Tag Archives: Medicare

Election Surprise: Health Care Galvanizes Voters

A voter casts his ballot at Hillsboro Old Stone School on November 7, 2017 in Purcellivlle, Va. (Katherine Frey/The Washington Post via Getty Images)

Health care appears to have played an unexpectedly robust role in Tuesday’s off-year elections, as Democrats swept statewide races in Virginia and New Jersey and voters told pollsters it was a top concern.

The health headline of the night came in Maine, where voters by a large margin rebuked Republican Gov. Paul LePage and approved a referendum  expanding Medicaid under the Affordable Care Act. Maine is one of 19 states that has not expanded the program to people with incomes up to 138 percent of the federal poverty line, or about $16,600 for an individual. An estimated 70,000 to 90,000 Mainers could gain insurance under the expansion.

The Legislature has passed similar bills five times, but LePage vetoed each one. And despite Tuesday’s outcome, he held firm in his opposition. The governor announced Wednesday that he would not implement the expansion, which he said would be “ruinous” for the state’s budget, unless it is fully funded by the Legislature.

Medicaid expansion might also be back in play in Virginia. Voters there not only elevated Democratic Lt. Gov. Ralph Northam to the governorship, they may have steered Democrats to a takeover of the state House of Delegates, which has been the primary source of opposition to Gov. Terry McAuliffe’s efforts to expand Medicaid. As of Wednesday morning, Democrats had picked up 15 of the 17 seats they would need to take over the majority with several races too close to call or requiring a recount.

And while it was not a headline issue in the governor’s race, health care proved decisive to Virginia voters, according to exit polls funded by a pool of media organizations.

Health care was by far the top issue for voters, according to the poll, which asked voters which of five issues mattered most to them. Nearly 4 in 10 said health care was the issue most important to their vote, followed by gun policy at 17 percent, taxes at 15 percent, immigration at 12 percent and abortion at 8 percent. Among those voters who cited health care, 77 percent voted for Democrat Northam, making it his strongest issue by a wide margin.

The fallout will depend on who holds which views, said Rodney Whitlock, a former GOP Senate staffer. If health care is a top concern for Democrats, “that doesn’t have a lot of meaning for Republicans,” he said. But if independents are the ones who see health as a salient voting issue, “that means much more.”

But Robert Blendon, a professor of health policy and political analysis at Harvard University, said the election results suggest that health care has again become a positive for Democrats. “You don’t have to say you love the ACA, but that you don’t want to drop millions of people” from coverage, he explained.

In New Jersey, voters said they were more concerned with state issues, with property taxes and corruption topping the list of topics they told exit pollsters drove their votes. But health care was third.

Still, the election results likely hinged on a host of concerns, warned Drew Altman, president and CEO of the Kaiser Family Foundation. Health issues are still strongly viewed through partisan lenses, he said, and the voting probably was more of a referendum on President Donald Trump than on health care. But the results in the Maine referendum could have repercussions beyond that state, showing that Medicaid expansion is “far more popular” than Republicans have acknowledged. (Kaiser Health News is an editorially independent program of the Kaiser Family Foundation.)

In Ohio, voters defeated what some called a confusing ballot measure aimed at limiting prescription drug prices to no more than the amount paid by the Department of Veterans Affairs. A similar measure was voted down in California last year.

Taxpayers also pay when drug companies price gouge

epipen

Even as the cost of EpiPens dramatically rose, so too did the number of prescriptions written for patients in Medicare, sending spending by the program skyrocketing nearly 1,100 percent from 2007 to 2014, a new report shows.

During the same period, the total number of Medicare beneficiaries using EpiPens climbed 164 percent, from nearly 80,000 users in 2007 to more than 211,000 in 2014, according to the analysis by the Kaiser Family Foundation. While the report does not delve into what’s behind the increase, factors could include increased awareness among people with allergies, marketing efforts and access to insurance coverage.

