Band Aids or Healthcare Reform?

Reform was the right answer - May 24, 2023

May 25, 2023

Happy Thursday Healthcare Advocates

Please enter requests for research using the comment button at the bottom of this newsletter. Remember our advocacy educates our representatives and lets them know what we want them to do for us.

Items in work are prison healthcare (a hot mess) and rural healthcare (another hot mess).

Unwind Medicaid

Several months ago we had an article about unwinding Medicaid when the pandemic ended. There was a risk that many people who received Medicaid access because the pandemic was raging would lose their coverage this Spring. The problem envisioned was that the in states that didn’t expand Medicaid people would fall off the rolls as the income requirement was again reduced. A real threat, but not what happened in Florida. There, 82% of enrollees were kicked off Medicaid for administrivia reasons such as wrong address or phone number. I’m never going back to Florida

Pharmacy Benefit Managers (from Hell)

As we mentioned previously there are a variety of different pieces of legislation addressing pharmacy benefit managers in front of Congress. Here is a link to that article which had a tutorial about how they do business. I think bribery and chicanery are the technical terms.

If you have a few moments here is a video from Congress of Representative Jamie Raskin interviewing his doctor. She describes how PBMs put her patient’s life at risk by refusing to authorize the correct cancer treatment, The drug they would cover would not work and they could not understand why her recommended drug was the drug of choice. Maybe it is because drugs wind up on the insurance formulary because PBMS are bribed to put them there and they went to medical school, like never. Here is the video.

If you have some extra time here is a video of Representative Katie Porter and a video of Representative Ocasio Cortez grilling big Pharma cheaters.

Senators Sanders (VT) and Murray (WA) have proposed legislation to address PBM transparency and it seems fairly reasonable. It is S. 1339. IMHO this one is fairly well written as it demands that any PBM bribes be returned to the policy sponsors - like the Employers who provide the policies. I would be more in favor of giving the money jointly to the policy holder and the sponsor.

In the House, H.R. 3561, the Promoting Access to Treatments and Increasing Extremely Needed Transparency Act of 2023 or the PATIENT Act of 2023, led by Reps. Cathy McMorris Rodgers (WA) and Frank Pallone Jr., was favorably reported, as amended, to the House by a bipartisan vote of 49-0 from the Energy and Commerce Committee. That is a link to that committee’s report.

I will review and compare these over the next couple of days and let you know what I find. The House bill is huge and PBMs are just a small part.

Keep in mind that these PBM bills are just a few of the hundreds that come to each Congress as band-aids to fix problems in our broken healthcare delivery and payment systems. What we need is reform designed from the bottom up so that all of us can have healthcare, stay healthier longer, and compete better with the rest of the world. You know what to do. It is in the action below.

ACTION

Call or email your Congressperson and Senators about this. There is a sample text below or use RESISTBOT on your phone by texting SIGN PHLQAE to tell them:

“I am your constituent in [zipcode] and I have had enough of the hundreds of bills that come to each Congress to fix individual parts of our broken healthcare system every session. While each of these band-aids might be important to some of us, they do not fix the systemic problem we have - that is too many people motivated by profit standing between our doctors and our health.

I want you to cosponsor the Improved Medicare for All ACT. H.R. 3421 or S. 1655 whichever applies to you. Let’s make sure we can all go to the doctor and be treated. It will lower costs, cover everyone, and make the US much more competitive. Do it.”