Democrats have twelve years of healthcare accomplishment to run on

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Chuck Schumer tours Adirondack Medical Center

HuffPost reports that Priorities USA is urging Democrats to tout recent healthcare achievements:

In a memo set to be published Wednesday, Priorities USA says the most popular achievements of President Joe Biden’s tenure are giving Medicare the power to negotiate prescription drug prices, capping the price of insulin and continuing expanded subsidies for the Affordable Care Act.

Priorities USA recommends focusing on these issues while also attacking Republicans for working to restrict abortion rights in the wake of the Supreme Court decision overturning Roe v. Wade.

Amen. And below those top lines -- the healthcare provisions in the Inflation Reduction Act passed this month -- Democrats should also tout a long tail of recent accomplishments that have improved healthcare affordability and access. Their claim to be the party of healthcare bears not only recent but cumulative weight.

Healthcare was a potent issue for Democrats in 2018, with Republicans fresh off their failed attempt to repeal the ACA's core programs in 2017.  Because they failed, the ACA Medicaid expansion and subsidized marketplace survived to catch the newly uninsured when more than 20 million Americans lost their jobs in the first onslaught of the COVID-19 pandemic. 

Dem chorus rising: Don't let them take your freedom

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For most of the post-January 6 era, the U.S. has seemed to be sleepwalking toward autocracy. 

Republicans swiftly fell in all but unanimously behind Trump's Big Lie that he won the 2020 election; red states passed a raft of voter suppression laws; Trump acolytes positioned themselves to seize control of election administration and machinery; pardoned Team Trump criminals and the RNC encouraged thousands to sign up as poll workers; and diehard election deniers won Republican primaries for secretary of state, attorney general and governor in key states.

Meanwhile, inflation dominated headlines, Biden's approval rating sank to record lows for a first- and second-year president, courts upheld Republican gerrymanders and struck down Democratic ones, off-year elections swung heavily toward Republicans, and Republicans led in generic Congressional polling.

Then came the riveting January 6 Commission hearings in June and July, with Republican officials laying bare Trump's criminality and pathology -- and smack in the middle of that timeline, the intense shock of the Supreme Court ruling in Dobbs, overturning Roe v. Wade. Democrats woke up -- some Democrats, anyway. Gavin Newsom laid down a keynote in a July 4 ad aimed at Floridians ("inviting "them to move to California): freedom is under attack in your state...don't let them take your freedom.

Loony interlude

 

I wish the photo were better...

No healthcare this week, as we are in the Adirondacks, at a collection of Finnish (?!) huts on a small crystalline lake, with no motorboats allowed. On sunny Tuesday morning, in kayaks, we watched a family of loons (father, mother, adolescent) pursue and eat their breakfast. They sail along intermittently in tandem, with adults constantly diving for a minute or so at a time and coming up a few hundred feet away. After some time the female came up with a small silver fish, which she worked around in her beak for a long time, both as she swam back to the other two and as they circled together. At one point the male appeared to make a grab at it. Eventually she put it down the young one's throat. Then it was rinse, repeat: one of the adults (not sure which) caught another fish, worked it for a while, then swallowed it.

Widespread misconception of Medicare Part D enrollees' out-of-pocket exposure

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I object

Late last year, I took some pains to tease out the out-of-pocket (OOP) exposure of Medicare Part D enrollees up to the point where they reach the so-called "catastrophic threshold" of coverage. Beyond that point, they're responsible for a comparatively low 5% of subsequent costs until the end of the coverage year. 

The answer is no real mystery: it's well understood by involved professionals and scholars. It's just awfully hard to derive from general news coverage and even trade press coverage or scholarly coverage.

The exposure up to the catastrophic threshold in 2022 is $2,937, despite an often-cited cap of $7,050, referred to in the trade as the trOOP cap, or true out of pocket cap. 

Attention, Bernie Sanders: Medicare benefits from Inflation Reduction Act begin in 2023

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Free in 2023

Senate Democrats' passage of the Inflation Reduction Act yesterday evening was an exercise in the art of the possible, the culmination of a year-long immersion in the reality principle. Senate Democrats as a body probed to the last minute what first Manchin and finally Sinema would allow them to pass, and ultimately maxed out on that allowance. 

The result is powerful legislation that gives us a fighting chance to mitigate the worst effects of climate change and sets up a starter home for Medicare to negotiate prescription drug prices. It also boosts the perhaps still-long odds that Democrats can hold the Senate and House and so stave off the Republican threat to democracy itself.

How much drug price control are we getting in the Inflation Reduction Act?

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When media addresses the prescription drug cost control measures in the Inflation Reduction Act, the provisions empowering Medicare to negotiate the price of select high-value drugs tends to suck up all the attention. 

Rightly, perhaps. While the negotiation regime is slow to start (beginning with 10 drugs to be negotiated in 2026), modest in number (rising to 20 drugs negotiated in 2029), and abjuring reference pricing from European countries (instead capping prices at a set discount of average U.S. prices), it establishes a vital principle, and the scope and terms of negotiation may be expanded and strengthened over time. 

That said,  a lower-profile provision that kicks in quickly (in 2023) is projected (by the Congressional Budget Office) to save/raise roughly as much money as drug negotiation: Inflation caps on the prices of drugs currently on the market. If a drug manufacturer raises the average price charged for a given drug by an amount that exceeds the consumer price index for urban consumers (CPI-U) it must rebate the difference to Medicare. That provision not only starts right away, it also applies to employer-sponsored and individual market health plans as well as Medicare (the rebates accrue from all drugs sold but are paid only to the federal government). CBO projects that the inflation caps will generate $62 billion in savings and $38 billion in revenue over ten years.

U.S. uninsured rate hits an all-time low; Biden's HHS takes a victory lap; xpostfactoid claims prepostfactoid credit

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Record broken!

Biden's HHS took something of a victory lap yesterday, announcing that the national uninsured rate -- 8.0% for all ages --  was at an all-time low in the first quarter of 2022. Since the fourth quarter of 2020, the uninsured rate has dropped by 2.7 percentage both for ages 18-64 and for children, according to the ASPE* brief.

The brief is based on quarterly updates from the National Health Interview Survey. Those updates are notoriously bouncy, but the change over the time frame selected is clearly statistically significant. 

The brief asserts: "These gains in health insurance coverage are concurrent with [mustn't claim causality, now...] the implementation of the American Rescue Plan’s enhanced Marketplace subsidies, the continuous enrollment provision in Medicaid, several recent state Medicaid expansions, and substantial enrollment outreach by the Biden-Harris Administration in 2021- 2022."

I must note that I've been something of a canary in the coal mine on this front, first speculating that we might be approaching an uninsured low in April 2021; wondering whether the 2021 Special Enrollment Period coupled with the ARPA subsidy boosts might have got us there by late August 2021; and parsing the NHIS quarterly data in light of the 2022 marketplace enrollment surge in January 2022.

Ultimately, I noted in the January post, the enrollment math, if not the survey data, told a fairly simple story: