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  • Why Do Politicians Weaponize Medicare? Because It Works

    Why Do Politicians Weaponize Medicare? Because It Works

    Julie Rovner, Kaiser Overall health Information

    The Medicare wars are back again, and nearly no 1 in Washington is amazed.

    This time it’s Democrats accusing Republicans of wanting to maim the very well-liked federal wellbeing software that addresses 64 million seniors and individuals with disabilities. In the earlier, Republicans have productively pinned Democrats as the risk to Medicare.

    Why do politicians persistently wield Medicare, as perfectly as Social Security, as weapons? Simply because heritage shows that functions at the ballot box. Normally, the get together accused of menacing the sacrosanct entitlements pays a price tag — though it is the millions of beneficiaries relying on feuding lawmakers to retain the courses funded who stand to lose the most.

    Republicans have regularly warned they would hold increasing the federal financial debt ceiling hostage unless Democrats negotiated modifications to Medicare, Medicaid, and Social Security. The 3 systems jointly, together with funding for the Reasonably priced Treatment Act and Children’s Overall health Coverage Software, account for just about 50 {fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of the federal finances.

    The political bomb that went off during President Joe Biden’s State of the Union speech on Feb. 7 experienced been ticking for months. In his speech, Biden threatened to veto any Republican attempts to cut Social Security or Medicare. It was one particular of only a few veto threats he created that night. During a vacation to Florida right after the speech, he claimed it more forcefully: “I know a whole lot of Republicans, their dream is to reduce Social Safety and Medicare. Perfectly, let me say this: If which is your dream, I’m your nightmare.”

    Senior Republicans have distanced them selves from the proposals Biden was referencing, notably strategies from the Household Republican Research Committee and Sen. Rick Scott (R-Fla.) to make cuts or even permit Medicare expire unless Congress votes to hold it going.

    “That’s not the Republican system that’s the Rick Scott system,” Senate Minority Leader Mitch McConnell said on a Kentucky radio show Feb. 9, echoing his opposition to the system very last year.

    “Cuts to Social Stability and Medicare are off the desk,” House Speaker Kevin McCarthy declared the day right before Biden’s veto menace.

    McConnell and McCarthy know a little something that Rick Scott seemingly does not: Politicians threaten large, well-known entitlement systems at their peril. And, usually, it’s been Republicans who endure the electoral implications.

    This dates at minimum to 1982, when Democrats made use of threats of Republican cuts to Social Safety to pick up extra than two dozen Household seats in President Ronald Reagan’s initially midterm elections. In 1996, President Bill Clinton won reelection in element by convincing voters that Republicans led by Household Speaker Newt Gingrich wanted to privatize Medicare and Social Protection.

    At the beginning of his next phrase, in 2005, President George W. Bush created it his top precedence to “partially privatize” Social Security. That proved singularly unpopular. In the adhering to midterm elections, Democrats won again the House for the to start with time since shedding it in 1994.

    In 2010, Republicans turned the tables, making use of what they explained as “Medicare cuts” in the Economical Care Act to sweep back again to power in the Residence. (People “cuts” ended up mainly reductions in payments to providers beneficiaries essentially got extra advantages by means of the ACA.)

    The use of the Medicare cudgel possible attained its zenith in 2012, when Democrats took purpose at Medicare privatization proposals provided by Paul Ryan, the Dwelling Finances Committee chair and Republican vice presidential prospect. That discussion generated the infamous “pushing Granny off the cliff” ad.

    The actuality is that Medicare’s price as a political weapon also sabotages any exertion to arrive together to clear up the program’s funding problems. The past two moments the Medicare Healthcare facility Insurance policy Belief Fund was this close to insolvency — in the early 1980s and late 1990s — Congress passed bipartisan charges to preserve the plan afloat.

    Even the term “cut” can be political. A single stakeholder’s Medicare “cut” is another’s benefit. Lessening payments to healthcare vendors (or, far more generally, reducing the dimensions of payment increases to medical practitioners and hospitals) could reduce premiums for beneficiaries, whose payments are centered on overall plan expenditures. Boosting rates or price tag sharing for beneficiaries is a advantage to taxpayers, who help fund Medicare. Expanding readily available positive aspects assists vendors and beneficiaries, but expenditures additional for taxpayers. And on, and on.

