How Walking Can Ease Arthritis Symptoms

By Mary Altpeter | 7.26.2018

Today, 30.8 million people—1 in almost every 10 American adults—have osteoarthritis (OA), a serious disease that mainly affects the hands, knees, and hips in adults. OA rates are expected to increase in the years ahead as baby boomers age, and the effects of the obesity epidemic continue to manifest.

Osteoarthritis is common, expensive, and a leading cause of disability … but it also can be prevented and managed.

Whether you need relief from arthritis pain or just want to be active, the Arthritis Foundation’s six-week Walk With Ease (WWE) program can teach you how to safely and comfortably make physical activity part of your everyday life.

WWE is an evidence-based program proven to:

• Reduce the pain and discomfort of arthritis
• Increase balance, strength, and walking pace
• Build confidence in your ability to be physically active
• Improve overall health

The Walk With Ease program is offered as an instructor-led class that meets three times a week, or you can do it on your own. Both formats of the program are guided by the Walk With Ease Workbook. The Workbook includes:

• Self-assessments for measuring your progress
• Action plans for setting goals
• Activity logs for tracking your walks
• Information about the importance of physical activity for people with arthritis
• Strategies for arthritis symptom management
• Tips for safe walking, warm-up, and cool-down exercises

There also is a Walk With Ease mobile app and other online videos of exercises and other online tools.

More information about osteoarthritis and about the Walk With Ease Program is available at the OsteoArthritis Action Alliance website. To help decide if Walk With Ease is right for you, watch the “Class Zero” orientation video below or visit the Arthritis Foundation’s Walk With Ease website.

https://www.ncoa.org/blog/walk-with-ease/?utm_source=newsletter&utm_medium=email&utm_campaign=07312018_NCOAWeek

Let’s stop letting women age out of the workforce worse off than men

We try to prepare girls to be successful women by plotting their career paths early. But women heading toward retirement get little support.

• 07.27.18
• WORKING WHILE FEMALE
• BY ANNA MARIA CHÁVEZ3 MINUTE READ
  When your father or grandfather retired, his company might’ve thrown a little get-together, complete with toasts by backslapping colleagues, a cake, and an engraved watch. If he was lucky, he walked into retirement knowing he had a company pension or ample retirement savings to see him through the rest of his life.

  Today? Not so much. Especially not for women.

  Women who are approaching retirement in the U.S. today face a trifecta of challenges: They’re living longer (an average of 20 years past age 65), have significantly less money saved (an average of just $34,000), and face ever-increasing costs, especially for health care (an average of $5,503 a year out-of-pocket). This adds up to far greater economic insecurity among women as they age. In fact, according to the National Institute on Retirement Security, women aged 65 and older have incomes that are 25% lower than men’s, and they are 80% more likely than men to be impoverished past age 65.

  Women of color face even deeper disparities as they age. African American and Latinas earn less from Social Security, assets, and pensions than do white women, and they rely on Social Security for a larger portion of their income, according to the U.S. Department of Labor.

  The good news is that employers have a unique opportunity to turn these numbers around by thinking proactively about supporting working women today so they can age well later. Here are three ideas.

  CLOSE THE PAY GAP AND EXPAND MENTORING

  Women begin retirement with a hurdle that’s followed them their entire careers: the gender pay gap. Labor Department statistics show the gap is as stubborn as ever, with women earning 21% less than men, a disparity that worsens among women of color and in certain industriesmore than others. Lower pay means less money saved, both in personal retirement accounts and Social Security benefits. Overall, women receive nearly $4,000 a year less in Social Security than men.

  Employers can level the playing field by eliminating the gender wage gap among their employees now, so their women employees don’t leave the workforce already disadvantaged once they retire. This is not an impossible goal. Starbucks, for example, has reached 100% pay equity among its employees. One part of the solution is to widen women’s participation in STEM fields; another is for employers to offer more flexible schedules and remote-work opportunities.

  Companies also need to do a better job of nurturing and mentoring women to move up into leadership positions that offer greater opportunities and more pay. Staff development and performance management are critical to ensuring that women keep learning and developing over the entire course of their careers–this way they can retire from them on a more secure financial footing.

  LET WOMEN PHASE INTO LIFE AFTER WORK

  Few women today want to work one day and stop the next. They want and need to continue working, but other responsibilities may be tugging at them. By one recent estimate, for example, up to 20% of working women are also caring for an elderly loved one.

