Tag Archives for CMS

Pandemic Lessons: “Essential Caregivers Act” Can’t Wait. A Merciful, Bipartisan Bill for a Voiceless Population

Published in RINewsToday on January 19, 2026

As COVID-19 spread rapidly across the country in March 2020—entering nursing homes largely through community transmission and staff movement—the Centers for Medicare & Medicaid Services (CMS) issued guidance calling for nationwide visitor bans in nursing homes. These strict restrictions barred all visitors and non-essential health care personnel, with limited exceptions for hospice care.

According to March 29, 2025 article, “Changes in Federal and State Policies on Visitation Restrictions in Nursing Homes During the COVID-19 Pandemic,” published in the Journal of Applied Gerontology, 31 states enacted statewide indoor visitation bans through executive orders between March 9 and April 6, 2020, and the end dates were between 6/15/2020 and 3/24/2021. CMS would later relax its guidance, permitting indoor visitation when facilities reported no new COVID-19 cases for 14 days and community positivity rates were low.

Charlie Galligan, a licensed criminal defense investigator in Rhode Island, knows firsthand the toll those restrictions took. He and his wife, Kerry, provided daily care for his parents for 13 years—his father, Jack, who died from Alzheimer’s disease in 2022, and his mother, Audrey, who lives with a traumatic brain injury. Balancing work with caregiving became the catalyst that pushed Galligan to lobby Congress to prevent the prolonged and unnecessary isolation of nursing home residents during future pandemics, including advocating for policies that allow designated family caregivers to visit.

“Long-term care lockdowns continued well after humane safety measures were established and family caregivers had been vaccinated,” Galligan claimed, noting that countless residents died alone as a result. “Daughters were forced to say goodbye to mothers with Alzheimer’s over FaceTime—often staring at their phones as exhausted staff struggled to provide even minimal connection.”

A Legislative Effort Revisited

The initial legislative proposal—the Essential Caregivers Act (H.R. 3733)—was introduced in June 2021 to reaffirm and enforce the right of nursing home residents to receive visits from family and friends during declared emergencies. When that proposal stalled due to the absence of a Senate companion bill, a second attempt followed the next year with the introduction of S. 4280/ H.R. 8331.  Political insiders say that these bills stalled due to the legislative process, timing, and competing priorities not because Congress rejected the process. Most recently, the Essential Caregivers Act of 2025 was reintroduced last month.

On Dec. 16, 2025, U.S. Senator Richard Blumenthal (D-CT) and U.S. Representative Claudia Tenney (R-NY) introduced bipartisan legislation in their respective chambers to prevent a repeat of the prolonged isolation and reduced care nursing home residents faced during the COVID-19 pandemic. U.S. Senator John Cornyn (R-TX) and U.S. Representative John B. Larson (D-CT) joined them in cosponsoring the Essential Caregivers Act.

The Senate bill, S. 3492, currently with seven cosponsors, was referred to the Senate Finance Committee. That same day, the companion measure, H.R. 6766, with 35 cosponsors, was introduced in the House and referred to the Ways and Means Committee and the Energy and Commerce Committee.

“Our movement to enact the Essential Caregivers Act is not led by professionals or lobbyists,” Galligan said. “We are simply a determined group of family caregivers—primarily brilliant, tenacious women from across the country, and one token guy from Rhode Island—who love our mothers and fathers and refuse to accept silence and separation as acceptable standards of care.”

Congressional Supporters Call for Passage

“During the COVID-19 pandemic, we experienced how dangerous and inhumane it is to isolate seniors and vulnerable patients from the people who care for them the most, say Rep. Tenney, in a statement announcing the introduction of the bill.  “Families were locked out, residents declined rapidly, and farm to many suffered alone,” she said.

“The Essential Caregivers Act ensures that this never happens again,” says Rep. Tenney, noting that they are loved ones, not visitors.  “They are caregivers, advocates, and lifelines. This bipartisan legislation protects dignity, safeguards patient rights, and makes sure compassion and comment sense guide our response during an future emergency,” she adds.

Sen. Blumenthal emphasized the bill’s bipartisan intent. “By allowing at least one designated essential caregiver to have safe, in-person access to their loved ones during an emergency, our legislation ensures that residents will never again face the devastating isolation experienced by so many during COVID-19,” he said.

