Author Archives: Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), an independent journalist who resides in Brewster, Massachusetts, is AHCJ’s topic leader on health reform. He welcomes questions and suggestions and tip sheets at joseph@healthjournalism.org.

Resources for covering the ACA preventive care ruling in Texas

Preventive Medicine by Nick Youngson CC BY-SA 3.0 Pix4free.org

Among the many significant parts of the Affordable Care Act, one of the most important for consumers is the requirement that health insurers cover preventive-care services at no cost to patients. That provision is facing a significant legal challenge in a Texas court that could take months or years to resolve, according to legal experts.

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Useful sources to aid reporting on pharmacy benefit managers

Federal Trade Commission headquarters in Washington, D.C. (Photo courtesy of Postdlf  via wikimedia.)

Last month, Ed Silverman at STAT News covered the story about how Centene, one of the nation’s largest health insurers, agreed to pay $33 million to settle allegations from the state of Washington that Centene’s pharmacy benefits management (PBM) subsidiary had overcharged the state Medicaid program.

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History shows Inflation Reduction Act subsidies help Americans save on health insurance

In states where health insurance premiums are highest, consumers losing marketplace subsidies would have seen the steepest increases if Congress did not pass the Inflation Reduction Act’s continuation of the enhanced subsidies. Source: “Five Things to Know about the Renewal of Extra Affordable Care Act Subsidies in the Inflation Reduction Act,” Kaiser Family Foundation, Aug. 11, 2022. Accessed Aug. 18, 2022.

By signing the Inflation Reduction Act (IRA) on Tuesday, August 16, President Biden made history by continuing a 12-year trend to reduce the number of nonelderly Americans without health insurance.

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3 reasons it’s significant that the percentage of uninsured Americans hit an all-time low

Source: National Center for Health Statistics, National Health Interview Survey, 2021–2022. Cohen RA and Cha AE. Health insurance coverage: Early release of quarterly estimates from the National Health Interview Survey, January 2021–March 2022. National Center for Health Statistics. July 2022.

The percentage of Americans who lack health insurance hit an all-time low of 8% in the first quarter of this year, reflecting an increase of 5.2 million people who gained coverage since 2020, according to a report by the federal Department of Health and Human Services (HHS) released on Tuesday. 

Using data from the National Health Interview Survey and the American Community Survey, the report from the HHS Assistant Secretary for Planning and Education (ASPE) shows the effect of better subsidies for health insurance that consumers buy on the Affordable Care Act’s marketplaces, increased federal efforts to encourage the uninsured to enroll, the continuous enrollment provisions in the federal-and-state Medicaid program and recent decisions in several states to increase enrollment in Medicaid, HHS said in a press release

Since 2019, seven states have expanded enrollment in the federal-and-state funded Medicaid program, according to Louise Norris at HealthInsurance.org. Those states are: Virginia and Maine in 2019; Utah, Idaho, and Nebraska in 2020; and Oklahoma and Missouri last year, she wrote.

The HHS announcement is significant for three reasons. First, the all-time low 8% rate means that about 26.4 million people lack health insurance, down from 48 million in 2010, according to an ASPE report last year. Second, the report includes a table showing changes in the uninsured rates in each state for low-income adults ages 18 to 64 from 2018 to 2020. In 18 states (15 of which expanded Medicaid), the uninsured rates for this population dropped in those years.

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The Federal Trade Commission launches probe into pharmacy benefit managers

The average annual prices of brand name drugs have risen faster than general inflation since at least 2006, according to data from The Rx Price Watch Report, 2021, from AARP, “Trends in Retail Prices of Brand Name Prescription Drugs Widely Used by Older Americans, 2006 to 2020.” Reprinted with permission.

Noting that so many companies in the prescription drug supply chain are vertically integrated, the Federal Trade Commission voted unanimously on Tuesday to investigate the role pharmacy benefit managers (PBMs) have on consumers’ costs and access to prescription drugs.

Given that health insurers own most of the largest PBMs and therefore own their affiliated mail-order and specialty pharmacy companies, the FTC ordered six PBMs to comply with requests for information on their operations: CVS Caremark (which owns Aetna), Express Scripts (a division of Cigna), OptumRx (a UnitedHealth Group unit), Humana (an insurer), Prime Therapeutics (which contracts with multiple Blue Cross Blue Shield plans) and MedImpact Healthcare Systems (which contracts with employers and government and commercial health insurers).

PBMs are middlemen that negotiate rebates and fees with drug manufacturers, create drug formularies and reimburse pharmacies for patients’ prescriptions.

For four years, Darrel Rowland (@darrelbrowland) has covered PBMs closely for The Columbus Dispatch in Ohio. The headline on his story about the FTC decision focused on the potential benefit of such a probe on consumers’ costs: “FTC agrees to ‘shine a light’ on how drug middlemen impact your prescription prices.”

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