  Employers need to create organizational climates where women approaching retirement don’t feel it’s risky to have conversations about phased retirement options. Working part-time or moving to a position that requires less responsibility can be a solution–and employers should be game to offer that. In the latest Transamerica Retirement Survey, only 23% of workers said they plan to immediately stop working at a specific point in time. However, 25% also said that their employers do nothing to help employees enter retirement. Organizations need to step up and change that.

  ARM WOMEN WITH KNOWLEDGE OF WHAT’S AHEAD

  As a society, we try to prepare girls to grow into successful women; think Girl Scouts, STEM initiatives, and Girls on the Run. But how do we help women prepare to age well? We don’t teach them how their bodies are going to change as they age, or how to manage their savings so it will last an extra 20 years.

  Just as we counsel younger women to make informed decisions about their education and careers, we need to support older women in planning for a successful third phase of life. My organization, the National Council on Aging, created an “Aging Mastery Program” to provide this kind of unbiased guidance, complete with small steps people can take to chart their own paths toward aging well.

  While the days of engraved watches and pension plans may be over for most (and were never equitably available to all to begin with), a secure retirement should be a right for every person who has put in a lifetime of work–especially women. Forward-thinking employers need to help women plan not just for successful careers but for successful lives after work. And they need to start right now.

  ---

  Anna Maria Chávez is executive vice president and chief growth officer at the National Council on Aging.

https://www.fastcompany.com/90208127/lets-stop-letting-women-age-out-of-the-workforce-worse-off-than-men

From Coverage to Care (C2C) Prevention Webinar

From Coverage to Care (C2C) Prevention Webinar – Register Today! Need information on prevention? Join C2C, HealthFinder, and CDC!  The Centers for Medicare and Medicaid Services (CMS) Office of Minority Health (OMH) in collaboration with the Office of Assistant Secretary for Health (OASH) Office of Disease Prevention and Health Promotion’s HealthFinder team and the Centers for Disease Control’s (CDC) Office of the Associate Director for Policy will host a webinar to provide information and resources that From Coverage to Care (C2C) partners can use to help consumers understand their health care coverage and use prevention services.  Date:              Tuesday, August 7th Time:              2:00 p.m. ET (1:00 CT, 12:00 MT, 11:00 am PT) Duration:       60 minutes  Register here: http://bit.ly/C2CPrevWebinar  An important part of the From Coverage to Care journey is prevention. C2C has a number of tools to help consumers understand health coverage, learn important terms, and directs them to additional resources. These prevention and healthy living resources can be shared with consumers, reposted online, printed or ordered. C2C Prevention Resources are available in English and Spanish. Visit https://go.cms.gov/c2cprevention and start using them.

Cuomo cuts New York insurers' request in jab at Trump

The governor said he wouldn't let the president's attacks on the ACA fuel higher prices for health insurance

By Jonathan LaMantia  | July 30, 2018

Gov. Andrew Cuomo has directed New York's top insurance regulator to reject the portion of health plans' proposed premium increases attributed to the requirement that individuals get health coverage or pay a penalty.

Health insurers asked the state Department of Financial Services to approve an average 24% increase to their premiums in June, with 11.9% related to the end of the so-called individual mandate. The effect of Cuomo's action would be to reduce by half, on average, the amount by which insurers can raise their rates next year.

"Insurance premiums must be based on actual cost and not political manipulation," Cuomo said at Mount Sinai Hospital in Manhattan, where lawmakers, health care officials and union members gathered for an event today. "We're not going to let Trump tear down our health care system."

In December President Donald Trump signed the Republicans' $1.5 trillion tax bill into law. One of its provisions eliminated the penalties for not being insured. Cuomo said he would not let that action, one of several the Trump administration has deployed to dismantle the Affordable Care Act, result in a "bonanza" of hundreds of millions of dollars to insurance companies.

The proposed rate increases would have led to a more than $1,500 increase in insurance costs annually for people buying coverage in the individual market, such as those who don't have coverage through their employer. DFS said last year that about 349,000 New Yorkers were enrolled in the individual market, including those who buy directly from plans, not through the state's marketplace.

When DFS announced the health plans' proposed rate increases, it showed the percentage they were increasing rates that was attributable to the end of the individual mandate. Cuomo's decision will hit hardest for plans that based most of their price increases on the demise of the mandate. Fidelis Care, for instance, asked for a 38.6% average increase and said two-thirds of that increase were tied to the individual mandate.

