ReportWire

Tag: Medicare

  • The Five Minute Read

    The Five Minute Read

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    MCC hosts transfer fairs

    To introduce students of all ages and stages in their life to different four-year colleges and universities, Middlesex Community College is hosting transfer fairs on both its Lowell and Bedford campuses.

    The Lowell Transfer Fair will take place Wednesday, Oct. 30, from 10 a.m. to 1 p.m. at the Cowan Center Cafeteria, 33 Kearney Square; the Bedford Transfer Fair takes place Thursday, Oct. 31, 10 a.m. to 1 p.m., 591 Springs Road.

    MCC helps students transfer to four-year colleges and universities across New England and nationwide each year. With a number of articulation agreements and MassTransfer, MCC makes the transfer process as easy as possible. This year’s fairs will welcome more than 40 colleges and universities.

    “At MCC, we strive to work with our students to develop and put into action a plan for their academic, transfer and career goals from day one of their time with us,” Coordinator of Transfer Affairs Nick Cloutier said.

    For more information, contact Coordinator of Transfer Affairs Jane Fain at FainJ@middlesex.mass.edu.

    Solidarity Lowell standout

    LOWELL — Join fellow activists and organizers for a voting standout for Tuesday’s general election with Solidarity Lowell on Friday, Nov. 1, at 5:30 p.m., Ladd-Whitney Memorial, 309 Merrimack St. Bring signs or make one there. Afterward, participants are invited to gather at a local restaurant for food and conversation.

    Solidarity Lowell is a volunteer group of community members of Greater Lowell working toward social justice by defending the human rights, dignity and equality of all persons against all forms of hate and discrimination.

    For information, email ryan@solidaritylowell.com.

    Household Hazardous Waste Day

    CHELMSFORD — The Department of Public Works hosts two Household Hazardous Waste events a year at the Chelmsford DPW yard located at 9 Alpha Road. The events are an opportunity for residents to remove household hazardous waste from their home, instead of just throwing it out with the trash (which is illegal). The next event is scheduled for Saturday, Nov. 2, from 9 a.m. to 1 p.m.

    The list below contains many, but not all, hazardous products you may find in your home that will be accepted at a Household Hazardous Waste Day: Antifreeze; propane tanks; brake fluid; car polishes and waxes; degreasers; drain openers; driveway sealers, epoxies, adhesive strippers and preservatives; fertilizers, fungicides, herbicides and pesticides; hobby/photography chemicals; metal or furniture polish; motor oil; gasoline and transmission fluid; oil paint, paint thinner, solvents, stains and varnishes; oven cleaners, pool chemicals. Latex paint will not be accepted — check labels before bringing items to the drop-off event.

    For a complete list of accepted items, visit chelmsfordma.gov/204/Household-Hazardous-Waste. For more information, call Solid Waste & Recycling at 978-674-4309.

    Medicare enrollment help

    CHELMSFORD — Certified counselors from SHINE (Serving Health Insurance Needs of Everyone) offer free, unbiased and confidential counseling on all aspects of health insurance to anyone on or eligible for Medicare, at the Council on Aging, 75 Groton Road. For information, or to make an appointment, call 978-251-0533.

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    Melanie Gilbert

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  • Medicare Advantage plans received $4.2 billion in payments for questionable home visits, report says

    Medicare Advantage plans received $4.2 billion in payments for questionable home visits, report says

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    Medicare Advantage plans reaped $4.2 billion in extra payments last year by making home visits to senior citizens who may not have received treatment for serious health issues, a new government report has found.

    The report, issued by the Office of Inspector General for the Department of Health and Human Services, flags concerns with so-called health risk assessments, or HRAs, which are home visits used to diagnose Medicare enrollees for serious health issues. 

    Because senior citizens who suffer from major health issues can trigger higher risk-adjusted payments for Medicare Advantage plans, the agency wanted to determine whether these HRAs are misused, with taxpayers footing the bill. Roughly half of the 66 million seniors enrolled in Medicare are also enrolled in a Medicare Advantage plan, which are offered by private insurers such as UnitedHealthcare and Humana.

    The analysis said UnitedHealthcare collected $3.7 billion of risk-adjusted payments last year, making it the biggest benefactor of the practice, followed by Humana, with $1.7 billion. Neither UnitedHealthcare nor Humana immediately responded to requests for comment.

    The report raises concerns about how Medicare Advantage (MA) plans are using HRAs, as well as the amount of taxpayer spending linked to these home visits. About 1.7 million people who are enrolled in Medicare Advantage plans received these home visits last year but had no follow-up visits, procedures, tests or supplies for their diagnoses, which suggests the payments may have been “improper” or that enrollees didn’t receive needed care, the report concluded.

    In addition to potential overpayments for HRAs, Medicare Advantage plans may also be receiving additional billions from so-called HRA-linked chart reviews. These occur when a Medicare Advantage company later reviews a senior citizen’s medical record to look for diagnoses that a provider didn’t submit or may have submitted in error. 

    “In-home HRAs and HRA-linked chart reviews may be more vulnerable to misuse because these tools are often administered by MA companies or their third-party vendors and not enrollees’ own providers,” the report noted. “Diagnoses reported only on these types of records heighten concerns about the validity of the diagnoses or the coordination of care for MA enrollees.”

    Medicare paid private insurers operating Medicare Advantage plans about $7.5 billion last year for diagnoses reported via both HRAs and HRA-linked chart reviews, the report found.

    A $1,869 home visit 

    Each in-home HRA generates about $1,869 in estimated risk-adjusted payments, the report found. By comparison, Medicare Advantage plans receive about $365 in payments when patients visit a doctor’s office or other health care facility.

    Thirteen health conditions produced $5.6 billion of the $7.5 billion in risk-adjusted payments for Medicare Advantage plans, with vascular disease linked to almost $1 billion of these payments, the most of any diagnosis, the analysis found.

    But at-home diagnoses aren’t always backed up by visits to a doctor or health care facility, the analysis found. For example, Medicare Advantage companies diagnosed “secondary hyperaldosteronism,” an adrenal gland issue, in 74% of enrollees with this diagnosis through a home visit or HRA-linked chart review that resulted in payment.

    Only 3% of enrollees received this diagnosis through a visit to a doctor’s office or other health care facility. 

    Twenty Medicare Advantage companies generated about 80% of $7.5 billion in risk-adjusted payments, the analysis found. The report flagged UnitedHealth Group, saying it “stood out from its peers, especially in its use of in-home HRAs and HRA-linked chart reviews to generate risk-adjusted payments.”

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  • SoCal pair milked Medicare for $6 million in gold bars, other riches, feds allege

    SoCal pair milked Medicare for $6 million in gold bars, other riches, feds allege

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    A Medicare fraud scheme ran by a Southern California duo involved multiple local medical facilities, foreign nationals, fake bank accounts and laundering millions of dollars with gold in a Glendale apartment, prosecutors say.

    Larchmont-area resident Sophia Shaklian, 36, and Alex Alexsanian, 47, of Burbank, are accused of submitting more than $54 million in fraudulent Medicare claims for hospice and diagnostic testing services that were never provided, then illegally laundering the $23 million they received in reimbursements, according to a news release from the U.S. Attorney’s Office for the Central District of California and the indictment.

    As a part of that scheme, about $6 million in gold bars and coins were purchased and moved through an apartment a few blocks from The Americana at Brand in Glendale, according to the indictment.

    The duo was arrested Wednesday and indicted on 24 counts altogether by a federal grand jury in connection with incidents over the last five years.

    Shaklian, who often used aliases, submitted Medicare claims on behalf of seven healthcare providers across Los Angeles County, including a hospice company she owned, the Chateau d’Lumina Hospice and Palliative Care in Pasadena, prosecutors said.

    Shaklian and her co-conspirators submitted claims for services on behalf of beneficiaries “who, in fact, never received any such services, did not need them, and were not even familiar with the fraudulent providers,” U.S. Attorney spokesperson Ciaran McEvoy wrote in the release. The $54 million worth of claims were submitted from March 2019 to August 2024.

    Shaklian allegedly laundered some of the $23 million in Medicare reimbursements by transferring them to accounts held in the name of a fake identity, prosecutors said.

    Alexsanian is accused of directing a foreign national, described as a Ukrainian citizen who later left the country, to open a medical facility in Sylmar and acquire an ongoing practice in Van Nuys, two of the locations for which Shaklian submitted false claims, according to the indictment. Alexsanian then had the Ukrainian relinquish control of the facilities’ bank accounts to him, prosecutors said.

    Alexsanian is accused of conspiring with the foreign national and others to then launder Medicare reimbursements to buy gold bars and coins, prosecutors said.

    Shaklian has been charged with 16 counts of healthcare fraud and four counts of transactional money laundering after an investigation from the U.S. Department of Health and Human Services Office of the Inspector General and the FBI, the release said. Alexsanian is charged with one count of conspiracy to launder monetary instruments and three counts of concealment money laundering.

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    Grace Toohey

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  • Kamala Harris proposes Medicare pay for home health care for first time

    Kamala Harris proposes Medicare pay for home health care for first time

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    (CNN) — Vice President Kamala Harris on Tuesday proposed broadening Medicare benefits to cover home health care for the first time, as she seeks to appeal to Americans caring for both children and aging parents.

    “There are so many people in our country who are right in the middle. They’re taking care of their kids and they’re taking care of their aging parents, and it’s just almost impossible to do it all, especially if they work,” Harris said on ABC’s “The View,” part of a media blitz this week that’s putting her in front of friendlier interviewers with more targeted audiences.

    Harris, who has promised on the campaign trail to improve long-term care, said the proposal will allow aging Americans to keep their dignity and help families with the emotional, financial and physical burdens of caring for their elders.

    Nearly one-quarter of American adults are in the “sandwich generation,” which contains many remaining undecided voters, according to Harris campaign data. More than 105 million Americans are acting as caregivers, according to the campaign.

    “We’re finding that so many are then having to leave their job, which means losing a source of income, not to mention the emotional stress,” Harris said Tuesday.

    The plan calls for Medicare enrollees to be independently evaluated to determine whether they cannot handle activities of daily living, such as bathing, eating or going to the bathroom, according to a fact sheet issued by the campaign. The vast majority of seniors could continue living at home with an average of 20 hours or less a week of care provided by an aide, the fact sheet said.

    Medicare would provide coverage for those with modest incomes, while seniors with higher incomes would share in the cost, according to the campaign.

