President Trump released his budget proposal today for 2021 through 2030. And just like last year (and the year before) Democrats and the main stream media are screaming about how he is planning to slash Medicare and Medicaid.
Joe Biden, said it “eviscerates Medicare,” while top Senate Democrat Chuck Schumer of New York said Trump is planning to ”rip away health care from millions of Americans” with cuts to Medicare and the Medicaid health program for the poor.
What’s the real story?
Under President Trump’s budget, Medicare spending in 2030 would be almost 200% of 2019 spending while Medicaid would approach 150% of 2019 levels. How can any rational person describe that as a slashing. Sounds like fake news.
Without any changes by President Trump, interest on the debt in 2030 would be more than double the 2019 payment of $409 billion and would alone eclipse Federal Medicaid spending. Does that sound sustainable?
The real headline should be that President Trump is taking steps towards a desparately needed balanced budget.
Below is the response from the AOA regarding the recent presidential executive order regarding Medicare.
Well they do make some accurate points towards the end of the letter there are many problems and issues that need to be brought out.
First. The federal government like most of America do not know what a DO or osteopathy is. Since this is a presidential executive order, does the President of the United States even know what osteopathy is? I doubt it! therefore the bureaucrats in Washington DC will not pay attention to this letter.
Second. The AOA does not speak for the 145,000 DO’s in this country. They can only speak for their membership which at this point is below 30% of all DO’s. since the AOA has not brought this information out to the membership and asked for support they cannot speak for any DO at this point. Likewise only 15% of MDs belong to the AMA. And again the AMA cannot speak for the vast majority of physicians in this country. Yet they do.
Third. Where in this response letter does the AOA expound on the difference between allopathic and osteopathic physician’s? And show our superiority in quality, cost containment etc. based on OSTEOPATHIC PRINCIPLES! Where does the AOA champion the use of osteopathic manipulative medicine in the care for seniors.
Please do not gloss over the potentially devastating impacts that Section 5 of President Trump’s Executive Order on Medicare will have on our healthcare system.
I am a board member for Physicians for Patient Protection, a grassroots physician group that promotes physician led care. We have been actively fighting scope of practice invasion in nearly every state for the last 3 years. NPs and PAs can be a valuable part of a physician led team but they are not equivalent to physicians in education, training, or ability. The government permitting them to independently practice medicine through legislation and not education will devastate healthcare. Here are a few of my concerns:
As NPs try to increase their numbers, they have sacrificed the quality of NP education. They have created degree mills that are churning out 27,000 NPs per year. Many schools have 100% acceptance and didactics that are 100% online and can be completed in as little as 18 months. This is followed by a mere 500 hours of shadowing as their “clinical experience”. Compare this to 16,000 clinical hours for a family medicine physician. We are seeing and hearing devastating stories of misdiagnosis and mismanagement of these poorly trained practitioners daily.
2. Medical expertise will be gradually diluted down.
Why will our best and brightest students even try to conquer to academic rigors and expense of medical school when you can take a cheaper, less time consuming course to practicing medicine independently and have the same reimbursement (due to pay parity proposed here). As a Family Medicine physician that has been practicing almost 15 years, I value every second of my training. It is needed for me to be an expert at my craft.
3. NPs and to a lesser extent PAs, in general are corporate YES men.
They have not been taught in their training to take ownership of patients as physicians do. They do not take the same oath to protect patients at all costs. If they are declared physician equals and can replace physicians, we will lose all negotiating power with corporate entities, government, and insurance companies. If physicians stand up for patients, they will simply be replaced by a more agreeable, complacent NP. There are probably a million additional reasons. But it is late and I’m sure you all are tired of reading my rant. But I am begging you all to please give this issue it’s due respect. The president has it WRONG on this issue. We can not continue to have this conversations in the dark corners because we are afraid of liking like we are being mean to nurses. Our profession, our fellow physicians, and our patients need us to speak up.
Thank you all for your wonderful advocacy. I believe it is people like us that can and will fix our broken system.
Amy Townsend, MD, Family Medicine/Hospital Medicine
The week before President Trump’s Independence Day “Salute to America” he gave a welcome Salute to Patients when he signed Executive Order 13877, “Improving Price and Quality Transparency in American Healthcare To Put Patients First.”