Insurers expect fewer younger, healthier people will buy health insurance when the penalty disappears. That will leave a group of less-healthy individuals buying coverage, which could increase insurers' medical spending and result in more price increases.

The department makes decisions on rate increases for plans individually and could lower rates even further for some insurers.

The elimination of the individual mandate justifies increases to premiums, Eric Linzer, president and CEO of the state Health Plan Association, said in a statement. He noted that the state Division of the Budget and the Department of Health had estimated that the end of the mandate would result in double-digit rate increases, and the Congressional Budget Office and actuaries at Oliver Wyman estimated its impact at 9% to 10%.

"We agree with Gov. Cuomo that decisions on health insurance premiums should be based on math, not politics," Linzer said. "A key priority must be maintaining a stable marketplace in New York. Politicizing the 2019 rate requests will not help in this effort."

Before the announcement, the event at Mount Sinai had the tone of a campaign event, with Greater New York Hospital Association President Kenneth Raske and 1199SEIU President George Gresham praising Cuomo's health care achievements while introducing the governor.

"If you look around this country and compare other governors and look at what we have in a governor that stands up for working people, stands up for health care, that celebrates our diversity rather then uses it as a wedge to divide us, you realize we were given a blessing in New York and we need to keep that blessing going," Gresham said.

Cuomo is running for a third term and faces a Democratic primary challenge from actress and activist Cynthia Nixon on Sept. 13.

http://www.modernhealthcare.com/article/20180730/NEWS/180739989?utm_source=modernhealthcare&utm_medium=email&utm_content=20180730-NEWS-180739989&utm_campaign=dose

Wisconsin, Maine win federal approval for new reinsurance pools

By Virgil Dickson  | July 30, 2018

HHS approved 1332 waiver applications from Maine and Wisconsin over the last two days to create individual market reinsurance funds. The states expect the move will lower exchange premiums for this upcoming open enrollment.

"People in the individual market saw their premiums go up by 44% on average last year, and some saw much larger increases—that's unsustainable and unacceptable," Republican Gov. Scott Walker said in a statement. "Thankfully, the federal government is giving us the flexibility to implement a Wisconsin-based solution to help stabilize premiums."

Wisconsin projects that its 1332 waiver, approved on Sunday, will cause premiums to drop 11% in 2019 compared to where they would be without the waiver, according to HHS. The state also predicts that enrollment will increase by nearly 1% in 2019 due to the lower cost of coverage.

Conservatives in the state have said they hope the lower exchange premiums will help them win more races during the 2018 midterm elections.

The reinsurance fund will reimburse insurers for 50% of an enrollee's claims between $50,000 and $250,000. The state and federal government have collectively allocated $200 million for the pool. Wisconsin is expected to chip in $34 million and the federal government will pay the remaining $166 million.

HHS said it will fund its share through so-called pass-through savings. Since the waiver will lead to lower premiums, the government will spend less in tax credits in the state. As required by federal law, the 1332 waiver will not increase the federal deficit.

On Monday, HHS also approved Maine's 1332 waiver. Under its reinsurance pool, up to 90% of claims between $47,000 and $77,000 will be paid and 100% of claims in excess of $77,000 for high-risk enrollees diagnosed with certain health conditions or who are referred by the insurer's underwriting judgment.

The pool is funded up to $93 million, with $33 million coming from the federal government via pass through savings. Maine projects that under the 1332 waiver, premiums will be about 9% lower in 2019 than they would be without the waiver. In addition, it predicts the number of uninsured will fall by about 1.7% due to the lower cost of coverage.

HHS has also approved 1332 waivers in Alaska, Hawaii, Minnesota and Oregon.

http://www.modernhealthcare.com/article/20180730/NEWS/180739998?utm_source=modernhealthcare&utm_medium=email&utm_content=20180730-NEWS-180739998&utm_campaign=dose

Opioid laws hit physicians, patients in unintended ways

By Jay Greene  | July 30, 2018

New state laws on opioids intended to save lives have physicians complaining about unintended consequences.

None of the doctors interviewed by Crain's objected to the laws' intent: Reducing misuse of the powerful painkillers that have contributed to rising deaths and addictions.

But they say regulations have added unnecessary administrative headaches, led to a climate of fear for doctors and left patients unable to get medications when they really need them.

