Ahead of Midterms, Trump Unveils His Proposal to Slash Prescription Drug Costs

Published in Woonsocket Call on October 28, 2018

With mid-term elections looming, President Trump moves to block Democrats tying the high cost of prescription drugs to an unresponsive Republican-controlled Congress and to GOP efforts to undo health care protections for people with preexisting medical conditions, one of the most popular provisions of the Affordable Care Act, referred to as Obamacare.

According to recent Roll Call poll, health care is a top issue for Democratic and Independent voters in key battle ground states while the GOP tout’s immigration and the economy and jobs as its priority.

Last Thursday, afternoon, at the Department of Health and Human Services (HHS) with Secretary Alex Aza, FDA Commissioner Scott Gottlieb and CMS Administrator Seem Verman standing by President Trump, he announced major changes as to how Medicare pays for prescription drug to bring down costs by making prescribed medications more affordable to seniors, making pricing of U.S. drugs fairer relative to costs paid by other countries.

Bringing Down Medicare’s Skyrocketing Drug Costs

“We’re taking aim at the global freeloading that forces American consumers to subsidize lower prices in foreign countries through higher prices in our country,” said Trump at the Oct. 25 press conference in his 14-minute speech. He noted that the costs for the same pharmaceutical drug in some countries are 20 percent less than those purchased in the United States even though it was made by the same manufacturing company.

“At long last, the drug companies and foreign countries will be held accountable for how they rigged the system against American consumers,” says Trump.

Trump rattled off specific examples of how Medicare pays higher prices for the same pharmaceutical drugs that are cheaper in other developed countries. For instance, one eye medication that prevents blindness would annually cost about $187 million rather than $1 billion dollars if Medicare paid the same prices other countries pay, he said.

Another example, a highly used and very effective cancer drug is nearly seven times as expensive for Medicare as it is for other countries, said Trump, noting that “this happens because the government pays whatever price the drug companies set without any negotiation whatsoever.”

Under Trump’s unveiled proposal, a new Medicare model, the International Pricing Index (IPI), is created to bring down Medicare drug costs to ensure seniors get a “more fair deal on the discounts drug companies voluntarily give to other countries.”

Currently, Medicare sets payments for physician-administered drugs at the average sales price in the U.S. market—plus a price-based add-on fee. Trump’s proposal would allow Medicare to set the payment of these drugs at a Target Price, based on the discounts drug companies give other countries. With the model fully implemented, it is estimated that total payment for these drugs would drop by 30 percent.

Under the IPI model, described in an Advance Notice of Proposed Rulemaking, Medicare’s payments for select physician-administered drugs would shift to a level more closely aligned with prices in other countries. Overall savings for American taxpayers and patients is projected to total $17.2 billion, with out-of-pocket savings potentially totaling $3.4 billion over five years.

Medicare beneficiaries not covered by the IPI model could also see their drug costs lowered, because the average price used to calculate traditional Medicare reimbursement will drop.

Trump’s drug pricing proposal still needs to be refined and put though a federal rule-making process and its impact may not be seen for years.

Is Trump’s Efforts to Lower Drug Costs Just Election Year Posturing?

“It’s hard to take the Trump administration and Republicans seriously about reducing health care costs for seniors two weeks before the election when they have repeatedly advocated for and implemented policies that strip away protections for people with pre-existing conditions and lead to increased health care costs for millions of Americans,” says U.S. Senate Minority Leader Chuck E. Schumer in a statement.

“Once again, the President’s plan doesn’t go far enough to bring down the costs of prescription drugs. Democrats have proposed letting the HHS Secretary negotiate the prices of all drugs covered under Medicare, as well as new tools to ensure transparency and accountability when companies try to raise their prices. Without these critical steps, the President’s plan is just more words with little substance,” says Rhode Island Congressman David N. Cicilline.

Pharmaceutical Research and Manufacturers of America (PhRMA) president and CEO Stephen J. Ubl, opposes Trump’s proposal to lower Medicare’s drug costs, warning that it would “jeopardize access to medicines for seniors and patients with disabilities living with devastating conditions such as cancer, rheumatoid arthritis and other autoimmune diseases.” Trump’s proposal severely alters the Medicare Part B program by reducing physician reimbursement and inserting middlemen between patients and their physicians,” charges Ubl.

