Update for Week Ending May 29, 2020

Update for Week Ending May 29, 2020

Despite the coronavirus emergency, TSCL is continuing its fight for you to protect your Social Security, Medicare, and Medicaid benefits.  We have had to make some adjustments in the way we carry on our work, but we have not, and will not stop our work on your behalf.

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TSCL Meets (virtually) With High-Ranking Senate Leader

This week TSCL was part of a virtual meeting with Senator John Thune (R- S.D.) the Majority Whip of the Senate.  He is the second-ranking Republican in the Senate, after Majority Leader Mitch McConnell (R-Ky.).

During the wide-ranging question and answer session TSCL asked the Senator if legislation to lower prescription drug prices and end surprise medical billing would be passed this year.  The Senator's answer was disappointing but also not surprising.

He said it is still possible that legislation regarding those issues could be passed, but not very likely.  He said he was afraid they would be caught up in the elections and be used as campaign issues rather than being worked on in the Senate.  That means that if any action is taken it will probably not be until later in November or even December, depending on how late in the year Congress works.

According to Senator Thune, there is likely to be another major bill providing more money for businesses and others to keep the economy afloat.  However, that may not happen until later in June or sometime in July.  Obviously, that will take up time that would otherwise have been spent dealing with the other important issues that have to be addressed by Congress.

Senator Thune also said there are no plans for the Senate to stay in session longer than it normally would to get their work done.  That means they will take their usual August break as well as the usual recesses during upcoming holidays.

Meanwhile, the House of Representatives announced they will also be taking the usual August recess – if they get needed legislation passed before then.

Because of the coronavirus pandemic, the Senate, in particular, is behind in getting its regular work accomplished.  We think it's a shame they won't spend more time in session getting the legislation passed that's needed, especially on prescription drug prices, surprise medical billing, shoring up the Social Security and Medicare and Medicaid, and fixing the COLA to reflect the true inflationary costs that seniors face.

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President Announces Lower Insulin Costs for some Seniors

President Trump announced this week that there will be a new type of Medicare prescription drug plan that will cap insulin costs at $35 per month for some seniors who have diabetes.   While TSCL applauds that as far as it goes, it is woefully short of what is needed.

Unfortunately, it is not as cut-and-dried as “everyone will now pay $35 per month for their insulin.”  It is much more complicated than that.

To begin with, it will apply only to some seniors, depending on which Medicare supplement program they enroll in, and it is completely voluntary on the part of both the supplement provider and the individual enrolled in Medicare.

In our analysis, it appears that this new program adds layers of complexity and apparently will drive up the overall costs of everyone enrolled in the Part D plans that participate in this.

The main point is that this program would be limited in scale, and only available in certain types of plans, which means only in certain areas of the country.  The premiums of these plans would be higher for all enrollees due to the capping of the cost of insulin to the patient, but not actually lowering the cost of insulin overall.  That means the supplemental insurance plan would still be paying the full cost of insulin that is charged by the drug companies.  To pay for that, the insurance companies would likely increase the costs of their Medicare supplement plans to all who are covered, not just those who are diabetic.

We believe that given the complexity of the new program, seniors who need insulin would be wise to enlist the assistance of a trained counselor before switching to such a plan to ensure they aren’t giving up better coverage in other ways.  This is particularly true if they are now in a Medigap plan and considering moving to a Medicare Advantage plan.

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Administration considering new Surprise Billing plan

Also, this week, the Trump administration announced they are considering a plan regarding the issue of surprise medical billing.  It would prohibit health care providers from charging patients for medical services they received, mainly in hospitals that were covered by their insurance plan, but where some of the doctors who treated them did not accept their insurance.

However, the Trump plan does not mandate how doctors and hospitals would recover their costs from insurers.  Billing disputes would have to be worked out on a case-by-case basis.

This issue was thought to be an easy one to deal with last year, but it became the object of months of fierce lobbying and rivalries between congressional health committees.  House Speaker Nancy Pelosi (D- Calif.) has included a prohibition on surprise billing in the latest rescue proposal being considered in the House of Representatives.

Because the Trump plan does not mandate a way for medical providers to recover their costs of services, the plan has the potential of raising health care costs overall.  The prospect of that could once again take away the enthusiasm on Capitol Hill to pass new legislation. Though a formal estimate of the cost of the proposal has not been released, a congressional aide said the Congressional Budget Office has advised through informal guidance that the plan would raise premiums by driving up insurance provider rates.

Meanwhile, insurers and employers say that without a formula to resolve payment disputes, they could face costly litigation if hospitals or doctors want higher rates. Their fear is a patchwork of possibly conflicting formulas that judges could impose to decide payouts, or that a decision that sides with doctors or hospitals could make high rates the precedent.

TSCL continues to support legislation to end surprise billing, so if the Administration formally releases its proposal, we will carefully examine it to see if it does take the actions that are necessary.

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For progress updates or for more information about these and other bills that would strengthen Social Security and Medicare programs, visit the Bill Tracking section of our website or follow TSCL on Twitter.