What Trump's Proposed Medicaid Cuts Could Mean For You

They could force states to limit benefits and cap the number of people enrolled

Consumers Union / Consumer Reports /  Donna Rosato / May 23, 2017

President Donald Trump’s 2018 budget blueprint calls for huge reductions to social safety net programs. In particular, it targets Medicaid, the program that provides health insurance for millions of poor, disabled, and elderly people, about 1 in 5 Americans. 

Republican plans to repeal and replace the Affordable Care Act already has proposed hitting people on Medicaid hard. The Affordable Health Care Act (AHCA) legislation, which the House passed earlier this month, called for $880 billion in cuts to the program. Trump’s budget calls for cutting another $615 billion from Medicaid. Together, the $1.5 trillion in cuts would slash federal Medicaid funds by nearly 50 percent in 10 years.

“This cuts quite a bit more in federal funding than the AHCA alone,” says John Holahan, a fellow in the Health Policy Center at the Urban Institute, a non-partisan research organization. “States are going to have to figure out how to make up the difference."

The budget proposal must be approved by Congress and much could change in the meantime. The Senate is working on a healthcare overhaul of its own. Democrats are opposed to steep Medicaid cuts, as are some moderate Senate Republicans, particularly those in states that expanded Medicaid. 

Still, the prospect of such a massive change to the government's largest health insurance program is troubling to consumer advocates.

“The proposed cuts to Medicaid would decimate the program, dramatically reducing the number of people covered and the quality of coverage for the most vulnerable Americans,” says Betsy Imholz, director of special projects for Consumers Union, the policy and mobilization arm of Consumer Reports.

The budget proposal comes at a time when Americans are increasingly concerned about their ability to afford health insurance.

More than half (57 percent) of those surveyed for Consumer Reports second CR Consumer Voices Survey in March said they lack confidence they and their loved ones will be able to afford health insurance.

And 41 percent now say they're not confident they'll have access to quality care to get the doctors, tests, treatments and medications they need. That’s up from 35 percent in the first CR Consumer Voices Survey in January.

How Medicaid Could Change

Here are five things you need to know about how the possible Medicaid cuts proposed by Trump and House Republican leadership would affect you.


1. The proposed cuts in the Trump budget and AHCA wouldn't take place until 2020.

2. How you are affected will depend on where you live. That's because under the current system, the federal government gives states money based on costs no matter how many are enrolled. The Trump budget blueprint reduces the amount given to states but lets each choose how they receive the money. States could opt to receive a limited and capped amount per person enrolled, or take a “block grant” and decide how to spend it. Trump and other Republicans say block grants give states more flexibility to design their own programs. But experts say it will be difficult for states to make up the shortfall from lost federal funds.

3. If enrolled in Medicaid, you might face stricter work requirements and have to cover more costs, such as higher co-pays, out of pocket. That's because the Department of Health and Human Services is encouraging states to experiment with ways to curtail costs. Under current law, several states, including Maine and Wisconsin, have already applied for waivers to make such changes, says Robin Rudowitz, an associate director for the Program on Medicaid and the Uninsured at the Kaiser Family Foundation.

It's unclear how much money such changes would save, says Rudowitz. For example, only 15 percent of Medicaid dollars are currently spent on able-bodied adults who might be subject to new work requirements, according to an analysis by the Kaiser Family Foundation and the Urban Institute.

4. The disabled and the elderly will be hit the hardest. The disabled account for 42 percent of Medicaid spending, while the elderly account for 21 percent, to pay for services such as long-term care and nursing homes. Another 21 percent of Medicaid spending provides health insurance for children.

5. It's still unknown how many Medicaid recipients might lose coverage in the end. The Congressional Budget Office's initial analysis of the AHCA passed by the House, estimated that 14 million people would drop out of the program if the bill became law. The CBO plans to issue a new analysis Wednesday meant to reflect amendments to the initial AHCA legislation. But that analysis won't take into account the proposed cuts in the Trump budget.

As a result, it's unknown how many people might lose coverage overall, says Dee Mahan, director of Medicaid Initiatives at Families USA, a non-profit focused on consumer healthcare issues. "But this is a massive cost shift from the federal government to states. States won't be able to make up all this money," says Mahan. "A lot of people will lose their coverage."