Adds, Frederick Isasi, executive director of Families USA, in his statement: “The data is clear. The way we currently pay providers and pharmaceutical companies for drugs administered in doctors’ offices and hospitals creates perverse financial incentives for providers to select extraordinarily expensive drugs that may not be best for their patients. “

“Medicare Part B is the perfect example of misaligned incentives, and the proposed rule, if implemented, could pilot significant new ways to pay for drugs that align incentives so that patients get the highest value care, they have the best outcomes possible, and costs come down, says Isasi.

Like many, Isasi hopes that Trump’s proposal of using the power of the federal government to reduce Medicare drug costs is “not just election year posturing” but truly reflects a policy shift to using federal negotiating power to get unstainable prescription drug prices under control.

Next year, after the dust settles after the mid-term elections, Congress must work together to hammer out a comprehensive legislative strategy to lower pharmaceutical drug costs and to provide health care to all Americans. Listen to the polls.

New Report Charges that States Disfranchise Older Voters

Published in Woonsocket Call on November 11, 2017

Since 1948, Wisconsin resident Christine Krucki had voted in every presidential election, but effectively lost her right to vote when her state enacted a voter ID law in 2011. An old Illinois photo ID and proof of her residence in Wisconsin was just not good enough to allow her to cast a vote.

Krucki did not have a birth certificate and was forced to purchase one for $20. However, her last name on the document did not match her current last name, changed when she married. She then paid $15 dollars for a copy of her marriage certificate , but that document listed her list name differently than her birth name, as she was adopted a different name after moving in with her stepsister when she was in her early 20s. Changing her name on the Illinois marriage certificate to match her birth certificate to solve the problem would cost between $ 150 and
$ 300.

The obstacles Krucki faced when attempting to exercise her right to vote are encountered by millions of older Americans when they attempt to vote. With the 2018 mid-term elections less than a year away, two U.S. Senators release a report detailing Krucki’s problem at the polls, and notes how suppressive state laws and inaccessible voting locations disenfranchise older voters.

Pushing Older Voters Away from the Polls

Senators Bob Casey (D-PA), Ranking Member of the Special Committee on Aging, and Amy Klobuchar (D-MN), Ranking Member of the Committee on Rules and Administration’s 15 page report, “Barriers to Voting for Older Americans: How States are Making it Harder for Seniors to Vote,” finds that strict voter identification (ID) laws, closure of voting locations, inaccessible polling places and limits on early voting and absentee ballots are preventing seniors and people with disabilities from casting votes.

“The right to vote is one of the fundamental pillars of American democracy. But, that right is under threat for millions of older Americans and individuals with disabilities across the nation,” stated Sen. Bob Casey in a statement announcing the report’s release. “This report brings awareness to the unique challenges that seniors face in exercising their constitutional right. We must work to ensure that all Americans have equal access to the voting booth.”

“The right to vote is the foundation of our democracy, but exercising that right is becoming harder and harder for many Americans, especially our seniors,” add Sen. Klobuchar, noting that long lines, inaccessible polling places, and strict voter ID laws have become barriers to voting for older Americans. “This important report shines a light on the hardships these voters face and proposes common sense solutions to make voting easier for everyone. We need to do more to restore Americans’ confidence in our political system. Our first step should be making it easier for their voices to be heard on Election Day,” he says.

The report, released on Nov. 2, also includes new information from the U.S. Government Accountability Office (GAO), which found that only 17 percent of the polling places it examined during the 2016 election were fully accessible. Most polling places GAO examined had one or more impediments from parking to the voting area and had accessible voting stations that could impede private and independent voting.

According to the report, suppressive voting laws and issues of accessibility affect tens of millions of older Americans and people with disabilities. In the 2016 election, 30 percent of the voters were between the ages of 50 and 64-years-old and 13 percent were 65 and older. Sixteen million (11.5 percent) of the 139 million votes were cast by people with disabilities. As the baby boomer population continues to age, these restrictions and barriers are likely to adversely impact more Americans.

In order to protect the voting rights of older voters and persons with disabilities, the report calls on Congress to ensure the full authorization and empowerment of all federal voting laws, which will make polling places accessible to older voters. Access to polls can also be increased by allowing opportunities for accessible early voting and absentee voting. Finally, it calls on limiting restrictions on voting and ensure that election laws fully consider the needs and abilities of older Americans.