Rhode Island Sen. Jack Reed, a cosponsor of the Senate bill, echoed that sentiment. “We want to keep people safe from germs, but we also want to keep them connected—because isolation can take a real toll on health,” Reed said. “Essential Caregivers Act would ensure that even during limited visitation, residents can still have in-person contact with a loved one.”

Sen. Sheldon Whitehouse has expressed support and is on a waiting list to cosponsor it – cosponsors are being added in bipartisan pairs. “Loneliness can take a real toll on residents of long-term care facilities,” he said. “This legislation recognizes the critical role loved ones play in supporting residents’ well-being, even during public health emergencies.”

Not yet committed to cosponsoring are Rhode Island’s two Representatives

At press time, Rep. Gabe Amo, had not yet committed to cosponsoring the bill. “I am reviewing the Essential Caregivers Act of 2025,” Amo said. “Family caregivers are the backbone of our long-term care system, and I remain committed to advancing policies that support patients, caregivers, families, and health care providers.”

Like his House colleague, Rep. Seth Magaziner (D-RI), has not yet committed to sponsoring the bill. Magaziner acknowledges the importance of allowing nursing home residents access to their loved ones and is open to considering the legislation. However, he is also working to understand what safeguards would be in place to ensure resident safety during emergencies, according to Noah Boucher, the lawmaker’s communications director.

The Nuts and Bolts

Recognizing that family members are essential to residents’ care and well-being, S. 3492 and H.R. 6766 aim to prevent the emotional, psychological, and physical harm caused by prolonged separation during public health emergencies.  This bill strikes a balance protecting public health while safeguarding the wellness of residents.

The Essential Caregivers Act requires nursing facilities receiving Medicare or Medicaid funding to participate. It guarantees that at least one designated essential caregiver may access a resident during periods of restricted visitation, provided the caregiver follows the same safety protocols as facility staff. If a resident is unable to designate a caregiver, a representative may do so on the resident’s behalf.

The legislation also affirms caregivers’ rights to advocate for residents, participate in care planning, and ensure residents’ civil rights are protected. Additional provisions address roommate rights, as well as exemptions for end-of-life and compassionate care.

Facilities must provide written justification if caregiver access is denied, with appeals overseen by state survey agencies.

The bill has been endorsed by the AARP and Consumer Voice.

Rhode Island Advocates Call for Passage

Calling for passage of the legislation, Rhode Island Long-Term Care Ombudsman Lori Light said the COVID-19 pandemic made painfully clear how critical family caregivers are to residents’ health, safety, and well-being.

“During extended lockdowns, we witnessed firsthand the profound impact isolation had on residents, including increased depression, anxiety, cognitive decline, weight loss, and loss of engagement in daily life. For many residents, family members are not simply visitors—they are essential partners in care – they provide emotional support, help residents communicate their needs, notice subtle changes in medical conditions, and advocate when something doesn’t seem right. When access was cut off, residents lost a vital layer of protection and connection. The lessons we learned during COVID-19 must guide future policy decisions,” Light said. “No resident should ever again experience prolonged isolation from the people who know them best,” said Light.

According to Deb Burton, MS, executive director of RI Elder, the isolation imposed on long-term care residents during the pandemic was devastating. While infection control was essential, she said, the complete separation of residents from their families caused profound and lasting harm. Burton, a gerontologist, noted that residents experienced rapid physical, cognitive, and emotional decline.

“Families endured anguish knowing their loved ones were frightened, confused, and alone during the most vulnerable moments of their lives. Family members are not simply visitors—they truly are essential caregivers. They provide a familiar face, a steady hand to hold, and an understanding of a resident’s routines, preferences, and communication needs. This is especially true for individuals living with dementia or other forms of memory loss, for whom familiarity and connection are critical to well-being and safety,” Burton said.

Comments from the American Health Care Association 

While expressing support for family involvement, the nursing home industry has raised concerns about certain provisions of the bill.

From Holly Harmon, senior vice president of quality, regulatory, and clinical services at the American Health Care Association: “While we wholeheartedly support family members taking an active role in their loved one’s care, there are certain provisions of this bill where we have concerns. Mainly, we believe each situation, including public health emergencies, requires a collaborative process among public health officials and stakeholders to determine the most appropriate way to keep residents safe and loved ones connected, rather than implementing a blanket, inflexible process for all situations. We hope to work with lawmakers to make improvements to these proposals as the engagement of loved ones is critical to our residents’ wellbeing.