Doctors also say some health insurers are using the laws to inappropriately deny or delay prescriptions, sometimes even for patients with cancer and terminal illness. Some pharmacists are also making it harder to get prescriptions filled in ways that go beyond the law, the physicians say.

A number of doctors told Crain's they have voluntarily limited the number of opioid prescriptions they write for patients because they fear they might be arrested or disciplined for overprescribing. One physician gave up his DEA license because he didn't want to learn all the new rules or risk breaking the law.

Doctors who include Betty Chu, M.D., president of the Michigan State Medical Society, and Chris Bush, M.D., a family practice physician in Riverview affiliated with Henry Ford Health System, say legislators and the state Department of Licensing and Regulatory Affairs need to listen to doctors and correct the problems.

"We are hoping that LARA (and legislators) work with us and multiple other stakeholders to fix the laws and improve stakeholders' goals: reducing deaths and improve patients' health," Chu said.

Kim Gaedeke, deputy director with LARA, said the department is working with providers to address problems.

"There also is misunderstanding with these laws," said Gaedeke, adding: "The message has been really been letting providers know we are all in it together. We have a mutual mission, including our law enforcement partners, to protect health and welfare of citizens."

Gaedeke said LARA issued an online fact sheet earlier this month to answer some physician and pharmacist questions and address unintended effects related to pharmacies and health insurers.

One big concern is that laws making it more difficult to get prescription drugs could be pushing addicts and some patients into buying heroin or other drugs on the street, Chu and Bush agree.

And that includes black-market prescription drugs. Because prescription drugs for chronic diseases such as diabetes cost so much, some normally law-abiding patients sell their opioid prescriptions to be able to buy insulin or even food, doctors and state officials tell Crain's.

As a result, the number of deaths and addictions hasn't appreciably changed the past several years in Michigan, physicians and state officials say.

Nationally, more than 115 people die per day of opioid overdoses. Prescription opioids are powerful pain-reducing medications such as Vicodin or morphine. Illegal opioids include heroin, illegally produced fentanyl and an array of synthetic substances.

In Michigan, opioid deaths and overdoses rank 18th-highest in the nation. In 2016, 2,356 people died of drug overdoses, about six per day, more deaths than from car accidents.

Many health systems are prescribing fewer opioids. It's less clear that has done anything to slow the epidemic.

While Chu said she hasn't seen any data showing reduced deaths, Henry Ford Health has tracked a 40 percent reduction in opioid prescriptions the past five years. Chu is vice president of medical affairs at Henry Ford West Bloomfield Hospital.

"Deaths have not gone down, because of the issue of illicit drugs," Chu said. "As prescribing has gone down, people still deal with pain."

Chu said more discussion needs to be directed to non-pharmacy pain resources to help patients. "It's not like people don't have pain anymore. They do. There are patients who need something. We as doctors are not just responsible for managing opioid prescriptions, but to manage patient care and pain."

But Chu said over the past several months the medical society has been getting "a ton of feedback" from physicians and patients about the negative effects of the new laws.

"We are hearing a lot from (doctors) about patients who are suffering because of the laws. We recognize the pressure the legislature had to do something, but ... some of the provisions have been very challenging," Chu said.

State Sen. Mike Shirkey, chairman of the Senate health policy committee, said the Legislature will look at tweaking the bills to fix any problems.

"We have to be patient and avoid reacting to resistance to change versus resistance to unnecessary or non-value-adding regulation," Shirkey said.

Provider conflicts

Bush said doctors have told him the new opioid laws are creating additional conflict between prescribers, pharmacists and health insurance companies over correct dosages.

"The bills are mostly good, but legislators took a heavy-handed approach to the crisis, and the result may not have a big effect on opioid" deaths and addictions, Bush said.

For example, one patient who is also a physician, who asked for anonymity, was prescribed a seven-day supply of the painkiller Norco from her doctor, 28 pills. However, the health insurer denied the prescription for 28 pills and allowed only 20 to be filled. The insurer had recently changed its policy to limit opioid prescriptions for acute pain to five days, even though the laws allow for seven.

"How did the pharmacist know it was for acute pain and not chronic pain?" the physician-patient said. "The bottle wasn't marked."

"When I challenged with the fact that the state law now gives pharmacists the ability to do split opioid prescriptions, he said that wasn't what" the pharmacy does, the physician-patient said. "Clearly, (the pharmacy) is making money."

Beginning March 27, Michigan law allows pharmacists to fill Schedule 2 controlled substances in increments to avoid making the patient go back to the doctor.