Reflections from Rhode Island

“The depth of this issue varies from state to state,” says AARP State Director Kathleen Connell, who herself is a former Rhode Island Secretary of State. “I believe that older Rhode Islanders are well protected here, but we must be vigilant. Older Rhode Islanders are traditionally the most engaged voting group. Their voices are important and should not be silenced in any way.”

“I would add, however, that deliberate voter suppression is a threat to voters of all ages and the implications are as serious as they are obvious.

“When Voter ID legislation was passed in Rhode Island, we worked with then Secretary of State Ralph Mollis to set up photo booths to create ID cards for voters who did not have proper photo IDs. It was well received, but transportation was identified as a barrier to reaching some potential voters. Fortunately there were other remedies in place and, I have to say, no one contacted us saying they were prohibited from voting.”

Adds, Secretary of State Nellie Gorbea, this report presents a troubling situation across our country. The right to vote is sacred. I have spent the past three years modernizing our elections so that we can engage and empower all Rhode Islanders. Civic participation at all age levels is critical to our success as a state. I will continue to work to remove barriers so that eligible Rhode Islanders can have easier access to the ballot.”

Joe Graziano, Gorbea’s Communication Coordinator, notes that the GAO findings cited in this “Barriers to Voting” report is based on Council on State Governments research that his Department did not have a chance to review. “While it is not called “early voting”, Rhode Island does have an emergency mail ballot period that allows Rhode Islanders to cast their ballot ahead of Election Day without an excuse, says Graziano, noting that older voters have been able to use this system, in fact, 45 percent of the emergency mail ballots cast last year were by Rhode Islanders 65 and older.

Graziano admits that the GAO report shines a light on some of the barriers to voting across the nation. “Secretary Gorbea agrees that access to voting is critical and has successfully strived to improve it in the last three years including the introduction of online voter registration, automatic voter registration and the implementation of new, easier to use elections technologies (voting machines and ePoll books). Additionally, she has redesigned the ballot and the voter information guide to make them easier to read and understand. She also introduced legislation to update and expand opportunities for early, in-person voting,” he says.

“As a way to mitigate the negative impact of the photo ID requirement for voting, the Rhode Island Department of State has made sure that free photo Voter IDs are available to people in the communities where they live,” says Graziano, noting that last year alone, the Secretary of State staff held 51 events at senior centers and retirement facilities to ensure that eligible, older voters had proper voter identification, were introduced to new voting technologies and had any of their elections related questions answered by our Elections Division staff.

Looking to the upcoming General Assembly Session, Graziano says that Secretary Gorbea will once again introduce legislation for early in-person voting. “The legislation would eliminate the need for emergency mail ballots by allowing voters to cast their ballot at their local city or town hall, up to 20 days prior to an election, including the Saturday and Sunday prior to Election Day,” he says.

For more details about the Senate voting obstacle report, go to http://www.aging.senate.gov/imo/media/doc/Voting%20Rights%20Report.pdf.

Winning the Votes of Older Women

Published in Pawtucket Times on October 10, 2016

On Oct. 7, Washington Post reporter David Fahrenthol’s story broke detailing a three minute video of GOP Presidential candidate Donald Trump wearing a hot microphone during a 2005 bus ride with former-host Bill Bush, of “Access Hollywood” to the set of “Days of Our Lives” where the real estate mogul had a walk on cameo on the soap opera. The video captured Trump saying “And when you’re a star they let you do it. You can do anything …Grab them by the p—y. You can do anything” and crudely describing his failed attempts to seduce a woman while being recently married.

Reaction came swiftly to Trump’s locker room banter with Bush. “No woman should never be described in these terms or talked about in this manner. Ever,” said Reince Priebus, the chairman of the Republican National Committee, who was doing damage control to keep woman voters from voting Democrat. The leaked video has also resulted in a number of Republican Senate and House candidates running in November to withdrawal their endorsements of Trump.

This is horrific,” Democratic Presidential Candidate Hillary Clinton said on Twitter, noting a link to the Washington Post article. “We cannot allow this man to become president.”