The abrupt rise is notable because many people think that life-threatening allergies are less common among the elderly. In addition, epinephrine — the active ingredient in EpiPens — can pose greater risks to older adults. Food and Drug Administration labeling urges caution when prescribing to this age group.

“That level of increase gives me pause,” said Martha Twaddle, senior medical officer for Illinois at Aspire Health, which provides home-based supportive care for people with serious illness.  She did not work on the study. Epinephrine — the active ingredient in EpiPens — can cause side effects including chest pain, rapid increase in blood pressure or irregular heart rhythms, which could be fatal, for people with certain medical conditions, including heart disease.

The foundation study comes amid ongoing scrutiny — including congressional testimony Wednesday by Mylan CEO Heather Bresch — over EpiPen price increases. (Kaiser Health News is an editorially independent program of the Foundation.)

EpiPens are used in cases of severe allergic reactions. Costs for a two-pack of the pens has gone from about $94 in January 2007 to $609 in May of this year. In response to criticism of its price increase, Mylan announced in late August that it would make a generic version and price it at half of its current brand name price.

The new numbers from Medicare could add fuel to the debate over these price increases and voters’ demands that Congress take action to roll back the cost of the popular medication.

The health insurance program for senior citizens and disabled people spent about $6.4 million on the devices in 2007, but spent $75.3 million in 2014, with sharp price hikes by the manufacturer driving much of the increase. Those figures reduce the amount spent based on estimates of how much Medicare saved in rebates from manufacturers, although the agency would not disclose the exact amounts.

Still, when patients show up in emergency rooms with life-threatening allergic reactions, epinephrine is a first line of defense, said Robert Glatter, emergency room physician at Lenox Hill Hospital in Manhattan. Those whose allergic reaction isn’t immediately life threatening would more likely get a mix of steroids and antihistamines, he said.

All patients with suspected severe allergic reactions — even the elderly — are given either a prescription or an actual epinephrine auto injector upon discharge, he said.

“We tell them to have it and use it if they have a lip or tongue swelling, shortness of breath, a skin rash [or other symptoms] of a problem,” said Glatter, adding that adults tend to become more susceptible to food allergies as they age.

Increased awareness among doctors and patients about the importance of epinephrine could account for some of the increase seen in the study, said Richard Lockey, a past president of both the World Allergy Organization and the American Academy of Allergy, Asthma & Immunology.

“Most people survive an allergic reaction … the people who don’t survive are those who don’t get epinephrine or don’t get it soon enough,” said Lockey, who says it is necessary to balance this idea with the possible risks epinephrine poses for older patients. “It’s a matter of clinical judgment.”

Although Medicare is generally thought of as the government health program for older people, about 16 percent — or 9.1 million beneficiaries — are younger than 65. They are generally disabled or have kidney problems requiring dialysis. According to foundation researchers, although the majority of users were older than 65, a disproportionate share – 35 percent — of the EpiPen users were younger than 65. Additionally, 26 percent were between 65 and 69. Use fell off with age, with only 15 percent of the users being between ages 75-85.

“You can come up with a ton of reasons why the under-65 population might see an increase in EpiPen use,” said James Goodwin, an expert in geriatric medicine at the University of Texas Medical Branch in Galveston. He did not work on the study.

As for the overall increase, Goodwin said there are likely many factors and it isn’t necessarily evidence of overutilization. Still, Goodwin says he specializes in patients older than age 80 and has never prescribed an EpiPen, nor had three of his colleagues, who work with slightly younger elderly patients.

One geriatrician said he has patients who are on it with prescriptions from their allergists, who weigh the pros and cons of having the drug. Those physicians “are the ones to say your allergy is serious enough to potentially become life threatening.”

At the American Geriatrics Society, epinephrine is not included on the organization’s list of potentially inappropriate medicines, said Nicole Brandt, a professor at the School of Pharmacy at the University of Maryland.

“When you look at in context of someone having a severe anaphylactic reaction, which is life threatening, you want access to treatment,” said Brandt. She said doctors should caution patients about the appropriate use of the devices and encourage them to seek additional medical attention if they experience side effects.

