Democrat Warren: Medicare for All would not raise U.S. middle-class taxes ‘one penny’

NEW YORK/WASHINGTON (Reuters) – Democratic U.S. presidential candidate Elizabeth Warren on Friday proposed a $20.5 trillion Medicare for All plan that she said would not require raising middle-class taxes “one penny,” answering critics who had attacked her for failing to explain how she would pay for the sweeping healthcare system overhaul.

Warren said her plan would save American households $11 trillion in out-of-pocket healthcare spending over the next decade while imposing significant new taxes on corporations and the wealthy to help finance it.

“Healthcare is a human right, and we need a system that reflects our values,” Warren wrote in a 20-page essay outlining her plan. “That system is Medicare for All.”

The proposal to remake the U.S. healthcare system will face scrutiny from Warren’s more moderate Democratic opponents, who have questioned Medicare for All’s practicality.

Warren’s proposal also calls for cuts in defense spending and passing immigration reform to increase tax revenue from newly legal Americans, two steps that would face an uphill battle in Congress. The $20.5 trillion in new spending over 10 years would increase the entire federal budget by a third.

Warren, a U.S. senator from Massachusetts, is one of 17 Democrats vying for the party’s nomination to take on Republican President Donald Trump in the November 2020 election. She is near the front of the pack in opinion polls, having closed in on former Vice President Joe Biden, the early front-runner.

Medicare for All would replace private health insurance, including employer-sponsored plans, with full government-sponsored coverage, and individuals would no longer have to pay premiums, deductibles, co-pays or other out-of-pocket costs.

It would extend Medicare, the U.S. government’s health insurance program for people 65 years and older and the disabled, to cover all Americans, including the roughly 27.5 million – 8.5% of the population – who are currently uninsured.

Warren, a former law professor, has become known for a bevy of detailed policy proposals. But she had faced criticism for not detailing how she would pay for a Medicare for All plan she backs, which was introduced in the Senate by rival Democratic candidate Bernie Sanders of Vermont.

At recent debates, Warren had refused to answer directly when asked whether she would be forced to raise middle-class taxes to cover the costs, even as Sanders acknowledged he would.

More moderate 2020 candidates such as Biden and South Bend, Indiana, Mayor Pete Buttigieg have said Medicare for All would be too disruptive and favor a more incremental approach.

‘MATHEMATICAL GYMNASTICS’

On Friday, Biden’s campaign questioned Warren’s calculations, calling them “double talk” and “mathematical gymnastics” and asserting that middle-class taxes would rise despite her vow.

“It’s impossible to pay for Medicare for All without middle-class tax increases,” said Kate Bedingfield, Biden’s deputy campaign manager. “To accomplish this sleight of hand, her proposal dramatically understates its cost, overstates its savings, inflates the revenue, and pretends that an employer payroll tax increase is something else.”

Warren, speaking to reporters in Iowa on Friday, said she was “just not sure where he (Biden) is going,” adding that her proposal and its costs were authenticated by outside experts.

“Democrats are not going to win by repeating Republican talking points and by dusting off the points of view of the giant drug companies and the giant insurance companies,” Warren said.

House of Representatives Speaker Nancy Pelosi also questioned the feasibility of enacting Medicare for All, saying in an interview with Bloomberg on Friday that Democrats should focus on expanding the Affordable Care Act, commonly known as Obamacare.

Critics like Warren note that the current U.S. healthcare system – a patchwork of private insurance often provided by employers or obtained through Obamacare marketplaces and public programs covering the poor, elderly and disabled – is the most costly in the world despite leaving tens of millions uncovered.

Medicare for All legislation stands little chance of passing Congress, where Democrats control the House and Republicans control the Senate.

The plan relies on aggressive ways of lowering healthcare costs, including major cuts in prescription drug prices and significant reductions in administrative costs by eliminating private insurers.

“She makes some assumptions about how effectively healthcare costs could be contained that may not pan out,” said Larry Levitt, a health policy expert at the Kaiser Family Foundation.

