Marco Rubio jumps into 2016 presidential race

“…Jenny Beth Martin, co-founder of the Tea Party Patriots, hailed Rubio’s announcement. “Marco Rubio’s candidacy and the 2016 election are about the future, not the past,” Martin said. “He knows firsthand that prosperity comes not from a government program but from free markets and the hard work done by millions of individuals and small business that still believe in the promise of the American Dream.”…”


Rubio vows to lead new ‘American century’

“…Jenny Beth Martin, co-founder of the Tea Party Patriots, hailed Rubio’s announcement. “Marco Rubio’s candidacy and the 2016 election are about the future, not the past,” Martin said. “He knows firsthand that prosperity comes not from a government program but from free markets and the hard work done by millions of individuals and small business that still believe in the promise of the American Dream.”…”


‘Ripping Rubio’: Marco Rubio has drawn an unfriendly media for years

“..Criticism and instant conclusions about the GOP presidential hopeful intensified even before he made his White House intentions official Monday. Multiple news organizations were revisiting Mr. Rubio’s “watergate” moment in 2013 when he sipped water on camera during a major speech; old video clips and commentaries were many. Despite a strong statement of support from the Tea Party Patriots issued Monday, many news organizations also painted him as a lapsed tea party darling, or as a GOP outsider…”



How the IRS repeatedly rewrites Obamacare tax credit provisions

“The plaintiffs in King v. Burwell argue that an IRS regulation unlawfully extends tax credit eligibility beyond what is expressly authorized under Section 1401 of the Patient Protection and Affordable Care Act (PPACA).  It appears that this sort of administrative rewrite of the PPACA may be more the rule than the exception, as there are at least two other instances of the IRS rewriting the PPACA’s tax credit eligibility requirements. Section 1401 (which creates Section 36B of the Internal Revenue Code) authorizes tax creits for the purchase of qualifying health insurance in an exchange “established by the State under Section 1311″ of the Act. The IRS rule also authorizes tax credits for the purchase of health insurance in an exchange established by the federal government. The Supreme Court will rule on this challenge later this year. In a series of posts at “Notice & Comment,” the blog of the Yale Journal on Regulation, Professor Andy Grewal documents two additional cases in which the IRS has rewritten the PPACA’s tax credit eligibility requirements so as to expand eligibility beyond what Congress authorized.  Combined with other instances of the IRS and HHS disregarding the PPACA’s plain text, it appears the federal government has little regard for what the PPACA actually says. In his first two posts, Professor Grewall explains how IRS regulations disregard the statutory text so as to extend tax credit eligibility to some low-income aliens not lawfully residing in the U.S.  In this way, the IRS regulation “casts a wider net than the statute” by expanding the number of people eligible for tax credits. Yet the IRS never provided any rationale for this change.  Indeed, if one had just read the IRS explanation for what its regulations accomplish — as opposed to the regulations themselves — one would not even be aware of what the IRS did…”


Obamacare’s Cadillac Tax Hits the College Campus

“Higher education and its comfortable inhabitants on campus have long been hotbeds of support for Obama and Obamacare. Now, along with business and labor, i.e., the other inhabitants of what passes for the real world, they are about to become victims of one of its high “Cadillac” tax on generous health plans. In 2009 President Obama gave assurances that he did not want any tax on health insurance plans he considered wasteful or too generous to affect average Americans. In one of his now famous talks broadcast on CNN, MIT economist Jonathan Gruber, “one of the men who helped draft the legislation, [explains] that is not only precisely what will happen – but that was the intention of the tax.” Politico notes that “a mix of business groups and labor unions” are arm in arm — and up in arms — fighting to kill this tax. Unnoted in the article is that higher education also will be hit especially hard. The dramatic impact of the “Cadillac” tax on higher education has been noticed before, such as on this site (“Obamacare Hits Adjuncts Hard”) and Megan McArdle’s delicious putdown, “Whining Harvard Professors Discover Obamacare.” Now, as the scheduled 2018 implementation of the tax gets closer and more and more colleges begin to adjust their health plans to deal with it, awareness of the impending pain is beginning to spread. In New Jersey, four of the state’s 11 public colleges and universities have dropped student health insurance, and three of Washington State’s 6 public institutions have done so as well. Here are a few more tax induced changes:

–George Washington University: “It no longer offers its most generous plan as to avoid paying the tax.”

–University of Virginia: “Major changes are coming to the University of Virginia health plan. With U.VA facing rising health care costs, spiking expenses of high-dollar claims and looming fees and taxes connected with federal health reform….”

–William Patterson University: Dropping health insurance.

–University of Minnesota: “One of the state’s largest employers is proposing to scale back its employee health plans to avoid a massive tax penalty under the new federal health care law.”