Latest Hospital Injury Penalties Include Crackdown On Antibiotic Resistant Germs

Reprinted from KHN / Kaiser Health News

By Jordan Rau December 21, 2016

http://www.khn.org/

The federal government has cut payments to 769 hospitals with high rates of patient injuries, for the first time counting the spread of antibiotic-resistant germs in assessing penalties.

The punishments come in the third year of Medicare penalties for hospitals with patients most frequently suffering from potentially avoidable complications, including various types of infections, blood clots, bed sores and falls. This year the government also examined the prevalence of two types of bacteria impervious to drugs.

Based on rates of all these complications, the hospitals identified by federal officials this week will lose 1 percent of all Medicare payments for a year — with that time frame beginning this past October.  While the government did not release the dollar amount of the penalties, they will exceed a million dollars for many larger hospitals. In total, hospitals will lose about $430 million, 18 percent more than they lost last year, according to an estimate from the Association of American Medical Colleges.

The reductions apply not only to patient stays but also will reduce the amount of money hospitals get to teach medical residents and care for low-income people.

Forty percent of the hospitals penalized this year escaped punishment in the first two years of the program, a Kaiser Health News analysis shows. Those 306 hospitals include the University of Miami Hospital in Florida, Cambridge Health Alliance in Massachusetts, the University of Michigan Health System in Ann Arbor and Mount Sinai Hospital in New York City.

Nationally, hospital-acquired conditions declined by 21 percent between 2010 and 2015, according to the federal Agency for Healthcare Research and Quality, or AHRQ. The biggest reductions were for bad reactions to medicines, catheter infections and post-surgical blood clots.

Still, hospital harm remains a threat. AHRQ estimates there were 3.8 million hospital injuries last year, which translates to 115 injuries during every 1,000 patient hospital stays during that period.

Each year, at least 2 million people become infected with bacteria that are resistant to antibiotics, including nearly a quarter million cases in hospitals. The Centers for Disease Control and Prevention estimates 23,000 people die from them.

Infection experts fear that soon patients may face new strains of germs that are resistant to all existing antibiotics. Between 20 and 50 percent of all antibiotics prescribed in hospitals are either not needed or inappropriate, studies have found. Their proliferation — inside the hospital, in doctor’s prescriptions and in farm animals sold for food — have hastened new strains of bacteria that are resistant to many drugs.

One resistant bacteria that Medicare included into its formula for determining financial penalties for hospitals is methicillin-resistant Staphylococcus aureus, or MRSA, which can cause pneumonia and bloodstream and skin infections. MRSA is prevalent outside of hospitals and sometimes people with it show no signs of disease. But these people can bring the germ into a hospital, where it can be spread by health care providers and be especially dangerous for older or sick patients whose immune system cannot fight the infection.

Hospitals have had some success in reducing MRSA infections, which dropped by 13 percent between 2011 and 2014, according to the CDC. AHRQ estimates there were 6,300 cases in hospitals last year.

The second bacteria measured for the penalties is Clostridium difficile, known as C. diff, a germ that can multiply in the gut and colon when patients take some antibiotics to kill off other germs. It can also spread through contaminated surfaces or hands.

While it can be treated by antibiotics, C. diff can also become so serious that some patients need to have part of their intestines surgically removed. C. diff can cause diarrhea and can be deadly for the elderly and other vulnerable patients.

C. diff has challenged infection control efforts. While hospital infections dropped 8 percent from 2008 to 2014, there was a “significant increase” in C. diff that final year, the CDC says. AHRQ estimated there were 100,000 hospital cases last year.

“The reality is we don’t know how to prevent all these infections,” said Dr. Louise Dembry, a professor at the Yale School of Medicine and president of the Society for Healthcare Epidemiology of America.

The Hospital-Acquired Condition Reduction Program also factors in rates of infections from hysterectomies, colon surgeries, urinary tract catheters and central line tubs. Those infections carry the most weight in determining penalties, but the formula also takes into account the frequency of bed sores, hip fractures, blood clots and four other complications.

Specialized hospitals, such as those that treat psychiatric patients, veterans and children, are exempted from the penalties, as are hospitals with the “critical access” designation for being the only provider in an area. Of the remaining hospitals, the Affordable Care Act requires that Medicare penalize the 25 percent that perform the worst on these measures, even if they have reduced infection rates from previous years.

That inflexible quota is one objection the hospital industry has with the penalties. In addition, many hospitals complain that they are penalized because of their vigilance in detecting infections, even ones that do not cause any symptoms in patients. Academic medical centers in particular have been frequently punished.

