Vox had an interesting article explaining how Trump’s admission and attempts to destroy the Affordable Care Act violates his sworn oath to the Constitution.  “The president has a legal obligation, under Article II of the US Constitution, to “take Care that the laws be faithfully executed.” That means he must make sure that our laws are implemented in good faith and that he uses his executive discretion reasonably toward that end.”

Additionally, his Administration and agencies also have a legal obligation, under the Administrative Procedure Act not to abuse their power by engaging in arbitrary action.  The intentional sabotage of the ACA that we have seen over the past nine months violates both Trump’s constitutional obligations and quite possibly the obligations of his Department of Health and Human Services.

His legal responsibility and moral obligation is to “take care” that the laws are enforced and implemented. Since he has flouted this obligation, lawsuits by individuals and states harmed by the damage will be filed.

Trump refuses to support the open enrollment period — in which individuals must sign up for insurance or lose their chance to do so. The ACA requires the federal government to, among other things, maintain a website and work with local “navigators” and other groups to educate consumers and encourage them to sign up for insurance.  Trump instead has set out to make open enrollment a failure.

He cut the enrollment period in half, from three months to six weeks. He shut down the federal enrollment website for nearly 12 hours every Sunday during the crucial period. He has canceled events in which federal officials had planned to help with enrollment. He cut advertising for enrollment by 90 percent, from $100 million to $10 million, even though his administration charged insurers on the exchanges user fees to generate money for that same advertising. (Those fees far exceeded $10 million.)

Trump announced his plan to cut off important cost-sharing payments that the ACA promises to insurers to compensate them for reducing what individuals have to pay in premiums, creating extreme instability in the insurance industry.

“The president has a right not to like the ACA. But so long as it is the law of the land, he does not have the right to undermine it through the use of executive power.

“Faithful” execution of a law that is validly on the books is what the words of the Constitution require of Trump — until Congress decides otherwise.”

 

The New York Times had an article on how Trump’s latest decision on health care will lessen coverage, increase premiums, and hurt the health insurance market.  “The Affordable Care Act remains the law of the land, and none of the proposed changes would substantially alter its main provisions. The funding cut and executive order could result in higher insurance premiums for some Obamacare customers and lower premiums for less regulated coverage for those who want to try new insurance options. They could cause some insurers to exit some markets in the long term.”

The executive order alters the rules for parts of the insurance system as a way of offering more Americans access to those types of insurance.  The biggest risk to consumers is that insurance companies, faced with the news about the subsidies going away, will drop out of the market for next year.

 

The Age had an article about Australia’s “broken” nursing home industry.  Elderly people are being sent in record numbers from nursing homes to be treated in hospitals.  The hospital transfer figures come in the midst of a debate on the quality of aged care in Australia, and accusations that nursing homes are in crisis.

The bulk of the transfers happen during the week, with the number plunging on weekends, which, according to the nurses’ union reflects a serious lack of staff on hand in many nursing homes on Saturdays and Sundays to make clinical decisions.

The Hill reported the five things to know about Trump’s awful decision on ObamaCare.

  1.  ObamaCare remains the law of the land.  Trump’s sabotage will not kill it.
  2.  Premiums will increase because of Trump’s sabotage.
  3.  Insurance companies will leave some marketplaces because of Trump’s reckless decision.
  4.  Lawsuits will be filed to protect the insurance markets.
  5.   Trump now owns the healthcare issue and will be blamed.

AARP reported on CNN’s investigation into Nuedexta. “A “little red pill” being aggressively marketed to long-term care residents is bringing in more than $100 million a year in Medicare money for its manufacturer, even though it “may be unnecessary or even unsafe,” CNN is reporting.”

“The drug, Nuedexta, is approved to treat pseudobulbar affect (PBA), a relatively rare condition marked by uncontrollable laughing or crying. However, the pill “is being propelled by a sales force focused on expanding the drug’s use among elderly patients suffering from dementia and Alzheimer’s disease, and high-volume prescribing and advocacy efforts by doctors receiving payments” from manufacturer Avanir Pharmaceuticals, CNN reported.”

The full report, which also contains details about possible health risks of Nuedexta, can be found at CNN.com.

The Washington Post reported how Big Pharma bullied and bought the Federal Drug Administration and Drug Enforcement Administration.  In April 2016, Congress stripped the DEA of its most potent weapon against large drug companies suspected of spilling prescription narcotics onto the nation’s streets.  For years, some drug distributors were fined for repeatedly ignoring warnings from the DEA to shut down suspicious sales of hundreds of millions of pills, while they racked up billions of dollars in sales. One internal DEA memo obtained by The Post and “60 Minutes” noted that the bill essentially eliminates the agency’s power to file immediate suspension orders of drug shipments. The new law “is fixing a problem that doesn’t need fixing,” a DEA official wrote.

