NCPA Backs New Amendments to Senate Health Reform Bill; Expresses Concern over Revised Public Option’s Pharmacy Benefit

(BUSINESS WIRE)--The National Community Pharmacists Association (NCPA) today endorsed three amendments recently proposed to the Patient Protection and Affordable Care Act and raised questions about an emerging public insurance option that would be administered by the federal Office of Personnel Management (OPM). NCPA Executive Vice President and CEO Bruce T. Roberts, RPh, issued the following statement:

“NCPA strongly supports an amendment by Sen. Sherrod Brown (D-OH) that allows pharmacies to continue providing Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) and Part B drugs to Medicare beneficiaries without purchasing a surety bond. Like the 14 other types of medical professionals that Medicare exempted from the surety bond requirement, pharmacists are licensed and regulated by the states. Requiring surety bonds is duplicative and may lead to loss of patient access to valuable health care services, such as diabetes testing supplies, canes and crutches.

“We continue to work with Congress on both a permanent pharmacy exemption from DMEPOS accreditation requirements, as well as an extension of the current moratorium, which is scheduled to expire on Dec. 31, 2009.

“Sen. Kay Hagan (D-NC) added important language to the Senate ‘Freshmen Value and Innovation Package’ amendment to codify Medicare’s medication therapy management (MTM) program. MTM utilizes community pharmacists to help patients adhere to, and maximize the benefits of, their medicine. The programs have been shown to improve outcomes while lowering health care costs.

“An amendment by Sen. Michael Bennet (D-CO) would require the Government Accountability Office (GAO) to conduct the first detailed study in more than 10 years of pharmacists’ cost of dispensing in the Medicaid program. Private studies have shown community pharmacists to be compensated well below their cost of dispensing and a GAO study could give Congress and the states needed information for measuring the adequacy of the dispensing fees they pay and the impact upon patient access to pharmacy services.

“Various news reports indicate Senators are considering an OPM-administered health plan for the uninsured. Under such a model, we urge lawmakers to utilize a pharmacy benefit administrator (PBA) to manage drug coverage, rather than a pharmacy benefit manager (PBM).

“PBMs have a history of inflating health care costs through bloated administrative fees and questionable practices that are hidden from patients and plan sponsors. OPM’s inspector general told a House subcommittee investigating the PBMs’ effect on the federal employee health plan that ‘there’s a good chance we’re not getting a good deal because of the lack of transparency.’

“A PBA, such as those employed by Medicaid and the Pentagon, would give patients and taxpayers the best bang for their buck by passing through all rebates, discounts, and price concessions. PBM transparency requirements in the current bill should continue to apply to any plan that operates within the exchange, including the public option.

“NCPA is grateful for Congress’ bipartisan support of community pharmacy in health care reform and we will continue to work with lawmakers as the legislative process continues.”

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AUL's Statement on New House Health Care Bill

/PRNewswire/ -- Statement by Americans United for Life President and CEO Dr. Charmaine Yoest:

"Just as Americans United for Life had expected, the new House health care bill unveiled this morning includes the Capps Amendment language added during the Energy and Commerce Committee mark-up. This bill will explicitly allow federal funding of abortion through the public option and permits federal subsidies to go to private insurance plans that cover abortion. The bill also ensures that at least one health insurance plan must cover abortion in every area of the country."

Dr. Yoest continued, "These provisions create a dramatic change from the status quo -- currently no federal dollars are used to pay for elective abortions or plans that cover abortion. Now, more than ever, pro-life members of Congress must demand the opportunity to vote on the Stupak/Pitts Amendment to prohibit abortion funding. Explicit language must be added to this health care bill to prevent unprecedented federal funding of abortion."