She suggested the increase in Medicare prescriptions seen in the study reflects access to insurance more than overuse.

Since Medicare drug plans cover part of enrollees’ total drug costs, beneficiaries in prescription drug plans pay less that the full retail price. But beneficiaries still paid significantly more of their own money for EpiPens during the seven-year period studied in the report. Average out-of-pocket spending for beneficiaries with Medicare drug coverage nearly doubled for each EpiPen, from $30 to $56. The report does not include price increases beyond 2014.

Still, those costs are far less than what some people with private insurance might pay, particularly those with high deductibles. As a result, at least one doctor — geriatrician David Barile from Princeton, New Jersey — who did not work on the study, speculated that the rise in Medicare use of EpiPens might simply be older people getting them for their grandchildren.

Mylan's embattled CEO Heather Bresch is shown here (right) speaking at Fortune Magazine's at a meeting for Wall's Street's most powerful women.
Mylan’s embattled CEO Heather Bresch is shown here (right) speaking at a Fortune Magazine meeting for Wall’s Street’s most powerful women.

Liz Szabo contributed to this report.

KHN’s coverage of prescription drug development, costs and pricing is supported in part by the Laura and John Arnold Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Obamacare allows people to buy health insurance. But many then can’t afford to use it.

Another sign that we need single-payer health care:

More than a quarter of adults who bought health insurance on exchanges created under Obamacare skipped important doctor visits and medical tests because they could not afford to pay, a study published Thursday by Families USA found. Among low- and middle-income adults, the proportion of people who avoided care was even higher, at nearly one-third.

More than 14 million people in the United States gained health insurance through Obamacare, landmark legislation officially known as the Affordable Care Act that was passed in 2010. Nearly 12 million people signed up for health coverage plans on exchanges created under Obamacare, according to the website ACAsignups.net.

But more than half of the adults who bought such plans had deductibles of $1,500 or more, Families USA, a Washington nonprofit organization focused on health care, found. A deductible is the cumulative amount a person has to spend on health care before his or her insurance company starts to pay. Despite receiving tax credits to help offset the cost of coverage, these deductibles were prohibitively expensive.

“Simply having health insurance is no guarantee that consumers can afford to pay for health care,” the report noted. When people decided to forgo medical care, fees that would have to be paid out-of-pocket were a major contributing factor, the report, which surveyed adults with lower- and middle-income levels, found. The report did not include people who had health insurance through Medicaid or those who had health insurance through their employers.

Overall, the Affordable Care Act made health insurance and health care itself more affordable, in part by subsidizing the cost through tax credits to those who qualify. But for some Americans, it was not affordable enough, the report showed. Of adults who were insured for a full year, 25.2 percent did not get necessary medical care, including tests, treatments and medications. Of lower- to middle-income adults, 32.3 percent reported not getting care they needed.

It’s all well and good that people can actually sign up for health insurance they would not otherwise have. But it’s kind of pointless if those people have deductibles so high they don’t even go to the doctor.

If you think you don’t have to care, you should. One of the main points of the fight over Obamacare was to get as many people as possible onto health insurance of some sort so that the taxpayers don’t keep footing the bill for uninsured people who get sick or have accidents. It was also to get people going to the doctor so that potentially serious problems might be caught before a minor problem turns into a more serious (and more expensive) ailment.

We will eventually need single-payer health care. If our leaders can get over the health care gridlock that almost consumed Obamacare, and manage to get the health establishment on-board. That might be a tough job. One of the chief reasons health care costs are out of control is not so much waste by each consumer — although that plays a part — as much as it is the simple fact that there is a lot of money to be made on health care and a lot of vested interests don’t want to see that gravy train disappear.

Via: Is Obamacare Working? Quarter Of Americans Who Bought Health Insurance On Exchanges Couldn’t Afford Medical Care (International Business Times)

Via: What is Single Payer? (Physicians For A National Health Program)