The new law made it virtually impossible for the DEA to freeze suspicious narcotic shipments from the companies. That powerful tool had allowed the agency to immediately prevent drugs from reaching the street.  The chief advocate of the law that hobbled the DEA was Rep. Tom Marino, a Pennsylvania Republican who is now President Trump’s nominee to become the nation’s next drug czar.

Political action committees representing the industry contributed at least $1.5 million to the lawmakers who sponsored or co-sponsored four versions of the bill, including nearly $100,000 to Marino and $177,000 to Hatch. Overall, the drug industry spent $106 million lobbying Congress on the bill and other legislation between 2014 and 2016, according to lobbying reports.

“The law was the crowning achievement of a multifaceted campaign by the drug industry to weaken aggressive DEA enforcement efforts against drug distribution companies that were supplying corrupt doctors and pharmacists who peddled narcotics to the black market. The industry worked behind the scenes with lobbyists and key members of Congress, pouring more than a million dollars into their election campaigns.”

By then, the opioid war had claimed 200,000 lives. Overdose deaths continue to rise. There is no end in sight.  Drug industry officials and experts blame the origins of the opioid crisis on the overprescribing of pain pills by doctors.

CNN had a great article on the menace of a “little red pill” pushed on nursing home residents.  “The maker of a little red pill intended to treat a rare condition is raking in hundreds of millions of dollars a year as it aggressively targets frail and elderly nursing home residents for whom the drug may be unnecessary or even unsafe, a CNN investigation has found.”

“The pill, called Nuedexta, is approved to treat a disorder marked by sudden and uncontrollable laughing or crying — known as pseudobulbar affect, or PBA. This condition afflicts less than 1% of all Americans, based on a calculation using the drugmaker’s own figures, and it is most commonly associated with people who have multiple sclerosis (MS) or ALS, also known as Lou Gehrig’s disease.”

“Nuedexta’s financial success, however, is being propelled by a sales force focused on expanding the drug’s use among elderly patients suffering from dementia and Alzheimer’s disease, and high-volume prescribing and advocacy efforts by doctors receiving payments from the company, CNN found.”

“Since 2012, more than half of all Nuedexta pills have gone to long-term care facilities. The number of pills rose to roughly 14 million in 2016, a jump of nearly 400% in just four years, according to data obtained from QuintilesIMS, which tracks pharmaceutical sales. Total sales of Nuedexta reached almost $300 million that year.”

“Nuedexta is being increasingly prescribed in nursing homes even though drugmaker Avanir Pharmaceuticals acknowledges in prescribing information that the drug has not been extensively studied in elderly patients — prompting critics to liken its use to an uncontrolled experiment. The one study the company conducted solely on patients with Alzheimer’s (a type of dementia) had 194 subjects and found that those on Nuedexta experienced falls at more than twice the rate as those on a placebo.”

“There has to be a diagnosis for every drug prescribed, and that diagnosis has to be real … it cannot be simply made up by a doctor,” said Kathryn Locatell, a geriatric physician who helps the California Department of Justice investigate cases of elder abuse in nursing homes. “There is little to no medical literature to support the drug’s use in nursing home residents (with dementia) — the population apparently being targeted.”

“Medicare is supposed to pay for drug uses that have been proven safe and effective for the population they are intended to treat or that have been otherwise supported by a specific collection of medical research. Nuedexta is currently only approved by the FDA for patients who have PBA. So experts say that Medicare coverage of the drug, which has been crucial to its financial success, relies on the diagnosis of this single condition. So-called “off-label” prescribing, in which doctors use the drug to treat patients who have not been diagnosed with PBA, would typically not be covered.”

Bloomberg reported the recent maneuver by Trump to sabotage ObamaCare as the law of the land.  Trump is halting subsidies which will cost the government almost $200 billion more on health insurance.  It all adds up to a hefty bill for taxpayers. The Congressional Budget Office estimated that ending the cost-sharing payments would increase the budget deficit by $194 billion over the next decade as subsidy outlays jump.

“Here’s why: The subsidies clamped by Trump, known as cost-sharing reductions, are paid to insurers, reimbursing them for lowering deductibles and other out-of-pocket costs for low-income people. If the funds vanish, insurers will make up for them by boosting the cost of health coverage for everyone. Many had already said they will charge more for plans next year, on the expectation that the administration would follow through on months of threats to end the payments.”