“Despite our caregivers doing everything they could to step in for family members during the pandemic, we were deeply concerned about the prolonged isolation of our residents. Public health officials were put between a rock and a hard place on how to best protect those in long term care, and due to the vicious nature of the virus on our resident population, it was determined best to restrict visitors and social interactions. Nursing homes were required to follow these restrictions until March 2021, and even then, CMS and CDC had strict guidelines due to the ongoing spread of the virus.

“The best way to prevent this global tragedy again is for officials to prioritize long term care residents and staff during public health emergencies, so that they can remain protected, active, and engaged with their loved ones and the community.”

A Final Note…

The best way to prevent another tragedy is to prioritize long-term care residents and staff during public health emergencies, so they can remain protected, active, and connected to loved ones. We must learn from the painful lessons of COVID-19. No one should be forced to decline alone, grieve alone, or die alone because of a lack of clear policy, RIElder’s Burton added. She noted that the Essential Caregivers Act ensures that in the next public health emergency” when it could be any one of us in a facility” we will not be separated from the person who knows us best and stands ready to advocate for us.

Caregiver Galligan remains hopeful. “This is simply a merciful bill for a voiceless population”, he said.

(updated 1-21-26)

Medicare Drug Savings Eclipsed by Part B Premiums, COLA Challenges and ACA’s Rising Costs

Published in RINewsToday on January 5, 2026

The official arrival of the New Year was marked by millions of viewers channel surfing between ABC, CBS, NBC, and CNN, eager to watch the ball drop in Times Square and ring in 2026. The iconic New York City ball—12,000 pounds and adorned with 5,280 Waterford Crystal discs and LED lights—descended a 139-foot flagpole atop One Times Square. In just 60 seconds, it reached the bottom at midnight on New Year’s Eve, signaling the beginning of 2026.

Just two days before January 1—when Medicare-negotiated prices for 10 prescription drugs take effect—AARP Executive Vice President and Chief Advocacy & Engagement Officer, Nancy LeaMond, shared good news. As the clock struck midnight, she announced that older Americans would see lower prices for the first 10 Medicare-negotiated drugs, which would take effect on January 1, 2026. AARP quickly issued a statement, celebrating the first-ever Medicare-negotiated drug prices and estimating a whopping 50% reduction in out-of-pocket costs for beneficiaries.

“For millions of older Americans managing chronic conditions, prescription drugs are not optional—they are a lifeline. But medicine doesn’t work if people can’t afford it,” said LeaMond in a Dec. 29 statement. She emphasized that AARP has been at the forefront of advocating for drug pricing reforms since 2022. The nation’s largest aging advocacy group, representing nearly 38 million members, shared their stories, conducted national research on drug costs, and urged lawmakers on both sides of the aisle to support legislative efforts to lower drug costs.

According to LeaMond, this advocacy has delivered significant progress. On January 1, negotiated prices will take effect for the first time, marking a major milestone for both patients and taxpayers. “Older Americans will see real results and billions in savings as the first Medicare-negotiated prices take effect,” she stated, pledging that “AARP won’t stop fighting to lower drug prices until every American can get the medications they need at a price they can afford.”

“These drugs are used by nearly 9 million Medicare beneficiaries and treat conditions such as diabetes, heart disease, autoimmune disorders, and cancer,” she noted.

While Medicare beneficiaries are set to see substantial savings, the Centers for Medicare and Medicaid Services (CMS) anticipates that the Medicare drug price negotiation program will save billions. CMS, a federal agency providing health coverage to over 160 million people through Medicare, Medicaid, the Children’s Health Insurance Program, and the Marketplace, expects the program to save enrollees roughly $1.5 billion in out-of-pocket costs in 2026 while saving the Medicare program $6 billion per year.  The negotiated prices are a minimum of 38% off the 2023 list price.

On the Other Hand

Though Medicare beneficiaries will benefit from lower out-of-pocket costs on 10 Medicare-negotiated drugs in the new year, the 2026 Social Security COLAs will barely cover Medicare Part B premiums and rising inflation.  Meanwhile, older Americans who are not eligible for Medicare coverage will face soaring health insurance premiums due to the Senate’s failure to extend the Affordable Care Act (ACA) Tax Credits.

