Category Archives: Health care reform

When covering drug-price reform, be sure to follow the money

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health reform. He welcomes questions and suggestions and tip sheets at

Source: Aimee Cicchiello and Lovisa Gustafsson, “Brand-Name Drug Prices: The Key Driver of High Pharmaceutical Spending in the U.S. — An International Comparison of Prescription Drug Spending and Costs,” chartpack, Commonwealth Fund, November 2021.

Last week, when the U.S. House of Representatives passed and sent to the U.S. Senate H.R.5376, the Build Back Better Act, speculation began on which parts of the bill would survive a vote in the senate.

For journalists covering the health care elements in the bill (including provisions that would affect what consumers pay for prescription drugs), the question of which parts will remain will require following the money. As we’ve seen in recent years, the health care industry has spent multiple millions of dollars on lobbying and advertising to get members of Congress to water down various parts of the bill they don’t like.

 Reporting on spending for advertising and lobbying shows how much the pharmaceutical industry has spent in Congress to weaken provisions designed to make health care and prescription drugs more affordable for consumers.

Story angles to consider

Among the angles to cover in this story are how much money members of Congress in your district or state have received from pharmaceutical companies. One way to identify how much members of Congress have received is to use the Pharma Cash to Congress database from Kaiser Health News. This data set shows who’s received the most money this cycle, who’s in the million-dollar club and how much each member has received, and from which pharma companies.

Other angles to cover include how some of the advertisements from pharmaceutical companies can mislead consumers and how some consumers have been affected by high costs for prescription drugs. To find consumers willing to discuss high prescription drug costs, call patient-advocacy organizations such as Patients for Affordable Drugs and the Leukemia and Lymphoma Society.

When covering this story, keep in mind two reports that came out this year: In U.S., an Estimated 18 Million Can’t Pay for Needed Drugs, from Gallup in September; and, Prescription Drug Prices in the United States Are 2.56 Times Those in Other Countries, from RAND in January.

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Preventing consumers from getting scammed when searching for ACA-compliant health insurance

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health reform. He welcomes questions and suggestions and tip sheets at

A report from the U.S. Census Bureau shows the percentage of Americans who were uninsured in 2018 and 2020 by age group. The uninsured are eligible to sign up for health insurance coverage during the Affordable Care Act’s open enrollment period through Jan. 15. (Photo courtesy of the U.S. Census Bureau)

Health insurance scammers plagued consumers online and on the phone during the special enrollment period for the Affordable Care Act (which ran from February 15, 2021- September 15, 2021), a recent study showed.

The study, conducted by researchers from the Georgetown University Center for Health Insurance Reform found that consumers were likely to be referred to alternative health insurance plans that do not comply with the rules of the Affordable Care Act (ACA). Those noncompliant alternative plans included fixed indemnity insurance, health care sharing ministries, short-term plans and other health care options that were impossible to categorize based on the information the insurers provided, the researchers noted.

Scammers also told consumers that ACA-compliant plans were extremely expensive, which is false because Congress passed the American Rescue Plan in March. Under that law, monthly premiums for many low-income consumers buying ACA plans cost $10 per month or less. Also, the law capped the amount all consumers pay for ACA plans at no more than 8.5% of income, as we reported last month in this blog post.

Reporting on the research from CHIR and other sources is particularly important during the annual open enrollment period for ACA plans (which runs through Jan. 15 in most states) because it shows that it’s difficult (and may be nearly impossible) for consumers to know if they’re getting scammed into buying noncompliant health plans, said Dania Palanker, an assistant research professor at CHIR and one of the researchers on the study. Palanker and her colleague JoAnn Volk, a research professor, collaborated to produce this research.

“For consumers looking to buy ACA health insurance, I wouldn’t even start with a search engine,” Palanker warned. “It’s best to go directly to That will help to keep you safe. Once you’re connected to a navigator or a broker through, then you know they’re selling marketplace plans.”