Dianne Malburg, COO of the Michigan Pharmacists Association, said there is confusion with some of the opioid laws between doctors and pharmacists. She said common questions from pharmacies range from whether to allow partial refills and whether the prescription was intended for acute or chronic pain.

"We have heard some physicians write two scripts for patients and predate them so patients don't have to go back again," Malburg said.

On partial refills, Malburg said patients can't get the whole prescription filled the same day if there is a limit from the health insurer or state law. "They can come back and get the remainder" when the initial fill has run out, she said.

Pharmacists are concerned they might not know if a prescription is for acute or chronic pain, Malburg said. State law limits opioids to a seven-day supply for acute pain, but prescriptions for chronic pain can be longer.

Problems with limits

Beginning June 1, Public Act 248 of 2017 requires physicians who want to issue a prescription for more than three days to first check with the Michigan Automated Prescription System, the state's online database that houses information on prescriptions for opioid and other controlled substances. The act excludes prescriptions written for a patient in a hospital or ambulatory surgery center.

Fred Van Alstine, M.D., a family physician in Traverse City who specializes in palliative care and is a hospice medical director, said there also should be exceptions in opioid laws for hospice patients and those in palliative care who are dying.

"This was a solution looking for a problem. ... It is an administrative burden because our patients are end of life and they need" opioids to control pain, Van Alstine said.

James Forshee, M.D., Priority Health's chief medical officer, said his company's prior-authorization rules on opioids exempt patients in palliative care, hospice or in cancer treatment.

"The whole effort of the law is to reduce opioid use, prevent addiction, misuse and abuse," Forshee said. "That is not an issue with palliative care and hospice treatment. Pain control is the primary purpose."

Bush said the opioid laws' blanket restrictions illustrates the quandary physicians sometimes face when they must fill a pain prescription for a major broken limb, when a patient has been discharged after a surgery or has another serious condition.

For example, say the doctor writes a prescription for a seven-day supply on a Monday and the pharmacist or health insurer instead limits the prescription to five days.

"The patient runs out Friday evening, and since no one can ever find their primary physicians on a weekend, the hurting patient goes to the ER, where they will not provide that person with another prescription because they did not take care of the initial problem," the physician-patient said. "In the end, the poor patient suffers. But the doctor can get two office visits from this and the pharmacy gets two different prescriptions plus markup."

Chu said there have been reported conflicts between pharmacists and doctors that need to be worked out.

"We passed laws to punish (offenders), but patients have chronic pain and a lot are feeling like they are criminals now" when they fill their prescription, she said.

Elizabeth Pionk, D.O., a hospitalist physician at McLaren Bay Region hospital in Bay City, said the laws have also created problems for doctors at hospitals.

"Our hospitalist group has agreed to discharge patients with two or three days of medicine, but sometimes it is difficult for patients to get a refill after they are discharged before two or three days," said Pionk, who also is on the foundation board for the Michigan Academy of Family Physicians.

Doctors fear giving opioids to patients for more than three days because of the laws in place, Pionk said.

But that means patients who run out of pain medications will sometimes show up in the emergency room, which won't give them medications. "The acute pain issue is a difficult one," she said.

Shirkey acknowledged there is a problem, a "gray area between acute and chronic pain (in the bills) ... and the limitations on number of doses per script."

For example, Shirkey said, physicians may need to be able to give a patient pain medication for more than seven days if they know the patient "need(s) back surgery but cannot get into a specialist for weeks," he said.

The medical society has received a number of other complaints about the opioid laws from patients. Among them was a patient whose doctor would no longer prescribe pain medications and sent her to a pain clinic, but the pain clinic was booked for weeks because of the new law, Chu said.

Rural Michigan faces problems as well.

Loretta Leja, M.D., a family physician in solo practice in Cheboygan, said shortages of doctors in rural northern Michigan cause people to travel hundreds of miles for primary care and surgeries. Sometimes they run out of pain medications before they can get a doctor to refill.

"I had a patient who was having major surgery downstate, and her doctor told her she could get seven days of pain medication and to come back and see him after three weeks" for a follow-up appointment, said Leja, who is chairman of the Michigan Academy of Family Physicians. "She was worried because what do you do for two weeks with no pain meds?"

Mary Marshall, M.D., a solo practicing family physician in Grand Blanc, said a growing number of her patients are coming to her when they run out of pain pills after they have had same-day surgery.