Employers would be asked to repurpose the money they currently spend on workers’ healthcare into Medicare contributions, while billionaires, high-earning investors and corporations would face trillions of dollars in higher taxes.

In an effort to appease union leaders, some of whom have expressed skepticism about giving up hard-fought healthcare plans, Warren said employers that already offer benefits under a collective bargaining agreement could reduce their contributions if they pass the savings along to workers.

FILE PHOTO: Democratic 2020 U.S. presidential candidate and U.S. Senator Elizabeth Warren (D-MA) speaks at a campaign town hall meeting at the University of New Hampshire in Durham, New Hampshire, U.S., October 30, 2019. REUTERS/Brian Snyder/File Photo

Warren released two letters supporting her calculations from several experts, including Simon Johnson, the former chief economist for the International Monetary Fund; Donald Berwick, who oversaw Medicare in the Obama administration; and Mark Zandi, the chief economist at Moody’s Analytics.

An online calculator launched by Warren’s campaign showed an average family of four with employer-provided insurance would save $12,378 per year.

Warren said with her Medicare for All plan in place, projected total healthcare costs in the United States over 10 years would be just under $52 trillion – slightly less than maintaining the current system.

Reporting by Amanda Becker and Joseph Ax; Additional reporting by John Whitesides in Iowa; Editing by Colleen Jenkins, Will Dunham and Jonathan Oatis

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Obamacare’s Star Ratings Offer A Glimmer Of Insight ― But Not For All

ST. LOUIS — As millions of Americans start shopping Friday for individual health insurance for 2020, they will see federal ratings comparing the quality of health plans on the Affordable Care Act’s insurance marketplaces.

But Christina Rinehart of Moberly, Mo., who has bought coverage on the federal insurance exchange for several years, won’t be swayed by the new five-star rating system.

That’s because only one insurer sells on the exchange where the 50-year-old former public school kitchen manager lives in central Missouri. Anthem Blue Cross Blue Shield in Missouri was not ranked by the Centers for Medicare & Medicaid Services.

“I’m pleased with the service I get with that and the coverage I have,” she said, noting she focuses on cost and whether her medications and checkups are covered.

Rinehart’s case illustrates one reason why the star ratings are unlikely to play a big role in people’s decision-making for the first year of the national rollout. Nearly a third of health plans on the federal exchanges don’t yet have a quality rating — including all the plans in Iowa, Kansas and Nebraska. Only one insurer is available in nearly a quarter of counties across the U.S. And consumers may not find the information behind the star ratings valuable without additional details, insurance experts say.

Across Missouri, Cigna is the only one of seven insurers to get ratings. The others have not yet been in the marketplace for the three years needed to merit a score.

Missouri is one of eight states that don’t have any health plans that earned at least three stars. The others are Iowa, Kansas, Nebraska, Nevada, New Mexico, West Virginia and Wyoming. States with the most three-star or higher health plans are New York (12), Michigan (10), Pennsylvania (9), Massachusetts (8) and California (7).

The star ratings are largely new to the federal exchanges, which operate in 39 states. About 80% of plans in the federal marketplaces earned three or more stars overall, CMS said. Only 1% earned five stars.

The new federal star ratings are based on three main areas: evaluations of the plans’ administration, such as customer service; clinical measures that include how often the plans provide preventive screenings; and surveys of members’ perception of their plan and its doctors.

Ratings can be viewed at healthcare.gov, where consumers review plans’ benefits and prices. Open enrollment runs from Friday through Dec. 15 for the federal exchange states, though enrollment lasts longer in the District of Columbia and most of the 11 states that operate their own marketplaces.

Last year, about 11.4 million people bought coverage on all the exchanges, with more than 80% getting federal subsidies to lower their premiums.

The good news for consumers is premium prices on the federal exchanges are dropping by about 4% on average for 2020.

And consumers generally will have a wider array of choices as more companies enter the markets. Nationally, the average number of health plan choices per customer has risen from 26 to 38, according to Joshua Peck, co-founder of Get America Covered, a nonprofit that helps people enroll and find coverage. Missouri, for example, will have 28 plans from its seven insurers, he said, up from 14 this past year.