“The HAC penalty payment program is regarded as rather arbitrary, so other than people getting upset when they incur a penalty, it is not in and of itself changing behavior,” said Nancy Foster, vice president for quality and patient safety at the American Hospital Association.

Federal records show that 347 hospitals penalized last year will not have payments reduced because their performance was better than others. Those include Harbor-UCLA Medical Center in Los Angeles, the Johns Hopkins Hospital in Baltimore and the University of Tennessee Medical Center in Knoxville.

Over the lifetime of the penalty program, 241 hospitals have been punished in all three years, including the Cleveland Clinic; Intermountain Medical Center in Murray, Utah; Ronald Reagan UCLA Medical Center in Los Angeles; Grady Memorial Hospital in Atlanta; Northwestern Memorial Hospital in Chicago; and Brigham & Women’s Hospital in Boston.

The penalties come as the Centers for Medicare & Medicaid Services also launches new requirements for hospitals to ensure that the use of antibiotics is limited to cases where they are necessary and be circumspect in determining which of the drugs are most likely to work for a given infection. Hospitals will have to establish these antibiotic stewardship programs as a condition of receiving Medicare funding under a regulation the government drafted last summer.

Lisa McGiffert, who directs Consumers Union’s Safe Patient Project, said that as a result of Medicare’s penalties and other efforts, “more hospitals are thinking more about appropriate use of antibiotics.” However, she said, “I think most hospitals do not have effective antibiotic stewardship programs yet.”

Congress Passes Bill with Billions for Cancer Research

But some consumer groups say new standards for drug approvals could put patients at risk

Consumer Reports / Teresa Carr / December 7, 2016

Congress has passed the most expensive and far-reaching health reform bill since the Affordable Care Act in 2010.

The 21st Century Cures Act, which garnered widespread, bipartisan support in both the House and Senate, is expected to be signed into law by President Obama soon.

The bill signifies an investment of billions of dollars over the next decade to fight cancer, prevent and treat brain disorders, and harness enormous amounts of data to develop individualized treatments based on person’s environment, genes, and lifestyle.

But the bill also lowers the bar for the kind of scientific evidence companies must provide to gain the Food and Drug Administration’s (FDA) approval for their products. It would mean, for instance, that in some circumstances the FDA could rely in part on individual patient experiences with a drug or device, instead of evidence from large-scale, randomized controlled clinical trials.

Rep. Fred Upton, the Republican from Michigan who chairs the House Energy and Commerce Committee and co-sponsored the bill, says the Cures Act "expedites the approval of drugs and devices and includes literally billions of dollars in additional spending for health research so that we can find a cure and the answers to what patients are demanding today.”

Consumer groups, including Consumers Union, the policy and moblization arm of Consumer Reports, have deep concerns that this effort to speed medical innovation comes with a potentially harmful tradeoff for consumers.

“The unfortunate consequence of 21st Century Cures is that less thoroughly tested medications and medical devices will reach the market,” says Lisa McGiffert, director of Consumer Reports’ Safe Patient Project. “And that means that consumers will have less assurance that a new treatment will help and not harm them.”

More Research Dollars

The bill directs $4.8 billion over the next decade to research, in part, to fight cancer.

“Considering that one in two men and one in three women will be diagnosed with cancer in their lifetime, cancer research funding is an investment in yours, mine, and everyone’s health,” says David Pugach, vice president of federal relations at the American Cancer Society Cancer Action Network, the advocacy arm of the ACS.

Pugach says 21st Century Cures represents a “historic opportunity” to accelerate cancer research. “This includes devoting more resources to improve and use new treatments like immunotherapy,” he says, “where the body’s own defenses are used against cancer—as well as creating ways for researchers to more easily share data so they can see patterns across studies more quickly.”

The bill also allocates funds to treat brain disorders, combat opioid abuse, improve suicide prevention programs, and provide mental health care to children. It establishes a task force for research on women who are pregnant or breastfeeding because these women are typically excluded from medical studies.

Faster Drug Approvals, But Lower Standards

The Cures Act loosens requirements for how drugs are studied and approved that have been in place since 1962.

Here's how it usually works: A company submits evidence from studies done under controlled conditions, comparing patients who received the treatment with those who didn't. The studies typically have to show that people who were given the new drug lived longer or felt better than those who didn't get it.

This kind of research can be expensive and time-consuming for drug companies to collect, says Diana Zuckerman, Ph.D., president of the National Center for Health Research, a nonprofit think tank focused on health research. Cancer drugs, for example, can take several years to show that a drug improves survival.