"For whatever reason the physicians or physician assistants don't want to write more than a three-day supply of pain medications. The problem is the patient runs out," said Marshall, who also is president of the Michigan Academy of Family Physicians.

Marshall said pharmacists and health insurers also are questioning more pain prescriptions.

"I prescribed Norco, a common opioid, and the question came up, and you have to stop what you are doing and submit information to the insurance company," said Marshall.

The laws, and policies from pharmacies and health insurers often don't match up, she said. "It is such a tangled web."

Van Alstine said health insurers have used the opioid laws to deny prescriptions for palliative care patients.

"Most hospice patients receive 14-day supplies. The prior authorization process is a nightmare. Insurers are using (the laws) as an excuse to deny," he said. "Before it was a problem, but it became more acute after the laws passed."

For example, Van Alstine said recently he had a terminally ill patient discharged from a hospital, and he wanted to prescribe a 14-day supply of oxycontin. The pharmacist called to let him know the health insurer had denied the prescription.

"I spent four hours on a Saturday trying to get him access to medications" for pain related to liver cancer, Van Alstine said. "I filed a complaint with the insurance commissioner on Monday. They got involved and the situation was resolved, but the guy died 24 hours later. He was in pain for days before."

Some health insurers and pharmacists have over-interpreted the laws, Chu said. "(Some health insurers) will probably use it as an opportunity to decrease utilization," she said.

Gaedeke said she is unaware that health insurers and pharmacists are rejecting prescriptions from doctors. "They may require more visits (by patients), but we were told the laws don't require additional visits for pain medications," she said. "Some (pharmacists) are thinking the seven-day supply for acute pain applies for chronic pain. There is some confusion there."

Forshee said he knows there has been confusion among physicians. Last year, Priority Health implemented new policies, which are less stringent than the state laws, that eliminated 90-day prescriptions for opioids, and limited prescription coverage to 30 days for long-acting opioids and 15 days for short-acting opioids.

"We saw there was a problem and put in requirements" that reduce the number of opioids prescribed, creates care management plans and offers additional behavioral health and medication management support, Forshee said.

Over the next three years, Priority projects a 25 percent reduction the number of prescribed opioids, Forshee said. He said the company will take another look at its policies later this year after it reviews data.

"We work closely and talk with primary care physicians, specialists like surgeons and pain-management specialists and groups to make sure our policies are based on science and evidence," he said.

Fear of discipline

In early July, Detroit physician Zeyn Nez Seabron became one of about 53 doctors or pharmacists suspended or otherwise disciplined for overprescribing controlled substances, according to LARA.

LARA's complaint stated that during nine months in 2017 and 2018, Seabron was a top prescriber of oxycodone and oxymorphone, both commonly abused opioids.

Forshee said he can understand why doctors might hesitate to prescribe for fear of "gotcha" investigations and discipline.

But Gaedeke said LARA hopes over time the new opioid laws will help reduce the number of disciplinary actions taken against prescribers.

"Our goal is to go after the worst of the worst. Those blatantly prescribing, violating laws and causing deaths," Gaedeke said.

Chu supports the intent of LARA's crackdown. "It has been too easy to get prescriptions, but we don't want to make it too difficult for legitimate purposes," she said.

"Opioid laws hit physicians, patients in unintended ways" originally appeared in Crain's Detroit Business.

http://www.modernhealthcare.com/article/20180730/NEWS/180739995?utm_source=modernhealthcare&utm_medium=email&utm_content=20180730-NEWS-180739995&utm_campaign=dose

Libertarian think tank: Providers would pay for Medicare for All

By Susannah Luthi  | July 30, 2018

A libertarian think tank on Monday alleged that the Medicare for All plan backed by Sen. Bernie Sanders would put the brunt of the proposal's costs on provider pay cuts.

In a white paper released Monday by the Mercatus Center of George Mason University, senior research strategist Charles Blahous claimed healthcare spending constraints laid out in the plan from the Vermont independent senator fall almost totally on providers. The plan could save the U.S. more than $2 trillion over 10 years in national healthcare spending, but could increase the federal government's costs to nearly $33 trillion above current levels, according to Blahous' calculations.

Nearly all the savings for national health spending come from across-the-board Medicare rate cuts, which Blahous projects would reduce provider payments by $384 billion in the first year, and by nearly $660 billion in 2030.