    Covering home health care, however, could be very expensive. One recent estimate from the Brookings Institution for a “very-conservatively designed” program, which would cover those unable to perform two activities of daily living and would require enrollees to share part of the cost, would have a price tag of about $40 billion a year.

    The Harris campaign cited the Brookings research as a building block for the vice president’s proposal.

    To cover the cost, Harris said she would expand Medicare drug price negotiations. Increasing drug discounts from manufacturers, implementing international tax reform and other measures would also help pay for the program.

    In addition, Harris is proposing that Medicare cover hearing aids and exams, eye exams, and new glasses and lenses. She also wants to stop states from seizing seniors’ homes to recover Medicaid funds spent on long-term care services.

    Costly long-term care

    The proposal aims to address the long-term care needs of senior citizens and people with disabilities, helping them stay at home instead of moving to a nursing home, which can cost thousands of dollars a month. Medicare does not cover home health care except in very narrow circumstances. So most senior citizens have to pay for the services out of pocket or through Medicaid, if they are eligible.

    On average, an American turning 65 in 2022 would incur an estimated $120,900 in future long-term services and supports, with families footing one-third of the bill themselves, according to the Department of Health and Human Services.

    A home health aide costs nearly $69,000 a year for 40 hours of weekly care and more than $288,000 for round-the-clock services, while nursing home stays can total between $104,000 and nearly $117,000 a year, according to KFF, a nonpartisan health policy research organization. The typical Medicare beneficiary’s income is $36,000 a year.

    In her caregiving push to voters, Harris has previously leaned into her experience of taking care of her late mother, Shyamala Gopalan, who died of colon cancer in 2009. She mentioned it again Tuesday, relaying the stress of taking care of a sick parent.

    “That means trying to cook what they want to eat, what they can eat,” she said. “It means picking out clothes for them that [are] soft enough that it doesn’t irritate their skin, right? It means trying to think of something funny to make them laugh or smile.”

    Some two-thirds of caregivers reporting having difficulty balancing their career and care responsibilities, according to a survey conducted in 2023 by AARP and S&P Global.

    Just over a quarter of working caregivers have had to shift from full-time to part-time positions or have reduced hours, the survey found. About 1 in 6 stopped working for a period of time.

    “Family caregivers are the backbone of a broken long-term care system, providing $600 billion in unpaid labor each year and saving taxpayers billions,” Nancy LeaMond, AARP’s chief public policy and engagement officer, said in a statement. “It is long past time for lawmakers to enact commonsense solutions that support family caregivers and help older Americans live independently in their homes, where they want to be.”

    On the heels of Harris’ announcement, Care in Action PAC — the political arm of an organization advocating for care workers and care givers — announced a multimillion-dollar additional investment across battleground states and praised Harris’ longtime commitment to working adults who care for both their aging parents and their children.

    “This is the financial relief that families are screaming for,” said the group’s executive director Hillary Holley. The money will in part support a new digital ad featuring a woman talking about her mother brushing her hair as a child and how she now has the responsibility of doing the same for her mother and daughter.

    Harris’ appearance on “The View” comes as both she and her running mate, Minnesota Gov. Tim Walz, are appearing in a handful of interviews with traditional and new media figures after Republicans have criticized the pair for weeks for avoiding taking questions from the media.

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  • What is Harris’ “Medicare at Home” plan and how would it work?

    What is Harris’ “Medicare at Home” plan and how would it work?

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    Vice President Kamala Harris is proposing an expansion of Medicare to cover the costs of an in-home aide for many seniors, a direct pitch to the “sandwich generation” of adults caring for aging parents in addition to their own children. 

    The plan, dubbed “Medicare at Home,” focuses on having Medicare cover costs of home care services and nurses as a way for families to help avoid costs of nursing homes. Harris is pairing it with a plan she’s already announced that would expand the child care tax credit to up to $3,600, and $6,000 for parents with newborns. 

    Harris unveiled the plan in a Tuesday interview on “The View” talk show, where she talked about her own experience taking care of her mother while she had cancer. 

    She emphasized that her plan would be an expansion of Medicare, rather than Medicaid. This would enable it to coexist with private insurance. Medicaid also has certain stricter eligibility rules.

    About a quarter of U.S. adults are part of the sandwich generation of those taking care of children and aging parents, according to census data. A Harris campaign official says its  internal data shows this demographic of caregivers has a substantial number of undecided voters. 

    “In an election this close, proposals that speak to the financial security and health care needs of older Americans will resonate and can make a difference,” said Rich Fiesta, the executive director of the Alliance for Retired Americans, who has a PAC running anti-Trump advertisements. 

    A September AARP poll showed that 78% of women who are over 50 years old and care for older family members say they’ve been struggling financially. Another AARP poll in Pennsylvania, a crucial battleground state, showed former president Donald Trump with an edge among voters 50 and over: 53% for Trump and 44% for Harris. 

    Except for the poorest seniors, for whom Medicaid can pick up the tab, most older adults have to rely on their own savings or family members for home care when they can no longer handle all of their daily needs but aren’t ready to move to a long-term care facility.

    “We increasingly encounter families that want to qualify for Medicaid today that aren’t considered the lowest income, but for whom providing and paying for long-term care is making them low income,” said Kevin Prindiville, executive director of the group Justice in Aging.

    Democrats have accused Trump of supporting cuts to Medicare’s budget during his term in the White House, a charge that the Republican candidate has denied. 

    While he floated the idea in a March CNBC interview, saying, “There is a lot you can do in terms of entitlements in terms of cutting,” he then suggested that these cuts would affect “the theft and the bad management of entitlements.” 

    He has since said he won’t “cut one penny” from Social Security or Medicare, and the Republican Party platform has similar language. 

    How much would “Medicare at home” cost?

    Adding Medicare coverage for home care could start at $40 billion annually, according to an estimate from a Brookings Institution study cited by the campaign.

    However, the authors of the study caution that their figure is only a starting point for a “very conservatively designed universal program.” The ultimate price tag could be significantly higher, depending on how generous Congress is willing to be. 

    “It’s not saying it’s the program we should adopt, but just that you could make this work for dollars that are not crazy,” said Jonathan Gruber, chairman of the economics department at the Massachusetts Institute of Technology and a co-author of the estimate.

    Gruber said the modeling also did not factor in major savings that the benefit could spur as ripple effects, like less money spent on nursing homes or family members who would be able to return to full-time jobs. 

    “We think we’re going to free potentially millions of informal care workers to go earn income in the labor market. And they’re going to pay taxes,” he said.

    How would Harris pay for Medicare at home?

    Harris said her expansion will be paid for mainly by expanding the Medicare Drug Price Negotiation Program, combined with a list of other reforms, like increasing the discounts that drugmakers would have to offer for brand-name prescriptions. 

    This is not the first time that Harris has pledged to expand the Inflation Reduction Act’s policies targeting prescription drug prices. Medicare is currently on track to save only $31 billion each year from the negotiation program and other drug price provisions, which would fall short of covering even the starting price tag for her proposal. 

    Harris has called on Congress to broaden the drug negotiation program, accelerating the pace of new price caps set by Medicare and making more drugs subject to the limits. More aggressive drug price negotiations could save hundreds of billions over the next decade, according to a Stanford University white paper cited by the campaign, assuming it’s able to survive an uphill battle on Capitol Hill.

    Marc Cohen is the co-director of a center focused on long-term services and support backed by LeadingAge, the association of nonprofit providers of aging services. LeadingAge has called for adding home care to Medicare for years, as a fix to the “dangerously broken” system.

    “At some point we will need to talk about a source, like Medicare itself, to pay for it. But I think that’s a very clever idea right now for getting this going. And then what you do is develop a constituency of political support, even for the young generation to say, ‘I want this to be available for my parents,’” Cohen, a professor of gerontology at the University of Massachusetts Boston, said.

    Who would be covered by Harris’ Medicare at Home” proposal?

    All Medicare enrollees deemed to be “unable to independently perform activities of daily living like bathing, eating and going to the bathroom” would be eligible after being screened by physicians or nurses, according to the campaign’s proposal. People with “serious cognitive impairment” would also be covered.

    Not everyone would get all their costs paid for by Medicare. Seniors with higher incomes would have to pay a larger share of the cost out of their own pockets.

    The details of that coverage are a big factor that could also impact the cost of the plan, affecting how many Americans end up taking advantage of the proposed benefit.

    Only home care aides “designated by Medicare” would be covered under the proposal, which would include “any qualified home health aides, personal care attendants, or direct care workers recognized by their state.” 

    The campaign did not address whether family members would be able to be paid with cash for taking care of an older relative, as a previous bill by House Democrats had proposed.

    Prindiville said that was among the things they were hoping for in the details of the proposal, as lawmakers try to “strike the right balance” to make home care more affordable. 

    “When families want to provide that care, let’s pay them for it so that economically it makes sense,” said Prindiville.

    Alexander Tin

    Alexander Tin is a digital reporter for CBS News based in the Washington, D.C. bureau. He covers the Biden administration’s public health agencies, including the federal response to infectious disease outbreaks like COVID-19.

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  • Fact-checking AARP’s interviews of Harris, Trump

    Fact-checking AARP’s interviews of Harris, Trump

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    After AARP published interviews with Vice President Kamala Harris and former President Donald Trump, a PolitiFact reader noticed that the organization did not fact-check the candidates’ responses.

    The presidential candidates spoke by phone with Robert Love, vice president and editor-in-chief of AARP Publications, in late August. On Oct. 2, AARP published the Q&A’s, in which each candidate was asked the same questions, focused on inflation, Social Security, Medicare and drug prices.

    To serve our readers, we fact-checked some of the candidates’ claims:

    Economy

    Harris: “In terms of the price of groceries, one of the issues that we’ve seen is the price-gouging issue, where bad actors actually hike up the cost of everyday essentials, including groceries.”

    This lacks context, experts have told PolitiFact. Price gouging sometimes happens, but inflation has largely stemmed from other factors.

    Some examples of price-gouging include a 2023 antitrust lawsuit in which the Justice Department accused Agri Stats Inc. a data analytics and consulting company, of harming grocery stores and consumers by illegally “collecting, integrating and distributing competitively sensitive information related to price, cost and output among competing meat processors.” Agri Stats also occasionally, “encouraged meat processors to raise prices and reduce supply,” the Justice Department said. The lawsuit is pending.

    In another example, the Washington state attorney general won price-fixing lawsuits against tuna companies and broiler chicken producers.

    A 2023 paper from the Federal Reserve Bank of Kansas City (Missouri) found that growth of price markups — how much a product’s sale price exceeds its cost to the company —  contributed more than 50% to inflation in 2021. However, researchers concluded that the markups could be explained as ones companies took “in anticipation of future cost pressures” rather than purely to extract profits. 