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Votes Against 'Public Option' Make Regulation of Health Insurance Premiums and Rates a Last Chance for Healthy, Competitive Market Under Reform,

Votes Against 'Public Option' Make Regulation of Health Insurance Premiums and Rates a Last Chance for Healthy, Competitive Market Under Reform, Says Consumer Watchdog

/PRNewswire/ -- The defeat of the so-called public insurance option in the Senate Finance Committee's version of health reform makes regulation of insurance premiums and copays even more critical, said Consumer Watchdog. If Americans are forced to buy private insurance policies under national health reform and nothing is done to regulate the prices of policies, consumers will remain trapped in a rising cost spiral enabled by insurers. Rate regulation is far from radical and is also good for the insurance industry, said the nonprofit, nonpartisan advocacy group.

The nation's toughest regulation of other types of insurance, including auto and homeowner policies, has produced a healthier, more competitive and even more profitable insurance market in California than in other states.

A 2008 study by Robert Hunter of the Consumer Federation of America found that since California passed highly effective regulation of property and casualty insurance in 1998, the state's dysfunctional insurance market has transformed. It is now the nation's fourth most competitive, fewer drivers are thrown into high-risk pools and insurers' average profits, at 10.6%, are well above the national average. Yet consumers also saved $61.8 billion dollars on their premiums over the same period and California insurance prices went from the second most expensive in the nation in 1989 to 20th in 2005 for auto liability premiums.

(see the study at http://www.consumerwatchdog.org/resources/state_auto_insurance_report.pdf)

Even medical malpractice insurance prices in California dropped sharply after the introduction of regulation, which appears far more effective in cost control than forbidding lawsuits against malpractice.

With health insurance rate regulation, insurers would have good reason to push for better, more effective and less wasteful health care, said Consumer Watchdog, just as auto insurers in California have backed tough auto and driver safety measures and home safety measures, as well as curbing fraud. Without regulation, insurers have no need to become more efficient.

"Mandatory insurance, as proposed in all the major bills in Congress, will turn government into a massive customer delivery system on behalf of a private industry," said Judy Dugan, research director of Consumer Watchdog. "Regulation is no more than a balancing force to this great benefit for insurance companies. For the Senate to brush off regulation as too much 'intervention' will leave millions of consumers dangling at the mercy of corporate sharks."

In a recent news report, former California Lieutenant Gov. and former Insurance Commissioner John Garamendi pinpointed the lack of cost controls without rate regulation. But Sen. Jeff Bingaman of New Mexico, a key figure in developing the Senate's proposals on health reform, said of regulation:

"That would be a very substantial additional intervention in the marketplace. I just don't think the support would be there for that kind of a change."

(see the L.A. Times story at http://www.latimes.com/news/nationworld/nation/la-na-healthcare-affordability2 -2009sep24,0,2139648,full.story )

Consumer Watchdog said rate regulation is a far lighter intervention than requiring everyone to purchase health insurance, and is a familiar presence in the U.S. marketplace.

"The mystery of today's debate is that tough rate regulation is not being seriously considered," said Dugan. "Forcing Americans to buy private insurance is radical, but rate regulation is the opposite of radical. It results in both lower rates and a healthier marketplace."

Here are some of the key points of the 2008 Consumer Federation study of Proposition 103, the 1998 voter initiative that regulates property and casualty insurance:

*An important adjunct to the regulatory framework established by Proposition 103 is its mechanism for public scrutiny and participation in the process of reviewing and approving rates. Proposition 103 grants consumers the right to challenge improper rates and practices before the Department of Insurance as well as the courts.

*A key factor in reducing insurer costs and consumer rates for automobile insurance is the strong financial incentives that the law provides consumers to drive more safely.

*California profits outpaced national insurer profits:

CALIFORNIA AND NATIONAL AUTO INSURER PROFITS

1989 - 2005 Return on Net Worth

(First figure is California returns, second figure is national returns)

Personal Auto Liability 12.9% 7.5%
Personal Auto Physical Damage 15.8% 16.3%
Personal Auto Total 13.5% 9.9%
Homeowners 7.4% -1.2%
All Property/Casualty Lines 13.9% 6.5%

-- California is first among all states in holding down insurance
premiums, with a 12.9 percent increase compared to an average national
increase of 50 percent;

-- California is the fourth most competitive auto insurance market in the
nation; Completely unregulated Illinois ranks 44th.