The embattled Trump initially issued a statement and later a video to try to defuse the controversy and get his flailing campaign back on track 30 days before the November presidential election.

Many political pundits believe that Trump’s off-the-cuff comments that are derogatory to woman, a powerful voting block who decide elections, might just block his chances of becoming the next occupant of the White House.

Women’s Campaign Issues

One day before the politically damaging Washington Post article appeared detailing Trump’s lewd comments in a leaked video, AARP, the nation’s largest aging advocacy group, released survey findings highlighting issues of importance to women voters ages 50 to 69 in key battleground states.

“Older women voters – particularly women of the Boomer generation — could help decide the 2016 presidential election,” said AARP Executive Vice President Nancy LeaMond. “Yet many of their real concerns are being ignored and their questions overlooked in a largely issueless campaign. The candidates still have an opportunity to talk to these women about the issues that matter to them.”

The 27 page report, Women Voters Ages 50 +: Economic Anxieties, Social Security, and the 2016 Election, says that heading into this year’s presidential election, Democratic candidate Hillary Clinton has a whopping 15 point lead (48 percent) over the GOP’s standard bearer Donald Trump (33 percent) among woman over age 50. The findings also indicate that older woman favor Democrats running for Congress by a narrower margin (47 percent are inclined to vote for a Democrat while 36 percent inclined to vote for a Republican).

AARP’s survey results noted that majority of woman age 50 and over believe that Clinton will do a better job than Trump in addressing family caregiving (Clinton, 57 percent; Trump, 27 percent), education (56 percent; 31 percent), environment (55 percent; 29 percent) and health (53 percent; 35 percent). The Democratic presidential candidate is also perceived by older woman as having a slight advantage over Trump in controlling government spending and controlling the budget deficit (44 percent; 43 percent).

“It’s the Economy Stupid”
Plus Retirement Issues

As to the economy, the majority of the older woman respondents across these 15 battle ground states worry about pocketbook issues such as prices rising faster than their income (61 percent) and having to pay too much in taxes (54 percent. Four in ten (41%) worry about having prescription drug expenses they cannot afford. Women with lower household incomes are especially likely to worry about these pocketbook issues.

Also, the AARP survey found that many women also worry about retirement security, including their ability to care for themselves as they age (45 percent), not having financial security in retirement (41 percent), and whether Social Security will be there when they retire (38 percent). These retirement-related issues are of particular concern to women with lower household incomes.

Additionally, most women (53 percent) say that the nearly 25 percent cut in Social Security benefits that would result from not addressing the solvency of Social Security would impact them, including 32 percent who say it would impact them “a lot.”

Fixing Social Security is a key issue to older woman voters. The AARP survey noted that the vast majority of women voters ages 50+ (72 percent) say that the next president and Congress should address Social Security immediately.

Most women (67 percent) also favor giving a caregiver credit in calculating Social Security benefits to people who take time off from work to care for loved ones, says the report.

Social Security is flying under the radar screen of the voter. The survey findings noted that few women say that they have heard about the candidates’ plans for Social Security. About one in three (34 percent) say they have seen or heard anything from Clinton, and even fewer (20 percent) say that they have seen or heard anything from Trump.

The AARP survey found that over 54 percent of the respondents are currently, or have been, a family caregiver providing unpaid care to an adult loved one. More than eight in ten (85 percent) women voter’s ages 50+ think it is important for the presidential candidates to talk about how they would support family caregivers who provide unpaid care to aging parents or spouses or other adult family members.

Finally, four in ten (41 percent) women are not confident that they will be able to cover the cost of care for an aging or elderly parent, spouse, or other family member.

Women: A Powerful Voting Block

According to the Center for American Women in Politics, “In recent elections voter turnout rates for women have equaled or exceeded voter turnout rates for men. Women, who constitute more than half of the population, have cast between four to seven million more votes than men in recent elections.“

Only weeks will tell if embattled Trump can overcome the political backlash generated from his locker room banter degrading woman, political insiders predicting that the gender vote gap might just historically widen.

AARP’s survey findings provide sound advice to Clinton and Trump and congressional candidates who are scrambling for last minute votes, especially from married women, younger millennials and women living in the nation’s suburbs. The women’s voting block might just surely tilt the election to a candidate in many legislative districts.