–Ohio University: “Ohio University employees might see their health care deductibles double and premiums rise because of a provision of the Affordable Care Act that taxes so-called ‘Cadillac’ health plans, officials have said.”…”


After the Obamacare tax hit, the REAL pain

“…Because of the tax pain, many of the non-covered holdouts will begrudgingly sign up for lower premium/higher deductible plans. In the past, I have called the people who wouldn’t sign up for any kind of health care insurance “stupid.” And I still think it was a stupid move not to have at least some kind of plan. But now that so many of those people will be joining the rolls of the insured, I’ll just feel sorry for them. Here’s why: If you’re relatively healthy and relatively young and you have a health insurance plan with a $5,000 or $6,000 deductible, then in all reality you really don’t have health insurance. Without a major accident or sudden health problem, most people don’t rack up $6,000 in medical bills in a year all on their own. Worse than that, having to pay the first six grand of your annual medical bills 100 percent out of pocket is understandably going to make people “covered” by those plans very hesitant to go to the doctor until they get really worried or a lot sicker. In other words, they’ll be showing up in the emergency rooms instead, where that $6,000 deductible will be eaten up pretty quickly.  This scenario is exactly how this tax season will produce the first profound effect to the health care system. Health-insurance companies will enjoy a bonanza of people signing up for high deductible plans that, at least at first, will bring them thousands — maybe millions — of customers who will pay their premiums and still avoid doctors and real health care like the plague. In the short run, this will boost health-insurance earnings but in the longer run, the system will be more heavily taxed by all those ER visits…”


Many unaware of required tax-time insurance reporting

“The special health insurance enrollment period set up for people surprised by their tax penalties hasn’t appeared to increase either awareness or enrollment by much, new research shows. People who live in the 34 states that use HealthCare.gov and didn’t know about the requirement to have health insurance can sign up through April 30 for 2015 coverage. But nearly half of people planning to file taxes said they had heard nothing or very little about the requirement to report whether they have insurance on their tax return, according to new research funded by the Robert Wood Johnson Foundation.. “Very few people are reacting to the news by insuring,” said Kathy Hempstead, who directs insurance coverage issues at RWJF. “So far it doesn’t seem we’re seeing this mass teachable moment.”…”


Average Fine For Noncompliance With ObamaCare Is $1130, Expert Testifies

“As millions of Americans scramble to file their tax returns, many are shocked by the full cost of ObamaCare’s individual mandate. “Those who failed to obtain minimum essential health insurance coverage last year will have had to send the Internal Revenue Service (IRS) a check for $1,130, on average,” Doug Holtz-Eakin, former director of the Congressional Budget Office, testified today before a congressional hearing. A Kaiser Family Foundation study estimated that 7% of tax households owing a repayment this year would owe between $2,000 and $5,000, and 2% would owe $5,000 or more. An estimated 6.3 million people will be required to pay a penalty this year because they didn’t buy qualifying health insurance in 2014, Holtz-Eakin testified. Another 30 million people didn’t by the mandated coverage either but won’t have to pay the penalty because of the myriad exemptions the Obama administration is allowing, with or without legal justification. Holtz-Eakin, now president of the American Action Forum, based his calculations on the number of people who will pay the penalty and the average value of the penalty, using demographic information from the American Community Survey and enrollment statistics from the U.S. Department of Health and Human Services. “In reality, the individual mandate has been less of a mandate and more of a suggestion,” he told the House Ways and Means Health Subcommittee, chaired by Rep. Kevin Brady, R-TX…”


Ron Johnson offers latest GOP plan to deal with Obamacare subsidies ruling

“Sen. Ron Johnson added his voice Tuesday to the mounting number of Republican proposals to revamp health care in the wake of a Supreme Court decision this June that could gut Obamacare. Mr. Johnson, of Wisconsin, said the GOP needs to be ready when the justices decide whether the administration is unlawfully paying subsidies to customers in at least 34 states that use the federal HealthCare.gov exchange. Without the subsidies, the law will be much less attractive in those states, opening the door to Republican-led reforms. But it would also expose the party to political attacks, as millions of Americans lose health coverage in the wake of a lawsuit that many in the GOP cheered. In an op-ed for the Wall Street Journal, Mr. Johnson said Republicans need to be ready to parry those attacks by rescuing Americans affected by the ruling. “Without an effective response from Republicans, there is little doubt that the crisis would allow President Obama to permanently cement ObamaCare in place,” he wrote…”


Federal courts reject Ron Johnson’s Obamacare lawsuit for a second time

“A federal appeals court on Monday rejected a Republican senator’s lawsuit challenging the way Congress is treated under Obamacare. Sen. Ron Johnson, of Wisconsin, said he was disappointed with the decision by a three-judge panel of the U.S. Court of Appeals for the 7th District, which found he lacked legal standing to sue because he could not prove he was harmed by administration rules that allowed congressional lawmakers and staff to keep an employer-based subsidy while using the Obamacare exchanges. A lower-court judge tossed the Mr. Johnson’s lawsuit last summer on similar grounds. “For the second time, my attempt to restore the constitutional balance between the executive and legislative co-equal branches of government has been stymied by the courts,” Mr. Johnson said. “With this decision today, another executive action by the administration will go unchallenged, all based on the legal technicality of standing. “This is unfortunate for America,” he added, “because it means the important issue this case presents will not get its day in court.” Mr. Johnson says the Office of Personnel Management provided illegal preferential treatment to Congress when it decided it would still dole out employer-based subsidies to help them pay their monthly premiums…”


Johnson Reviewing Options After Obamacare Lawsuit

“Senate Homeland Security and Governmental Affairs Chairman Ron Johnson isn’t ruling out further challenges to the Obama administration’s treatment of members of Congress and their staff members under the Affordable Care Act. The U.S. Court of Appeals for the 7th Circuit on Tuesday agreed with a lower court ruling that the Wisconsin Republican and his Senate counsel lacked standing because neither of them could show an injury from the Office of Personnel Management’s determination that federal employees making use of the District of Columbia’s health care exchange are eligible for employer contributions. “Respectfully, we do not see how Senator Johnson’s reputation could be sullied or his electability diminished by being offered, against his will, a benefit that he then decided to refuse. He could not be accused of participating in an illegal scheme if he declined to participate,” the 7th Circuit opinion said. But that’s not stopping the first-term senator, who faces re-election next year. “For the second time, my attempt to restore the constitutional balance between the executive and legislative co-equal branches of government has been stymied by the courts. With this decision today, another executive action by the administration will go unchallenged, all based on the legal technicality of standing,” the Wisconsin Republican said…”


