Update for Week Ending July 31, 2021

Update for Week Ending July 31, 2021

It’s August – Congress’ Traditional Vacation Month

The House of Representatives has recessed for the month of August which means members will be going back home to their districts to meet with constituents.  Many will also likely be taking some vacation time.  However, they are on notice that they may be brought back in session if there is legislation to be voted on that cannot wait until September.

This could include the infrastructure bill currently being worked on in the Senate and also an eviction moratorium bill, depending on what actions the Biden administration may take in the next few days.

The Senate continues to work on the infrastructure bill and if they manage to pass it Senate Majority Leader Chuck Schumer (D-N.Y.) has vowed they will also pass a budget blueprint for a $3.5 trillion social spending package.  However, that legislation has no Republican support and even some Democrats are balking at it because of its cost.

There are no committee hearings scheduled in the House of Representatives but the Senate will hold various committee hearings this week and will continue to do so until they officially recess for their August break.

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Infrastructure Bill Could Affect Medicare

The infrastructure bill being worked on in the Senate this week, one of only issues facing Congress where there is general agreement by both political parties, could affect Medicare in a positive way.

According to Bloomberg News, “To offset some of the cost, the lawmakers are considering proposals to raise money from drug corporations and pharmacy benefit managers, which are third-party administrators that help employers and states oversee their pharmacy benefits, according to two health-care lobbyists and a Republican congressional aide familiar with the discussions.”

“Specifically, lawmakers want to demand refunds from drugmakers for some kinds of physician-administered single-use medicines, which the Congressional Budget Office has estimated could lower Medicare spending by $9 billion over a decade,” according to the Bloomberg report.

The infrastructure proposal also includes savings from reducing what Medicare spends on unused drugs that are left over from single-use vials.  This may sound like a small matter but drug-makers stand to lose money from it.   In 2019, Medicare paid more than $752 million for drugs that were discarded, according to government data.

The legislation could also affect Medicaid.  “They also want to bar spread pricing, in which a pharmaceutical benefit manager charges an employer or Medicaid program more for a drug than they reimburse pharmacies for administering it. PBMs say that practice helps them avoid fluctuations in pharmacy costs,” according to that same report.

As you might expect, drug manufacturers and anyone else affected by the changes are all fighting to stop them with tv ads predicting dire consequences if the plan becomes law.

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Medicare Prescription Drug Costs to Increase in 2021

According to Bloomberg News, “Senior citizens can expect to see their monthly Medicare costs increase by nearly 5% for prescription drugs in 2022, under projections the federal government announced Thursday.

The basic Medicare Part D premium is expected to reach roughly $33 next year, marking a 4.9% increase from 2021’s rate of $31.47, the Centers for Medicare & Medicaid Services said.

Part D helps recipients pay both name-brand and prescription drug costs and is one of Medicare’s most utilized programs, the CMS said, noting over 48 million beneficiaries are enrolled. The agency said it’s “carefully” looking at changes for the program and working with stakeholders on “opportunities for improvements” like cutting costs.

“Driving down prescription drug costs remains a priority for the Biden-Harris Administration,” the CMS said.

The agency said it expects to release the final premium cost in mid- or late September of this year.

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Bi-partisan Draft Legislation Addressing Medicare Advantage Care in Last Year of Life Released Last Week

On Wednesday of last week U.S. Senators Bill Cassidy, M.D. (R-La.) and Debbie Stabenow (D-Mich.) released discussion draft legislation following a troubling U.S. Government Accountability Office (GAO) report conducted at the request of the Senators. The report shows Medicare Advantage (MA) beneficiaries in the last year of life disenrolled to join Medicare fee for service (FFS), or “original Medicare,” at more than twice the rate of all other MA beneficiaries.

The report stated, “Stakeholders told GAO that, among other reasons, beneficiaries in the last of year life may disenroll because of potential limitations accessing specialized care under MA.” It also showed that MA disenrollment in the last year of life increased overall costs to the Medicare program, estimating that FFS payments for such beneficiaries were $490 million higher than if they would have stayed in MA in 2017.

“Medicare Advantage gives seniors better care at a lower cost,” said Dr. Cassidy. “To improve this program, we need to make sure it best serves beneficiaries in their last year of life and does not shift costs to other parts of Medicare and taxpayers.”

“This report is alarming and raises serious questions. I’m very concerned that insurance companies may be denying seniors enrolled in Medicare Advantage plans the care they need, right when they need it the most. In addition to disrupting care, this leaves seniors and the government on the hook for higher costs. I look forward to further investigating this issue and working with Senator Cassidy on legislation to make sure seniors get the high-quality health care they need,” said Senator Stabenow.

The discussion draft marks the beginning of a conversation to uncover the reason patients are facing these limitations and form solutions. Should this concerning trend continue, the discussion draft suggests requiring MA plans to retroactively pay for the first 90 days of FFS claims following a patient disenrolling from MA into FFS when in their last year of life.

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As we continue recovering from the Covid 19 pandemic, TSCL remains constant in our fight for you to protect your Social Security, Medicare, and Medicaid benefits.  We’ve 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.

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