ST. PAUL, Minn. – From coast to coast, people who rely on Medicare Part D could be left without their medications if a proposal by the Centers for Medicare and Medicaid Services is adopted.
Medicare Part D is a federal program that subsidizes prescription drug costs for 45 million seniors and people with disabilities. The feds say they want to amend what's called the "six protected classes rule," and allow insurers to exclude many drugs from Part D plans.
Fatima Hyacinthe, trainer and engagement director with the Black AIDS Institute, says people who rely on those medications already report discriminatory practices by insurance companies, despite the rules.
"Situations where people who were in treatment for substance use disorder, and as soon as they were seen to not need that kind of intensive treatment – which is often the best practice for treatment – their insurance stops covering it," says Hyacinthe.
The CMS says the change would save money, but opponents warn that short-term savings could be canceled out by more spending on emergency-room visits.
This month, a California judge ruled against Minnesota's UnitedHealth Group, after determining the insurer discriminated against patients with mental health and substance abuse disorders in order to save money.
The proposal was made late last year but has not yet taken effect. Consumer advocates say removing drug-price protections from people with a serious illness could make a dire situation worse.
Hyacinthe sees the Medicaid Part D proposal as part of a broader attack on equality in health care.
"One day, we're defunding Medicare Part D or taking the teeth out of it," says Hyacinthe. “Another day we're creating work requirements for Medicaid recipients. And these things target the same group of folks – again and again, and again."
The Trump administration's proposal also would allow insurers to require that a patient try cheaper and potentially less effective medications first – and only grant access to newer, more effective prescriptions if the cheaper medications don't work.
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It's been 13 years since more than 156,000 West Virginians gained health insurance coverage through the Affordable Care Act.
As sweeping and sometimes controversial as the ACA has been, its longer-term effects are still being felt today at the state level.
Gary Zuckett, executive director of the West Virginia Citizen Action Group, pointed to a new West Virginia law capping insulin copays at $35 per month. The law goes into effect January 1.
"I think we now have the best insulin copay cap legislation in the country that we just helped get passed in a very 'red' legislature," Zuckett noted. "Which does show you that health care is not partisan."
Federal data shows since the launch of the federal health insurance exchange, enrollment in health insurance plans has doubled from 8 million to more than 16 million nationwide.
According to the West Virginia Center on Budget and Policy, the Medicaid expansion included in the ACA allowed more than 200,000 West Virginians to gain access to health coverage.
Zuckett cautioned when the "continuous coverage" rules enacted during the pandemic expire April 1, the state will begin re-evaluating people's eligibility, which could signal a setback in progress.
"A lot of people won't qualify or won't fill out the paperwork, and they'll lose their health insurance in West Virginia," Zuckett explained. "That could be as many as 50 or 100,000 people. So, that's going to be a step backwards."
According to America's Health Rankings, around 6% of West Virginians were uninsured in 2021, far fewer than the nearly 16% of the state's population who lacked coverage prior to the Affordable Care Act.
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Beginning next year, more Kentuckians will have expanded access to biomarker testing - which helps doctors customize cancer treatment. Advocates of the new law say it will save lives and improve patients' quality of life.
Signed into law by Gov. Andy Beshear, House Bill 180 requires both private insurers and Medicaid to cover biomarker testing after a cancer diagnosis.
Doug Hogan - director of government relations for the American Cancer Society Cancer Action Network (ACS CAN) - explained that without biomarker testing, doctors typically try several rounds of chemotherapy or other treatments, without knowing which will work best for the patient.
He said biomarkers increase the odds of matching the right treatment to a specific cancer.
"We will be the fifth state in the country to adopt an enhanced access to biomarker testing law," said Hogan. "And so, we're on the cutting edge. This is the way that we can utilize technology to improve health outcomes."
The bill passed unanimously in both the House and Senate. According to the American Cancer Society, more than 30,000 Kentuckians will be diagnosed with cancer this year.
Hogan added that the new law will allow care teams to use the latest technology to make the best decisions for their patients.
"It is so important for these patients to get that right treatment at the right time," said Hogan. "It really will improve their health outcomes. It will save lives in many instances, and certainly will improve the quality of life."
Research shows biomarkers can in many cases reduce the cost of therapy, especially for lung cancer and colorectal cancer patients.
Cancer-care costs are expected to top more than $245 billion by 2030, according to the American Association for Cancer Research.
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Oregon's nonprofit hospitals are not doing enough to provide assistance on medical bills for low-income patients, but a bill in Salem aims to change it.
Nonprofit hospitals are required by federal law to alleviate medical costs for patients who cannot afford them.
Matt Swanson, political strategist for the Service Employees International Union Oregon State Council, said investigations have found the institutions are not going far enough to help.
"People really aren't getting the assistance they need," Swanson explained. "Instead, they're getting every last dollar really wrung out of them in order to satisfy a bill that they really can't pay, and it's risking other things in their life, like housing and food and the ability to get over their health issue."
House Bill 3320 is designed to ensure people get the financial assistance they need and hospitals are transparent about their assistance practices. In written testimony on the bill, the Oregon Association of Hospitals and Health Systems said it agrees with parts of the legislation but wants lawmakers to keep in mind insurers are part of the cost picture as well.
Swanson added it is important for people who cannot afford medical bills to know they have assistance available.
"The purpose of this bill is to really tighten up what compliance looks like," Swanson emphasized. "And ensure that everyone gets screened before they are sent a bill, so that the hospital is giving a hand to folks who need the help, instead of letting them get lost in systems that are often confusing and overwhelming at a time when they're really struggling."
The bill received a public hearing last week and is scheduled for a work session Wednesday.
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