As free market champion Dr. Keith Smith of the Surgery Center of Oklahoma puts it, the “healthcare industry price gougers wore out their welcome” and were “kicked to the curb by President Trump.”
What does the order do? Its first priority is to end “opaque pricing structures,” that “benefit powerful special interest groups, such as large hospital systems and insurance companies,” but, “generally leave patients and taxpayers worse off than would a more transparent system.”
But there’s more: the order also aims to “enhance patients’ control over their own healthcare resources” by removing failed policies that impede patients from choosing to enroll in affordable Direct Primary Care practices or alternatives to big insurance like Health Care Sharing Ministries.
The bottom line is increasing patient freedom and choice is the centerpiece of President Trump’s order. However, make no mistake, it is also put a target squarely on the middlemen who have for too long taken advantage of backroom deals made with government cronies. And the middlemen are already fighting back with a vengeance and working to undermine the order.
Underestimating the special interests’ power to stop the good changes is not an option. Just last week the Pharmacy Benefits Manager (PBM) cartel killed a White House proposal that would begin to unwind corrupt kickbacks that result in out of control price hikes for life saving drugs through disingenuous propaganda that lower prices would somehow raise premiums.
And the fake news campaigns about the Transparency Order are already underway.
Thankfully physicians like Chad Savage, MD are debunking the industry lies:
No price transparency will not lead to higher prices. “This is akin to saying the best way to get a good price on a new Sony TV is to have no idea what it costs. If someone said that to you, you would rightly reject any future advice from that individual,” explains Dr. Savage.
Marni Jamison of the Association of Independent Doctors exposes another tactic of those who oppose transparency:
The cronies are “lawyering and lobbying up, busily working to undermine, narrow and water down the order. They are not going to give up the hundreds of billions of excess dollars flowing their way easily,” she writes and shares examples of weasel words insurers and mega health systems will attempt to use to corrupt the outcome.
Middlemen’s fingerprints are already evident on the order itself to some extent. For example the “Health Quality Roadmap” provisions empower the use of failed quality metrics that are already driving up the cost of care with out any benefit to outcomes. “Practitioners who practice according to the needs of their individual patients, not according to some standardized protocol approved by a third party whose only focus may be efficiency and cost-cutting, may be penalized,” warns Twila Brase of the Citizens’ Council for Health Freedom and award-winning author of Big Brother in the Exam Room. AAPS, while overall supportive of the order, flagged provisions as potentially harmful to privacy rights and urged that “patients’ right to consent to use of their data must also be respected.”
Winning these battles for patients and those who care for them will not be easy! But nothing worthwhile ever is. So let’s all Salute President Trump for taking these bold steps by stepping to help him fend off the special interests trying to thwart his welcome orders.
1) CNBC professes to tell you who will lose their insurance if the ACA is repealed. Not might…WILL…they say. Their number is 25 million.
2) They outline 3 groups but fail to mention that most people are in all 3 subsets. So their number is erroneous.
3) Truth: none of these people would be forced off a plan. Of course, there would be a ramp off the ACA and the current plans would be grandfathered as new options would become available subject to state regs not federal. States can amend their regs to tailor them to their state.
4) Freedom does not force people off plans but gives more options.
Options are about to multiply for 12-million Americans trapped in ObamaCare plans, the 12% uninsured, and others ACA victims, with coming new proposals from the Trump administration. After signing “Right to Try” into law Wednesday, President Trump hinted that these changes are mere weeks away.
Once the new policies are in place, new lower cost and flexible insurance alternatives will be unleashed, freeing Americans from disruptive (in a bad way) ObamaCare rules that drive up costs and decrease patients’ and workers’ choices.
Here are the two expected policies plus one hack that will floor the accelerator on their impact:
First, the Department of Labor is set to expand the availability of Association Health Plans. These will give Americans with common connections the ability to join together in plans they control. Less regulation is not the only advantage of AHPs, although savings will be significant: an estimated $9,700 a year less compared to the individual market by 2022, reports Avalere. Escaping state-based mandates is another advantage; these plans can be sold across state lines. In addition, association plans will allow employees to more readily keep their plan if their work situation changes.