Jodi Ray, who runs Florida’s largest patient navigator program as director of Florida Covering Kids & Families at the University of South Florida, is skeptical consumers will use the new ratings. Instead, she said, they will likely focus first on whether their doctor is on the plan, if their medications are covered, the size of the deductible and the monthly costs.

“The star ratings may fall out the door at that point,” she said.

Many of the states that operate their own exchanges have already offered quality ratings, which were required under the ACA. California’s insurance exchange has been providing quality ratings for several years, though it’s unclear how much weight consumers give them.

“They have a limited effect on consumers but have a significant effect on health plans,” said Peter Lee, executive director of Covered California, the state’s insurance exchange. “It does tip health plans to focus on what they can do to improve care, and I think that is a positive effect.”

Kaiser Permanente (which is not affiliated with Kaiser Health News) is the only insurer in the California exchange to garner the maximum five stars, Lee said. It also has the most enrollment of any plan in the state’s exchange. But, he noted, the plan has a lower share of the enrollment in Southern California partly because its prices are higher compared with rival insurers, indicating low cost may trump high rankings in attracting enrollees.

“It’s good news that nationally the federal marketplace is putting quality data out there for consumers,” Lee said. Still, he added, customers would want to see the specific criteria that matter to them, such as how well plans care for patients with diabetes. Currently, that data is not immediately accessible for consumers at healthcare.gov.

Consumers tend to stick with their insurer even when prices and benefits change, said Katherine Hempstead, a senior policy adviser at the Robert Wood Johnson Foundation, the nation’s largest public health philanthropy. “People think changing health insurance plans is a huge pain and they don’t know if things will get better or worse.” But, she added, “people respond to consumer ratings and reviews.”

The federal government already uses star ratings to help consumers choose a Medicare Advantage plan as well as compare hospitals. It began testing the exchange ratings in a handful of states over the past two years.

Heather Korbulic, executive director of the Nevada health exchange, worries the ratings could be steered by a relatively small number of member surveys. “It’s such a narrow sample,” she said, noting one plan’s rating was partly based on just 200 member reviews.

Even though many counties have only one insurer in 2020 ― most of them rural areas or clustered in the Southeast ― the number of enrollees with access to just one insurer is falling to 12% next year from 20% now.

States that have not expanded Medicaid see premiums that are 7% higher than states that have, according to a 2016 study from the U.S. Department of Health and Human Services.

“If you look at Arkansas, they’ve got nice competition in their marketplace, but they’ve also expanded Medicaid,” Watson said. “We look a lot like Mississippi, which is struggling to get insurance in rural counties.”

That leaves people, like Rinehart, stuck with one insurer.

Rinehart remains loyal to Anthem particularly after it helped her get care and deal with the costs of suffering four heart attacks in 24 hours nearly three years ago. She’s thrilled Anthem’s prices are down slightly for 2020.

“I wasn’t able to afford insurance before [the Affordable Care Act],” she said, “so it was a blessing to have.”

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Women lag men in receipt of kidney transplants, dialysis

(Reuters Health) – More men than women get kidney transplants and dialysis even though more women need these treatments for chronic kidney disease, a European study suggests.

Researchers examined five decades of data on the prevalence of chronic kidney disease and receipt of kidney replacement therapies like dialysis and transplants in nine European countries. Throughout the study period, women consistently lagged behind men in receipt of kidney replacement therapies – with about 60% of men and 40% of women who needed the treatments receiving them.

“These findings neither prove nor disprove the existence of gender disparity, but these results nevertheless might sensitize patients and their caretakers to potential sex differences, especially when it comes to initiating kidney replacement therapy,” said Dr. Manfred Hecking, senior author of the study and associate professor of internal medicine at the Medical University of Vienna.

That’s because the best time to consider dialysis or a transplant may vary from one patient to the next, and it’s unclear from the study results how much the disparities might have been influenced by biology, access to care, or other factors, Hecking and colleagues write in the Clinical Journal of the American Society of Nephrology.

“The best timing of kidney replacement therapy initiation is matter of debate,” Hecking said by email.