Max Richtman, President and CEO of the National Committee to Preserve Social Security & Medicare, stressed the importance of ACA marketplace coverage for older adults, who often struggle to find affordable health insurance. “It’s not only cruel to let their premiums skyrocket; it costs everyone in the long run,” observes Richtman. “Older patients without insurance will be forced to use emergency rooms for care, which drives up costs for all healthcare consumers,” he says in a statement released on Dec. 11, 2026.

“They’ll also arrive at Medicare sicker or more disabled, which not only costs taxpayers more but raises premiums for all older Americans on Medicare,” warns Richtman.

Richtman pointed out that 40% of ACA enrollees are between the ages of 45 and 64. Without the extended tax credits, many of these individuals—including farmers, ranchers, entrepreneurs, and small business owners—will face unaffordable premium increases and may be forced to drop or downgrade their health care coverage. “Extending these tax credits to prevent premium hikes would have made simple common sense,” Richtman argued. “Why would Senators vote to push people off health insurance instead of widening the safety net when the ACA is so clearly beneficial, especially for older, vulnerable enrollees?,” he asked.

Additionally, this year’s premium increase for the standard Medicare Part B program, while not as high as originally projected, will still affect beneficiaries, too. They will face an increase of nearly $18 per month, marking roughly a 10% hike in 2026. In a statement on Nov. 17, 2025, Richtman said that this rise basically cancels out one-third of the average beneficiary’s cost-of-living adjustment (COLA) for 2026.

The standard Part B premium for 2026 will be $ 202.90 a month, which is $17.90 more than last year’s $ 186.  The average COLA will be $ 56 a month in 2026. After accounting for the $18 Part B premium increase, the average Social Security beneficiary will be left with an effective monthly increase of only $36 next year, notes Richtman.

Richtman pointed out that the 2.8% COLA for 2026, announced in October, was already modest before the Medicare premium hike. “In this economy, an extra $36 per month will provide only marginal relief for Social Security beneficiaries,” he said, stressing that seniors with below-average benefits will see even less of a benefit increase once Medicare Part B premiums are deducted.

“Some in lower-income brackets may experience an effective COLA of zero,” predicts Richtman.

A Final Note…

Yes, Medicare beneficiaries will see a decrease in Medicare-negotiated prices for 10 prescription drugs that took effect last week.  But, with inflation rising and older adults struggling to afford basic needs such as food, rent, utilities, and healthcare costs, aging advocates urge Congress to  take action to mitigate the negative impacts of HR 1, the 2025 budget reconciliation bill, on the Medicare drug price negotiation program.  It’s also crucial that Social Security COLAs accurately reflect the out-of-pocket expenses faced by beneficiaries, they say.

“Unfortunately, the 2025 budget reconciliation bill—HR 1—further limits the drugs that can be negotiated under the IRA’s negotiation program, reducing its effectiveness,” warns Julie Carter of the Medicare Rights Center in an October 9, 2025, blog post for Medicare Watch. “KFF, an independent health policy and research organization, estimates that this change will increase Medicare spending by at least $5 billion. As always, increases in Medicare spending lead to higher out-of-pocket costs for beneficiaries,” she says.

“At Medicare Rights, we strongly oppose efforts to scale back the IRA’s negotiation framework. We believe more drugs should be subject to negotiation, not fewer. We also advocate for expanding other cost-saving aspects of the law to reduce expenses for those covered by other forms of insurance,” Carter adds.

“Social Security COLAs are meant to offset the impact of inflation on beneficiaries. However, they are clearly insufficient for many seniors living on fixed incomes,” argues NCPSSM’s Richtman. He explains that this is why his organization has been pushing for an improved COLA formula—the CPI-E (Consumer Price Index for the Elderly). The CPI-E would more accurately reflect the inflationary effects on the goods and services seniors rely on, he says.

“We support legislation that would adopt the CPI-E for determining COLAs, but Congress has yet to take action. Adopting this formula would be a reasonable step toward expanding benefits and truly meeting the needs of 21st-century seniors,” Richtman concludes.