    There are elementary discrepancies among the get-togethers that just cannot be papered above. Lots of Republicans want Medicare to change from a “defined benefit” application — in which beneficiaries are confirmed a certain established of products and services and the federal government pays no matter what they price tag — to a “defined contribution” software, in which beneficiaries would get a certain quantity of income to finance as a lot as they can — and would be on the hook for the rest of their medical costs.

    This would change the hazard of wellness inflation from the authorities to the beneficiary. And though it evidently would benefit the taxpayer, it would downside both equally suppliers and beneficiaries of the system.

    But there are quite a few, numerous intermediate steps Congress could consider to at the very least delay insolvency for both equally Medicare and Social Security. Some are far more controversial than others (boosting the payroll tax that funds Medicare, for instance), but none are outside of the techniques past Congresses have taken every single time the systems have neared insolvency.

    Republicans are right about this: Medicare and Social Protection just cannot be “fixed” till the two sides lay down their weapons and commence conversing. But each individual time a granny in a wheelchair receives pushed off a cliff, that truce looks considerably less and less possible.

    HealthBent, a typical function of Kaiser Health Information, delivers insight and analysis of policies and politics from KHN’s chief Washington correspondent, Julie Rovner, who has included wellbeing care for much more than 30 years.

    KHN (Kaiser Wellness News) is a national newsroom that produces in-depth journalism about health and fitness difficulties. With each other with Policy Examination and Polling, KHN is a person of the a few important running programs at KFF (Kaiser Relatives Basis). KFF is an endowed nonprofit corporation providing information on wellness challenges to the country.

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  • KAISER HEALTH NEWS: Centene showers politicians with millions as it courts contracts and settles overbilling allegations | News

    KAISER HEALTH NEWS: Centene showers politicians with millions as it courts contracts and settles overbilling allegations | News

    On Nov. 2, 2021, Nevada Gov. Steve Sisolak’s reelection campaign received 10 separate $10,000 contributions from what appeared to be unrelated health insurance plans from across the country.

    The Buckeye Community Health Plan of Ohio, Louisiana Healthcare Connections, and Peach State Health Plan of Georgia were among the companies that sent money to the Democrat, according to state campaign finance records, even though only one, SilverSummit Healthplan, provided insurance in the Silver State.

    But a thread connects the companies: Each is a subsidiary of Centene Corp., ranked 26th on the Fortune 500 list, and the nation’s largest private managed-care provider for Medicaid, the government insurance program for people with low incomes or disabilities.

    Centene had already sealed Medicaid deals in Nevada through its SilverSummit subsidiary — yet a potential new line of business was on the horizon. Sisolak, who is up for reelection Nov. 8, had just approved a new public health plan option that would later open up to bidding from contractors such as SilverSummit.

    And then, less than two months after Centene’s subsidiary contributions were made, Nevada settled with the company over allegations the insurer overbilled the state’s Medicaid pharmacy program. The state attorney general’s office did not publicly announce the $11.3 million settlement but disclosed it in response to a public records request from KHN.

    Sisolak — who has accepted at least $197,000 from Centene, its subsidiaries, top executives, and their spouses since August 2018 — issued a statement through his campaign spokesperson Molly Forgey that said Medicaid contracts are awarded by an independent group. “There is zero correlation between Centene’s donations and how the governor legislates,” Forgey said. “The governor in no way acts unilaterally in decisions to award state contracts.”

    The contract went before the Nevada Board of Examiners for final approval. Sisolak is one of three voting members.

    Centene has similarly amplified campaign contributions to governors in New York and South Carolina, two states where it has profitable contracts and such giving by multiple subsidiaries is allowed. And despite having pledged to investors to disclose its political giving, Centene has revealed to shareholders only a portion of its contributions — omitting much of its subsidiary giving from reports on its website.

    Under corporate law, each subsidiary is its own business, which allows companies to increase their political footprints in some states by giving the maximum allowed donations from more than one entity, said Ciara Torres-Spelliscy, a law professor at Stetson University in Florida.