Clear reasons for kidney replacement therapy include severe fluid overload that can lead to congestion in the lungs as well as high potassium levels that can cause heart rhythm abnormalities, Hecking said.

“Kidney replacement therapy helps normalize these problems, and people who need kidney replacement therapy but don’t receive it might die.”

It’s not clear if women might have slower progression of kidney disease than men, making it possible for them to go longer before needing kidney replacement therapy, Hecking said.

But without needed dialysis, it’s also possible that women have a higher risk of dying from kidney problems than men because women tend to live longer and have lower risk of dying from something else, Hecking added.

To examine sex differences in kidney replacement therapy over time, Hecking and colleagues analyzed data reported to the European Renal Association-European Dialysis and Transplant Association Registry from 1965 to 2015.

The study included information on 230,378 patients, and 39% were women.

The gender gap in receipt of kidney replacement therapy widened with age.

However, the gap remained consistent over time even as the main reasons for dialysis and transplants shifted to include more people with kidney failure resulting from diabetes.

The study wasn’t designed to prove whether or how sex might impact receipt of kidney transplants or dialysis.

Still, the results suggest that patients should educate themselves about their treatment options when they have chronic kidney disease, said Dr. Catherine Clase of St. Joseph’s Hamilton Healthcare and McMaster University in Ontario, Canada.

“Women with low kidney function should receive education on their options and, supported by their social structures and their health care team, should feel free to make the decision for themselves about which management options they prefer,” said Clase, co-author of an editorial accompanying the study.

“In this regard, many people, both women and men, would prefer transplantation, but a big problem here is the relative scarcity of live donors,” Clase said by email.

“People with good kidney function, who are close to someone with kidney failure who is eligible for a kidney transplant, should strongly consider being assessed as potential donors,” Clase added. “All people should advocate for health policy that reimburses costs to donors and prioritizes a former donor who now has kidney failure to receive a transplant themselves.”

SOURCE: bit.ly/2qexKAo and bit.ly/2po1dYU Clinical Journal of the American Society of Nephrology, online October 24, 2019.

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Trump nominates MD Anderson oncologist as U.S. FDA Commissioner

(Reuters) – U.S. President Donald Trump has nominated Dr. Stephen Hahn, chief medical executive of the University of Texas MD Anderson Cancer Center, to lead the Food and Drug Administration, the White House said on Friday.

Hahn, a radiation oncologist who has been at MD Anderson in Houston since 2015, if confirmed would follow Scott Gottlieb as FDA commissioner. Hahn’s nomination passes over Ned Sharpless, a previous director of the National Cancer Institute (NCI), who is currently serving s acting FDA commissioner.[L1N20Z12K]

Sharpless will return to his role at NCI, the U.S. Department of Health and Human Services announced on Friday.

Hahn, who had previously been head of radiation oncology at Philadelphia’s University of Pennsylvania School of Medicine, would be taking over a regulatory agency that oversees products ranging from complex cancer drugs to food, cosmetics and tobacco.

“The FDA is a massive government bureaucracy… There is a political aspect to running the FDA that is not really something that Dr. Hahn has done in the past,” said Christopher Mikson, leader of law firm Mayer Brown’s FDA regulatory practice.

“One of the reasons the Trump Administration would bring him in is because is an outsider. He is an academic medical administrator from Texas by way of Philadelphia, not a Washington insider,” Mikson added.

Hahn briefly worked for at the NCI earlier in his career.

Gottlieb, who stepped down from the post earlier this year, was well regarded by public health advocates and won bipartisan support for his efforts to curb use of flavored e-cigarettes by youth and to speed approval for lower cost generic medicines.

E-cigarettes and vaping products also will likely be on Hahn’s agenda. Vaping products have been linked in recent months to a mysterious lung illness that has killed nearly three dozen people in the United States and sickened more than 1,600.

The Centers for Disease Control and Prevention has said it is still uncertain of the exact cause of the serious lung illnesses, but most cases have been linked to vaping products containing the marijuana ingredient THC.