Medicare Enrolled will see Lower Costs on Select Drugs in 2026

Published in Blackstone Valley Call & Times on December 2, 2025

With Medicare Open Enrollment ending next week, the Centers for Medicare & Medicaid Services (CMS) has announced that last year’s Medicare negotiations produced a net savings of 44%—about $12 billion—on 15 widely used prescription drugs that treat cancer and other serious chronic conditions.

The new Maximum Fair Prices (MFPs) for these 15 drugs will take effect on January 1, 2027. Combined with the 10 drugs already negotiated—whose MFPs take effect January 1, 2026—a total of 25 drugs will have negotiated lower prices. These medications, used to treat conditions such as cancer, diabetes, asthma, and cardiovascular and neurological disorders, represent some of the highest Medicare Part D spending.

The Beginning of Drug Price Negotiations

Three years ago, after President Biden signed the Inflation Reduction Act (IRA) in August 2022, CMS began developing the process for Medicare’s first-ever drug price negotiations. On March 15, 2023, the federal agency issued its initial program guidance and received more than 7,500 public comments from consumer groups, patient advocates, drug manufacturers, and pharmacies. Revised guidance followed on June 30, 2023.

On August 29, 2023, CMS released the first list of 10 high-cost drugs selected for negotiation—marking the first time in Medicare’s history that it could negotiate directly with pharmaceutical companies.

Pharmaceutical industry groups and several companies attempted to block the law in court. In response, 70 organizations and 150,000 petition signers urged Merck, Bristol Myers Squibb, Janssen Pharmaceuticals, Astellas Pharma US, the Pharmaceutical Research and Manufacturers of America (PhRMA), and the U.S. Chamber of Commerce to drop their lawsuits. Multiple organizations also filed amicus briefs supporting the law.

Three years in process, and with courts ultimately allowing the program to proceed, that first round of 10 drugs with negotiated prices will take effect in 2026.

CMS Drug Negotiations Added 15 Drugs

On January 17th, CMS announced it had selected 15 additional drugs for the second cycle of negotiations under Medicare Part D and on November 25th, it was announced that agreements had been reached on all of them. These medications are among the most costly and most commonly used by Medicare beneficiaries, treating conditions such as cancer, diabetes, and asthma. The new round of negotiations is expected to save Medicare billions and strengthen the program’s long-term sustainability.

“This year’s results stand in stark contrast to last year’s,” said CMS Administrator Mehmet Oz, MD, in announcing the second cycle of negotiations.  “Using the same process with a bolder direction, we have achieved substantially better outcomes for taxpayers and seniors in the Medicare Part D program — not the modest or even counterproductive ‘deals’ we saw before.”

“Whether through the Inflation Reduction Act or President Trump’s Most Favored Nation policy, this is what serious, fair, and disciplined negotiation looks like,” adds CMS Deputy Administrator and Medicare Director Chris Klomp. “I’m deeply proud of our team, who execute exceptionally well to bring affordability to the country in everything we do.”

Between January 1 and December 31, 2024, approximately 5.3 million Medicare Part D enrollees used one or more of these 15 drugs. Total gross Part D spending for them was $42.5 billion, representing about 15% of all Part D drug costs.

Anthony Wright, executive director of Families USA, praised the newly released negotiated prices, stating that they show what is possible when “policymakers put patients before corporate profits.” Wright emphasized that these reductions build on the work of establishing the Drug Price Negotiation Program, which aims to provide financial relief to older adults and people with disabilities.

Wright noted that the first and second rounds of negotiated drugs together account for about one-third of Medicare Part D spending, with price reductions ranging from 38% to 85%. In 2027, beneficiaries using these drugs are projected to save $685 million in out-of-pocket costs. He added that the savings support both individual beneficiaries and the long-term sustainability of the Medicare program.

Despite pharmaceutical companies’ continued attempts to limit the program—through lawsuits and legislative provisions such as those in H.R. 1—Wright said the negotiation program remains “the most effective tool currently available to lower drug prices.”

“The Medicare Negotiation Program changed the trajectory of drug pricing in the United States, helping to reduce Big Pharma’s monopoly pricing power, which dictated prices to Americans on Medicare for two decades,” said Merith Basey, executive director of Patients for Affordable Drugs in a statement. “This second round of negotiations — now under President Trump — marks another major milestone, delivering continued savings for patients and taxpayers,” he said.