    More broadly, economists told PolitiFact that rising production costs — including rising wages and raw materials and real estate prices — are high consumer prices’ primary causes, not price gouging.

    A 2024 Federal Reserve Bank of San Francisco study found that corporations’ price markups were not the recent inflation surge’s main driver. 

    Joseph Balagtas, an agricultural economics professor at Purdue University, said the COVID-19 pandemic caused supply-chain disruptions in 2020 that sparked high inflation through the summer of 2022, when year-to-year inflation hit a 40-year high of 9%. These snags increased production costs, the pandemic altered consumer behavior and fiscal and monetary policy  increased consumer demand. These forces combined to drive prices higher, Balagtas said.

    Trump: I signed the “largest tax cut in the history of our country.”

    False.

    In inflation-adjusted dollars, the tax bill Trump signed was the fourth-largest since 1940, and as a percentage of gross domestic product — the total monetary value of the goods and services produced a nation produces — it ranked seventh.

    Our colleagues at the Washington Post Fact Checker found that this was Trump’s second-most-commonly repeated false claim, shared 295 times as president.

    Trump: During the Trump administration, Americans “had low interest rates and no inflation” while under Biden, “they have high interest rates and the worst inflation we’ve ever had.”

    Interest rates under Biden have been higher than under Trump, but Trump is wrong to call Biden-era inflation a historic worst.

    During Trump’s prepandemic period, the year-over-year inflation rate ranged from 1.5% to 3%. After hitting a peak in mid-2022 of 9% under Biden, it is now 2.6%, which is lower than it was at some points under Trump, but far from all.

    At its highest under Biden, inflation was not at a record high. The highest sustained, year-over-year U.S. inflation rates were recorded in the 1970s and early 1980s, when the price increase sometimes ranged from 12% to 15%. For one year — 1946, after the U.S. won World War II — the overall year-over-year inflation rate exceeded 18%.

    Even before the pandemic sent interest rates plummeting, mortgage interest rates under Trump ranged from 3.5% to 5%. Under Biden, they approached 7.6% due to Federal Reserve interest rate hikes designed to restrain inflation. They have since fallen back to just more than 6%, but that was still higher than at any point during Trump’s presidency.

    Health and human services

    Harris: “For our seniors, (Social Security) is their only source of income.”

    This is exaggerated.

    The most recent data we found comes from a 2020 report by the National Institute on Retirement Security, a Washington, D.C.-based think tank.

    The report found that about 40% of Americans 60 and older had only Social Security income, not income from defined benefit plans (such as company pensions) or defined contribution plans (such as 401(k) accounts). However, some of this 40% may have had income from working part time.

    Harris: Donald Trump “tried 60 times” to end the Affordable Care Act “when in office.”

    Trump did try to kill the act, which passed in 2010 during the Obama administration. But Harris exaggerated how often he tried this.

    As president, Trump cut millions of dollars in federal funding for Affordable Care Act outreach and navigators who help people sign up for health coverage. He enabled the sale of short-term health plans that don’t comply with the act’s consumer protections and allowed them to be sold for longer durations, which siphoned people away from the health law’s marketplaces.

    Trump’s administration also backed state Medicaid waivers that imposed the first-ever work requirements, which reduced enrollment. He also ended insurance company subsidies that helped offset costs for low-income enrollees, backed an unsuccessful repeal of the law and supported ending a penalty for failing to purchase health insurance.

    During Trump’s presidency, Affordable Care Act enrollment declined by more than 2 million people and the number of uninsured Americans rose by 2.3 million, including 726,000 children.

    However, getting to 60 specific actions under Trump requires counting dozens of attempts from 2010 to 2017. This period includes time before Trump was elected, and, in some cases, before he was active in politics.

    Trump: “Massive Medicare premium increases (resulted) from the Biden-Harris Inflation Reduction Act.”

    A few months ago, health policy analysts said this was a legitimate concern. However, Biden administration actions seem to have avoided creating “massive” increases for beneficiaries, at least for now.

    One provision of the Inflation Reduction Act, which Biden signed in 2022, was a $2,000 cap on out-of-pocket spending Medicare Part D, the portion the health insurance program that pays for prescription drugs. The enactment was a boost for beneficiaries but troubling for insurers, who would be left to pay a greater share of costs. 

    For a while, it looked as if this would drive insurers to increase premiums sharply to recover some of those costs.

    But the Biden administration invoked its authority to create a “demonstration” program that provided additional money to insurers who limited their premium increases to $35 a month, easing the premium hit. 

    An October analysis by KFF. a health research organization, found that the federal efforts largely “moderated” insurers’ 2025 premium increases. 

    Some congressional Republicans have criticized the administration’s election-eve move. Republicans used the same authority before the 2006 midterm elections, and in 2007, to cushion the blow after then-President George W. Bush’s administration introduced the Medicare prescription drug benefit.

    Trump: The Trump administration instituted “rules giving seniors $35 … insulin.”

    This lacks context.

    Trump’s administration enacted a program to lower insulin costs for some Medicare patients, but it was limited.

    In 2020, the Trump administration “established a voluntary, time-limited model under the Center for Medicare and Medicaid Innovation known as the Part D Senior Savings Model,” according to KFF. “Under this model, participating Medicare Part D prescription drug plans covered at least one of each dosage form and type of insulin product at no more than $35 per month. The model was in effect from 2021 through 2023, and less than half of all Part D plans chose to participate in each year.”

    In 2022, the program included a total of 2,159 Medicare drug plans, and the Centers for Medicare and Medicaid Services estimated that more than 800,000 Medicare beneficiaries who use insulin could have benefited from it that year. The Department of Health and Human Services has estimated that more than 1.5 million Medicare beneficiaries paid more than $35 a month for insulin in 2020, before Trump’s program took effect. 

    The Inflation Reduction Act, which Congress passed and Biden signed into law in August 2022, included an insulin provision that went further than Trump’s voluntary initiative.

    The act capped out-of-pocket costs of insulin for Medicare patients at $35 per month. But, whereas the Trump program applied only to certain Medicare Part D plans, the Biden-era act mandated that all Medicare drug programs cap out-of-pocket insulin costs — including those in what’s known as Medicare Part B, which pays for medical equipment such as insulin pumps. 

    The act also mandated that the out-of-pocket price cap apply to all insulin products a given Medicare plan covers, not just a subset. 

    Trump also signed an executive order that would have reduced insulin prices, but only for low-income patients at Federally Qualified Health Centers, which serve 10% of Americans. Biden paused and then rescinded the order, so it never took effect.

    Energy

    Trump: “Energy prices (are) what really led to the problem of inflation.”

    This is partially accurate.

    Economists say Russia’s 2022 invasion of Ukraine worsened inflation by spiking oil prices and interfering with global trade. The invasion happened just a few months before inflation in the U.S. peaked around 9% under Biden in the summer of 2022.

    But economists also widely agree that supply chain shortages starting a year or more earlier, during the COVID-19 pandemic, ignited the inflation increase, and that Biden’s pandemic relief bill, the American Rescue Plan Act, exacerbated it by putting too much money in Americans’ pockets at a time when supplies were low.

    Inflation has fallen from its 2022 level by about two-thirds to 2.6% year over year, which is close to what the Federal Reserve wants to see before it cuts interest rates.

    Oil prices and inflation have both fallen since their mid-2022 peaks.

    Trump: During the Trump administration, “we were energy independent.”

    This lacks context.

    Some Trump policies led to the U.S. meeting some definitions of “energy independence,” but not others. Trump also ignores that Biden, too, has met some benchmarks of energy independence. 

    One definition met under both Trump and Biden is the U.S. exporting more energy than it imports. 

    The Energy Information Administration, a federal office that tracks energy statistics, found that in 2019 — when Trump was president — the United States became a net exporter of overall energy for the first time since 1952. 

    That has continued ever since, with the gap widening to a record level in 2023, the most recent full year with available statistics. 

    Another, narrower, measure of energy independence is whether the U.S. is a net exporter of petroleum specifically. In 2020, the last year of Trump’s term, the U.S. became a net exporter of petroleum for the first time since at least 1949. That has continued through 2022, the last year with available data.

    A third form of energy independence occurs when domestic energy production exceeds domestic consumption. This has been so from 2019 to 2023, under both presidents.

    There is one important metric keeping the U.S. from complete energy independence: The data for crude oil — which is used to manufacture gasoline, a key consumer commodity  — has not followed the same pattern as energy overall. Crude oil imports outpaced exports in each of the four years Trump was president, and during Biden’s first three years in office.

    Although the U.S. theoretically produces enough crude oil to satisfy its consumption, the U.S. cannot refine all of the crude oil it produces because its refineries are built to process heavy, sour crude from the Middle East and other overseas suppliers, not domestically produced light, sweet crude. (Crude is graded by its weight and “sweetness,” a measure of sulfur content.)

    This means the U.S. is exporting a lot of its domestically produced crude on the international market. To make up for this, the U.S. still must import a substantial amount of oil for domestic use. That leaves the U.S. at the mercy of international events to keep its supply coming in.

    Trump: “We have more oil and gas than any other country in the world by far.”

    This is False.

    On oil, Venezuela ranked first in 2021 with 304 billion barrels of proven crude oil reserves, followed by Saudi Arabia, Iran, Canada, Iraq, the United Arab Emirates, Kuwait and Russia, the U.S. Energy Information Administration reported. The U.S. ranked ninth internationally, with 61 billion barrels.

    On natural gas, the U.S, ranks No. 4.

    The U.S. ranks No. 1 internationally in coal reserves.

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  • Colorado hospitals collected $13 billion in facility fees over 6 years, new state report finds

    Colorado hospitals collected $13 billion in facility fees over 6 years, new state report finds

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    Colorado hospitals collected an estimated $13.4 billion in facility fees over a recent six-year period, doubling the average cost of care for patients with certain types of insurance, according to a new state report released this week.

    When patients receive care at a facility owned by a hospital system, whether on the hospital’s campus or elsewhere, their bills typically have at least two parts: professional fees, for the doctors and other providers performing the service, and facility fees, for overhead costs.

    While they’ve existed since the early 2000s, the fees have become controversial in recent years as health systems have bought up outpatient providers, meaning that patients may have to pay new fees for the same care they’d received before.

    The 200-page report, compiled by a committee and staff from the Colorado Department of Health Care Policy and Financing, came up with its cost estimate by using data from 2017 to 2022 on Medicare and commercial insurance payments, which the authors obtained through Colorado’s All-Payer Claims Database.