The FDA has said it plans to begin enforcing existing law that requires vaping products to show that they are “appropriate for the protection of public health” before they can receive marketing approval from the agency.

Several states have already banned flavored vaping products.

While e-cigarettes have been promoted as a means to help people quit smoking, public health officials are concerned they are being marketed to get a new generation hooked on nicotine.

Reporting by Deena Beasley; Editing by Bill Berkrot

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Number of Americans With Dementia Will Double by 2040: Report

News Picture: Number of Americans With Dementia Will Double by 2040: Report

Latest Alzheimer’s News

WEDNESDAY, Oct. 30, 2019 (HealthDay News) — Nearly 13 million Americans will have dementia by 2040 — nearly twice as many as today, a new report says.

The number of women with dementia is expected to rise from 4.7 million next year to 8.5 million in 2040. The number of men with dementia is projected to increase from 2.6 million to 4.5 million.

Over the next 20 years, the economic impact of Alzheimer’s disease and other forms of dementia will be more than $2 trillion. Women will shoulder more than 80% of those costs, according to a report released Tuesday at the 2019 Milken Institute Future of Health Summit, in Washington, D.C.

“Longer life spans are perhaps one of the greatest success stories of our modern public health system,” said lead author Nora Super, senior director of the Milken Institute Center for the Future of Aging.

“But along with this success comes one of our greatest challenges,” she added in an institute news release. “Our risk of developing dementia doubles every five years after we turn 65; by age 85, nearly one in three of us will have the disease.”

With no cure on the horizon, reducing the risk of dementia and its cost must be the focus, Super noted.

“Emerging evidence shows that despite family history and personal genetics, lifestyle changes such as diet, exercise and better sleep can improve health at all ages,” she said.

The report recommends expanded research; programs to maintain and improve brain health; increased access to testing and early diagnosis, and services and policies that promote supportive communities and workplaces for people with dementia and their caregivers.

“As this important new report shows, dementia is one of the greatest public health challenges of our time,” said Sarah Lenz Lock, the AARP’s senior vice president for policy and brain health.

“It also demonstrates that we have the power to create change, whether by helping consumers maintain and improve their brain health, advancing research on the causes and treatment of dementia, or supporting caregivers who bear so much of the burden of this disease,” Lock said in the news release.

— Robert Preidt

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SOURCE: Milken Institute, news release, Oct. 29, 2019

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Test Given at 8 May Predict Your Brain Health in Old Age

News Picture: Test Given at 8 May Predict Your Brain Health in Old AgeBy Amy Norton
HealthDay Reporter

Latest Alzheimer’s News

WEDNESDAY, Oct. 30, 2019 (HealthDay News) — If you were good with words and puzzles at age 8, you’re likely to fare well on tests of mental acuity at age 70, too.

That’s among the findings of a new study that followed the thinking abilities of a group of Britons born in the 1940s. Researchers found that their performance on standard cognitive tests at age 8 predicted their performance around age 70. People who scored in the top quarter as kids were likely to remain in that bracket later in life.

“Cognition” refers to our ability to pay attention, process information, commit things to memory, to reason and to solve problems.

And it’s no surprise, experts said, that there is a correlation between childhood and adulthood skills.

However, no one is saying that your brain-health destiny is set in childhood, according to senior researcher Dr. Jonathan Schott, a professor of neurology at University College London.

In this study, for example, education also mattered. Older adults who’d gone further in their formal education tended to score higher, regardless of their test performance as children.

A number of past studies have linked higher education levels to a lower risk of dementia. And the new findings bolster that evidence, said Rebecca Edelmayer, director of scientific engagement at the Alzheimer’s Association.

“It’s really unique to have data like this, from a cohort that was followed for 60 years,” said Edelmayer, who was not involved in the study.

Why would education matter in dementia risk? It’s not certain, but Dr. Glen Finney, a fellow of the American Academy of Neurology, explained the “cognitive reserve” theory: Dementia is marked by the buildup of abnormal proteins known as “plaques” and “tangles.” In people with more education, the brain might be better equipped to compensate for such damage, allowing it to function normally for a longer period.