Cruz slams ‘doc fix’ as expanding ObamaCare

“Sen. Ted Cruz (R-Texas) on Tuesday said he will vote against the $200 billion Medicare “doc fix” bill that is hitting the Senate floor, becoming the first 2016 candidate to oppose the legislation. The senator said he opposes the House-passed Medicare reform package because it “institutionalizes and expands ObamaCare policies” while adding billions to the deficit. “Any deal should be fully paid for and include significant and structural reforms to Medicare,” Cruz wrote in a statement, released just a few hours before the Senate is expected to take up the legislation. Cruz’s move could ramp up the pressure on the other two presidential candidates in the upper chamber, Sens. Marco Rubio (R-Fla.) and Rand Paul (R-Ky.), who have not yet said how they will vote on the bill. The legislation would repeal a flawed doctor payment formula known as the “sustainable growth rate,” which lawmakers of both parties have failed to resolve for nearly two decades. This year’s bill would pay for about a third of the bill’s total cost over 10 years, which Cruz and other fiscal conservatives have blasted as contrary to their party’s goal of balancing the budget. Several fiscal conservatives, including Sens. Jeff Sessions (R-Ala.), Mike Lee (R-Utah) and Ben Sasse (R-Neb.) have also raised concerns about the price tag of the bill, though none except Cruz have publicly declared they will vote against it. Lee plans to propose an amendment that would require Congress to find offsets for the bill’s costs using “Pay As You Go” budget rules. Sessions, who slammed the bill on the Senate floor on Monday evening, said later that he has not yet decided whether to vote against the bill if Lee’s amendment is not included. “I haven’t decided,” Sessions told reporters Monday evening. But he added: “Republicans ought not to move legislation adding this much to the debt before we even get a budget signed.”  The Senate has one day to approve the Medicare reform package before the Centers for Medicare and Medicaid hits doctors with the planned 21 percent cuts in reimbursement rates. The legislation has been praised by both Senate Majority Leader Mitch McConnell (R-Ky.) and  Speaker John Boehner (R-Ohio), who negotiated the deal with Minority Leader Nancy Pelosi (D-Calif.). President Obama has already promised to sign the bill…”


Senators reject Obamacare repeal in ‘doc fix’ vote

“Senators rejected an amendment to the House-passed Medicare deal that would repeal Obamacare’s individual mandate to pay for the legislation.  Lawmakers voted 54-45 on the amendment proposed by Sen. John Cornyn (R-Texas). It would roll back the Affordable Care Act’s requirement that a person has to have health insurance. Cornyn’s amendment, one of six senators are considering, faced a 60-vote threshold. The Texas Republican said the move would save about $400 billion. “There’s [a] more-than-adequate amount of money,” he said. Cornyn suggested earlier Tuesday his amendment was one step in a larger effort by Republicans to repeal and replace President Obama’s signature healthcare law. “This mandate is bad for America and it hurts people instead of giving them the helping hand they need when it comes to healthcare,” he said. “So we’re going to have a lot more to say about how we need to repeal and replace Obamacare with more affordable health insurance that gives people access to the doctors and the services they want and need.” He added the mandate “coerces our citizens into purchasing healthcare that they apparently don’t want or they wouldn’t otherwise buy but for the government.” Sen. Ron Wyden (D-Ore.) said Cornyn’s amendment would start a “death spiral” on affordable healthcare in America. “Sick people will definitely sign up,” he said, urging his colleagues to vote against the amendment. “Healthy people will stay on the sidelines. Premiums will skyrocket.” Under ObamaCare, a person can face a tax penalty if they don’t have health insurance…”


Senate Votes for $141 Billion in More Debt to Cover Medicare Patch

“The Republican-led Senate passed legislation Tuesday night that would increase the national debt by an estimated $141 billion over the next decade, and would use the borrowed money to avoid a steep cut in reimbursement rates for Medicare doctors. Senators approved the bill in an easy 92-8 vote, a margin that showed most Republicans were fine with the idea of borrowing to pay for the policy change. In the final vote, only eight Republican senators voted against the bill to protest an increase in the national debt: Ted Cruz (Texas), Mike Lee (Utah), David Perdue (Ga.), Marco Rubio (Fla.), Ben Sasse (Neb.), Tim Scott (S.C.), Jeff Sessions (Ala.), and Richard Shelby (Ala.)…”


Senate Approves a Bill on Changes to Medicare


BREAKING: ‘Doc fix’ headed to president’s desk after easily clearing Senate


Hours from deadline, bipartisan Medicare bill heads to White House

“America’s doctors can rest easy: Not only has Congress ensured they will be paid in full for the services they render to Medicare patients, it has ended the yearly ritual putting that in doubt. The Senate voted 92-8 to approve a long-term “doc fix,” as the legislation adjusting Medicare fees has long been known, less than three hours before federal officials would have reduced payments to health-care providers by 21 percent. President Obama has indicated that he will sign the bill, which also extends the federal Children’s Health Insurance Program, a key Democratic priority. Despite the last-minute nature of the vote, it was lauded by Hill leaders as a bipartisan triumph for both removing a yearly headache from the legislative calendar but also by implementing modest reforms to Medicare, including future incentives for doctors to deliver better care as well as premium hikes for the wealthiest Medicare recipients….”