    The report estimated total spending on facility fees rose about 10% annually during that time, due to some combination of population growth, hospitals charging higher amounts and more locations charging the fees, among other factors.

    Click here to read the full story from our partners at The Denver Post.

    Coloradans making a difference | Denver7 featured videos

    Denver7 is committed to making a difference in our community by standing up for what’s right, listening, lending a helping hand and following through on promises. See that work in action, in the videos above.

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  • Medicare Advantage shopping season arrives with a dose of confusion and some political implications

    Medicare Advantage shopping season arrives with a dose of confusion and some political implications

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    Thinner benefits and coverage changes await many older Americans shopping for health insurance this fall. That’s if their plan is even still available in 2025.

    More than a million people will probably have to find new coverage as major insurers cut costs and pull back from markets for Medicare Advantage plans, the privately run version of the federal government’s coverage program mostly for people ages 65 and older.

    Industry experts also predict some price increases for Medicare prescription drug plans as required coverage improvements kick in.

    Voters will learn about the insurance changes just weeks before they pick the next president and as Democrat Kamala Harris campaigns on promises to lower health care costs. Early voting has already started in some states.

    “This could be bad news for Vice President Harris. If that premium is going up, that’s a very obvious sign that you’re paying more,” said Massey Whorley, an analyst for health care consulting company Avalere. “That has significant implications for how they’re viewing the performance of the current administration.”

    Insurance agents say the distraction of the election adds another complication to an already challenging annual enrollment window that starts next month.

    Insurers are pulling back from Medicare Advantage

    Medicare Advantage plans will cover more than 35 million people next year, or around half of all people enrolled in Medicare, according to the federal government. Insurance agents say they expect more people than usual will have to find new coverage for 2025 because their insurer has either ended a plan or left their market.

    The health insurer Humana expects more than half a million customers — about 10% of its total — to be affected as it pulls Medicare Advantage plans from places around the country. Many customers will be able to transfer to other Humana plans, but company leaders still anticipate losing a few hundred thousand customers.

    CVS Health’s Aetna projects a similar loss, and other big insurers have said they are leaving several states.

    Insurers say rising costs and care use, along with reimbursement cuts from the government, are forcing them to pull back.

    Some people can expect a tough search

    When insurers leave Medicare Advantage markets, they tend to stop selling plans that have lower quality ratings and those with a higher proportion of Black buyers, said Dr. Amal Trivedi, a Brown University public health researcher.

    He noted that market exits can be particularly hard on people with several doctors and on patients with cognitive trouble like dementia.

    Most markets will still have dozens of plan choices. But finding a new option involves understanding out-of-pocket costs for each choice, plus figuring out how physicians and regular prescriptions are covered.

    “People don’t like change when it comes to health insurance because you don’t know what’s on the other side of the fence,” said Tricia Neuman, a Medicare expert at KFF, a nonprofit that researches health care.

    Plans that don’t leave markets may raise deductibles and trim perks like cards used to pay for utilities or food.

    Those proved popular in recent years as inflation rose, said Danielle Roberts, co-founder of the Fort Worth, Texas, insurance agency Boomer Benefits.

    “It’s really difficult for a person on a fixed income to choose a health plan for the right reasons … when $900 on a flex card in free groceries sounds pretty good,” she said.

    Don’t “sleep” on picking a Medicare plan

    Prices also could rise for some so-called standalone Part D prescription drug plans, which people pair with traditional Medicare coverage. KFF says that population includes more than 13 million people.

    The Centers for Medicare and Medicaid Services said Friday that premiums for these plans will decrease about 4% on average to $40 next year.

    But brokers and agents say premiums can vary widely, and they still expect some increases. They also expect fewer plan choices and changes to formularies, or lists of covered drugs. Roberts said she has already seen premium hikes of $30 or more from some plans for next year.

    Any price shift will hit a customer base known to switch plans for premium changes as small as $1, said Fran Soistman, CEO of the online insurance marketplace eHealth.

    The changes come as a congressional-approved coverage overhaul takes hold. Most notably, out-of-pocket drug costs will be capped at $2,000 for those on Medicare, an effort championed by Democrats and President Joe Biden in 2022.

    In the long run, these changes will lead to a “much richer benefit,” Whorley said.

    KFF’s Neuman noted that the cap on drug costs will be especially helpful to cancer patients and others with expensive prescriptions. She estimates about 1.5 million people will benefit.

    To ward off big premium spikes because of the changes, the Biden administration will pull billions of dollars from the Medicare trust fund to pay insurers to keep premium prices down, a move some Republicans have criticized. Insurers will not be allowed to raise premium prices beyond $35 next year.

    People will be able to sign up for 2025 coverage between Oct. 15 and Dec. 7. Experts say all the potential changes make it important for shoppers to study closely any new choices or coverage they expect to renew.

    “This is not a year to sleep on it, just re-enroll in the status quo,” said Whorley, the health care analyst.

    ___

    The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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  • Montana asbestos clinic seeks to reverse $6M in fines, penalties over false claims

    Montana asbestos clinic seeks to reverse $6M in fines, penalties over false claims

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    BILLINGS, Mont. — A health clinic in a Montana town that was polluted with deadly asbestos will ask a federal appeals court on Wednesday to reverse almost $6 million in fines and penalties after a jury determined it submitted hundreds of false claims on behalf of patients.

    The jury verdict came last year in a lawsuit brought by Texas-based BNSF Railway, which separately has been found liable over contamination in Libby, Montana, that’s sickened or killed thousands of people. Asbestos-tainted vermiculite was mined from a nearby mountain and shipped through the 3,000-person town by rail over decades.

    After BNSF questioned the validity of more than 2,000 cases of asbestos-related diseases found by the clinic, a jury last year said 337 of those cases were based on false claims, making patients eligible for Medicare and other benefits they shouldn’t have received.

    Asbestos-related diseases can range from a thickening of a person’s lung cavity that can hamper breathing to deadly cancer. Exposure to even a minuscule amount of asbestos can cause lung problems, according to scientists. Symptoms can take decades to develop.

    BNSF alleged the clinic submitted claims based on patient X-ray evidence that should have been corroborated by a health care provider’s diagnosis, but were not. Clinic representatives argued they were acting in good faith and following the guidance of federal officials who said an X-ray reading alone was sufficient diagnosis of asbestos disease.

    Judge Dana Christensen ordered the clinic to pay $5.8 million in penalties and damages. BNSF would get 25% of the money because it brought the lawsuit on behalf of the government. Federal prosecutors previously declined to intervene in the false claims case and there have been no criminal charges brought against the clinic.

    Clinic attorney Tim Bechtold said in court filings that the judge overseeing the lawsuit gave the seven-person jury erroneous instructions, essentially pre-determining the verdict. Attorneys for BNSF urged the 9th U.S. Circuit Court of Appeals to affirm last year’s ruling.

    Arguments from the two sides were scheduled for 9 a.m. local time on Wednesday in Portland, Oregon.

    The judgment prompted clinic officials to file for bankruptcy, but the bankruptcy case was later dismissed at the request of government attorneys. They said the U.S. Department of Health and Human Services was the main funding source for the clinic but also its primary creditor, therefore any costs associated with the bankruptcy would come at taxpayers’ expense.

    The clinic has certified more than 3,400 people with asbestos-related disease and received more than $20 million in federal funding, according to court documents.

    Under a provision in the 2009 federal health law, victims of asbestos exposure in the Libby area are eligible for taxpayer-funded services including Medicare, housekeeping, travel to medical appointments and disability benefits for those who can’t work.

    The Libby area was declared a Superfund site two decades ago following media reports that mine workers and their families were getting sick and dying due to hazardous asbestos dust from vermiculite that was mined by W.R. Grace & Co.

    BNSF is itself a defendant in hundreds of asbestos-related lawsuits. In April, a federal jury said the railway contributed to the deaths of two people who were exposed to asbestos decades ago by tainted mining material was shipped through Libby.

    The jury awarded $4 million each in compensatory damages to the estates of the two plaintiffs, who died in 2020. Jurors said asbestos-contaminated vermiculite that spilled in Libby’s downtown rail yard was a substantial factor in the plaintiffs’ illnesses and deaths.

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  • Montana asbestos clinic seeks to reverse $6M in fines, penalties over false claims

    Montana asbestos clinic seeks to reverse $6M in fines, penalties over false claims

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    BILLINGS, Mont. — A health clinic in a Montana town that was polluted with deadly asbestos will ask a federal appeals court on Wednesday to reverse almost $6 million in fines and penalties after a jury determined it submitted hundreds of false claims on behalf of patients.

    The jury verdict came last year in a lawsuit brought by Texas-based BNSF Railway, which separately has been found liable over contamination in Libby, Montana, that’s sickened or killed thousands of people. Asbestos-tainted vermiculite was mined from a nearby mountain and shipped through the 3,000-person town by rail over decades.

    After BNSF questioned the validity of more than 2,000 cases of asbestos-related diseases found by the clinic, a jury last year said 337 of those cases were based on false claims, making patients eligible for Medicare and other benefits they shouldn’t have received.

    Asbestos-related diseases can range from a thickening of a person’s lung cavity that can hamper breathing to deadly cancer. Exposure to even a minuscule amount of asbestos can cause lung problems, according to scientists. Symptoms can take decades to develop.

    BNSF alleged the clinic submitted claims based on patient X-ray evidence that should have been corroborated by a health care provider’s diagnosis, but were not. Clinic representatives argued they were acting in good faith and following the guidance of federal officials who said an X-ray reading alone was sufficient diagnosis of asbestos disease.

    Judge Dana Christensen ordered the clinic to pay $5.8 million in penalties and damages. BNSF would get 25% of the money because it brought the lawsuit on behalf of the government. Federal prosecutors previously declined to intervene in the false claims case and there have been no criminal charges brought against the clinic.

    Clinic attorney Tim Bechtold said in court filings that the judge overseeing the lawsuit gave the seven-person jury erroneous instructions, essentially pre-determining the verdict. Attorneys for BNSF urged the 9th U.S. Circuit Court of Appeals to affirm last year’s ruling.

    Arguments from the two sides were scheduled for 9 a.m. local time on Wednesday in Portland, Oregon.

    The judgment prompted clinic officials to file for bankruptcy, but the bankruptcy case was later dismissed at the request of government attorneys. They said the U.S. Department of Health and Human Services was the main funding source for the clinic but also its primary creditor, therefore any costs associated with the bankruptcy would come at taxpayers’ expense.

