and what changes can only be achieved through new laws enacted by Congress, which will increasingly be preoccupied by November’s election. [Continued here.]…
Besieged EPA Chief still committed to Trump agenda
Susan Jaffe | Washington Correspondent for The Lancet | 8th May 2018
At last count, at least four federal agencies were conducting nearly a dozen investigations of Environmental Protection Agency chief Scott Pruitt, probing his office renovations, a round-the-clock security unit who accompanied him on a trip to Disneyland, personnel management, and first-class air travel. The Capitol Hill condo he rented at a bargain rate of only $50 a night from the wife of an energy industry lobbyist has also come under scrutiny.
Environmental Protection Agency Administrator Scott Pruitt testifies at a congressional hearing April 26, 2018 (Getty Images).
But in separate hearings held by the congressional subcommittees that oversee EPA, Pruitt dismissed the investigations as politically motivated.
“Those who attack the EPA and attack me are doing so because they want to attack and derail the president’s agenda and undermine this administration’s priorities,” Pruitt told the congressional panels two weeks ago. “I am simply not going to let that happen.”
…Republicans were eager to praise his achievements during the hearings, and encouraged him to keep at it. [Continued here] …
Scientists and physicians run for office in the USA
Volume 391, Number 10131
28 April 2018
WORLD REPORT Frustrated by what they say is the US Government’s disregard for science, more scientists and physicians are entering politics. Susan Jaffe, The Lancet’s Washington correspondent, reports.
Nuclear engineer Elaine Luria running for Congress in southeast Virginia (photo/elaineforcongress.com)
Scientists, physicians, engineers, and their supporters surprised many people—and maybe themselves—when they assembled in cities across the USA a year ago demanding an end to President Donald Trump’s Administration’s so-called war on science, which has attacked climate change, environmental protection laws, and funds for biomedical research, among other targets.
But, for some critics, protests are not enough. Instead of appealing to elected officials, now they want to take their place.
“…More and more scientists realise that they have… an obligation to see that the idea of science is defended, that evidence is respected, and that the conditions for science to thrive are respected”, said Rush Holt, chief executive officer of the American Association for the Advancement of Science. [Continued here.] …
Medicare Advantage Plans Cleared To Go Beyond Medical Coverage — Even Groceries
By Susan Jaffe | Kaiser Health News | April 3, 2018 | This KHN story also ran on 
Air conditioners for people with asthma, healthy groceries, rides to medical appointments and home-delivered meals may be among the new benefits added to Medicare Advantage [private insurance] coverage when new federal rules take effect next year.
The Institute for Aging in San Francisco helps seniors get to doctor appointments and social activities. (Photo/Susan Jaffe)
…But patient advocates including David Lipschutz. senior policy attorney at the Center for Medicare Advocacy, are concerned about those who may be left behind. “It’s great for the people in Medicare Advantage plans, but what about the majority of the people who are in traditional Medicare?” he asked. “As we tip the scales more in favor of Medicare Advantage, it’s to the detriment of people in traditional Medicare.” [Continued at Kaiser Health News, The Philadelphia Inquirer, The Washington Post and CNN Money]
…No barrier to CDC research on gun violence—except funding
Susan Jaffe | Washington Correspondent for The Lancet | 28th March 2018
A day after the horrific mass shooting at Marjory Stoneman Douglas High School in Parkland, Florida on February 14, where 17 students and faculty were murdered and 14 injured, Health and Human Services Secretary Alex Azar fielded budget questions from a congressional committee. In response to Representative Kathy Castor, a Democrat from Tampa, Florida, Azar said there is no restriction on the ability of the Centers for Disease Control and Prevention (CDC) to conduct research into the causes of gun violence.
Questions about CDC’s ability to investigate gun violence—as it
“March for Our Lives” rally in Washington, D. C. March 24, 2018. (Photo/Susan Jaffe)
would other public health threats—have persisted ever since Congress passed the 1996 Dickey Amendment prohibiting the use of research funds to advocate or promote gun control.
“We don’t believe that it gets in the way of our ability to do violence research or firearms violence research at any part of HHS,” Azar told another congressional panel a month later. “I think we’ve now made it quite publicly—and within the administration—clear that we don’t see any barriers around violence or firearm violence research. We’re in the evidence and science-gathering business.”
His assurances were also included in the instructions that accompanied the budget agreement Congress approved and President Donald Trump signed into law last week. While some observers believe this means CDC has permission from Congress to proceed, some leading experts in firearms research are skeptical. There may be no barriers, but they say there’s no funding either.[Continued here] …
Trump Administration’s new direction for Medicaid
Volume 391, Number 10126
24 March 2018
WORLD REPORT Medicaid work requirements would make the health insurance programme a pathway out of poverty, say top US health officials. Susan Jaffe, The Lancet’s Washington correspondent, reports.
Beneficiaries can lose their health care if they fail to pay a premium, submit documentation that they qualify for an exemption, or to report a change in eligibility. “All roads lead to people being terminated from the programme or locked out of coverage,” said Leonardo Cuello, an attorney and director of health policy at the National Health Law Program in Washington, DC.
“This is not about punishing anyone”, said Arkansas Governor Asa Hutchinson. “It’s about giving people an opportunity to work and give them the training they need and help them move out of poverty and up the economic ladder.” [Full article here.] …
Lifting Therapy Caps Is A Load Off Medicare Patients’ Shoulders
Last month’s budget deal means Medicare beneficiaries are eligible for physical and occupational therapy indefinitely. Plus, prescription drug costs will fall for more seniors.
By Susan Jaffe | Kaiser Health News | March 14, 2018 | This KHN story also ran on
Physical therapy helps Leon Beers, 73, get out of bed in the morning and
Leon Beers gets help from caregiver Timothy Wehe. (Bert Johnson for KHN)
maneuver around his home using his walker. Other treatment strengthens his throat muscles so that he can communicate and swallow food, said his sister Karen Morse. But in mid-January, his home health care agency told Morse it could no longer provide these services because he had used all his therapy benefits allowed under Medicare for the year.
… Under a recent change in federal law, people who qualify for Medicare’s [physical, occupational and speech] therapy services will no longer lose them solely because they used too much.
“It is a great idea,” said Beers. “It will help me get back to walking.” [Continued at Kaiser Health News, NPR and The Washington Post]
…
Home Care Agencies Often Wrongly Deny Medicare Help To The Chronically Ill
By Susan Jaffe | Kaiser Health News | January 18, 2018 | This KHN story also ran on
Colin Campbell (Heidi de Marco/KHN)
Colin Campbell needs help dressing, bathing and moving between his bed and his wheelchair. He has a feeding tube because his partially paralyzed tongue makes swallowing “almost impossible,”he said.
Campbell, 58, spends $4,000 a month on home health care services so he can continue to live in his home just outside Los Angeles. Eight years ago, he was diagnosed with amyotrophic lateral sclerosis, or “Lou Gehrig’s disease,” which relentlessly attacks the nerve cells in his brain and spinal cord and has no cure.
The former computer systems manager has Medicare coverage because of his disability, but no fewer than 14 home health care providers have told him he can’t use it to pay for their services. That’s an incorrect but common belief…. [Continued at Kaiser Health News and NPR]…