The Fix to the ‘Doc Fix’ Is No Fix at All

“The Senate should reject new legislation that would use pay increases to coerce doctors to join Medicare ACOs. The Senate is now considering the Medicare-physician-payment legislation that the House passed shortly before Congress’s recent two-week break. In all likelihood, a large, bipartisan group of senators will support the bill and thus ensure it becomes law (the Obama administration has already indicated that the president will sign it). That’s very unfortunate because it’s misguided legislation that will do far more harm than good. Some House and Senate Republicans are enthused about the bill because it would probably break (at least for some period of time) the cycle of annual “doc fixes” that have been implemented for more than a decade to prevent large, irrational cuts to physician fees under Medicare. Spending money on higher physician fees has strong appeal, even for supposed fiscal conservatives. They are also pleased that the bill includes two modest reforms in Medicare’s structure — small increases in premiums for upper-income beneficiaries, and a prospective prohibition on Medigap plan coverage of the part B deductible. These reforms are worthwhile, but they are really minor in comparison with the far more consequential provisions in the legislation related to the payment of physicians under Medicare. Unfortunately, many in the GOP seem completely unaware of how these provisions will work. The heart of the bill is a new, two-tiered indexing system for physician fees. Physicians who agree to participate in Medicare Accountable Care Organizations (ACOs) — or in similar structures established by the Medicare bureaucracy — will receive a permanent 0.75 percent increase in their fees each year. Physicians that don’t join an ACO will be placed into a new Merit-Based Incentive Payment System, or MIPS. Under MIPS, the Medicare bureaucracy will assess the “quality” of a physician’s services to patients and reward or penalize them accordingly. On average, physicians in MIPS will receive a payment increase of 0.25 percent every year — far below the annual payment increase for physicians in ACOs. The actuaries who assess Medicare finances for the administration have looked at these provisions and come to the perfectly rational conclusion that physicians will have little choice but to join an ACO to get an extra 0.5-percentage-point bump in their payments every year. By 2019, the actuaries assume that 60 percent of all physicians taking care of Medicare beneficiaries will be part of an ACO, up from 25 percent today. By 2038, they assume that 100 percent of physicians participating in Medicare will be a part of an ACO or a similar structure invented by the Medicare bureaucracy. And so what are these ACOs that will feature so prominently in Medicare’s future? The basic idea is to provide incentives to hospitals and physicians to form new organizations that will better coordinate care for Medicare beneficiaries, sort of like an HMO except without the insurance component. The Medicare bureaucracy sets the rules that ACOs must live by, and if an ACO is able to reduce costs through better coordination of care, it gets to share in the savings with the Medicare program. A crucial feature of the ACO design is the concept of “beneficiary assignment.” Medicare’s enrollees are never explicitly asked if they would like to obtain their care through an ACO. Instead, the Medicare bureaucracy assigns beneficiaries to ACOs based on their use of physician services. If a beneficiary’s presumed “primary” physician is part of an ACO, then the beneficiary is assumed to be a part of it, too. Under current rules, nothing prevents Medicare beneficiaries from seeing physicians outside of an ACO, but the expectation is that ACO-affiliated physicians will steer their patients to other ACO-affiliated physicians, even if the beneficiary is completely unaware of the existence of the ACO. In effect, Medicare beneficiaries are being shoved into managed care–like structures without their explicit consent…”


Under Obamacare, Medicaid now covers one-fifth of N.J. residents

“Medicaid, the public health insurance program expanded under the Affordable Care Act, now covers nearly one out of every five New Jersey residents, according to the latest enrollment figures. More than 420,000 people signed up for insurance since New Jersey allowed more people to into the program, according to Valerie Harr, director of the division of medical assistance and health services for the N.J. Department of Human Services. While that flood of applications produced long delays in people getting coverage, the state recently paid for extra outside workers to tackle the backlog, Harr said. About 80,000 of those people already qualified for the program under the old income guidelines – but didn’t realize it until they attempted to enroll in Obamacare policies and found they were poor enough to qualify for Medicaid. All told, 1.7 million New Jersey residents will now have the bulk of their medical expenses covered by Medicaid. The enrollment backlogs that have bedeviled the program since New Jersey became one of the states to expand Medicaid are nearly cleared up, Harr told a quarterly meeting of public health and welfare providers. Between 9,000 and 12,000 applications remain unprocessed statewide, Harr said – a far cry from the tens of thousands that piled up in county welfare offices last summer. The solution was to pay Xerox, an outside contractor already handling some of the program, to hire 127 new workers to process applications. That will cost $7.5 million through the rest of this year, said Nicole Brossoie…”


Signed by the Governor: New Arizona Law Blocks Crucial Obamacare Enforcement Mechanism

“Arizona Gov. Doug Ducey has signed a bill into law that creates significant roadblocks for implementation of the Affordable Care Act, leaving the federal program without an enforcement mechanism in the state. Introduced State Reps. Justin Olson and Vince Leach, House Bill 2643 (HB2643) prohibits the state in various ways from “from using any personnel or financial resources to enforce, administer or cooperate with the Affordable Care Act.” “If the federal government is going to enact a law, then the federal government needs to enforce that law,” said Olson. “We’re not going to do it.” With just five minutes before the Senate closed for the 2015 legislative session, the bill was given its final approval in the Senate, by a 16-10 vote and the House with a 34-24 vote….”