    “In some cases, they can increase it tenfold depending on how many subsidiaries and how much money they want to aim at a particular politician,” Torres-Spelliscy said. “They will exploit any loophole.”

    Since 2015, the St. Louis-based insurance behemoth, its subsidiaries, its top executives, and their spouses have given more than $26.9 million to state politicians in 33 states, to their political parties, and to nonprofit fundraising groups, according to a KHN analysis of IRS tax filings and data from the nonpartisan, nonprofit group OpenSecrets. That total doesn’t include the millions of dollars Centene and its subsidiaries have given to state politicians’ political action committees because OpenSecrets doesn’t track those donations. The KHN analysis also does not include giving to congressional and presidential candidates.

    It’s a purposeful political investment: Centene earns billions of dollars from governments and then uses its profits to back the campaigns of the officials who oversee those government contracts. The company has developed this sophisticated, multipronged strategy as it pursues even more state government-funded contracts and defends against sweeping accusations that it overbilled many of those very governments.

    Centene declined to make a representative available for an interview and didn’t respond to specific questions about its political giving. But company spokesperson Suzy DePrizio said in a statement that the company follows all local, state, and federal laws and records all contributions from its political action committee. She said Centene’s contributions “are intended to serve as support to those who advocate for sound public policy healthcare decisions, which is evident by our nearly equal support of candidates from both parties.”

    This year, according to IRS filings that go through Sept. 30, Centene has given $2.2 million, combined, to the Republican and Democratic governors’ associations, which help elect candidates from their respective parties. And Centene gave $250,000, combined, to the Republican Attorneys General Association and its Democratic counterpart.

    Since last year, state attorneys general, whose campaigns are benefiting from the associations’ money, have negotiated massive settlements with Centene over accusations the company’s prescription drug programs overbilled Medicaid.

    More than 20 states are investigating or have investigated Centene’s Medicaid pharmacy billing. The company has agreed to pay settlements to 13 of those states, with the total reaching about $596 million. And Centene told KHN in October that it is working to settle with Georgia and eight more states that it didn’t identify. It has denied wrongdoing in all the investigations.

    KHN found that Centene, like many corporations, also pays dozens of lobbyists in state capitals across the country and in Washington, D.C. It courts officials with fundraising parties and perks such as tickets to sporting events like Sacramento Kings games. And it helps fund committees set up to pay for governors’ inaugural events — as it did for Sisolak, with a $50,000 donation, separate from its campaign contributions, according to the Nevada secretary of state’s office.

    Executives and their family members make political contributions in their own names. For example, from 2015 through 2021, Centene’s then-CEO Michael Neidorff and his wife, Noémi, wrote at least $380,000 in personal checks to state candidates, with more than 60{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} going to California Gov. Gavin Newsom, a Democrat who governs a state where the insurer generated 11{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of its revenue in 2019. The Neidorffs lived in St. Louis.

    There’s no proof Centene’s contributions swayed politicians’ decisions, but campaign finance experts say money can translate into access and that can lead to influence.

    “They’re trying to protect their market share,” said Gerald Kominski, a senior fellow at the UCLA Center for Health Policy Research. “They see it as necessary to maintain good relations with the agencies and with the individuals who are involved in decision-making because that’s the way government works.”

    Billing Question Surfaces in Ohio

    Health care industry players — from insurers, to doctor lobbying groups, to drug companies — routinely make large political donations. Centene rival Elevance Health, formerly known as Anthem, has spent at least $21.8 million on state political contributions since 2015, according to KHN’s analysis.

    What makes Centene stand apart from competitors is the massive share of its business that is funded by taxpayers. Founded as a nonprofit in 1984 by a former hospital bookkeeper, Centene earned $126 billion in revenue last year — up from $5 billion a decade ago, according to the company’s annual reports.

    Its rocketing revenue has been fueled by its thriving Medicaid managed-care business, takeovers of competitors, and growth in its Medicare Advantage membership and in enrollment in health plans it sells via the Affordable Care Act health insurance marketplaces. Centene’s Ambetter plans, available on the exchanges, have the highest enrollment nationally. The company has also locked up lucrative deals to deliver health care to state prisoners, military members, and veterans.