The second anticipated policy, this one from the Department of Health and Human Security, will increase access to short term health insurance plans that are almost completely free of failed ACA requirements. Under President Obama, these plans were limited to 90 days of coverage, but Secretary Azar is expected to extend the limit to 364 days. Coverage in such a plan would costs on average $342 a month, vs. $619 per month for an exchange plan, reports Michael Cannon of CATO. Mr. Cannon also suggests the administration should allow short term plans to offer guaranteed renewability or even sell the guarantees separately (he estimates the average cost at $86/month). Renewability options would not only help consumers retain these plans long term, but would also inhibit expensive enrollees from being pushed back into the ACA exchanges.
Both of these proposals are going to help Americans; however the Trump administration could turbo-charge these good ideas with one simple hack. One sleek additional change to federal policy would lower costs even further, while increasing patients’ access to high quality care.
What else should the Trump administration do immediately? It’s simple: let patients use Health Savings Accounts (HSAs) for Direct Primary Care (DPC).
Most people already know about HSAs but, perhaps aren’t yet familiar with DPC, a direct arrangement between doctors and patients, that cuts the red tape out of health care, kicks the bureaucrats out of the exam room, and is set to sweep across the U.S. Dr. Marilyn Singleton explains DPC like this: “The Direct Primary Care (DPC) model is burgeoning as patients yearn for quality time with their doctor at an affordable price. Here, all primary care services and access to basic commonly used drugs at wholesale prices are included in a fixed transparent price,” often around $50 to 75 per month.
The bottom line is DPC saves money for patients and downstream payers (like Medicare), increases quality of care, and it relieves physicians of counterproductive red-tape hassles that are driving them out of practice. DPC is a win-win-win.
You’d think everyone would agree that encouraging the use of DPC is a no-brainer. Shockingly, the Internal Revenue Service is blocking the use of this innovation for the 30 million Americans with HSAs. Thanks to a letter issued by Obama’s IRS commissioner, John Koskinen (yes the same one who stonewalled efforts by Congress to investigate IRS retaliation against conservatives) patients are prohibited from contributing to their HSA if they are in a DPC practice. To add insult to injury, HSA funds cannot be used for DPC.
As the public becomes aware of this flawed IRS decree —deserving of a blue ribbon in the Health Policy Hall of Shame—momentum grows for change. Just last month, Senators Ted Cruz and Ron Johnson wrote Treasury asking for a reversal. In addition 1,125 patients and doctors have asked Congress to pass the Primary Care Enhancement Act (HR 365/S 1358) and force the IRS to change its misguided interpretation of law.
Disrupting (in a good way) Koskinen’s obstruction of patient freedom must be a priority for the Trump Administration as it moves forward with other reforms to remedy past policy disasters. Allowing patients to use HSAs for DPC will turbo-charge the ability of patients with short term and Association-based plans to make their health care dollar go even further and get the best care from the physicians of their choice.
Need one last reason, President Trump? DPC will boost your plans to lower prescription drug costs. A 72-year old female patient with multiple chronic conditions purchases all nine of her medications through a Direct Primary Care office in Allentown, Pennsylvania for $14.63 per month. Through Medicare “coverage” her cost would be $294.25 per month.
There is simply no legitimate reason for blocking patients with HSAs from DPC physicians … unless you are a middleman profiting off the status quo.
HHS Secretary Alex Azar talked a good game in a Rose Garden ceremony and subsequent press conference—held Friday, May 11—on Trump Administration efforts to lower prescription drug costs for American patients.
Azar is, of course, a former executive of Eli Lilly. Can he be trusted to champion the interests of everyday Americans?
We will soon find out. President Trump stated that Sec. Azar’s insider knowledge about the complex schemes to raise prices, perpetrated by industry middlemen, is exactly what makes him the right person for the job.
Watch the video of the Rose Garden Ceremony:
Although groups like Physicians Against Drug Shortages have been sounding the alarm for years, industry-led smoke and mirrors have, until recently, largely flown under the radar of the main-stream-media. Thankfully, respected outlets like the Wall Street Journal and Washington Times are now beginning to shine needed light on this malfeasance.
As these articles explain, a safe harbor to Medicare anti-kickback law is the major policy failure enabling the bad actors to line their pockets by driving up costs. The safe harbor legalizes kickbacks paid by manufacturers to Pharmacy Benefit Managers (PBMs) and their cousins-in-crime Group Purchasing Organizations (GPOs).
TownHall.com reports: Repealing the GPO/PBM safe harbor to Medicare anti-kickback law “would open the drug and medical supply segment of healthcare to free market competition and foster innovation. In addition, it would result in cost reductions estimated at $100 billion [actually more like $200 billion], including savings for the Medicare and Medicaid programs.”