How Obamacare Makes Chris Christie’s Medicare Plan Possible

“New Jersey Gov. Chris Christie would like to raise the age to qualify for Medicare, part of a bold plan to reform entitlements that he released Tuesday morning. The proposal was greeted with cheers from many conservatives, but there’s a twist. The main reason that slowly raising the retirement age from 65 to 69 is politically feasible is a law that many conservatives hate: Obamacare. That’s because working-class Americans who lose health insurance at work when they retire at, say, age 65, would instead be eligible to receive modest subsidies on insurance exchanges set up by the Affordable Care Act. (Very low-income seniors could also sign up for Medicaid in some states or receive larger subsidies for coverage on the exchanges.) “Obamacare soaks up the people who would otherwise be displaced by raising the eligibility age for Medicare,” said Avik Roy, a prominent Republican expert in health care policy who has argued that conservatives should use Obamacare to promote their own policies rather than repeal the law. “In the old days, if you raised the eligibility age for Medicare, then someone who is low-income at 65, but not eligible for Medicaid, are stuck in this gap, so what do you do?”…”


Olympic athletes’ health plan fails to meet Affordable Care Act rules

“It might seem like common sense that top U.S. Olympic athletes would have excellent health insurance to cover potentially serious injuries and illnesses. But it turns out that the health plan for about 900 elite athletes — provided through the U.S. Olympic Committee — fails to meet minimum requirements of the Affordable Care Act. Under the law’s individual mandate, almost all Americans are required to have insurance or face a penalty, which is due when their income taxes are paid. When it became apparent in recent months that athletes could face penalties for the 2014 tax year for having inadequate coverage — through no fault of their own — federal health officials decided to grant exemptions to all affected athletes who apply, according to federal health officials…”


IMS: US prescription drug spending jumped 13 pct. in 2014

“U.S. spending on prescription drugs soared last year, driven up primarily by costly breakthrough medicines, manufacturer price hikes and a surge from millions of people newly insured due to the Affordable Care Act. Spending rose 13 percent, the biggest jump since 2001, to a total of $374 billion, according to a report released Tuesday by the IMS Institute for Healthcare Informatics. After accounting for population growth and inflation, the increase equaled 10 percent. A record 4.3 billion prescriptions were filled in 2014, many of them for inexpensive generic pills going to patients now insured through Medicaid in states that expanded eligibility for the government health program for the poor and disabled. The number of prescriptions covered by Medicaid rose by nearly 17 percent, and that increase accounted for 70 percent of growth in the number of prescriptions filled at retail pharmacies. Another sign of the Affordable Care Ac’s impact was that prescriptions paid for in cash, normally filled by uninsured people, declined 5.5 percent. The higher spending, though, was mostly due to the many recent drugs with eye-popping price tags: tens of thousands of dollars for a year or course of treatment. Last year saw an unusually high 42 novel medicines launched, 18 for rare diseases, those that affect fewer than 200,000 Americans. Ten of the new drugs were designated as breakthrough therapies, for conditions including multiple sclerosis, various cancers and hepatitis C. “2014 was a remarkable year,” Murray Aitken, executive director of the IMS Institute, told The Associated Press. “We’re probably not going to see it again.” Altogether, spending on prescription medicines in the U.S. rose by $43.4 billion last year, including about $10 billion due to price increases and $20.3 billion spent on prescriptions for new drugs. That included a combined $11.3 billion spent on just four new medicines for hepatitis C, a liver-damaging virus so tough to eliminate that until recently, patients had to endure flu-like symptoms and other awful side effects for nearly a year, yet barely 60 percent were cured. The new hepatitis C treatments cure upwards of 90 percent, usually in 12 weeks. However, they carry list prices of $84,000 or more for a course of treatment…”


​What’s fueling drug sales? Obamacare and expensive meds

“The pharmaceutical industry is on track for a banner decade. Spending on prescription medicines by U.S. patients may rise 41 percent to as much as $480 billion by 2018, according to a new study from researcher IMS Institute for Healthcare Informatics. The biggest drivers in the rise in spending are the implementation of the Affordable Care Act, an aging American population, and higher drug prices, the report said. Medicaid prescriptions jumped 25.4 percent in states that expanded Medicaid coverage, compared with 2.8 percent in the states that didn’t expand coverage. With the Affordable Care Act going into effect in 2014, that led to a 13 percent jump in spending last year, the highest level since 2001, the report found. That surge likely won’t be repeated, with the study predicting more moderate growth through 2018. Obamacare was only part of the cause for the spike in spending, however. “Price increases, mostly in the U.S., contributed to growth in 2014, driven by some specific products and therapy areas where list price increases were above historic norms,” the study noted. The high cost of some prescription medicines is creating controversy, stress and a backlash from patients, doctors and insurers. Some states are pushing back on the sky-high cost of hepatitis C treatments such as Gilead’s Sovaldi, which is an effective treatment but carries a wholesale cost of $84,000 per person for a treatment course. Each pill has a $1,000 price tag. Medicaid programs shelled out $1.33 billion on Sovaldi and other hepatitis C treatments through the third quarter of 2014, or almost the same amount as in the prior three years, The Wall Street Journal reported earlier this month. Some states are pushing back against paying for Medicaid enrollees to receive the treatment, with Texas spending nothing on the drug during the first nine months of 2014, The Journal noted. A spokeswoman told the publication that “price was the biggest issue” in that decision. Gilead has extended free hepatitis C drugs to more than 100,000 people across the U.S., including several hundred Medicaid-enrolled Texans. It’s not only the latest therapies that are sending pharmaceutical costs skyward. Brand-name medicines have also surged in price since 2007, Bloomberg News found last year. Prices have doubled for established drugs treating conditions ranging from high blood pressure to cancer. New drugs are also introduced at higher prices, with 15 new cancer drugs hitting the market in the last five years that cost more than $10,000 per month…”


Medicaid Fuels Drug Growth; ObamaCare Trims Cash Paid

“U.S. spending on prescription drugs soared last year, driven up primarily by costly breakthrough medicines, manufacturer price hikes and a surge from millions of people newly insured due to the Affordable Care Act. Spending rose 13%, the biggest jump since 2001, to a total of $374 billion, according to a report released Tuesday by the IMS Institute for Healthcare Informatics. After accounting for population growth and inflation, the increase equaled 10%.