    The clinic has certified more than 3,400 people with asbestos-related disease and received more than $20 million in federal funding, according to court documents.

    Under a provision in the 2009 federal health law, victims of asbestos exposure in the Libby area are eligible for taxpayer-funded services including Medicare, housekeeping, travel to medical appointments and disability benefits for those who can’t work.

    The Libby area was declared a Superfund site two decades ago following media reports that mine workers and their families were getting sick and dying due to hazardous asbestos dust from vermiculite that was mined by W.R. Grace & Co.

    BNSF is itself a defendant in hundreds of asbestos-related lawsuits. In April, a federal jury said the railway contributed to the deaths of two people who were exposed to asbestos decades ago by tainted mining material was shipped through Libby.

    The jury awarded $4 million each in compensatory damages to the estates of the two plaintiffs, who died in 2020. Jurors said asbestos-contaminated vermiculite that spilled in Libby’s downtown rail yard was a substantial factor in the plaintiffs’ illnesses and deaths.

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  • FACT FOCUS: A look at Harris’ economic agenda

    FACT FOCUS: A look at Harris’ economic agenda

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    Vice President Kamala Harris unveiled her economic agenda in a speech Friday in Raleigh, North Carolina.

    The Democratic presidential nominee laid out plans including a proposal for a federal ban on what she called price gouging on groceries, as well as $25,000 in down payment help for certain first-time homebuyers and tax incentives for builders of starter homes. She also spoke at length about lowering drug costs and criticized the platform of her Republican opponent, former President Donald Trump.

    Here’s a closer look at some of her promises and claims.

    The impact of Trump’s proposed tariffs

    HARRIS: Trump “wants to impose what is in effect, a national sales tax on everyday products and basic necessities that we import from other countries. … And you know, economists have done the math. Donald Trump’s plan would cost a typical family $3,900 a year.”

    THE FACTS: Harris was referring to Trump’s proposal to impose a tariff of 10% to 20% on all imports — he has mentioned both figures — and up to 60% on imports from China.

    Most economists do expect it would raise prices on many goods. The Tax Policy Center, a joint project of the Urban Institute and the Brookings Institution, estimates it would reduce average incomes in the top 60% of earners by 1.8%. And the Center for American Progress Action Fund, a progressive advocacy group, has calculated that the higher tariffs would cost households an extra $3,900 a year. However, Trump has said the tariff revenue could be used to cut other taxes, which would reduce the overall cost of the policy.

    Lowering the cost of insulin and prescription drugs

    HARRIS: “I’ll lower the cost of insulin and prescription drugs for everyone.”

    THE FACTS: Harris made this promise while referencing the Inflation Reduction Act of 2022, which allows Medicare to negotiate medication costs directly with drug companies. While it is difficult to predict whether she will be able to keep it, especially without more details, recent policy can provide some clues.

    For example, the White House announced Thursday that it had inked deals with manufacturers that could save taxpayers billions of dollars by knocking down the list prices for 10 of Medicare’s costliest drugs. However, there are a number of factors — from discounts to the coinsurance or copays for the person’s Medicare drug plan — that determine the final price a person pays when they pick up the drugs at their pharmacy.

    Powerful drug companies unsuccessfully tried to file lawsuits to stop these negotiations. They ended up engaging in talks and executives hinted in recent weeks during earnings calls that they don’t expect the new Medicare drug prices to impact their bottom line. However, the manufacturers have warned that the Inflation Reduction Act could drive up prices for consumers in other areas.

    Both the Trump and Biden administrations achieved $35 insulin copay caps for certain Medicare recipients. Biden’s caps have a wider reach, as they apply to all insulin products covered by any Medicare Part D or Part B plan, according to health policy research nonprofit KFF. Trump’s applied only to some insulin products covered by a voluntary subset of Part D plans.

    A federal ban on grocery ‘price gouging’

    HARRIS: “As president, I will take on the high costs that matter most to most Americans. … And I will work to pass the first ever federal ban on price gouging on food.”

    What to know about the 2024 Election

    THE FACTS: While grocery prices are 25% higher than they were before the pandemic four-and-a-half years ago, they have settled down recently and it’s not clear that much price gouging is now going on.

    In the past 12 months, grocery prices on average are up just 1.1%, comparable to pre-pandemic increases. Also, prices for most goods and services, in general, don’t fall significantly except in steep, painful recessions. Instead, most economists expect that wages will rise enough so that Americans can adjust to higher costs. Still, prices remain higher overall than they were just a couple of years ago.

    Addressing housing shortages and helping home buyers

    HARRIS: “And by the end of my first term, we will end America’s housing shortage by building 3 million new homes and rentals. … While we work on the housing shortage, my administration will provide first time homebuyers with $25,000 to help with the down payment on a new home.”

    THE FACTS: These promises could end up working at cross-purposes. By helping more Americans afford homes, the Harris proposal to subsidize down payments would almost certainly increase demand, at a time when estimates of the U.S. housing shortage already range from 3 million to as high as 7 million.

    Harris’ proposal to provide tax incentives to builders to encourage more home and apartment construction would address that concern, but there are many reasons experts cite for the housing shortage, including restrictive zoning laws, higher costs for building materials, and even shortages of construction workers, which tax incentives can’t address.

    Harris is also promising to cut red tape that restricts new building, but that is mostly a state and local concern, and many localities are already moving to make it easier build homes.

    ___

    Find AP Fact Checks here: https://apnews.com/APFactCheck.

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  • Biden, Harris set to announce lower prescription drug prices at first joint event since he dropped out of 2024 race

    Biden, Harris set to announce lower prescription drug prices at first joint event since he dropped out of 2024 race

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    Washington — President Biden and Vice President Kamala Harris are unveiling a new milestone Thursday in the administration’s efforts to lower prescription drug prices in their first official appearance together since the president exited the 2024 race.  

    Slated to appear at Prince George’s County Community College in Maryland, Mr. Biden and the party’s new presidential nominee, Harris, are expected to announce the outcome of the first Medicare drug price negotiation as part of the administration’s efforts to lower costs for Americans. 

    In a statement Thursday, the president said that for the first time, Medicare has reached agreements with drug manufacturers on lower prices for all 10 of the drugs selected for the initial round of negotiation. “It’s a relief for the millions of seniors that take these drugs to treat everything from heart failure, blood clots, diabetes, arthritis, Crohn’s disease, and more — and it’s a relief for American taxpayers,” Mr. Biden said.

    The 10 prescription drugs in the first round included big names like Eliquis, Jardiance and Stelara, and others that have among the highest spending in Medicare Part D. The lower prices, which take effect in 2026, could save taxpayers around $6 billion in the first year, the White House said, while those who are enrolled in Medicare Part D would save around $1.5 billion in out-of-pocket costs. 

    The negotiated prices came after the passage of the Inflation Reduction Act, which gave Medicare the ability to negotiate with drugmakers on prescription prices. The president credited Harris’ tie-breaking vote in the Senate for propelling the legislation to passage in 2022. 

    Harris, who vaulted to the top of the Democratic ticket less than a month ago when Mr. Biden announced he wouldn’t be running for reelection, said in a statement that the administration isn’t stopping here, with plans to select additional drugs for price negotiations each year. The White House has also touted extending the $35 cap on insulin for Medicare recipients to the commercial market.

    “President Biden and I will never stop fighting for the health, wellbeing, and financial stability of the American people,” she said. 

    While Harris hit the campaign trail in the aftermath of the president’s announcement that he would not run for reelection, Mr. Biden has largely kept out of the spotlight. 

    Kaia Hubbard

    Kaia Hubbard is a politics reporter for CBS News Digital, based in Washington, D.C.

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  • How to Look Up the Money Your Doctor Is Getting From Big Pharma

    How to Look Up the Money Your Doctor Is Getting From Big Pharma

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    When doctors take money or gifts from pharmaceutical companies they’re required by law to report that to the U.S. government. But did you know there’s a website where you can look up how much money any doctor in the U.S. has taken from healthcare companies? It’s completely free and run by Medicare.

    Evil’s Michael Emerson on Working Opposite a Giant, Hairy, Five-Eyed Demon

    A new study from JAMA found that 26 of 28 physicians who had given endorsements to healthcare products on the social media platform X had taken at least one payment from the companies making those products, according to news outlet STAT on Thursday. Incredibly, roughly half of the physicians had published no research related to the topics they were endorsing.

    But the website for looking up payments to American doctors isn’t just about endorsements. It covers payments involving research, speaking fees, and a host of other areas where doctors receive payment from companies within the healthcare sector. Doctors are supposed to report any kind of compensation, even if it’s just a cup of coffee while the doctor and a drug company representative discuss the latest medications being released.

    The website is called Open Payments and is run by the Centers For Medicare and Medicaid Services. And you can type in the name of any doctor in the country to see their latest data. For example, you can plug in any celebrity doctor and see which companies might be giving them money.

    Screenshot: OpenPaymentsData.cms.gov

    Take Dr. Drew, a celebrity doctor whose full name is Drew Pinsky, a man who used to be on mainstream TV all the time with shows like Celebrity Rehab With Dr. Drew and Dr. Drew on Call. The most recent data for Pinsky is from 2022 and shows that he made a total of $60,000 in five payments that year from Metuchen Pharmaceuticals. Metuchen owns the rights to Stendra, an erectile dysfunction medication, which Pinsky started promoting in a social media-driven campaign, according to a press release from 2022.

    As you can see from the screenshot below, the nature of the payment is listed as, “Compensation for services other than consulting, including serving as faculty or as a speaker at a venue other than a continuing education program.” Pinsky didn’t immediately reply to a message sent through his website on Thursday.

    Image for article titled How to Look Up the Money Your Doctor Is Getting From Big Pharma

    Screenshot: OpenPaymentsData.cms.gov

    To be clear, it’s not necessarily wrong or shady when doctors get payments from Big Pharma companies. Firms that develop new drugs and introduce new medical devices are doing important work. But it can be tremendously useful to know who’s getting paid by whom in every aspect of life. As soon as we take money or gifts from someone, it can influence even the most ethical person’s behavior in sometimes subtle ways.

    It’s not just celebrity doctors with data available on the Open Payments website. Every doctor in the country is theoretically in the database and you can search your own doctor to find out what kind of money they’re taking from Big Pharma. The Open Payments website also has a video explaining what you can learn by using this tool.

    Open Payments Program Overview Video

    Frustratingly, not every doctor is diligent about reporting payments they’re receiving from healthcare companies. As STAT’s new article explains, almost half of the 28 physicians in that recent study didn’t report the compensation they’d received for social media endorsements.

