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Celebrating 35 years of making Medicare more accessible, affordable, and equitable!

Medicare Watch

Medicare Watch articles are featured in a weekly newsletter that helps readers stay up-to-date on Medicare policy and advocacy developments, and learn about changes in Medicare benefits and rules.

New Drug Spending Tool May be Helpful for Researchers and Policymakers—Not Much Help for Consumers

This week, the Centers for Medicare & Medicaid Services (CMS) released new data and a new tool on prescription medication: the Drug Spending Dashboard. The Dashboard allows users to see list prices of various medications, how many manufacturers supply the drug, what they have been paid by Medicare—both Part B and Part D—and Medicaid, total and per beneficiary spending on the drug, and comparisons of spending from 2015 to 2016. Such data show trends in both drug pricing and program spending, and CMS offers additional data for use outside of the Dashboard.

Read More »
a roll of bills from which spill out pills of many colors

Trump Administration Unveils Drug Pricing Strategy

On Friday, President Trump and U.S. Department of Health and Human Services (HHS) Secretary Azar outlined the Administration’s strategy to reduce drug prices. The Administration further described the plan, “American Patients First,” in a blueprint document also unveiled Friday.

The much-anticipated plan is a mix of existing policies laid out in the Administration’s 2019 budget request, as well as some new ideas designed to drive down drug prices and lower costs. Though neither the speech nor the blueprint offers much detail about the Administration’s next steps, there are several aspects of the plan that could significantly impact people with Medicare. This includes potential changes to how certain drugs are covered by Medicare, as well as proposals to reconsider the obligations of Pharmacy Benefit Managers (PBMs), and arrangements between Part D plans and drug manufacturers.

Read More »

Hearing on the Medicare Advantage Program Highlights Need for Improved Beneficiary Outreach and Education

This week, the U.S House of Representatives Committee on Ways and Means Health Subcommittee held a hearing on the Medicare Advantage (MA) program. MA allows people with Medicare to choose a private insurance option instead of traditional Medicare. Witnesses included representatives from two MA plans—Andrew Toy of Clover Health and Daphne Klauser of Independence Blue Cross—who spoke to their experience administering MA plans, as well as Dr. Karoline Mortensen, Associate Professor of the Department of Health Sector Management and Policy at the University of Miami Business School, who discussed quality measures in MA plans. Dr. Jack Hoadley, Research Professor Emeritus at Georgetown University’s McCourt School of Public Policy and former Commissioner on the Medicare Payment Advisory Commission (MedPAC) also testified, speaking for himself and not on behalf of Georgetown or MedPAC.

Read More »

Health Care Legislation Cropping Up in Unexpected Places

This week, several health care programs appeared in legislation that does not normally address health care. Two of the surprise provisions are embedded in draft Farm Bill legislation and in cuts, or rescissions, requested by the White House. While these measures may gain traction in the U.S. House of Representatives, they face a more uncertain future in the Senate.

Read More »

Kaiser Family Foundation Makes Predictions for Future of Medicare Drug Price Negotiation

The Kaiser Family Foundation released a new report looking at the history of the concept of Medicare drug price negotiation, including the dramatically different role that the federal government has in securing good prices for Medicare beneficiaries, compared to its active involvement in establishing drug prices for other government health programs, including Medicaid and the Department of Veterans Affairs (VA). The report outlines various bills that have been introduced in Congress since the enactment of the Part D benefit, and discusses how enthusiasm for making this change tracks closely with the rate of increase in Part D drug costs.

Read More »

Millions Lose Coverage as Affordable Care Act Changes Take Effect

This week, the Commonwealth Fund’s Affordable Care Act Tracking Survey showed recent coverage declines among 19-to-64-year-olds. The survey’s focus is on adults who gained coverage through the ACA’s marketplaces and Medicaid.

The findings show that an estimated four million people have lost coverage since 2016. Significant changes can be seen for lower income households and people aged 35-49, and the losses are even more pronounced in states that have not expanded Medicaid—especially southern states—and among people who self-identify as Republican. For example, among Republicans surveyed, the uninsured rate has risen from 7.9% in 2016 to 13.9% in 2018, with self-identified Democrats seeing no change.

Read More »

Improving Medicare Plan Finder Should be a Priority

This week, the National Council on Aging (NCOA) and the Council for Affordable Health Coverage’s Clear Choices Campaign released a long-anticipated report on the Medicare Plan Finder (MPF) tool. The Modernizing Medicare Plan Finder Report highlights some of the issues Medicare beneficiaries, their families, and their caregivers encounter while using the MPF tool as well as future considerations for the tool’s development and recommendations for improvement.

Read More »

Medicare Rights Outlines Concerns with Short-Term Insurance Plans

This week, we submitted comments to the U.S. Department of Health and Human Services (HHS) in response to the agency’s proposed rule to expand the availability of short-term, limited duration insurance (STLDI) plans. This rule would mean millions of people would have bad insurance plans that do not cover their health needs and millions more would be paying much higher prices for quality coverage.

Read More »

April is Medicaid Awareness Month: New Resources on Medicaid and Older Adults

This month, stakeholders and advocates across the country are observing Medicaid Awareness Month. Organized by the Protect Our Care coalition, the month-long campaign is intended to enhance awareness of the many ways the Medicaid program strengthens American communities.

To that end, the coalition is launching outreach and education efforts on a different topic each week. These activities will culminate in a national Medicaid Day of Action on April 30.

Read More »

Lawsuit Alleges Kentucky Medicaid Work Requirement Breaks Federal Law

On January 11, 2018, the Centers for Medicare & Medicaid Services (CMS) issued guidance announcing a new policy that, for the first time, will allow states to make participation in a work or “community engagement” program a condition for Medicaid enrollment. The next day, CMS approved a Medicaid waiver in Kentucky that will allow the state to test this new policy.