The Cures Act calls on the FDA to approve some drugs more quickly, based on less thorough testing. The problem with this, says Zuckerman, is that “getting drugs to market faster doesn’t help consumers at all if they turn out not to work or causes them harm.”

What Consumers Should Know

Once the Cures Act takes effect, consumers must be especially careful when considering a new medication or medical device, says Orly Avitzur, M.D., Consumer Reports’ medical director.

"When you have a choice, you may want to consider treatments with a proven track record, as you'll have more assurance that they work and are safe," Avitzur says. "Always make sure someone has taken the time to thoroughly explain all the options to you, and the possible risks and benefits of each."

Editor's Note: These materials were made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by a multistate settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).

Consumers Union Urges FTC to Investigate Mylan for Possible Antitrust Violations

Reprinted from CONSUMERS UNION
POLICY & ACTION FROM CONSUMER REPORTS
www.consumersunion.org

Wednesday, September 7, 2016

WASHINGTON, DC – Consumers Union, the policy and mobilization arm of Consumer Reports, today sent a letter urging the FTC to investigate Mylan for possible anti-competitive practices and antitrust law violations, noting troubling reports of Mylan’s efforts to undercut EpiPen competitors and suppress consumer choice.

Consumers Union describes the five-fold price hike of EpiPen as a “calculated decision by Mylan to exploit its monopoly power to enrich itself and its executives at the expense of the millions of consumers who use this life-saving drug and delivery system as a failsafe,” after a review of the situation produced no legitimate justification for the rapid price hikes. While the letter notes that taking advantage of a marketplace monopoly does not, by itself, violate antitrust laws, the consumer group calls into question several examples of Mylan potentially running afoul of the law.

“It is a violation for a company to maintain its monopoly power by sabotaging or undercutting efforts by competitors to give consumers a choice,” said George Slover, senior policy counsel for Consumers Union. “There are indications that Mylan may have resorted to questionable practices to block competition and sustain its monopoly. The FTC has the authority to prosecute anticompetitive marketplace abuses and we urge the Commission to thoroughly investigate and take appropriate action based on what it uncovers.”

New York Attorney General Eric Schneiderman yesterday announced an investigation into Mylan’s practices and Senators Klobuchar and Blumenthal have also called on the FTC to investigate the company’s conduct.

Visit ConsumersUnion.org to read the full letter.

Consumers Union is the policy and mobilization arm of Consumer Reports.  Consumers Union works for health reform, food and product safety, financial reform, and other consumer issues in Washington, D.C., the states, and in the marketplace. Consumer Reports is the world’s largest independent product-testing organization.  Using its more than 50 labs, auto test center, and survey research center, the nonprofit rates thousands of products and services annually.  Founded in 1936, Consumer Reports has over 8 million subscribers to its magazine, website, and other publications.

Safety Groups Urge Government to Recall Ikea Dresser

Three Deaths from falling furniture prompt urgent call for action from Consumer Reports and its partners

Consumer Reports / Daniel DiClerico / April 27, 2016

Following a report last week by the Philadelphia Inquirer that the death of a 22-month-old boy in February was caused by a falling Malm IKEA dresser, Consumer Reports, along with several consumer and child safety groups, is urging the U.S. Consumer Product Safety Commission (CPSC) to secure a formal recall of the IKEA dresser responsible for the tragedy. This is the third confirmed tip-over death from a Malm IKEA dresser.

In a joint letter issued today to CPSC Chairman Elliot Kaye, Consumers Union, the policy and advocacy arm of Consumer Reports, along with Kids In Danger, the Consumer Federation of America, and the National Center for Health Research, urged the federal safety agency to take strong, immediate action to better protect children from the tip-over hazard of certain Malm IKEA dressers.

Both IKEA and the CPSC were aware of the safety concerns with this particular furniture line prior to this latest incident. In July 2015, the commission and Sweden-based retailer announced two deaths from tipping IKEA dressers and launched a repair and education campaign for the products. But the warnings stopped short of a recall.

The announcement also didn’t inform consumers that Malm IKEA dressers fail to meet a voluntary safety standard agreed to by the furniture industry (ASTM F2057-14), which requires testing to ensure that each dresser drawer can withstand a 50-pound weight, while open, without the unit tipping over.