It’s also thought that mental engagement later in life might hold similar benefits. That could mean “challenging yourself to learn something completely new” — like studying an instrument or a foreign language, said Finney, who directs the Geisinger Health System’s Memory and Cognition Program in Wilkes-Barre, Pa. He was also not part of the study.

Beyond education, Finney noted, there is a body of evidence that other lifestyle factors are important in healthy brain aging. Blood pressure control is one, he said.

Finney pointed to a recent clinical trial finding that intensive treatment of high blood pressure lowered older adults’ risk of developing mild cognitive impairment.

That refers to subtler problems with memory and thinking that may precede dementia.

In general, the same things that protect the heart — exercise, controlling cholesterol and blood sugar, and a healthy diet — are also believed to be good for the brain, Edelmayer said.

“We just don’t know yet what the best recipe is for [dementia] risk reduction,” she said.

The current findings were published online Oct. 30 in Neurology. They’re based on more than 500 U.K. adults born in 1946. When they were 8 years old, they took tests of reading comprehension and other skills. When they were around age 70, they were tested for skills like memory and information processing.

They also underwent PET scans to detect any buildup of plaques in the brain.

It turned out that among participants who tested “cognitively normal,” about 18% did have signs of plaques in their brains. And on average, their test scores were lower, versus participants with no evidence of plaques.

That does not mean those people are destined to develop dementia, Edelmayer pointed out.

However, the findings do support a growing belief among researchers, according to Schott.

The fact that plaques exert subtle influences on mental performance even in people without symptoms is noteworthy. This “provides more evidence for the growing view that when disease-modifying therapies become available, they may have maximum benefits when given very early — and ideally prior to symptom onset,” Schott said.

How would that be done? In the future, Edelmayer said, it might be possible to use certain biological “markers” — such as plaques seen in brain scans — to identify people who are on a trajectory toward dementia.

“But we’re not there yet,” she stressed. “There’s a lot of work to be done.”

According to the Alzheimer’s Association, 5.8 million Americans are living with Alzheimer’s disease — a number that is expected to balloon to nearly 14 million by 2050.

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SOURCES: Jonathan Schott, M.D., professor, neurology, Queen Square Institute of Neurology, University College London; Rebecca Edelmayer, Ph.D., director, scientific engagement, Alzheimer’s Association, Chicago; Glen Finney, M.D., director, Memory and Cognition Program, Geisinger Health, Wilkes-Barre, Pa., and fellow, American Academy of Neurology; Oct. 30, 2019, Neurology, online

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November is American Diabetes Month — know the risks

Diabetes affects millions of Americans and it’s a leading cause of disability and death in the United States. The disease increases the risk of serious health problems like nerve damage, kidney failure, and heart disease. November is American Diabetes Month, the ideal time for you to find out if you’re at risk and learn about the services and diabetic supplies covered by Medicare.

Know the diabetes risk factors

You may be at high risk for diabetes if you’re obese, have high blood pressure, high cholesterol, or a family history of diabetes. Many people with diabetes don’t know they have it. Fortunately, Medicare covers screening tests so you can find out if you do. If you’re at high risk for developing diabetes or you’re diagnosed with pre-diabetes, you may be eligible for up to 2 fasting blood glucose (blood sugar) tests each year. If your doctor accepts assignment, you pay nothing for these tests. Talk to your doctor to find out when you should get your free diabetes screening test.

Medicare covers many diabetic supplies and training

If you have diabetes, Medicare covers many of your supplies, including blood sugar test stripsblood sugar monitors, and glucose control solutions. In some cases, Medicare also covers therapeutic shoes if you have diabetic foot problems. You pay 20% of the Medicare-approved amount for these supplies.

Medicare also covers diabetes self-management training to help you manage your diabetes. The program may include tips for eating healthy, being active, monitoring blood sugar, taking drugs, and reducing diabetes risk factors. Talk to your doctor about how this training can help you stay healthy and avoid serious complications.

Find out what steps you can take to prevent and treat this disease and learn more about American Diabetes Month.

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