Over a long career in medicine and politics, Price holds deeply held beliefs and now leads a department whose mission he has consistently criticized. He will be the Trump administration’s policy leader on repealing Obamacare, and proposed changes to Medicare and Medicaid as well as other policies that will affect seniors. So who is this man and what will he likely do in his new role?
Right now, the federal government says you pay a set share of these costs through Medicare premiums, deductibles and co-pays and beneficiaries get government funding to cover specific benefits. Under the premium support idea, Medicare would instead pay a specific amount of money, without the guaranteed benefits or defined set of benefits.
Each time sharp drug prices moves into the headlines, political candidates complain and pledge to do something about it, Congressional lawmakers conduct hearings and legislation is proposed. But drug prices keep skyrocketing.
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Preventing Medicare from negotiating directly with drug makers is in sharp contrast with what other government agencies can do. Medicaid requires mandatory drug price rebates, and drug manufacturers are not allowed to charge the Veterans Administration more than the lowest price paid by any private sector purchaser. Private HMOs also routinely negotiate discounts from the drug companies. But the Department of Veterans Affairs is also bound by fewer rules than Medicare and one result is that it covers far fewer drugs than Medicare does.
Since winning the presidency, Trump has sent signals that he may no longer see Medicare as untouchable — raising the possibility that at some point in his administration the Republicans may pursue a Medicare overhaul. After the election, Trump laid out a health care platform that called for “modernizing” the program — a phrase Ryan and his supporters also like to use. Nominating Price to run HHS reinforces that position.
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Democrats see a Republican-led push to privatize Medicare as a way to motivate liberals and progressives because politically they can frame themselves as defending seniors and as saviors of Medicare and Medicaid. Democrats worry privatized Medicare would replace a government service that most people think works well, with skimpy vouchers or “coupon care for seniors” as some label it.
The 21st Century Cures Act is one of the most significant pieces of legislation passed by this Congress, with bipartisan support – from both the outgoing Democratic White House and GOP leaders in Congress. It makes sweeping policy changes and funding increases for mental health care programs, money to fight the national opioid epidemic and additional money for Alzheimer’s disease research and cancer research. Supporters of the bill called it a “game-changer” that would touch almost every American in some way or another.
So Butterfli and other companies and local communities are working with insurance companies to provide transportation solutions to the elderly and now have an added incentive to provide it so they don’t get hit with readmission penalties.
Companies love forced arbitration because it overwhelmingly tilts in their favor and often shields them from liability. But in the process, consumers, investors, and in the case of nursing homes, patients and families, are often denied justice because they have no legal recourse when wronged.
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But the Centers for Medicare and Medicaid Services (CMS), which govern both Medicare and Medicaid and controls more than $1 trillion in funding for the two agencies, recently issued new rules cutting off funding to nursing facilities that require arbitration clauses as a condition of admission.
The actual choice facing voters are two candidates with sharply different views of the world. Where they have articulated a clear policy, like on issues involving immigration, ISIS and the economy, the differences are often stark. But little has been spoken about key issues with special importance to seniors.
One of the biggest criticisms of high-deductible plans is that instead of pushing people to be careful, cost‑conscious health care consumers, these plans force people to avoid care altogether. Instead, this [proposed legislation] inches toward the idea of a value‑based policy.
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Only days after Judy Hanttula came home from the hospital after surgery last November, her doctor’s office called with bad news. Records showed that instead of traditional Medicare, she had a private Medicare Advantage plan. The shock was that her doctor and hospital were not in its network. That meant that neither the plan nor Medicare would cover her medical costs. Her “seamless conversion” was going to cost her $16,622.
Those using virtual visits with a physician around the clock are finding they can charge an average cost of less than $50 per visit. Some have found they can charge as little as $15 for an online visit. By contrast, it takes, on average, 20 days to secure a 20-minute appointment with a physician that, with travel and waiting, can consume two hours of an individual’s time, the doctors found.