 More than eight in ten individuals who buy Obamacare plans also get help paying their premiums directly from the federal government. When their premiums climb, so does the cost to the Treasury.  Those subsidies cap how much people have to pay for insurance as a percentage of their income. Even if premiums climb, people who receive subsidies won’t pay more. The subsidies are available to people making as much as four times the federal poverty level, or just over $97,000 for a family of four.

People who make too much money to qualify for subsidies will now have to pay a much higher price for their health plans.

 

The Huffington Post reported on Medicaid cuts in Iowa.  “The aging population is fueling what some health experts call an “Alzheimer’s tsunami” for which Iowa, and the rest of the nation, is ill-prepared. Unless a cure is found, an estimated 7.1 million Americans age 65 and older could have Alzheimer’s by 2025, almost a 35 percent increase, according to the Alzheimer’s Association. Iowa’s 65-plus population is above the national average.   In South Carolina, the total number of cases of Alzheimers in 2015 was 86,000; 120,000 are expected by 2025, according to Alzheimer’s Association estimates.

But instead of preparing for the onslaught, Iowa and other states have begun tightening Medicaid, the only government program that pays for nursing home care, in ways that increase the burden on those with Alzheimer’s and their loved ones.

Medicaid, typically seen as the government health insurance program for people with low incomes and those with disabilities, spends about one-quarter of its $4.8 billion in annual funding in Iowa for nursing home care. The program pays for half the nursing home residents in the state, according to the Kaiser Family Foundation.

Already, Iowa’s move last year to a Medicaid system managed by three for-profit companies is affecting people diagnosed with Alzheimer’s and their caregivers.

Kathy Horan, vice president of AbbeHealth Aging Services, which operates adult day health centers in Marion, Cedar Rapids and Iowa City, said managed care organizations, or MCOs, that coordinate Medicaid recipients’ care have started to decrease the number of days covered at those centers.

ABC Action News reported the controversy surrounding a nursing home’s refusal to provide certain medicine to one of their residents. Zephyrhills Health and Rehab Center, which is operated by Adventist Health System, refuses to allow Charlotte Simpson pain relief by refusing to allow her to have the medical marijuana she has a legal prescription to take.  Simpson is confined to a wheelchair and suffers Parkinson’s Disease, arthritis and other ailments.

“You should see the condition she’s in. It’s horrible,” said Bert Greene, describing his mother Charlotte Simpson. “She’s got uncontrollably shaking, excruciating pain.”

Greene said after medical marijuana became legal in Florida, a doctor prescribed it for his mother and she applied for a compassionate use permit.

“When she was finally approved, and the medicine was delivered, they gave it to me and told me I had to take it home with me,” Greene said.

 

 

New York Magazine reported that health care premiums will increase significantly in 2018 because of Trump’s sabotage of the Affordable Care Act.  This week, health insurance plans across the country submitted their final rates for 2018, many requesting massive double-digit rate hikes and explicitly citing uncertainty around Congress and the president’s plans for the individual market.

“Right now, 2018 premiums for individual health policies under Obamacare are being decided by insurance companies without any certainty about one of the basic elements of the program: reimbursements to offset “cost sharing reductions” they are required to make to keep low-income consumers from bearing the brunt of high co-payments and deductibles. These reimbursements are currently stuck in limbo, as Trump refuses to promise to keep making them and bipartisan Senate negotiations to take the decision out of the president’s hands and authorize them legislatively crawl toward an uncertain conclusion.”

“In interviews with major publications, Donald Trump repeatedly threatened to destabilize the Affordable Care Act marketplaces — by abruptly halting subsidies to insurers — as a means of eroding popular support for the law. Meanwhile, his Health Department spread doubt about whether it would enforce the tax penalty for refusing to sign up for insurance; cut funding for the law’s outreach groups; slashed Obamacare’s advertising budget by 90 percent; spent a portion of the remaining ad budget on propaganda calling for the law’s repeal; cut the open-enrollment period by 45 days; and announced that it would be taking Healthcare.gov (where people can enroll in Obamacare online) offline for nearly every Sunday during that time period, for “maintenance” purposes.”

BuzzFeed News revealed that the Trump administration had instructed the Health Department’s ten regional directors not to participate in state-based events promoting ACA enrollment, as they had for each of the past three years.

All available polling suggests that most voters now trust Democrats more than Republicans on the issue of health care — and believe that Trump is responsible for any problems with Obamacare, going forward.