This analysis will likely push single-payer advocates to hone their message on healthcare pricing to make their proposal viable, said Benedic Ippolito, a health economist with the right-leaning American Enterprise Institute.

"Provider payment cuts are doing a lot of heavy lifting here," Ippolito said. "Changes to provider payments, whether you love them or not, have real consequences. And those real consequences extend beyond a budgetary score."

While the U.S. healthcare system does need to grapple with the "right price to pay for healthcare," Ippolito said, proponents of the Sanders plan and others like it need to determine what the right rate could be and how it will impact provider behavior, which determines major components of the healthcare system—investments in equipment and buildings, patient access and health outcomes.

"It's easy to think about prices as one piece of a broader market, but the thing that's special about prices is that it's the key that unlocks the whole thing," he added. "Whatever price you set will be highly consequential for the entire market. The decision you make for good or bad is extremely consequential, and you can't get around that."

Single-payer advocates lauded the paper's findings that the projected provider cuts would roughly pay for universal coverage. The Mercatus analysis also estimated the healthcare system would save billions every year on drug spending since the Sanders Medicare for All plan allows the HHS secretary to negotiate prescription drug prices with the manufacturers—and presumably refuse to buy certain high-priced drugs.

But Blahous warned that the Sanders blueprint for coverage would likely lead to a huge spike in overall healthcare utilization, not only because more people would automatically be covered for services like dental and vision care but also because it bans any co-pays or deductibles.

"As a general rule, the greater the percentage of an individual's healthcare that is paid by insurance ... the more healthcare services an individual tends to buy," Blahous wrote.

Blahous maintained that the jury is still out on whether MACRA effectively reins in provider costs, warning that the Medicare for All transition could disrupt access to healthcare as universal coverage goes into effect. He also noted that while some Medicaid-dependent providers would see a pay boost in the early years as their traditionally much-lower Medicaid reimbursements would rise to Medicare rates, they would start losing money soon after.

To back up his warning, Blahous cited the CMS' Office of the Actuary's projections that current payments would lead to negative operating margins for nearly half of hospitals by 2040. By 2019, over 80% of hospitals will lose money treating Medicare patients. A dramatic structural change to reimbursement structure could shutter many provider doors, Blahous wrote.

The paper acknowledged that phasing out employer-sponsored healthcare would translate into a huge increase in taxable wages, as it would free individuals, families and employers from hefty healthcare spending. States would also no longer have to fund Medicaid, consistently their largest budget item.

"These offsetting effects should be considered when weighing the implications of requiring federal taxpayers to finance the enormous federal expenditure increases under M4A," Blahous wrote. "These estimates should be understood as projecting the added federal cost commitments under M4A, as distinct from its net effect on the federal deficit. To the extent that the cost of M4A is financed by new payroll taxes, premium collections, or other revenue increases, the net effect on the federal budget deficit would be substantially less."

The picture the Mercatus study paints for utilization in the healthcare system runs counter to the latest House Republican push to leverage health savings accounts to cut spending on superfluous services.

Last week, the House passed a packet of bills originally projected to cost more than $90 billion to expand use of HSAs. In a subsequent speech before the conservative Heritage Foundation, HHS Secretary Alex Azar praised HSAs as a way to lower unnecessary spending, saying that from his own behavior when he had an HSA he was much more cautious about the number and manner of services on which he was willing to spend a limited number of dollars.

The Democratic Party at large is keeping Sanders' Medicare for All plan at arm's length, but its principles are gaining traction within the party. Prominent Democratic senators including Elizabeth Warren of Massachusetts, Kamala Harris of California and New Jersey's Cory Booker have signed onto Sanders' bill.

In the House, progressive Washington Democrat Pramila Jayapal founded a Medicare for All caucus to try to hammer out a comprehensive, streamlined platform over the next conference. More than 60 House Democrats have joined Jayapal's group.

But Ippolito said the new paper highlights that single-payer proponents will need to acknowledge the political fight on their hands.

