Posts Tagged ‘Doughnut hole’

Medicare Part D Costs Expected to Fall in 2012

Monday, August 22nd, 2011

Medicare Increased competition between Medicare Part D plans, greater generic drug use and more transparency for consumers are why the Center for Medicare and Medicaid Services (CMS) expects lower Medicare prescription drug premiums next year.  Next year, the average Medicare prescription drug plan premium will cost approximately $30, compared with an average of $30.76 in 2011, according to the Department of Health and Human Services (HHS).  CMS Administrator Dr. Donald Berwick said that the average premium is about 44 percent lower than what was estimated in 2003.

The Part D drug benefit,  enacted when George W. Bush was president, lets seniors and others on Medicare sign up for a privately administered, government-subsidized health plan to purchase their prescriptions.  The program enjoys high popularity with beneficiaries and has proven to be far less costly than budget analysts originally expected, partly because of competition among private plans and the growing use of less costly generic drugs.

HHS also announced that nearly 900,000 Americans in the Medicare Part D “doughnut hole” have benefited from a 50 percent discount in brand-name drugs in 2012.  HHS estimates that out-of-pocket savings on drug costs for Medicare beneficiaries to be about $461 million from January through June of this year.  The Obama administration has worked to strengthen the Medicare drug benefit with the help of the Patient Protection and Affordable Care Act (ACA).  The law phases out the coverage gap, long seen as one of the program’s weaknesses.  Last year, approximately four million seniors received $250 rebates because they fell into the gap in coverage.  This year, the law will provide 50 percent discounts on prescriptions for those who hit the doughnut hole.

Seniors can chose from a variety of Part D plans,  and Dr. Donald Berwick, administrator of the Center for Medicare and Medicaid Services, said competition “clearly helps” keep premiums from rising.  At the same time, he warned against overextending Part D.  HHS said 17 million seniors have received at least one preventive healthcare service without a co-pay.  The ACA eliminated co-pays for many preventive services under Medicare and will ultimately do the same for private insurance.

“This decline in the average creates more risk for plans like ‘Humana’ and ‘United Health’ that have a significant portion of the Part D members,” said Peter Costa, a Wells Fargo analyst.  Costa said one reason for the lower bids could be last year’s joint venture between Humana and Wal-Mart stores to offer Medicare drug coverage with the lowest premiums in the country.

“The Affordable Care Act is delivering on its promise of better health care for people with Medicare,” said HHS Secretary Kathleen Sebelius.  “People with Medicare who hit the doughnut hole are paying less for their prescription drugs, 17 million Americans have received free preventive services and prescription drug premiums will remain low.  These are important steps that are making a difference in the lives of millions of Americans right now.”

“Medicare beneficiaries will have more affordable prescription drug coverage next year as a result of vigorous competition in the Part D program and Medicare drug plans’ efforts to encourage seniors to choose the most affordable medicines,” said Karen Ignagni, president and CEO of America’s Health Insurance Plans.  Ignagni noted that “taxpayers are also saving billions of dollars as the total cost of the program continues to be far below original projections.”

Healthcare Lobbyists Busy on Capitol Hill

Thursday, April 7th, 2011

Even though the Patient Protection and Affordable Care Act (ACA) is the law of the land, the healthcare lobby is alive and well. Various federal agencies are working on full implementation of the law in 2014.  And with legislative tweaks and efforts to defund the law underway, lobbying on healthcare is ongoing.  So far, more than 180 groups have registered to continue shaping the law, according to the Sunlight Foundation.

Ever since President Barack Obama began the long journey to reform, healthcare lobbyists went into high gear.  During 2009 and 2010, $1.06 billion was spent on lobbying; more than $500 million was spent lobbying the legislation in each year, according to a report from the Center for Responsive Politics. Lobbyists for 1,251 organizations worked on healthcare reform in 2009 and 2010, according to the Sunlight Foundation.  Individual lobbyists who reported working on health related legislation totaled 3,154 in 2010, with Big Pharma topping the list.  The Pharmaceutical Research and Manufacturers of America spent $22 million and employs 52 lobbyists.  Political donors with ties to the healthcare sector raised $137 million for federal candidates in the 2010 elections.  That is $30 million less than that sector raised during the 2008 presidential race.

Barbara Kennelley, a former Congresswoman and current President and CEO of the National Committee to Preserve Social Security and Medicare, notes that lobbyists tried to raise an alarm among senior citizens about how the law might impact Medicare. “When the Affordable Care Act became law last March, critics predicted doom for the seniors and people with disabilities who rely on Medicare.  They said that coverage would disappear, benefits would be cut, and death panels were on their way – none of which was true.  But these lies scared many seniors about the law before it was explained to them.  Now, one year later, as the implementation of the law moves forward, Medicare is still sound – it’s stronger than it was before the law was passed – and millions of people with Medicare are benefitting from the law.”

Medicare has cracked down hard on waste, fraud, and abuse.  The Obama administration last year recovered $4 billion in Medicare fraud.  Additionally, the Affordable Care Act provides tools to crack down even further, specifically saying that Medicare’s guaranteed benefits – hospital care, doctors’ services, home health services, drug coverage, etc. – are protected.  “Benefits are as good as ever – better, in fact, Kennelly said.  “Prescription drugs are more affordable.  This year the nearly four million beneficiaries who fall into the prescription drug ‘doughnut hole’ will receive discounts on their drugs.  These discounts will increase over the next few years until the doughnut hole is closed.”

It’s now 2011 and the lobbying is still going full steam ahead. So far this year, more than 180 firms have registered to lobby for new clients on healthcare issues, 16 of which disclosed the Affordable Care Act as a specific lobbying interest, according to Sunlight’s Lobbying Registration Tracker.

The Obama administration is frustrated that the battle against healthcare reform hasn’t ended. “There still is a lot of intentional misinformation by opponents that continues to be repeated,” said Kathleen Sebelius, Department of Health and Human Services Secretary.  Agriculture Secretary Tom Vilsack agrees with Sebelius and believes that perceptions of the law are shifting as the benefits are implemented.  Vilsack noted that as farmers and small businesses file their 2010 tax returns, they are seeing a tax credit for small businesses of up to 35 percent for premiums paid on health insurance for employees.  “I think the acceptance of this and the awareness of this is going to grow substantially,” Vilsack said.