Read More »

New Drug Spending Tool May be Helpful for Researchers and Policymakers—Not Much Help for Consumers

This week, the Centers for Medicare & Medicaid Services (CMS) released new data and a new tool on prescription medication: the Drug Spending Dashboard. The Dashboard allows users to see list prices of various medications, how many manufacturers supply the drug, what they have been paid by Medicare—both Part B and Part D—and Medicaid, total and per beneficiary spending on the drug, and comparisons of spending from 2015 to 2016. Such data show trends in both drug pricing and program spending, and CMS offers additional data for use outside of the Dashboard.

a roll of bills from which spill out pills of many colors

Trump Administration Unveils Drug Pricing Strategy

On Friday, President Trump and U.S. Department of Health and Human Services (HHS) Secretary Azar outlined the Administration’s strategy to reduce drug prices. The Administration further described the plan, “American Patients First,” in a blueprint document also unveiled Friday.

The much-anticipated plan is a mix of existing policies laid out in the Administration’s 2019 budget request, as well as some new ideas designed to drive down drug prices and lower costs. Though neither the speech nor the blueprint offers much detail about the Administration’s next steps, there are several aspects of the plan that could significantly impact people with Medicare. This includes potential changes to how certain drugs are covered by Medicare, as well as proposals to reconsider the obligations of Pharmacy Benefit Managers (PBMs), and arrangements between Part D plans and drug manufacturers.

Hearing on the Medicare Advantage Program Highlights Need for Improved Beneficiary Outreach and Education

This week, the U.S House of Representatives Committee on Ways and Means Health Subcommittee held a hearing on the Medicare Advantage (MA) program. MA allows people with Medicare to choose a private insurance option instead of traditional Medicare. Witnesses included representatives from two MA plans—Andrew Toy of Clover Health and Daphne Klauser of Independence Blue Cross—who spoke to their experience administering MA plans, as well as Dr. Karoline Mortensen, Associate Professor of the Department of Health Sector Management and Policy at the University of Miami Business School, who discussed quality measures in MA plans. Dr. Jack Hoadley, Research Professor Emeritus at Georgetown University’s McCourt School of Public Policy and former Commissioner on the Medicare Payment Advisory Commission (MedPAC) also testified, speaking for himself and not on behalf of Georgetown or MedPAC.

Health Care Legislation Cropping Up in Unexpected Places

This week, several health care programs appeared in legislation that does not normally address health care. Two of the surprise provisions are embedded in draft Farm Bill legislation and in cuts, or rescissions, requested by the White House. While these measures may gain traction in the U.S. House of Representatives, they face a more uncertain future in the Senate.

Kaiser Family Foundation Makes Predictions for Future of Medicare Drug Price Negotiation

The Kaiser Family Foundation released a new report looking at the history of the concept of Medicare drug price negotiation, including the dramatically different role that the federal government has in securing good prices for Medicare beneficiaries, compared to its active involvement in establishing drug prices for other government health programs, including Medicaid and the Department of Veterans Affairs (VA). The report outlines various bills that have been introduced in Congress since the enactment of the Part D benefit, and discusses how enthusiasm for making this change tracks closely with the rate of increase in Part D drug costs.

Millions Lose Coverage as Affordable Care Act Changes Take Effect

This week, the Commonwealth Fund’s Affordable Care Act Tracking Survey showed recent coverage declines among 19-to-64-year-olds. The survey’s focus is on adults who gained coverage through the ACA’s marketplaces and Medicaid.

The findings show that an estimated four million people have lost coverage since 2016. Significant changes can be seen for lower income households and people aged 35-49, and the losses are even more pronounced in states that have not expanded Medicaid—especially southern states—and among people who self-identify as Republican. For example, among Republicans surveyed, the uninsured rate has risen from 7.9% in 2016 to 13.9% in 2018, with self-identified Democrats seeing no change.

Improving Medicare Plan Finder Should be a Priority

This week, the National Council on Aging (NCOA) and the Council for Affordable Health Coverage’s Clear Choices Campaign released a long-anticipated report on the Medicare Plan Finder (MPF) tool. The Modernizing Medicare Plan Finder Report highlights some of the issues Medicare beneficiaries, their families, and their caregivers encounter while using the MPF tool as well as future considerations for the tool’s development and recommendations for improvement.

Medicare Rights Outlines Concerns with Short-Term Insurance Plans

This week, we submitted comments to the U.S. Department of Health and Human Services (HHS) in response to the agency’s proposed rule to expand the availability of short-term, limited duration insurance (STLDI) plans. This rule would mean millions of people would have bad insurance plans that do not cover their health needs and millions more would be paying much higher prices for quality coverage.

April is Medicaid Awareness Month: New Resources on Medicaid and Older Adults

This month, stakeholders and advocates across the country are observing Medicaid Awareness Month. Organized by the Protect Our Care coalition, the month-long campaign is intended to enhance awareness of the many ways the Medicaid program strengthens American communities.

To that end, the coalition is launching outreach and education efforts on a different topic each week. These activities will culminate in a national Medicaid Day of Action on April 30.

Lawsuit Alleges Kentucky Medicaid Work Requirement Breaks Federal Law

On January 11, 2018, the Centers for Medicare & Medicaid Services (CMS) issued guidance announcing a new policy that, for the first time, will allow states to make participation in a work or “community engagement” program a condition for Medicaid enrollment. The next day, CMS approved a Medicaid waiver in Kentucky that will allow the state to test this new policy.

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