Other regulations under Proposition 103 that would benefit consumers directly, if applied to health insurance, include:

-- Requirement that insurers be transparent about how rates are
developed;
-- Prohibition on pass-through of excessive costs including unjustifiable
expenses, fines, and excessive executive salaries;
-- Standards that test the assumptions insurers make in setting rates.

It is worth recalling, in response to Sen. Bingaman, that insurance companies warned in 1988 that insurance regulation would be "massive government intervention" and would sharply raise insurance rates.

The result, notes Consumer Watchdog, was the opposite. And regulation was good for the industry as well.

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Millions of Uninsured Americans Need Healthcare Reform

/PRNewswire/ -- Following is an op-ed by Dr. Henrie M. Treadwell, director of Community Voices:

The uproar at this summer's raucous town hall meetings, Rep. Joe Wilson's outburst in Congress and the endless debate over whether some opposition to healthcare reform is racially-tinged are a major disservice to the millions of Americans who need healthcare reform.

Rep. Wilson doesn't worry about costs if a member of his family falls ill; he is covered. The majority of the people screaming and waving signs at town hall meetings don't worry either. They are covered. Their family members walk into a doctor's office or hospital emergency room, flash insurance cards and receive the best treatment available.

But who has been speaking on behalf of the 46 million uninsured Americans? When they get sick, there are real consequences. Do they pay the mortgage or the hospital bill? Do they buy food or save to pay for the tests that may prolong a family member's life?

These are issues that deserve attention from our lawmakers and policymakers, not red herrings like "death panels" and purported coverage for illegal immigrants. It's disheartening that public officials elected to serve their constituents have the audacity to play political football with something as crucial as healthcare reform. Our nation will have a serious discussion on healthcare reform only when the politicians put their constituents ahead of their desire to maneuver for political gains. What's so disturbing is that many opponents of healthcare reform, and most assuredly many public officials, are aware of the data showing how quickly healthcare costs are rising out of control and damaging our society.

The reality is that our safety-net systems are crumbling under the cost of caring for people who are uninsured or underinsured. The working poor simply have no or limited options for providing healthcare for themselves and their families. This predicament devastates communities of color, where more than seven million African Americans are without coverage. This is not a contrived problem; rising healthcare costs are a real crisis.

So why, suddenly, must healthcare reform legislation become a budget-reduction bill?

Instead of focusing on how to obtain the best coverage possible for millions of people without insurance, the debate in Congress has been transformed into a referendum on which plan can save government the most money. This is not how it should be. When Congress was allocating billions of dollars for the war in Iraq, the focus was on how to win the war, not on how much taxpayer money could be saved.

Right now, the nation needs its leaders, President Obama and the Congress to focus on the best plan for the people, regardless of the cost. There has been much debate over whether there should be a "public option" allowing the government to offer insurance. The public option should be considered not based on its cost, but its merit. It should be included if it can offer additional competition in the marketplace and drive down the premiums charged for other insurance plans. Now is not the time for ideological battles over government-run programs, now is the time for finding and implementing programs that work, be they government, private or hybrids. The nation needs programs that reduce the cost of insurance to consumers and cover the uninsured.

This over emphasis on costs has led to some ridiculous proposals that would ultimately be bad public policy if enacted.

Sen. Max Baucus (D-Mont.), for instance, has a plan mandating that all Americans purchase health insurance. Because his plan has no public option, struggling middle-class families would be forced to buy health insurance at rates likely to be difficult for them to pay.

The Kaiser Family Foundation recently released data further reinforcing why real healthcare reform must be enacted. Already, healthcare coverage for the average American family costs $13,375 a year, and health insurance premiums increased 138 percent over the last 10 years. At that rate, many families will suffer financial hardships.

Yet, largely because of the diversionary issues used to cloud the debate, the public doesn't focus on the fact that we all pay a price when healthcare costs skyrocket. The businesses that pay the healthcare coverage for 160 million Americans must either deduct more money from employee wages or raise the price of their products or services, or in some cases, do both.

Healthcare in America is a train racing toward derailment.