A record 4.3 billion prescriptions were filled in 2014, many of them for inexpensive generic pills going to patients now insured through Medicaid in states that expanded eligibility for the government health program for the poor and disabled. The number of prescriptions covered by Medicaid rose by nearly 17%, and that increase accounted for 70% of growth in the number of prescriptions filled at retail pharmacies. Another sign of the Affordable Care Act’s impact was that prescriptions paid for in cash, normally filled by uninsured people, declined 5.5 %.

The higher spending, though, was mostly due to the many recent drugs with eye-popping price tags: tens of thousands of dollars for a year or course of treatment. Last year saw an unusually high 42 novel medicines launched, 18 for rare diseases, those that affect fewer than 200,000 Americans. Ten of the new drugs were designated as breakthrough therapies, for conditions including multiple sclerosis, various cancers and hepatitis C. “2014 was a remarkable year,” Murray Aitken, executive director of the IMS Institute, told the Associated Press. “We’re probably not going to see it again.” Altogether, spending on prescription medicines in the U.S. rose by $43.4 billion last year, including about $10 billion due to price increases and $20.3 billion spent on prescriptions for new drugs. That included a combined $11.3 billion spent on just four new medicines for hepatitis C, a liver-damaging virus so tough to eliminate that until recently patients had to endure flulike symptoms and other awful side effects for nearly a year, yet barely 60% were cured. The new hepatitis C treatments cure more than 90%, usually in 12 weeks. However, they carry list prices of $84,000 or more for a course of treatment.

One of them, Sovaldi, was launched at the end of 2013 yet was the top-selling drug last year. It brought maker Gilead Sciences (NASDAQ:GILD) $7.9 billion. “Sovaldi is a record breaker in so many ways,” Aitkin said, yet Gilead’s successor drug launched last fall, Harvoni, has already surpassed it in sales…”


Pelosi: Obamacare, Equal Pay, Amnesty Promote ‘Life, Liberty, and the Pursuit of Happiness’


Marco Rubio Pledges To Repeal And Replace Obamacare — But With What?

“On Monday evening, in front of a cheering crowd, Florida Sen. Marco Rubio (R.) announced his candidacy for President of the United States. At times stirring, at times nervous, Rubio declared that one of the core planks of his policy platform would be to “repeal and replace Obamacare.” Unlike some of his companions in the race, Rubio has outlined what his Obamacare replacement might look like. It’s a solid start, but it’s silent on a key detail…”


House members angry over VA’s response to whistleblowers



Feds releasing hundreds of illegal immigrant rapists, murderers: report

“The administration is deporting fewer criminal aliens than it did last year, according to new statistics released Tuesday that undercut President Obama’s justification for his new amnesty, which he said was intended to free agents to focus on the most dangerous of criminals by focusing on “felons not families.” Instead, both arrests and deportations of criminal aliens are down about 30 percent through the first six months of fiscal year 2015, signaling that agents, who have been told to stop focusing on rank-and-file illegal immigrants, have not been able to refocus on criminal illegal immigrants instead. The data, released by House Judiciary Committee Chairman Robert W. Goodlatte at the beginning of a hearing with U.S. Immigration and Customs Enforcement Director Sarah Saldana, also showed that the 30,558 criminal aliens ICE knowingly released back into the community in 2014 had amassed nearly 80,000 convictions, including 250 homicides, 186 kidnappings and 373 sexual assaults…”



“Immigration and Customs Enforcement Director Sarah Saldaña struggled to explain the reasons behind the Obama administration’s release of thousands of criminal immigrants when pressed by Rep. Lamar Smith (R-TX) Tuesday during a House Judiciary Committee hearing. In Fiscal Year 2014, ICE released 30,558 convicted criminal immigrants, convicted of 79,059 crimes, allowing them to walk free in the U.S. “One-quarter of these 30,000 criminal aliens had been convicted of level one crimes, such as murder, rape, and sexual abuse of a minor. of those 30,000, only 8 percent were Zadvydas cases,” Smith said referring to the Supreme Court case that prevents the indefinite detention of certain immigrants. “Thousands could have been deported. Why did you — why did the administration intentionally endanger the lives of innocent Americans by releasing thousands of criminal aliens into our neighborhoods?” he asked. Saldaña responded that such releases are “an area of great concern for me.” The ICE director pointed to the courts and the the Zadvydas case as reasons. “Why we are moving forward as we are. We do not have a policy, our decisions, whether they’re detention decisions, bond decisions, release decisions are governed by several things and often involve the courts. As you know, and I think the the chairman noted, about half, in 2014, of the releases were, as a result of Zadvydas, and which requires us to release people,” Saldaña said. Smith responded that Saldaña had not contradicted his initial argument that the Obama administration is “intentionally releasing thousands” of convicted immigrant criminals back into the U.S…”