"In my time of listening to these single-payer proposals, a lot of emphasis is on administrative savings—they appeal to that because they don't rile up constituencies," he said. "But going after provider payment rates means taking on one of the most well-organized constituencies in domestic policy. When I read this, it struck me as: this really wants to pick a fight. It promises the moon, but it does set up, surely, that something's got to give here."

http://www.modernhealthcare.com/article/20180730/NEWS/180739993?utm_source=modernhealthcare&utm_medium=email&utm_content=20180730-NEWS-180739993&utm_campaign=dose

Medicare Part D premiums continue to decline in 2019

CMS NEWS FOR IMMEDIATE RELEASE July 31, 2018 Contact: CMS Media Relations (202) 690-6145 | CMS Media Inquiries Medicare Part D premiums continue to decline in 2019 Today, the Centers for Medicare & Medicaid Services (CMS) announced that, for the second year in a row, the average basic premium for a Medicare Part D prescription drug plan in 2019 is projected to decline. At a time when health insurance premiums are rising across-the-board, basic Part D premiums are expected to fall from $33.59 this year to $32.50 next year. “President Trump and Secretary Azar have made clear that prescription drug costs must come down. The actions that HHS and CMS are taking to increase competition in order to drive down costs for patients are working,” said CMS Administrator Seema Verma. “CMS will continue to strengthen the Part D program and bolster plans’ negotiating power so they can get the best deal for seniors from prescription drug manufacturers.” In Medicare Part D, beneficiaries choose the prescription drug plan that best meets their needs, and plans have to improve quality and lower costs to attract beneficiaries. This competitive dynamic sets up clear incentives that drive towards value, as determined by beneficiaries. Earlier this year, CMS announced several changes in the Part D program aimed at further empowering Part D plans to drive a hard bargain with drug manufacturers and lower the cost of prescription drugs. Strengthening negotiations is a key pillar of the Administration’s Blueprint to reduce prescription drug costs. CMS has been working to ensure that Medicare Part D plans can leverage all of the tools that are available to commercial plans in negotiations. Changes that CMS has made to date include: Reducing the maximum amount that low-income beneficiaries pay for certain innovative medicines known as “biosimilars.”  Allowing for certain generic drugs to be substituted onto plan formularies more quickly during the year, so beneficiaries immediately benefit and have lower cost sharing. Increasing competition among plans by removing the requirement that certain Part D plans have to “meaningfully differ” from each other, making more plan options available. Increasing competition among pharmacies by clarifying the “any willing provider” requirement, to increase the number of pharmacy options that beneficiaries have. The upcoming annual Medicare open enrollment period for 2019 begins on October 15, 2018, and ends on December 7, 2018. During this time, Medicare beneficiaries can choose health and drug plans for 2019 by comparing their current coverage and plan quality ratings to other plan offerings, or they can choose to remain in traditional Medicare. The agency will be continuing to improve the website for Medicare plan selection, so beneficiaries can more easily compare options and choose the plan that best meets their needs. CMS anticipates releasing the premiums and costs for Medicare health and drug plans for the 2019 calendar year in mid-to-late September. To view the 2019 Part D base beneficiary premium, the Part D national average monthly bid amount, the Part D regional low-income premium subsidy amounts, the de minimis amount, the Part D income-related monthly adjustment amounts, the Medicare Advantage employer group waiver plan regional payment rates, and the Medicare Advantage regional PPO benchmarks, visit: https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Ratebooks-and-Supporting-Data.html and select “2019.”  ### Get CMS news at cms.gov/newsroom, sign up for CMS news via email and follow CMS on Twitter CMS Administrator @SeemaCMS, @CMSgov, and @CMSgovPress.

(CMS) released the May 2018 monthly report on state Medicaid and Children's Health Insurance Program (CHIP) eligibility and enrollment data.

View in browser | Distributed by Center for Medicaid and CHIP Services (CMCS) Today the Centers for Medicare & Medicaid Services (CMS) released the May 2018 monthly report on state Medicaid and Children's Health Insurance Program (CHIP) eligibility and enrollment data. The full report is available on Medicaid.gov at https://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-enrollment-data/report-highlights/index.html

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The updated Affordable Care Act Federal Upper Limits (FUL) calculated in accordance with the Medicaid Covered Outpatient Drug final rule

View in browser | Distributed by Center for Medicaid and CHIP Services (CMCS) The updated Affordable Care Act Federal Upper Limits (FUL) calculated in accordance with the Medicaid Covered Outpatient Drug final rule with comment are now available on the Medicaid.gov website at https://www.medicaid.gov/medicaid/prescription-drugs/pharmacy-pricing/index.html. States will have up to 30 days from the August 1, 2018 effective date to implement these updated FULs.   For further information on the FUL program, please see the Federal Upper Limits page at https://www.medicaid.gov/medicaid/prescription-drugs/federal-upper-limits/index.html.

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