    Doctors received $12.58 billion in compensation from healthcare companies in 2022, according to the Open Payments website. The site has over 80 million records accounting for $68.44 billion dating back several years.

    And, again, none of this is necessarily evidence doctors are doing anything wrong by getting paid. However, the U.S. has the highest healthcare costs in the world while maintaining the lowest life expectancy among all large wealthy countries. It’s reasonable to ask if all the money sloshing around in the healthcare industry is really making any of us better off. Because all of the available evidence suggests it’s actually making us sicker.

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  • What women should know about Medicare coverage for health screenings and exams

    What women should know about Medicare coverage for health screenings and exams

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    As women get older, our risk for certain chronic diseases increase. We can thank the aging process itself, and the loss of estrogen’s protective effects after menopause. Older women are more prone to conditions like osteoporosis, which can cause brittle bones. The chance of heart disease rises, as do the odds of developing dementia, in part because women tend to live longer than men, and risk increases with age.

    Diagnosing some conditions is more challenging, since the frequency, appearance and long term effects of many diseases often appear differently in women than in men. It’s a key reason not to neglect regular health screenings and wellness visits, since staying healthier through preventive care and screenings can make the health challenges of aging easier.

    Wellness exams are critical for older women

    Medicare pays for annual preventive care with no co-pay. That’s especially relevant for women, who made up more than half (55%) of all Medicare beneficiaries in 2021. Nearly 1 in 8 (12%) were 85 or older; many had functional difficulties, an analysis from KFF found. That included difficulty walking, bathing, vision loss, or other issues that significantly impacted their quality of life. People age 85 and older tend to have five or more chronic conditions, which can become more complicated to manage with age.

    Women know they should focus on their health, says Alina Salganicoff, director of women’s health policy at KFF. But, “sometimes the system is not set up for women to take care of themselves, because they have competing demands, like work, or family caregiving responsibilities.” This often creates limited windows of time for women to prioritize themselves.

    And, if women don’t have access to a primary care provider or don’t receive regular care, they could skip important preventive measures like mammograms, she says.

    “Having coverage is the first step, but many other factors affect whether women get the services they need,” Salganicoff says. That includes their relationships with their clinicians, their own prior experiences, access to care, fears about conditions like dementia or cancer, or social supports like transportation, mobility or cognitive issues, or having someone to accompany them.

    That first wellness visit is probably key to everything else in managing an older patient, according to Segen Chase, an internal medicine physician in private practice in Manhattan, Kansas. About 35% of her clinic’s patients are Medicare beneficiaries, including many who live at a nearby retirement community.

    “It’s so important that we will do anything we can to have them visit and work with the practice’s wellness coordinator to go through all of the needed assessments,” said Chase, who is part of the American Medical Women’s WEL leadership training program.

    Wellness exams include annual tracking of numerous behavioral and physical markers like vision, hearing, fall risk, sexual health, nutrition, alcohol and tobacco use, as well as psychosocial risks like depression, stress, loneliness or social isolation, pain, and fatigue. Patients also undergo cognitive screening, which can reveal subtle changes in brain health.

    Wellness screenings may also include questions about someone’s living situation, because it helps us to determine whether they might need additional help at home, Chase says. “That also gives us an opportunity to discuss advance care planning, when they’re not in a crisis situation.” Medicare pays for this as part of the Part B annual wellness visit.

    Women with Medicare overall experience higher rates of certain health conditions compared to men, according to the KFF analysis. Urinary incontinence (37% vs. 18%), depression (31% vs. 21%), osteoporosis (29% vs. 7%), and pulmonary disease (20% vs. 16%) were more common among women than men. Women are also more likely than men to live alone. More than one-third of all women with Medicare (36%) live by themselves and more than half of those 85 and older live solo. This can increase the odds of  loneliness and social isolation, which are connected to increased risk of depression, dementia and stroke, according to the American Medical Association.

    The wellness visit can help uncover some of the hidden issues, and together, the physician and patient can create a care plan to manage these and other chronic conditions, Chase says.

    Which preventive women’s health services does Medicare cover?

    Medicare Part B covers a range of preventive services that benefit women’s health, including:

    There are no copays, deductibles or coinsurance charges for these and other covered screenings, although certain other criteria may apply, according to the Medicare Rights Center. Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) will even help pay for an osteoporosis injectable drug and visits by a home health nurse to inject the drug if you are eligible.

    This partial list of Medicare-covered screenings may seem daunting, which is why it’s so important for women to speak with their clinicians and discuss their health history, risk factors, and priorities, according to Salganicoff. “It’s a complicated program and can be difficult for people to navigate,” she says.

    These shouldn’t be one-off conversations, either, Chase says. As we age, priorities and what is realistic for a person to achieve may shift. So ongoing dialogue is a key to maintaining health.

    We know certain conditions show up differently in women, so “a lot of medicine comes back to communication, keeping the sanctity of the relationship while honoring their independence and finding out what’s most important to that person,” she says. Chase finds these discussions help women open up more about both their physical and emotional challenges, especially those who are caregivers. “They’re often exhausted but don’t want to admit it.”

    Providing women with clear, simple information so they can learn about all of their Medicare benefits and receive the necessary support to get the preventive care and other needed services, can go a long way towards keeping women healthy well into older age.

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    Liz Seegert

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  • Financial Doomsday Clock Is Ticking for Medicare, Social Security

    Financial Doomsday Clock Is Ticking for Medicare, Social Security

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    j4p4n, CC0, via Wikimedia Commons

    By Adam Andrzejewski for RealClearInvestigations

    Topline: It will take an extra $175.3 trillion to keep Medicare and Social Security intact for when today’s children reach old age, according to OpenTheBooks’ analysis of the nation’s latest financial report.

    Key facts: The Treasury Department projected spending over the “infinite horizon,” or the lifetime of everyone in the country today.

    Take A Look At How High Inflation Is Today Compared To Where Prices Were In 2019

    It projects that current participants in Medicare and Social Security will collect $105.4 trillion more in benefits from the programs than they contribute into them through payroll taxes.

    Future participants, who are younger than 15 and even in the womb, will use up $69.9 trillion more than they pay in taxes.

    Combined, that’s an unfathomable $175.3 trillion gap that can only be closed with “increased borrowing, higher taxes, reduced program spending or some combination,” according to the Treasury.

    There’s no easy way to put that number in context. The national debt is “only” $34 trillion. The federal government has spent roughly $200 trillion on everything since the Constitution was written in 1787, even adjusted for inflation.

    Medicare Part B, which covers doctor’s visits and medical equipment, is the largest liability. It’s expected to be underfunded by $99.5 trillion.

    Social Security needs an extra $68.8 trillion to be solvent.

    Since It Now Costs $1.5 million to Retire, It’s Time To Rethink What Retirement Means

    Background: Medicare and Social Security are supposed to fully fund themselves through payroll taxes, health care premiums and benefit taxes, a process that worked well until the 1980s.

    Former President Ronald Reagan, among others, warned of the looming funding crisis and encouraged Congress to pass the Social Security Reform Act of 1983.

    But since then, the system has remained largely untouched.

    Medicare spending was equal to 2.9% of the U.S. GDP in 2022, but the Congressional Budget Office expects it to reach 5.9% of GDP by 2052. Social Security spending is projected to rise from 4.9% to 6.4%.

    Medicare is expected to start cutting benefits in seven years, but the long-term implications are much more serious. The Treasury is required by U.S. law to borrow money if there is not enough to pay for Medicare and Social Security, which may soon be impossible without multiplying the federal debt.

    Summary: There’s no realistic path toward generating the amount of money needed to avoid slashing Medicare and Social Security payments. Politicians have deferred having this difficult conversation for decades, but soon that will no longer be an option.

    The #WasteOfTheDay is brought to you by the forensic auditors at OpenTheBooks.com

    Syndicated with permission from RealClearWire.

    Kamala Harris Falsely Claims Trump Said He Will ‘Weaponize’ The DOJ Against His Political Opponents

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  • Biden touts $35 insulin cap, overstates prior average cost

    Biden touts $35 insulin cap, overstates prior average cost

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    The cost of insulin in the United States has risen considerably in recent years, with some estimates finding that Americans have paid around 10 times more for the drug than people in other developed countries.

    But recent changes by the government and drug manufacturers have started to drive insulin prices down, something President Joe Biden often mentions at campaign events.

    Biden told the crowd at a March 19 campaign reception in Reno, Nevada, that he’s fought for years to allow Medicare to negotiate with drug companies.

    “How many of you know someone who needs insulin?” Biden asked. “OK, well, guess what? It was costing 400 bucks a month on average. It now costs $35 a month.”

    We’ve heard Biden make this point several times on the campaign trail — in other instances, he has said beneficiaries were paying “as much as” $400 a month — so we wanted to look into it.

    The Inflation Reduction Act, which Biden signed in 2022, caps out-of-pocket insulin costs at $35 a month for Medicare enrollees. The cap took effect in 2023. In response, three drug manufacturers said they planned to reduce the price of insulin to $35 through price caps or savings programs.

    The legislation also helped patients by clarifying how much they would have to pay for insulin and other drugs.

    But Biden overstated the average monthly cost that Medicare beneficiaries were paying before the law. 

    One government estimate for out-of-pocket insulin costs found that people with diabetes enrolled in Medicare or private insurance paid an average of $452 a year — not a month, as Biden said. That’s according to a December 2022 report by the U.S. Department of Health and Human Services using 2019 data. Uninsured users, however, paid more than twice as much on average for the drug, or about $996 annually.

    About half of U.S. insulin users are on Medicare

    More than 37 million Americans have diabetes, and more than 7 million of them need insulin to control their blood sugar levels and prevent dangerous complications. Of the Americans who take the drug, about 52% are on Medicare.

    It’s unlikely that many Medicare enrollees were paying the $400 out-of-pocket monthly average Biden referred to, though it could be on target for some people, especially if they’re uninsured, drug pricing experts told us.

    “It would be more accurate to say that it could cost people on Medicare over $400 for a month of insulin, but the average cost would have been quite a bit lower than $400 on Medicare,” said Stacie Dusetzina, a health policy professor at Vanderbilt University School of Medicine. 

    Medicare Part D, also called the Medicare prescription drug benefit, helps beneficiaries pay for self-administered prescriptions. The benefit has several phases, including a deductible, an initial coverage phase, a coverage gap phase and catastrophic coverage. What Medicare beneficiaries pay for their prescriptions often depends on which phase they’re in.