While voluntary standards like this one can’t be enforced by the government—unlike mandatory federal safety standards—it is possible that tragedy may have been averted if the IKEA dressers involved in the latest incident complied with the industry standard.

"To learn that a tipping IKEA Malm dresser killed yet another child, when the company and the CPSC chose not to do a recall after the first two deaths, is beyond heartbreaking—it is unacceptable,” writes Consumer Reports, along with its fellow safety advocates. “We recommend a stop sale of the type of furniture that was involved in deaths and that does not meet the ASTM standard, as well as refunds for consumers who want them,” the group added. “For those who want to anchor the furniture, IKEA should develop a program to provide an incentive for consumers to anchor their furniture.”

While a particularly restrictive federal law limits the information that the agency can disclose, CPSC Chairman Elliot Kaye said in response to the safety groups' letter, “I wholeheartedly agree that more needs to done, quickly, to protect innocent children from the hidden hazard of furniture tip-overs. Without commenting on any specific case, companies are on notice that even if there has been a public announcement about a remedy to address a dangerous product, the company must take every possible step to prevent further harm. This is especially the case when a child dies. Companies need to move fast and work with us on a comprehensive plan that offers their customers every necessary measure required for the sake of safety. I expect companies to truly put safety first, period.”

Click the link for more details:

http://www.consumerreports.org/home-garden/ikea-dresser-tip-overs-/

Cheers for Lisa McGiffert

Lisa McGiffert Makes Modern Healthcare’s “100 Most Influential People in Healthcare”

Lisa McGiffert, Director of Consumers Union’s Safe Patient Project, was recognized in Modern Healthcare’s “100 Most Influential People in Healthcare” 2015 list. Consumer Reports couldn’t be more proud of Lisa and her accomplishments.

“This recognition is well-deserved and long overdue,” said Consumer Reports President & CEO Marta Tellado.

“Lisa has been a tireless leader in the fight to reduce deadly hospital infections and medical errors. Her work has helped save countless lives by shining the spotlight on this preventable epidemic and by mobilizing patients and their families to hold hospitals accountable for improving the care they provide. Lisa’s partnership with patient safety activists across the country has demonstrated how much impact ordinary citizens can have by joining together and working for change.”

Lisa joined Consumers Union, the policy and advocacy arm of Consumer Reports, in 1991, working on a full array of health issues in Texas before launching the national Stop Hospital Infections campaign in 2003. Through this campaign, Consumers Union was instrumental in helping to pass legislation in 30 states requiring hospitals to publicly disclose their patient infection rates. Our success in the states helped prompt the federal government to establish a national hospital infection public reporting program in 2011.

As Director of CU’s Safe Patient Project, Lisa has been a tenacious advocate on a number of other patient safety issues, including working to eliminate preventable medical errors and to improve the safety of physician care and medical devices. She lobbies on national and state patient safety legislation and regulations to improve accountability and expand public disclosure about medical harm. Lisa provides a strong voice for consumers at conferences, with the media and when serving on state and national advisory committees, including current positions on the National Quality Forum Patient Safety Committee, the Measures Application Partnership (advises the Center for Medicare and Medicaid Services on quality measures for public reporting and pay for performance programs), and CDC’s Healthcare Infection Control Practices Advisory Committee.

She has led the development of a national patient safety activist network through collaboration with individuals who have personal experiences with medical harm, providing technical support and training for their work on state legislation and regulations.

Here’s what some Safe Patient Project activists had to say about Lisa’s award:

So good to see you, Lisa, on this list!! It shows what a strong leader of this movement you are and how our work is being heard and our voice is powerful.

Congratulations, Lisa!! We are honored to know you and to have been working with you to save more lives.

This is well deserved recognition for all you do in patient safety around the nation, and especially with the advocates and other people you touch every day! You are just getting started!

We believe that Lisa’s work has made a real difference in the way that American health care is delivered, and her work opens minds and commands attention. From Suzanne Henry, Safe Patient Project Policy Analyst: 

“Lisa influences the way leaders in healthcare approach their work when it comes to patient safety. She has led the charge to quantify patient safety measures, specifically hospital infections. And after ten years of passing laws to require reporting of hospital infections, the guessing game is over. Hospitals can now tell a story about their efforts to prevent infections. Patients can know if hospitals are reducing their infection rates. And reducing infections results in lives saved. Medical harm is the third leading cause of death in the U.S., a statistic that might have gone unnoticed and unchanged without Lisa’s work.”