    Centene has reported that two-thirds of its revenue comes from state Medicaid contracts that cover about 15 million people across the country.

    So when Ohio Attorney General Dave Yost sued Centene in March 2021 over what he called a complex scheme of “corporate greed” to “fleece taxpayers out of millions,” other states took notice.

    Ohio investigators accused Centene of overcharging the state’s Medicaid program through the company’s pharmacy benefit managers, which provided medications to Centene-managed Medicaid patients. Pharmacy benefit managers, known as PBMs, act as middlemen between drugmakers and health insurers and as intermediaries between health plans and pharmacies.

    Centene denied wrongdoing but faced immediate consequences. Ohio officials froze its application to renew its contract to offer insurance to state Medicaid enrollees.

    “Ohio had Centene over a barrel,” said Antonio Ciaccia, a consultant who worked with the state on the dispute.

    The company settled three months later for $88.3 million. Its application was soon unfrozen, and it won a Medicaid contract that summer for its subsidiary Buckeye Health, whose lobbyists include Michael Kiggin, a law school buddy of Republican Gov. Mike DeWine.

    Dan Tierney, a spokesperson for DeWine, said the state’s competitive bidding process was reviewed by a court, which “noted Buckeye Health Plan scored highly in the bid process.”

    Since last year, 12 other states have settled with Centene over pharmacy services: Arkansas, Illinois, Kansas, Louisiana, Massachusetts, Mississippi, Nebraska, Nevada, New Hampshire, New Mexico, Texas, and Washington.

    Of the states that have reached settlements so far, at least five have subsequently awarded government contracts to the company. Louisiana settled with the insurer in November 2021 for $64.2 million and just three months later awarded a statewide Medicaid contract to Centene’s subsidiary Louisiana Healthcare Connections. KHN learned of the settlement, which was not previously publicly announced, in October through a records request.

    Nebraska officials also hadn’t publicly announced the state’s $29.3 million settlement with Centene in December until they received a recent KHN public records request. Nine months after the settlement, the state awarded Centene subsidiary Nebraska Total Care a Medicaid contract.

    One reason Centene keeps winning contracts, Kominski said, is that such large insurers don’t have much competition in some parts of the country. “It’s not as if states can easily say, ‘OK, we’re going to have an open competition’ and then they have hundreds of insurers willing to participate in the marketplace,” Kominski said. “Health care is not, in general, a very competitive marketplace.”

    Some politicians are tired of that playbook. In Mississippi, the state House of Representatives voted in February to prohibit Republican Gov. Tate Reeves’ administration from awarding a contract to any company that the state had settled with for more than $50 million. Centene paid Mississippi $55.5 million the year before.

    “I am for doing away with our business to a company who took $55 million of our money that was supposed to be spent on the poor, the sick, the elderly, the mentally ill, the disabled,” Republican state Rep. Becky Currie, who authored the amendment, told her colleagues on the House floor.

    The House adopted Currie’s amendment, but the Senate stripped it out of the bill.

    Reeves’ gubernatorial campaign committee has received $210,000 from Centene since 2015, according to OpenSecrets data, and Mississippi lawmakers and party organizations have reaped at least $600,000. Reeves’ office did not respond to multiple requests for comment about the donations.

    In August, just over a year after the settlement, Mississippi awarded Centene subsidiary Magnolia Health Plan a new Medicaid managed-care contract.

  • Impending abortion decision weighs on politicians, health care officials- POLITICO

    Impending abortion decision weighs on politicians, health care officials- POLITICO

    Good morning and welcome to Monday’s New York Health Care newsletter, where we keep you posted on what’s coming up this week in health care news, and offer a look back at the important news from last week.

    New York politicians are preparing for the arrival of pregnant people coming here to seek abortions if and when the Supreme Court overturns Roe v. Wade. Executives at NYC Health + Hospitals — the city’s public hospital system and largest abortion provider — said it anticipates scaling up services once abortion becomes illegal in states across the country.