When lawmakers consider the cost of a plan, they need to also consider the pain and higher cost caused by their inaction. They need to hear the voices of the 46 million people who are uninsured. They need to hear from the people with soaring medical bills.

And they need to remember that if the town hall meetings had been populated with people without insurance, they would wave signs, saying, "Help Me."

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CPPR to Sen. Snowe: Vote No on PO

(BUSINESS WIRE)--With the release of the Senate Finance Committee’s new America’s Healthy Future Act of 2009, the Coalition to Protect Patients’ Rights (CPPR) is urging Sen. Olympia Snowe (R-Maine) to oppose any plan to implement a public option health insurance plan that limits patient choice and interferes with the patient-physician relationship. In addition, the Coalition is warning Sen. Snowe to be wary of the Committee’s consideration of both co-ops and triggers, because either could ultimately lead to a public option program.

Maine’s senior senator is being pressured on this issue from all sides. MSNBC reports Sen. Chuck Schumer (D-N.Y.) is hinting that Sen. Snowe could cast the deciding vote on reform. And, according to Politico, Sen. Snowe may hold the key to President Obama’s health care agenda. In light of this important role the senator will play in the continuing reform debate – and in support of her prior health care reform efforts – coalition spokesman and former president of the American Medical Association (AMA) Dr. Donald J. Palmisano states:

“Senator Snowe has done a great job of making sure that patients in Maine and throughout the rest of the country have received the kind of care America is known for, the world’s best. She must continue that great work by siding with patients and voting against any attempt to introduce a government-run public health plan that will stifle America’s dynamic health care system. We are also concerned about co-ops and triggers because they could lead to a public option down the not-too-distant road.

“As the Senate begins to debate the new health care bill, it is essential that the best interest of patients remains their top priority. If a public option plan is imposed, not only will patients face higher costs and lower quality care, but the American health care system will have to cope with more government red-tape and less innovative breakthroughs. I am confident that these are not the kind of changes that Senator Snowe has worked her whole life to achieve.”

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Health Affairs Report On Mass. Mandatory Insurance Law Confirms: Strong Public Option Must Be Included in National Health Reform

/PRNewswire / -- A study released today in Health Affairs finds that a Massachusetts law requiring all to show proof of health insurance has resulted in higher costs. This predictable result confirms that President Obama's promised "public option" to private insurance must be a part of national health reform, said Consumer Watchdog.

Consumer Watchdog said that Massachusetts' experience shows that reform is unaffordable without a public option like Medicare in competition with for-profit insurance companies. Unlike Massachusetts which is dominated by non-profit insurers, the mandatory purchase approach would be much more damaging if applied nationally, where most HMOs and insurance companies are for-profit and take 25% or more of premium charges for overhead and profit.

The Massachusetts law, similar to proposals pushed by health insurers at the national level, requires every person to either buy an insurance policy or show proof that an employer provides one, but does not regulate what insurers can charge. The state does not limit health insurance overhead and profit, and does not limit how much people have to pay out-of-pocket when they get sick. As result, the study released today found that the number of adults "who reported that they did not get care that they thought they needed" has increased due to the proliferation of high-deductible health insurance policies that require patients to pay up to thousands of dollars out-of-pocket before accessing care.

"Under the mandatory purchase approach, particularly one that does not provide a public option to for-profit insurance companies, patients might be technically 'insured' but will not receive the coverage they need when they get sick," said Jerry Flanagan, Health Care Policy Director for Consumer Watchdog. "National health reform must provide the American public an option to buy coverage through Medicare whose low-overhead costs provide the most health care for our dollar. Competition with a low-cost alternative will help keep the likes of WellPoint, United Health, and Humana in check."

According to Consumer Watchdog, the biggest advantage of a voluntary public option is that it is inexpensive to administer. Medicare's low administrative overhead costs (2 percent) are well below the overhead costs charged to large companies that are self-insured (5 to 10 percent of premiums), companies in the small group market (25 to 27 percent of premiums), and individual insurance (40 percent of premiums).

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