ICE director Saldana takes heat over agency’s record

Report: Convicted illegal immigrant murderers, rapists freed; families detained

“The administration released dozens of convicted illegal immigrant murderers and rapists back onto the streets last year, even as it began to hold more women and children, according to the latest statistics that have President Obama and his immigration team taking fire from all sides in the debate. Republicans said releasing murderers and rapists, as well as thousands of drunken-drivers, drug users, burglars and thieves is the latest step for an administration bent on ignoring enforcement, confronting Immigration and Customs Enforcement Director Sarah Saldana over her agency’s record. The 30,558 criminal aliens released into the community by ICE in 2014 had amassed 250 homicide convictions, 186 kidnappings and 373 sexual assaults, according to agency statistics put into the official records of the House Judiciary Committee…”



“Pinal County, AZ Sheriff Paul Babeu (R) said that he cannot get access to the names of the nearly 500 criminal illegal immigrants released in his county on Tuesday’s “Your World with Neil Cavuto” on the Fox News Channel. “30,000 this year, 36,000 the year prior, and these aren’t the run of the mill illegals. There’s 11 to 20 million illegals that are here in the United States. This is the group that everybody, even President Obama, said that are the worst of the worst actors, that everybody agreed need to be shipped out of our country back to their country of origin. There [were] 193 of them that were convicted of murder. 300-plus that were convicted of rape and sexual assault, and there [were] another 200 to 300 that were convicted of kidnapping [that were released in 2013]. So, these are the worst criminals in our society, and they were not returned to their country of origin because of what she [ICE Director Sarah Saldana] said and Jeh Johnson said, ‘well, their countries don’t want them back’” he stated. Babeu added, “we have no clue where they’re at today…they released nearly 500 in my county alone…I have demanded not only in formal letter, through FOIA, and legally have even talked to Senator McCain. Senator McCain, who’s a powerful Senator, said, ‘Sheriff, I promise you, I’m going to get you these names.’ He can’t get me the names. Nobody will get me these names, and the reason why they will refuse to provide the names is then we have a list of all these illegals that our government — President Obama has released into our communities that are committing new crimes, that are committing murder, that are committing rape, that are committing aggravated assault, armed robbery, and then we can directly link them back to the president’s action of this unlawful mass prison break.”


Immigration Reform 2015: Undocumented Children Allowed To Sue For Legal Representation, Judge Rules

“Seattle-based U.S. District Court Judge Thomas Zilly rejected the federal Justice Department’s motion Monday to dismiss a lawsuit seeking to secure legal representation for undocumented children who faced deportation. The legal fight was one of several cases related to the government’s handling of illegal immigration months after President Obama exercised executive authority to shield millions of undocumented immigrants from deportation. The American Civil Liberties Union filed the suit to advocate for a group of Salvadoran siblings who illegally entered America to escape gang violence. Federal officials asked Zilly to dismiss the case on jurisdictional grounds and argued it would be too expensive for the government to bankroll legal representation in immigration cases. Zilly ruled the immigrants’ request for council constituted an argument for due process and required a legal response. “The Court is of the opinion the due process question plaintiffs have raised in this case is far too important to consign it, as defendants propose, to the perhaps perpetual loop of the administrative and judicial review process,” Zilly’s ruling said, according to Politico. The unaccompanied children arrived in the country in 2013 after their father was killed in front of them by gang members outside their home. Federal officials found the children and located an unnamed family member, with whom they now live in Washington. The ACLU has repeatedly questioned the federal government’s use of immigration detention facilities to hold undocumented immigrants until a hearing to determine whether they will face deportation. The civil rights organization expressed disappointment last month when the federal government passed a new Department of Homeland Security funding bill that allocated more than $350 million toward these shelters. “Mandatory detention of people awaiting their immigration proceedings violates the right to due process and is inefficient and costly. Instead of funding immigration detention, Congress should appropriate money for community-based alternatives to detention with case management services, which have been proven to be effective and cost-efficient,” the ACLU said in a statement…”


Applications for H-1B tech visas reach record levels

“U.S. businesses have received a record number of applications for the H-1B tech visas. Applications for H-1B visas, which allow U.S. businesses to hire foreign workers in science, engineering and computer programing, reached a record of 233,000 for fiscal year 2016, according to new government figures released Monday. Under limits set by Congress, only 85,000 of the work visas, including 20,000 for holders of master’s degrees, are available yearly. Companies are frustrated with the cap and have been aggressively lobbying to raise it. Processing of the H-1B visas will begin May 11 and then will be allotted by a computer-generated lottery system, U.S. Citizenship and Immigration Services said Monday. Numerous tech industry lobbying groups have expressed displeasure at not just the visa cap, but how the visas are given out. “Year after year, the government falls back on a lottery system to determine which U.S. employers will ‘win’ the ability to hire top world talent,” Lynn Shotwell, executive director of the Council for Global Immigration, said in an email on Monday in response to the figures release. “This year, employers had a mere 36 percent chance of being granted an H-1B visa. U.S. economic growth should not be left up to this gamble.” According to Compete America, a coalition that represents tech giants such as Amazon and Facebook, the U.S. loses roughly 500,000 jobs a year because of the limit on H-1B visas.”


