The White House and Pharma were *this close* to a deal to lower Medicare drug spending by $150 billion over 10 years. But it blew up because the White House wanted to mail discount cards to Medicare beneficiaries before the election. nytimes.com/2020/09/18/us/…@jmartNYT@maggieNYT
Pharma balked at "Trump cards," which is why the president, for the second time, signed an executive order that says it will lower Medicare drug prices to the lowest price paid by foreign countries. whitehouse.gov/presidential-a…
As you may remember, the president signed such an order in July, too. But the White House never published the order in the Federal Register, as required by law. nytimes.com/2020/08/24/us/…
That order finally became public on Sunday, along with the. new one. But the new one somehow rescinds the previously unpublished order. (Here it is: whitehouse.gov/presidential-a…)
It is true that the pharmaceutical industry loathes the approach taken by this order, which would establish price controls--with low prices--for drugs purchased for Medicare beneficiaries. But the order itself is a long way from actually affecting drug prices paid by anyone.
Part of the order, which seeks to influence the prices paid for Medicare Part D drugs, seems legally vulnerable. The legislation establishing the program specifically bars the federal government from negotiating directly with the manufacturers. nytimes.com/2019/07/05/ups…
Lawsuits seem inevitable.
But aside from legal challenges, these programs will need to be designed through notice and comment rulemaking, and as pilot programs before they will go Medicare-wide. Look at the careful language here for a preview of what regulators will face.
All of which is to say: Drug prices are not going down before the election.
But it appears that Pharma was willing to make a deal that would have handed both sides a win right away. nytimes.com/2020/09/18/us/…
One final thought. I know many of these budget numbers sound like monopoly money. But $150 billion is a huge number.
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Medicare slowth: still going. One of the great (fortunate) mysteries of our time. @aliciaparlap @jshkatznytimes.com/interactive/20…
@aliciaparlap @jshkatz First of all, credit to @ddiamond for coining the term "slowth," to mean slow growth.
@aliciaparlap @jshkatz @ddiamond Medicare has been a budget buster for so long that a lot of smart people have found the program's recent trend of slow growth surprising.
When I was reporting on this story about the fiscal impacts of the GOP debt ceiling bill, I stumbled upon a provision that was getting very little attention but would be hugely consequential. nytimes.com/interactive/20…
The provision is called the REINS Act, and is designed to get Congress more engaged in the details of how laws they pass get implemented--by forcing Congress to vote every major regulation up or down. nytimes.com/2023/05/12/ups…
I started calling regulatory policy experts. Almost none of them knew this policy had just passed the House. nytimes.com/2023/05/12/ups…
Be sure to read @atmccann on the growing abortion pill underground, full of incredible details and never-before-collected data. nytimes.com/interactive/20…
This channel has provided 50,000 pill packs to women since the Dobbs decision.
For context, @clairecm and I wrote about data suggesting that the number of legal abortions during this period fell by around 32,000. nytimes.com/2023/04/12/ups…
A technical Medicare Advantage model change, buried deep in the annual rate notice, has unleashed a lobbying frenzy. nytimes.com/2023/03/22/hea…@ReedAbelson
There is tons of evidence that insurers in the program have been manipulating a program that pays them extra fees for enrolling customers with more illnesses. The change took away payments for some of diagnoses that are gamed the most.
@ReedAbelson and I wrote last year about how nearly every major player in Medicare Advantage is facing a federal fraud lawsuit for this type of behavior. nytimes.com/2022/10/08/ups…
Republicans in the House have been talking about balancing the budget. Since budget season kicks off this week, @aliciaparlap@jshkatz and I took a look at what that would take. nytimes.com/interactive/20…
First of all, balancing the budget in a decade would be hard. It would involve reducing spending and/or raising revenue by $16 trillion. That's around a quarter of federal spending.
The chart above is just an illustration. Almost no one recommends balancing the budget by just cutting everything in the budget by a quarter.
Last year, @ReedAbelson and I wrote about widespread fraud and overbilling in the Medicare Advantage program. The fraud we wrote about was in a system called "risk adjustment." nytimes.com/2022/10/08/ups…
@ReedAbelson Medicare pays the private plans for every beneficiary they enroll. But it pays more to the plans for patients who are sicker. This makes sense, since their medical care is likely to be more expensive.
But there is oodles of evidence that the plans had begun manipulating the formula, piling on lots of diagnoses to collect the extra payments. nytimes.com/2022/10/08/ups…