    “It is confusing, because the amount that a person was supposed to pay jumps around a lot in the Part D benefit,” Dusetzina said. For example, Dusetzina said that Medicare beneficiaries would be more likely to pay $400 a month for insulin during months when they hadn’t yet met their deductible. 

    Dr. Mariana Socal, an associate scientist at Johns Hopkins Bloomberg School of Public Health, said it’s also difficult to estimate insulin’s precise cost under Medicare because individual prices hinge on other factors, such as how many other prescription medications patients take. 

    “Because the Medicare program has multiple instances where the patient is required to pay a coinsurance (percentage of the drug’s cost) to get their drug, it is very likely that patients were paying much more than $35 per month, on average, before the cap established by the Inflation Reduction Act went into effect,” Socal wrote in an email.

    There are different ways to administer insulin, including through a pump, inhaler or pen injector filled with the medicine. 

    In a 2023 report, U.S. Health and Human Services department researchers estimated that about 37% of insulin fills for Medicare enrollees cost patients more than $35, and 24% of fills exceeded $70. Nationally, the average out-of-pocket cost for insulin was $58 per fill, typically for a 30-day supply, the report found. Patients with private insurance or Medicare paid about $63 per fill, on average.

    For people with employer-sponsored insurance, the average monthly out-of-pocket spending on insulin in 2019 was $82, according to an October 2021 report by the Health Care Cost Institute, a nonprofit that studies health care prices. The study found that the majority were spending an average of $35 a month, or lower, on the drug. But among the “8.7% of individuals in the highest spending category,” the median monthly out-of-pocket spending on insulin was about $315, the study said.

    Our ruling

    Biden said Medicare beneficiaries used to pay an average of $400 per month for insulin and are now paying $35 per month.

    The Inflation Reduction Act capped the monthly price of insulin at $35 for Medicare enrollees, starting in 2023.The change built in price predictability and helped insulin users save hundreds of dollars a year. 

    However, most Medicare enrollees were not paying a monthly average of $400 before these changes, according to experts and government data. Costs vary, so it is possible some people paid that much in a given month, depending on their coverage phase and dosage. 

    Research has shown that patients with private insurance or Medicare often paid more than $35 a month for their insulin, sometimes much more, but not as high as the $400 average Biden cited.

    We rate Biden’s statement Half True.

    PolitiFact Copy Chief Matthew Crowley contributed to this report.

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  • Medicare beneficiaries at high risk for severe COVID-19 received less treatment. A new study examines why

    Medicare beneficiaries at high risk for severe COVID-19 received less treatment. A new study examines why

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    A recently published study in the JAMA Health Forum of a cross-section of patients enrolled in Medicare in 2022, found that those at the highest risk for severe COVID-19 infection received COVID-19 therapy less often than those with the least risk.

    “We went into the study to find out why adoption of an effective COVID-19 treatment for high-risk individuals in the U.S. was so low,” says senior study author Michael L. Barnett, M.D., Associate Professor, Health Policy and Management, Harvard T. H. Chan School of Public Health. “Our first task was to identify the people who were using it.”

    “When we looked at different COVID-19 risk factors, the people at highest risk should be getting treated anywhere from five to 10 times the rate of those with lower risk factors,” says senior study author Dr. Michael L. Barnett, associate professor, health policy and management, Harvard T. H. Chan School of Public Health. “But our findings showed the opposite.”

    Free treatment for those at high risk for COVID-19

    Barnett and the research team were surprised by the results. “We have a free, safe, outpatient treatment for COVID-19 that is very effective for people at risk for severe COVID-19 infection, and it’s substantially underused in the U.S.” That medication is an oral antibiotic, Nirmatrelvir, which goes by the brand name Paxlovid.

    The study found that if the high-risk patients in their sample had received Paxlovid, 16% of COVID-19 deaths in their study would have been prevented, says Barnett.

    The findings also showed that some high-risk Medicare beneficiaries were less likely to get treatment than other patients, based on race, age, and income. Black patients were substantially less likely to get treatment than white patients (3% vs. 6.4%), as were patients over 90 and Medicaid-eligible patients.

    Education may increase the adoption of treatment

    Barnett and his team believe that education is the key to helping COVID-19 patients at high risk.

    “There needs to be a broader public awareness campaign,” says Barnett. “There’s a vastly disproportionate burden on older people with chronic conditions, and many are not aware of medication options.”

    Another potential concern, says Barnett, is that patients may shy away from this drug due to a long list of other medications with drug interactions. Doctors may also hesitate to prescribe it for the same reason.

    “We haven’t done a very good job educating primary care providers and physicians about just how frequently and under what circumstances we really should be using this medication,” says Barnett.

    Most of the drug interactions can be managed, he says. “For a week or two, many of the drugs can be easily skipped, to allow for the benefits of Paxlovid.” One example is cholesterol-reducing drugs (statins). Skipping this medication for a week or two, says Barnett, would be worth the COVID-fighting benefits of Paxlovid.

    However, other medications would provide a greater risk if they were stopped, such as blood thinners. “Most patients on blood thinners can just lower their doses on Paxlovid. But some people on blood thinners may not be good candidates for Paxlovid,” says Barnett.

    In addition, says Barnett, patients need to be educated on when Paxlovid is helpful. “Patients need to act on COVID-19 symptoms within five days to benefit from Paxlovid.”

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  • PolitiFact – Does U.S. Rep. Bryan Steil back cutting Social Security and Medicare?

    PolitiFact – Does U.S. Rep. Bryan Steil back cutting Social Security and Medicare?

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    Two familiar election-year policy topics have returned to the race for the 1st Congressional District — Medicare and Social Security. 

    Voters in the southern Wisconsin district, where U.S. Bryan Steil is running for a fourth term, may have started seeing a television ad aimed at his stances on the programs.

    The spot was launched Jan. 10, 2024 by Opportunity Wisconsin, a liberal group that describes itself as “a coalition of Wisconsin residents fighting for an economy that works for working people.”

    The ad features a Navy veteran from Racine, identified only as Jim, who expresses concerns about Steil’s positions on the benefits.

    “Bryan Steil is part of a group that wants to cut Social Security and Medicare, that would be devastating,” Jim says. “I earned my Social Security and Medicare benefits. Not given, not entitled, earned. Bryan Steil has no business touching them.”

    The position of Steil and other Republicans on Social Security and Medicare is likely to remain a frequent topic in campaign advertising ahead of the 2024 elections. 

    And, it could be a continued point of focus among Steil’s Democratic challengers.

    Federal lawmakers have struggled to agree on how to reform the programs, which could run out of money to pay out benefits in the early 2030s. 

    While the ad features “Jim,” we’re checking Opportunity Wisconsin, the group making the claim. Let’s take a look at where Steil stands on cuts to Social Security and Medicare. 

    Steil is part of group that looked at cuts to Social Security, but doesn’t support their plan

    By way of backup, Opportunity Wisconsin’s news release announcing the ads notes that Steil is part of the Republican Study Committee, “which has proposed a federal budget which would cut $718 billion from Social Security, raise the retirement age, and more.”

    Out of the gate, it’s worth noting that nearly 80% of House Republicans are part of that conservative caucus. Along with Steil, its members include U.S. Reps. Scott Fitzgerald, Glenn Grothman and Tom Tiffany of Wisconsin.

    PolitiFact National looked into the group’s most recent budget proposal when President Joe Biden made a similar claim that Republicans wanted to cut Social Security benefits. 

    That fact-check noted the plan was not universally endorsed by Republicans, didn’t provide a lot of detail, and was far from certain to be enacted. 

    Additionally, Steil was not one of the 14 members whose signature is on the plan, though Tiffany’s is.

    Chavonne Ludick, Steil’s communications director, said the representative opposes the budget proposal that is mentioned in the ad, which she called “recklessly misleading.”

    “While the congressman is a member of the Republican Study Committee, the 177 members of the group have widely differing views on many issues,” Ludick said. “Congressman Steil strongly supports Social Security and Medicare and opposes plans to cut them.”

    She said even if it came up for a vote, Steil “would vote against it and recommend others do the same.” 

    We’ve established that Steil is part of the Republican Study Committee, as Opportunity Wisconsin states. But his office says he doesn’t support the plan and wouldn’t vote for it. 

    So, there is a connection to Steil, but not a strong one.

    Plan would raise retirement age, but not cut benefits for people in or near retirement

    There are other problems with the ad, especially in how it characterizes the plan itself. Remember that Jim stressed he earned his benefits and Stiel “has no business touching them.”

    But the plan itself states: “We will not now or ever support cutting or delaying retirement benefits for any senior in or near retirement.”

    Rather, as the earlier fact-check noted, the plan would make changes to the benefit formula for people who aren’t near retirement and are on the higher end of the income scale.

    And it would make “modest adjustments” to the retirement age to receive full benefits “to account for increases in life expectancy.” That would cut benefits for some people, the fact-check explained.

    Roll Call reported that the committee was looking at raising the age to 69, for those who turn 62 in 2033.

    Now, what about the Medicare piece of the plan?

    The proposal calls for a “premium support model” that would subsidize private plans that would compete with Medicare. The caucus claimed their plans would lower premiums for seniors and would not cut benefits. 

    In a 2014 USA TODAY fact-check, we noted that the nonpartisan Congressional Budget Office said the idea — floated by then-U.S. Rep. Paul Ryan of Wisconsin — could lead to higher costs for beneficiaries.

    Sam Roecker, communications director for Opportunity Wisconsin, provided additional sources regarding Steil’s stances on Medicare, including votes against capping insulin costs at $35 for program recipients. 

    But that’s not the same as cutting benefits, as the ad suggests.

    Our ruling

    An Opportunity Wisconsin ad depicts a retiree who is concerned that Rep. Bryan Steil could cut his Social Security and Medicare benefits. 

    He says in part: “Bryan Steil is part of a group that wants to cut Social Security and Medicare, that would be devastating.” 

    Steil is part of the Republican Study Committee, which authored a plan aimed at addressing future Social Security and Medicare shortfalls, but so are many other House Republicans. 

    Importantly, Steil’s office says he opposes the plan and would vote against it. 

    Even if he did back the changes, the plan said it wouldn’t cut benefits for people in or near retirement, like the voter shown in the ad. 

    Our definition of Mostly False is “the statement contains an element of truth but ignores critical facts that would give a different impression.”

    That fits here.