“The lower negotiated prices are more than numbers on a page. For patients who’ve been forced to work multiple jobs, cut pills in half, or choose between filling a prescription and buying groceries, these lower prices will bring long-overdue relief, flexibility, and stability,” added Basey.

“The requirement that Medicare negotiate lower prices for prescription drugs continues to pay dividends for older Americans and taxpayers,” adds Richard Fiesta, executive director of the Alliance for Retired Americans. “The announcement of lower drug prices for 15 high-priced drugs is a win for more than 5 million seniors who take these drugs to treat asthma, diabetes, lung disease and other serious conditions, and will soon pay less for their medications,” he says.

“The 4.4 million members of the Alliance are pleased that the Trump Administration has followed the law, negotiated these prices, and defended this law in court,” Fiesta says, calling on Congress to increase the number of drugs subject to price negotiations.

While the White House along with aging groups praise the impact of IRA’s Medicare drug negotiation provisions, the Pharmaceutical Research and Manufacturers of America (PhRMA) issued a statement calling it “flawed.”

“Whether it is the IRA or MFN, government price setting for medicines is the wrong policy for America. Price setting does nothing to rein in PBMs who decide which medicines are covered and what patients pay. In fact, many patients are facing additional coverage barriers and paying more out-of-pocket for medicines because of the IRA, warns Alex Schriver, Senior Vice President of Public Affairs.

“These flawed policies also threaten future medical innovation by siphoning $300 billion from biopharmaceutical research, undermining the American economy and our ability to compete globally,” states Schriver, noting that PhRMA members are stepping up to make medicines more affordable by enabling direct purchase at lower prices and investing in U.S. manufacturing and infrastructure.

Lower Drug Cost Legislation Introduced

Congressman John B. Larson (D-CT), a senior member of the House Ways and Means Committee, praised the latest CMS announcement, estimating that both negotiation rounds will save older Americans more than $2 billion per year in out-of-pocket costs. Larson noted that families and seniors continue to struggle with rising prices, especially for prescription drugs.  The lawmaker pushed to enable Medicare to negotiate drug prices to lower drug costs by the enactment of IRA.

Last week, House Democrats introduced the Lower Drug Costs for American Families Act, aimed at closing loopholes in H.R. 1 and further reducing prescription drug prices. The bill (H.R. 6166), introduced November 20 by Ranking Members Frank Pallone Jr. (Energy and Commerce), Richard Neal (Ways and Means), and Bobby Scott (Education and Workforce), has been referred to all three committees.

Key provisions of the bill would:

  • Extend Medicare’s price negotiation authority to all Americans with private insurance—covering more than 164 million people with employer-sponsored plans and over 24 million enrolled in Affordable Care Act plans
  • Apply inflation-based rebate protections to private insurance markets, potentially saving $40 billion over 10 years
  • Increase the number of negotiated drugs from 20 to 50 per year
  • Extend the $2,000 annual out-of-pocket prescription drug cap to privately insured patients
  • Cap insulin costs at $35 per month for those with private insurance
  • Close the orphan-drug loophole that allows companies to avoid negotiation
  • Require consideration of international drug prices to ensure Americans do not pay three to five times more than patients in other countries

Continue the Momentum

According to CMS, the agency will announce the specifics on 15 drugs for the third round of Medicare price negotiations by February 1, 2026. This new round will include drugs paid under Medicare Part B for the first time and will begin with negotiated prices effective January 1, 2028. CMS has already released final guidance for the program and will also use this process to select drugs for renegotiation in previous cycles. IRA also establishes an ongoing process where more drugs will be selected for negotiation in subsequent years.

A Dec. 2024 AARP survey found that almost 3 in 5 adults age 50 and older expressed concern about their ability to afford prescriptions over the near future.  Respondents included both Medicare beneficiaries and younger persons. About 96 percent of the respondents call on the government to do more to lower pharmaceutical prices.

AARP noted that this survey was taken right before a new $2,000 cap on out-of-pocket drug expenses took effect in 2025.

With the announcement of lower drug costs that result from Medicare’s round 2 drug negotiations, there is an  opportunity to build on this momentum for real change. Lawmakers can legislate to put the public’s health above profit by giving consumers more power to negotiate, making competition stronger, and keeping patients from having to pay too much out of pocket.

It is now time for Congress to act.