Congress initially enacted the GPO safe harbor in 1986. Then in 1987 Congress reaffirmed the measure, instructed HHS to implant the the safe harbor into regulation, and granted HHS authority to create additional safe harbors. In 2003 HHS OIG issued guidance clearing the way for PBMs to piggyback on the GPO safe harbor. Such guidance could theoretically be revised or rescinded by the HHS Secretary, without needing action by Congress.
Later in the press room, Azar explained that there are perverse incentives at play: “These big price increases are actually a good deal for pharmacy benefit managers, who are supposed to keep prices down.”
Video of White House Press Conference With Sec. Azar:
What is HHS going to do? They put out a 44-page blueprint of their plan:
One step HHS announced it will implement immediately is a prohibition of Part D gag clauses, “preventing pharmacists’ telling patients when they could pay less out-of-pocket by not using insurance.”
Great words but let’s hope HHS doesn’t stop there. The blueprint is less clear about other action HHS will take related to PBMs, although it states HHS is considering: “Measures to restrict the use of rebates, including revisiting the safe harbor under the Anti-Kickback statute for drug rebate.”
Rebates? Why does CMS use that euphemism? They are not rebates, they are legalized kickbacks. Furthermore, rebates do not go to the patients, they flow to the PBM and insurance companies.
Unfortunately, HHS has a poor track record when it comes to using it’s existing authority to stop PBM abuse. The Government Accountability Office reports: “since 2004, [HHS] has not routinely exercised its authority to request and review disclosures” that PBMs are required to make available to comply with the safe harbor.
HHS promises there will be an opportunity for the public to comment through a “Request for Information.”
HHS appears to be asking the right questions, including:
“Do PBM rebates and fees based on the percentage of the list price create an incentive to favor higher list prices (and the potential for higher rebates) rather than lower prices?”
“Should PBMs be obligated to act solely in the interest of the entity for whom they are managing pharmaceutical benefits? Should PBMs be forbidden from receiving any payment or remuneration from manufacturers, and should PBM contracts be forbidden from including rebates or fees calculated as a percentage of list prices? What effect would imposing this fiduciary duty on PBMs on behalf of the ultimate payer (i.e.,
consumers) have on PBMs’ ability to negotiate drug prices?”
When details become available about the comment opportunity we will ask that all patients and doctors demand that HHS take strong action to stop the PBM and GPO kickbacks.
Ultimately, as Trump stated in his comments, Congress will need to do it’s part in concert with administration actions. One priority for Congress must be to repeal the GPO/PBM safe harbor and end legalized kickbacks.
In the meantime HHS can lead the way to educate Americans on how such repeal will save $200 billion dollars/year and prevent dangerous drug shortages.
Americans are depending on you to do the right thing, Secretary Azar.
I just read President Trump’s executive order on choice and competition across state lines. It has these amazing provisions which have not been discussed in the media at all!! These provisions go to the heart of a competitive market-based healthcare system.
“(c) My Administration will also continue to focus on promoting competition in healthcare markets and limiting excessive consolidation throughout the healthcare system. To the extent consistent with law, government rules and guidelines affecting the United States healthcare system should:
(i) expand the availability of and access to alternatives to expensive, mandate-laden PPACA insurance, including AHPs, STLDI, and HRAs;
(ii) re-inject competition into healthcare markets by lowering barriers to entry, limiting excessive consolidation, and preventing abuses of market power; and
(iii) improve access to and the quality of information that Americans need to make informed healthcare decisions, including data about healthcare prices and outcomes, while minimizing reporting burdens on affected plans, providers, or payers.”
The whole order can be read here: https://www.whitehouse.gov/the-press-office/2017/10/12/presidential-executive-order-promoting-healthcare-choice-and-competition . I love the title to promote choice and competition. I don’t think the order was overreach, because the language is to ” PRIORITIZE three areas for improvement in the near term: association health plans (AHPs), short-term, limited-duration insurance (STLDI), and health reimbursement arrangements (HRAs).” and “FOCUS on promoting competition in healthcare markets and limiting excessive consolidation “. I did note this part:” Public Comment. The Secretaries shall consider and evaluate public comments on any regulations proposed under sections 2 through 4 of this order.”