     

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  • PolitiFact – Donald Trump omits context on Nikki Haley’s comments about US retirement age being too low

    PolitiFact – Donald Trump omits context on Nikki Haley’s comments about US retirement age being too low

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    Days before voting starts in the Iowa caucuses, former President Donald Trump has his eyes trained on Nikki Haley, his closest Republican rival in the 2024 presidential campaign. 

    Trump targeted the former South Carolina governor during a Jan. 6 campaign stop in Newton, Iowa, and claimed she wants to cut Social Security and Medicare and raise the retirement age. 

    “Nikki says the retirement age at 65 is way too low, it must be much higher,” Trump said of his former U.N. ambassador.

    That characterization lacks context. Haley has recently said the federal U.S. retirement age, at which Americans would receive Social Security and Medicare benefits, is “way too low.” But she said it should be raised in line with longer life expectancy, and she did not support changing the age for current beneficiaries or those nearing retirement.

    In an Aug. 24 Bloomberg Markets interview, Haley said the U.S. should increase the retirement age to help prevent Social Security and Medicare from becoming insolvent. 

    “The way we deal with it, is we don’t touch anyone’s retirement or anyone who’s been promised in, but we go to people like my kids in their twenties, when they’re coming into the system, and we say the rules have changed,” Haley told Joe Mathieu, a Washington correspondent for Bloomberg TV and radio. “We change retirement age to reflect life expectancy. Instead of cost-of-living increases, we do it based on inflation. We limit the benefits on the wealthy and we expand Medicare advantage plans.”

    When Mathieu asked which “right age” she would recommend, Haley said it would need to be calculated, but that 65 “is way too low,” and needs to be increased according to life expectancy. 

    Although Haley cited 65 as the retirement age, that’s for people born before 1960. In 1983, Congress upped the age when Americans can receive full retirement benefits through Social Security from 65 to 67 for those born in 1960 or later.

    U.S. life expectancy dropped during the COVID-19 pandemic, but has shown signs of rebounding, increasing from 76.4 years in 2021 to 77.5 in 2022, according to federal data.

    Here are other instances in which Haley discussed the U.S.’ retirement age during her presidential campaign:

    • Sept. 22 at the New Hampshire Institute of Politics in Manchester, New Hampshire: “I’ll raise the retirement age — only for younger people who are just entering the system. Americans are living 15 years longer than they were in the 1930s. If we don’t get out of the 20th century mindset, Social Security and Medicare won’t survive the first half of the 21st century.”

    • Nov. 8 at the third Republican presidential debate in Miami: “Those that have been promised, should keep it. But for, like my kids in their 20s, you go and you say, ‘We are going to change the rules.’ You change the retirement age for them.” 

    On Medicare, Haley has proposed expanding Medicare Advantage, a type of Medicare health plan offered by approved private companies. The government pays the companies to cover Medicare benefits.

    Our ruling

    Trump claimed that Haley “says the retirement age at 65 is way too low.”

    This is missing context. When Haley said the federal retirement age of 65 was “way too low” she wasn’t talking about current Social Security beneficiaries or people who are close to retiring. She would propose raising the retirement age for younger people, in line with longer life expectancy. 

    Trump’s statement is partially accurate but leaves out important details or takes things out of context. We rate his claim Half True.

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  • New weight loss drugs are out of reach for millions of older Americans because Medicare won't pay

    New weight loss drugs are out of reach for millions of older Americans because Medicare won't pay

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    WASHINGTON — New obesity drugs are showing promising results in helping some people shed pounds but the injections will remain out of reach for millions of older Americans because Medicare is forbidden to cover such medications.

    Drugmakers and a wide-ranging and growing bipartisan coalition of lawmakers are gearing up to push for that to change next year.

    As obesity rates rise among older adults, some lawmakers say the United States cannot afford to keep a decades-old law that prohibits Medicare from paying for new weight loss drugs, including Wegovy and Zepbound. But research shows the initial price tag of covering those drugs is so steep it could drain Medicare’s already shaky bank account.

    A look at the debate around if — and how — Medicare should cover obesity drugs:

    The Food and Drug Administration has in recent years approved a new class of weekly injectables, Novo Nordisk’s Wegovy and Eli Lilly’s Zepbound, to treat obesity.

    People can lose as much as 15% to 25% of their body weight on the drugs, which imitate the hormones that regulate appetites by communicating fullness between the gut and brain when people eat.

    The cost of the drugs, beloved by celebrities, has largely limited them to the wealthy, A monthly supply of Wegovy rings up at $1,300 and Zepbound will put you out $1,000. Shortages for the drugs have also limited the supplies. Private insurers often do not cover the medications or place strict restrictions on who can access them.

    Last month, a large, international study found a 20% reduced risk of serious heart problems such as heart attacks in patients who took Wegovy.

    Long before Oprah Winfrey and TikTok influencers alike gushed about the benefits of these weight loss drugs, Congress made a rule: Medicare Part D, the health insurance plan for older Americans to get prescriptions, could not cover medications used to help gain or lose weight. Medicare will cover obesity screening and behavioral treatment if a person has body mass index over 30. People with BMIs over 30 are considered obese.

    The rule was tacked onto legislation passed by Congress in 2003 that overhauled Medicare’s prescription drug benefits.

    Lawmakers balked at paying high costs for drugs to treat a condition that was historically regarded as cosmetic. Safety problems in the 1990s with the anti-obesity treatment known as fen-phen, which had to be withdrawn from the market, were also fresh in their minds.

    Medicaid, the state and federal partnership program for low-income people, does cover the drugs in some areas, but access is fragmented.

    New studies are showing the drugs do more than help patients slim down.

    Rep. Brad Wenstrup, R-Ohio, introduced legislation with Rep. Raul Ruiz, D-Calif., this year that would allow Medicare to cover the now-forbidden anti-obesity drugs, therapy, nutritionists and dieticians.

    “For years there was a stigma against these people, then there was a stigma about talking about obesity,” Wenstrup said in an interview with The Associated Press. “Now we’re in a place where we’re saying this is a health problem we need to deal with this.”

    He believes the intervention could alleviate all sorts of ailments associated with obesity that cost the system money.

    “The problem is so prevalent,” Wenstrup said. “People are starting to realize you have to take into consideration the savings that comes with better health.”

    Last year, about 40% of the nearly 66 million people enrolled in Medicare had obesity. That roughly mirrors the larger U.S. population, where 42% of adults struggle with obesity, according to the Centers for Disease Control and Prevention.

    Notably, Medicare does cover certain surgical procedures to treat medical complications of obesity in people with a body mass index of 35 and at least one related condition. Congress approved the exception in 2006, noted Mark McClellan, a former head of the Centers for Medicare and Medicaid Services and the FDA.

    The 17-year-old law may provide a blueprint for expanding coverage of the new drugs, which mirror the results of bariatric surgery in some cases, McClellan said. Evidence showed that the surgery reduced the risks of death and serious illness from conditions related to obesity.

    “And that’s been the basis for coverage all this time,” McClellan said.

    Still, the upfront price tag for lifting the rule remains a challenge.

    Some research shows offering weight loss drugs would assure Medicare’s impending bankruptcy. A Vanderbilt University analysis this year put an annual price of about $26 billion on anti-obesity drugs for Medicare if just 10% of the system’s enrollees were prescribed the medication.

    Other research, however, shows it could also save the government billions, even trillions over many years, because it would reduce some of the chronic conditions and problems that stem from obesity.

    An analysis this year from the University of Southern California’s Schaeffer Center estimated the government could save as much as $245 billion in a decade, with the majority of savings coming from reducing hospitalizations and other care.

    “What we did is we looked at the long-term health consequences of treating obesity in the Medicare population,” said the study’s co-author, Darius Lakdawalla, the director of research at the center. The Schaeffer Center receives funding from pharmaceutical companies, including Eli Lilly.

    Lakdawalla said it’s nearly impossible to put a cost on covering the drugs because no one knows how many people will end up taking them or what the drugs will be priced at.

    The Congressional Budget Office, which is tasked with pricing out legislative proposals, acknowledged this difficulty in an October blog post, with the director calling for more research on the topic.

    Overall, the agency “expects that the drug’s net cost to the Medicare program would be significant over the next 10 years.”

    The cost of the legislation is the biggest hang up in getting support, Ruiz said.

    “When we talk about the initial cost, I often have to educate the members that the CBO does not take into account cost savings in their cost benefit analysis,” Ruiz told the AP. “Taking that number in isolation, one does not get the full picture of the full economies of reducing obesity and all of its comorbidities in our patients.”

    Doctors say weight loss drugs are only a part of the most effective strategies to treat a patient with obesity.

    When Dr. Andrew Kraftson develops a plan with his patients at the University of Michigan’s Weight Navigator program, it involves a “perfect marriage” of behavioral intervention, health and diet education, and possibly anti-obesity medication.

    But with Medicare patients, he is limited in what he can prescribe.

    “A blanket prohibition for use of anti-obesity medication is an antiquated way of thinking and does not recognize obesity as a disease and is perpetuating health disparities,” Kraftson said. “I’m not so ignorant to think that Medicare should just start covering expensive treatments for everyone. But there is something between all or nothing.”

    Lawmakers have introduced some variation of legislation that would permit Medicare coverage of weight loss drugs over the last decade. But this year’s bill has garnered interest from more than 60 lawmakers, from self-proclaimed budget hawk Rep. David Schweikert, R-Ariz., to progressive Rep. Judy Chu, D-Calif.

    Passage is a top priority for two lawmakers, Wenstrup and Sen. Tom Carper, D-Del., before they retire next year.

    Pharmaceutical companies also are readying for a lobbying blitz next year with the drugs getting the OK from the FDA to be used for weight loss.

    “Americans should have access to the medicines that their doctors believe they should have,” Stephen Ubl, the president of the lobbying group, Pharmaceutical Research and Manufacturers of America, said on a call with reporters last week. “We would call on Medicare to cover these medicines.”

    Already, Novo Nordisk has employed eight separate firms and spent nearly $20 million on lobbying the federal government on issues, including the Treat & Reduce Obesity Act, since 2020, disclosures show. Eli Lilly has spent roughly $2.4 million lobbying since 2021.

    Advocates for groups such as the Obesity Society have been pushing for Medicare coverage of the medications for years. But the momentum may be shifting, thanks to the growing evidence that the obesity drugs can prevent strokes, heart attacks, even death, said Ted Kyle, a policy advisor.

    “The conversation has shifted from debating whether obesity treatment is worthwhile to figuring out how to make the economics work,” he said. “This is why I now believe the change is inevitable.”

    ___

    Associated Press writers JoNel Aleccia in Temecula, California, and Brian Slodysko contributed to this report.

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