September 2023

September 2023

Disarray in the House of Representatives

Anyone paying any attention to the news knows the drama in Congress, specifically in the House of Representatives. For the first time in American history, a Speaker of the House has been removed from that position by his own party.

The Republican caucus has the majority in the House and, therefore, has the right to choose a Speaker, the top person in the legislative body. As this is written, the GOP appears to be in disarray, and they have adjourned for one week to try and figure out what to do next.

This comes as the House is far behind in passing the legislation needed to fund the federal government for the 2024 fiscal year, which began on Oct. 1. They managed to pass legislation to continue to fund the government at 2023 fiscal year levels, but that lasts only until Nov. 17. At that time, we could be facing a government shutdown once again, and the uncertainty inside the House increases those odds.

In the run-up to Oct. 1, rumors were going around about what would happen to Social Security checks and Medicare coverage in the event of a shutdown.

You need to know if the government shuts down Social Security checks and Medicare coverage will continue. Those programs are automatically funded every year and do not depend on the passage of new legislation every year.

In the meantime, TSCL urges both parties to come together, act in the public interest, and do the work they were elected to do.

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New Bi-Partisan Legislation Would Give Greater Transparency

Despite all the recent drama at the leadership level, the bitter polarization, and the inability to pass funding legislation, there is some work getting done in Congress with the support of both parties.

In late September, three House committees – Energy and Commerce, Ways and Means, and Education and Workforce – introduced the Lower Costs, More Transparency Act. The proposed legislation would require hospitals, payers, labs, imaging providers, and ambulatory surgical centers to list the prices they will charge patients. It also mandates that insurers and pharmacy benefit managers (PBMs) disclose drug rebates and discounts.

Supporters of the legislation hope it will lower out-of-pocket costs for seniors who receive medicine at a hospital-owned outpatient facility, expand access to generic drugs, and help employers give workers the best information possible.

If passed, the Lower Costs, More Transparency Act would:

  • Increase price transparency throughout the health care system.
  • Address the cost of prescription drugs.
  • Support patients, healthcare workers, community health centers, and hospitals

This is the latest example of PBMs drawing the anger of legislators. In July, the Senate Finance Committee voted to support bipartisan efforts to rein in practices that allow PBMs to operate in the shadows, mainly through a practice called spread pricing.

The lobbying arm of the PBMs, the Pharmaceutical Care Management Association, released a statement countering that the Lower Costs, More Transparency Act does nothing to reduce the cost of prescription drugs for patients.

This is a continuation of the war between the PBMs and the giant pharmaceutical companies over which one is to blame for the outrageously high cost of prescription drugs. Both sides are facing a backlash from Congress and the Administration. TSCL hopes this is a process that, in the end, will result in affordable drug prices for all seniors.

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Senate Bi-Partisan Bill to Rein in PBMs

Last week, Sens. Ron Wyden (R-Ore) and Mike Crapo (R-Idaho) introduced a bill that follows up on the Senate Finance Committee action in July mentioned above.

The bill is called the Modernizing and Ensuring PBM Accountability Act, or MEPA.

The legislation would:

  • Prohibit PBM compensation in Medicare from being tied to price.
  • Increase audit and enforcement measures; and
  • Aid independent community pharmacies that have struggled because of PBM practices.

The bill also calls for a survey of retail community pharmacy drug prices to determine the national average drug acquisition cost for covered outpatient drugs. It would include price concessions to the pharmacy, such as discounts and rebates.

Legislators have introduced at least a dozen bills this year to address the impact of increasing consolidation among PBMs and the lack of transparency into prescription drug access and pricing. The Pharmaceutical Care Management Association, the trade association representing PBMs, contends that none of the legislative proposals would lower drug prices.

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Government to Monitor Medicare Advantage Ads

With the Medicare open enrollment season soon upon us, ‘tis the season for Medicare Advantage ads again.

Because of that, TSCL participated in a video conference on Sept. 20 sponsored by KFF (formerly the Kaiser Family Foundation), which discussed the ads and what the government is doing to monitor them.

We learned that there were over 650,000 of the ads last fall, which surprises no one who watches TV. We also learned that the Centers for Medicare and Medicaid Services (CMS) has learned through their surveys that people enrolled in Medicare Advantage (MA) plans with dental coverage end up paying about the same as those enrolled in traditional Medicare.

There is a lot of confusion about the ads because, among other things, there are more than 40 MA plans.

Unsurprisingly, there are deceptive things in the ads, including calling the number they give a “Medicare hotline” or a “Medicare number,” when those numbers are private numbers that reach insurance agents or brokers.

For the first time this year, CMS is reviewing all the ads that will be shown on TV or social media. The companies that sponsor the ads are forbidden to picture an actual Medicare card or refer to their phone number as a “Medicare number.”

We were also told that state health insurance programs are a very good source for people to get the facts about MA plans.

Finally, we learned that the phone numbers in the ads are not good numbers to call for information about Medigap plans. For good information about Medigap plans, it is best to call the actual Medicare hotline: 1-800-Medicare (1-800-633-4227).

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Help With Prescription Drug Costs

Consumer Reports magazine recently published an article about what can be done if the cost of your prescription medication goes up.

Under President Biden’s 2022 Inflation Reduction Act, vaccinations, including the shingles vaccine, are free for people on Medicare. Most insulin shots cost just $35 or less a month for people on Medicare Part D. Beginning Jan. 1, 2025, another big benefit kicks in as well: Seniors on Medicare Part D won’t pay more than $2,000 annually out of pocket for medications.

In addition, seasonal flu vaccinations are free, as are the new Covid-19 vaccinations. If you’re on Medicare Part D, you also can get the RSV vaccination for free.

If you’re on Medicare Part D, you may qualify for “Extra Help” in 2024. According to the article, “A third of all enrollees in Medicare Part D get some sort of assistance, according to figures from KFF, and with the Inflation Reduction Act, up to 300,000 additional people will be eligible for the assistance. Find out whether you qualify at or call 800-772-1213.”

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For progress updates or more information about these and other bills that would strengthen Social Security and Medicare programs, visit our website at or follow TSCL on Facebook or Twitter.