    What New Yorkers won’t be seeing this year is a state-level equal rights constitutional amendment. State Sen. Liz Krueger, a Manhattan Democrat, told POLITICO that the constitutional amendment was “dead for now” and unlikely to see any action until next year. The issue has stalled in Albany for years amid debate over the proposal’s scope and concerns of its effect on religious freedoms.

    Want to receive this newsletter every weekday? Subscribe to POLITICO Pro. You’ll also receive daily policy news and other intelligence you need to act on the day’s biggest stories.

    SESSION ENDS — With the U.S. Supreme Court expected to soon issue a ruling that could strike down the landmark Roe v. Wade decision, Albany lawmakers spent the final days of the 2022 legislative session passing a series of bills to shore up protections for abortion providers and patients who travel to New York for the procedure, POLITICO’s Shannon Young reports.

    The Assembly approved legislation late Thursday that would prohibit disciplinary measures against health practitioners for providing legal reproductive health services to patients who reside in states where abortion is illegal, S9079/A9687; and bar medical malpractice insurance companies from taking any adverse action against a reproductive health care provider who performs legal reproductive health care, A9718/S9080.

    They were the only two that had yet to clear the Assembly out of a six-bill abortion-related package that passed the Senate earlier in the week.

    Assemblymember Linda Rosenthal, a Manhattan Democrat and sponsor of those bills, said they will ensure “the women and men who continue to provide reproductive healthcare, can do so without fear of persecution or prosecution.”

    Gov. Kathy Hochul announced late Thursday that she looks “forward to signing these bills into law.” “The Supreme Court is poised to overturn Roe v. Wade this month — but New York will be ready,” she said.

    But the governor’s statement was silent on another abortion-related measure that failed to move in the final hours of the 2022 session: a state-level equal rights constitutional amendment. Hochul and other Democrats had called for amending the state constitutional to protect abortion rights after POLITICO first reported on a U.S. Supreme Court draft opinion that could soon strike down Roe. 

    State Sen. Liz Krueger, a Manhattan Democrat, told POLITICO Thursday that the constitutional amendment was “dead for now” and unlikely to see any action until next year. The issue has stalled in Albany for years amid debate over the proposal’s scope and concerns of its effect on religious freedoms.

    The New York Civil Liberties Union, National Institute for Reproductive Health Action Fund and Planned Parenthood Empire State Acts, which have all endorsed Krueger’s “Equality Amendment,” called on the Legislature Friday to return to Albany and take up the amendment during a special session.

    IN OTHER NEWS: 

    — Hochul touted the Fiscal Year 2023 budget’s inclusion of more than $3 million for Choose Healthy Life to address health inequities and administer preventative wellness programs run by 20 churches during a Friday event in Harlem.

    — New York’s adult cigarette smoking rate hit a new low of 12 percent in 2020, Health Commissioner Mary Bassett announced Friday. The rate was even lower among young adults aged 18 to 24 at just 5.5 percent.

    — Mayor Eric Adams on Friday encouraged attendees at the Cannabis World Congress & Business Exposition to “light up” and bring ideas to his administration for improving the burgeoning industry in New York City. “We have to make people whole who have gone through some very difficult periods of over policing in the area of cannabis through this entire state,” Adams said, saying he wants to help those individuals with job training and improving their credit reports.

    After his brief remarks, Adams toured the exhibition hall at the Javits Center to speak with a few vendors, including a CBD-infused soap brand and food product line. Adams neither sampled the products nor responded to reporter’s questions about his preferred cannabis products. “Any time you have a new industry, you have to really keep the laws in line with the movement of that industry, and I don’t believe we have done that yet,” he told reporters about illegal weed trucks.

    WE LOVE TO HEAR FROM YOU: This roundup is for you! Send news tips, health tips, ideas, criticisms and corrections to [email protected] and [email protected].

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    The New Yorkerpublished a deep dive on how cars kill pedestrians, and how efforts like Vision Zero and speed cameras have made some difference.

    Rising debt in older Americans may adversely affect their health.

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    MISSED A ROUNDUP? Get caught up on the New York Health Care Newsletter.