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Approximately 80% of consumers expected to save significantly on 2022 Affordable Care Act plans

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health reform. He welcomes questions and suggestions and tip sheets at

Small Area Health Insurance Estimates

The U.S. Census Bureau’s 2019 Small Area Health Insurance Estimates report showed that the rate of Americans who lacked health insurance dropped between 2013 and 2019 in 2,909 counties and rose in just four counties after the Affordable Care Act (ACA) was implemented in 2014. (Photo courtesy of the United States Census Bureau.)

Health insurance premiums will cost $10 or less each month next year for four out of five consumers shopping for health insurance on the Affordable Care Act (ACA) marketplaces, the Biden administration announced on Monday. The savings come from higher subsidies for most Americans that Congress passed last spring under the American Rescue Plan Act (ARPA).

On Monday, Nov. 1, open enrollment for ACA plans will give consumers the widest variety of health insurance options and the lowest prices ever, said Health and Human Services (HHS) Secretary Xavier Becerra. Also, HHS quadrupled the number of health insurance navigators available to guide consumers seeking information on how to sign up, and added an extra month to the open enrollment period, which ends on Jan. 15.

According to Becerra, health insurance costs are the lowest ever because the ARPA increased the subsidies for monthly premiums through Dec. 31, 2022. Technically, those increased funds are called enhanced premium tax credit subsidies, the Center for Health Insurance Reforms explained in a recent blog post about open enrollment.

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Report shows consumers could save even more on health insurance

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health reform. He welcomes questions and suggestions and tip sheets at

Image courtesy of The Commonwealth Fund

Reporting on how much consumers will save on health insurance under the American Rescue Plan Act (ARPA) has never been easy, but last week, it got more complicated.

Previous studies on how ARPA would affect household spending on health insurance underestimated the effects of the law, according to a report on Oct. 6 from the Commonwealth Fund. That means consumers could spend much less out of pocket for copayments and deductibles if Congress passes the reforms being debated now under budget deliberations. The increased savings come because of a recalculation of the effects of ARPA, the fund reported.

Although the recalculation didn’t get much coverage, this story is important for journalists because the increased savings could be in the billions of dollars. In addition, the reforms proposed in Congress would cut the number of Americans without health insurance by 7 million, the fund reported.

In a report the fund published in September, “The Coverage and Cost Effects of Key Health Insurance Reforms Being Considered by Congress,” researchers from the Urban Institute noted that members of Congress have proposed a budget this year that includes reforming the Affordable Care Act (ACA) in two ways. One reform would make permanent the enhanced premium subsidies in ARPA that otherwise would expire at the end of next year. The other reform would fix what’s called the Medicaid coverage gap by extending eligibility for subsidies on the ACA marketplaces to people earning below 100% of the federal poverty level (FPL) in the 12 states that have not expanded Medicaid.

In those 12 states (Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin and Wyoming), Medicaid eligibility for adults is strictly limited. The median annual income limit for a family of three is just 41% of the FPL, or $8,905. Also, childless adults are ineligible.

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When covering drug-price reform, keep patients’ medication costs in perspective

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health reform. He welcomes questions and suggestions and tip sheets at

The Pharmaceutical Research and Manufacturers of America (PhRMA), the trade group for drug makers, produced the ad on the left that has been called misleading. The AARP produced the ad on the right calling out PhRMA for attempting to scare seniors into opposing efforts in Congress to pass drug-price reforms. (Photo courtesy of PhRMA and AARP’s YouTube video ads.)

Last week, Aimee Picchi reported for CBS News on a new Gallup and West Health survey showing that 18 million Americans (7% of U.S. adults) cannot afford the medications their doctors prescribe.

Households with annual income under $24,000 struggle even more, she wrote, adding that almost 20% of those Americans were unable to pay for at least one prescription drug in the previous three months. To save money, about 10% of all adults skipped a pill in the prior year, she noted. Gallup and West Health surveyed some 5,000 adults in June.

Picchi made two important points for journalists to consider when writing about efforts in Congress to reform how much Americans pay for prescription drugs. Continue reading