McCain and Congress should lead fight against drug-resistant TB

“Just below the media radar in early April, Sen. John McCain (R-Ariz.) pressed Department of Homeland Security Secretary Jeh Johnson to prevent the release from Immigration and Customs Enforcement (ICE) custody of an immigration detainee diagnosed with drug-resistant tuberculosis. McCain did so on behalf of Pinal County, Ariz., which faced staggering medical costs to treat the patient and to prevent further spread of a dreaded and difficult to treat disease. Now, ICE has capitulated. The man will not be released; the federal government will continue to pay for his care while he is in ICE detention. The Pinal County director of public health was right to be concerned: Drug-resistant tuberculosis can require 18 to 24 months of treatment and can cost more than $500,000. A local health department’s entire budget can be depleted with just one case. The one-off solution was a win for Pinal County, and it was likely in the best interest of the detainee. We don’t know the man’s immigration status or why he is in detention. We do know his case is not an isolated event but is likely to recur. At some point, detention ends. A sick detainee who wins his or her appeal is cast upon the nation’s fragmented public health system, often disproportionately based upon the location of the holding facility. When those persons are released, the federal government provides no follow-up care, even for those who present serious public health threats. But the question of who pays is a much larger problem than the relatively low number of persons with tuberculosis held in ICE facilities. Local health departments face the same costs when prisoners are released, when residents of one state or county relocate to another, and in homeless and other vulnerable populations. For any number of reasons, a local health department might enlist its congressional delegation to find federal money for persons it does not believe it should support. Tuberculosis is most common in communities with the least stability. Among people born in the United States, the greatest disparity is between blacks and whites; blacks contract it at a rate more than seven times higher than whites, often because of poverty and crowded living conditions. Although foreign-born individuals account for two-thirds of new cases in the U.S., we are wrong to worry only about the undocumented. School children and health workers are more likely to contract the disease from a U.S. citizen than from a non-citizen. Medical professionals are deeply concerned about the potential for epidemic, drug-resistant tuberculosis in the U.S. While tuberculosis rates have declined in the United States in the last decade, a worrisome number of drug-resistant cases have emerged. So far we have been lucky. The low numbers hide the precarious nature of the nation’s public health defense, and how vulnerable we would be to an epidemic. To make matters worse, those without legal status (an estimated 11 million persons) are excluded from ObamaCare, even if they could afford to pay for it. Access to basic healthcare protects everyone’s health, yet we intentionally exclude non-citizens from the social safety net…”


Obama pushes to naturalize more immigrants

“In the wake of President Obama’s executive action to shield illegal immigrants from deportation, the White House also launched a campaign Tuesday to encourage more legal immigrants to become U.S. citizens. White House aides said the “citizenship awareness campaign” will make use of social media and other traditional media to reach the more than 8.8 million legal residents who are eligible to become U.S. citizens but haven’t taken that step. Cecilia Munoz, director of White House domestic policy, said the effort is “just part of good governance” and isn’t related directly to Mr. Obama’s executive action last year to grant deportation amnesty to millions of illegal immigrants. A White House task force released a report Tuesday outlining the administration’s goals, which include “welcoming and integrating immigrants” nationwide. “Nothing in this report … is connected to the expansion of DACA [deferred action for childhood arrivals],” Ms. Munoz said. The administration is looking at using AmeriCorps volunteers to assist local communities in integration programs, and launching a “made it in America” campaign to tell the success stories of immigrants. A federal judge in New Orleans will hear an appeal on Friday of a court order blocking implementation of Mr. Obama’s amnesty program. Mr. Obama created the Task Force on New Americans last November at the same time he took the executive action on amnesty. He called for efforts across federal agencies and in collaboration with state and local governments to improve “the linguistic, economic, and civic integration of immigrants and refugees in the United States,” the White House said…”


Amnesty Advocates Enable Social Security, Identity Fraud, Overwhelmingly Hurting Children

“Judge Andrew Hanen of Texas District Court slapped down the Obama DOJ last week, ruling that his February 16 injunction order would stay in place pending a full hearing on the merits. DOJ’s attempt to convince the judge that the injunction was “disruptive to national security” had indeed been pretty weak. When he questioned the need for the DAPA program to dole out work permits to illegal aliens on top of providing amnesty, he was told it was necessary in order to “incentivize” the aliens to “come out and identify themselves.” DOJ’s poor showing, along with misrepresentations they’d made earlier to the court that no DACA applications would be processed during the injunction actually “reinforced” the judge’s original decision to halt the program, according to this latest order. Still, there is some truth to the DOJ’s assertion that mere deportation deferrals may not be enough to get illegal aliens to “come out of the shadows” and register for DACA and DAPA. The Obama administration appears to sincerely believe this, having promised to waive application fees for DACA and DAPA applicants, in effect subsidizing the program with fees from legal applicants. Then there’s the Earned Income Tax Credit refunds that beneficiaries will be entitled to receive if they sign up. It may be that Obama knows what immigration enforcement advocates have known for some time: Most illegal aliens are not in the shadows and are actually already in the system. Just illegally so…”


Rep. Gohmert Clashes With ICE Director Over ‘Illegal’ Deferrals: ‘I Would Appreciate You Not Yelling’

“The director of U.S. Immigration and Customs Enforcement clashed with Rep. Louie Gohmert (R-Texas) over the Obama administration’s immigration policies during a Tuesday House Judiciary Committee hearing. Things eventually got so tense that ICE Director Sarah Saldana actually had to ask Gohmert to stop “yelling.” Gohmert noted that Judge Andrew Hanen has temporarily halted President Barack Obama’s executive actions to shield millions of illegal immigrants from deportations — and then accused the administration of misleading the judge in its past approval of benefits for eligible immigrants. The Obama administration apparently argued in court and in legal documents that the president’s immigration plan would not be implemented until late February, according to Hanen. However, the Department of Justice later told Hanen that more than 100,000 illegal immigrants had been issued three-year deferrals between November 20 and February 16, when

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