This Week in Healthcare Reform: February 12th, 2021

Nearly half of those who are uninsured failed to explore their options through the ACA or Medicaid; meanwhile, Medicaid expansion could have had a larger impact during the pandemic; brand-name drug prices are found to be higher in the U.S. compared to other countries; and, a new report debunks drugmakers’ biggest defense.

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Week in Review

Uninsured: The ongoing COVID-19 health crisis has disrupted health coverage for millions of Americans.  Yet, despite these challenging conditions, nearly half of all newly-uninsured adults failed to explore their options through Medicaid, the Affordable Care Act (ACA), or the Children’s Health Insurance Program (CHIP).  According to the findings of a new study released jointly by the Urban Institute and the Robert Wood Johnson Foundation, some 47 percent of uninsured adults neither sought information on coverage through the ACA’s insurance exchange marketplace nor tried to obtain coverage through Medicaid or CHIP.  While not all of them may have qualified for Medicaid – especially in states that have yet to expand their programs (see next item) – it’s estimated that as many as 14 million vulnerable individuals were eligible for the program or subsidized ACA plans.

Medicaid Expansion: Separately, a recent analysis took a look at the impact that Medicaid could have had in the states that have failed to expand their programs.  Also released by the Urban Institute, according to researchers, if the 14 remaining non-expansion states had, in fact, expanded Medicaid, the uninsured rate during the pandemic would have decreased.  Adding to the growing body of evidence showing how the benefits of Medicaid expansion extend beyond just health coverage to include saving lives and increasing financial security, researchers estimate that 4.4 million fewer people would have been added to the ranks of the uninsured in 2020, had those states expanded Medicaid.  While the impacts of expansion would have been felt differently across the country, the insurance gains would have been most significant for young Americans, where uninsurance among this group would have dropped by nearly 46 percent.

Rx Prices Higher in U.S.: According to a new report from RAND, prescription drug prices in the U.S. are almost three times more than those in over 30 other countries.  Researchers found that prices for drugs in the U.S. were more than 256 percent higher than for 32 other countries in 2018, with that gap being largely driven by brand-name medicines, which averaged 3.44 times what other nations were being charged.  Total drug spending for all the countries studied came in at $795 billion.  To contextualize that spending, the U.S. accounted for 58 percent of those sales, but only 24 percent of that volume.  Between 2000 and 2017, drug spending in this country increased by 76 percent.  Worryingly, that spending is expected to continue its upward trajectory over the next decade.  Given that trend, it’s hardly surprising that spending on prescription drugs now accounts for more than 10 percent of all health care spending in this country.

Rx Report: Against that backdrop, there’s increased scrutiny being placed on what’s driving prescription drug prices.  For their part, pharmaceutical manufacturers have long pointed to higher drug prices being the necessary cost of innovation.  However, a separate new report takes aim at that defense.  Pulled together by Patients for Affordable Drugs (P4AD), that analysis debunks the claim that policy solutions aimed at lowering drug prices would hurt innovation.  Specifically, the report offers detailed evidence to support a number of key findings, including that: a new drug does not equal new innovation; drugmakers exaggerate the cost of new medicines; and, innovation is paid for by taxpayers.  The research also attacks the claim that drugs won’t be available in the U.S. if prices are lowered.


Last week, a new analysis was released by the Partnership for America’s Health Care Future (PAHCF) examining the economic fallout that would result from the creation of a government-controlled “public option” health system.  Earlier analysis had projected that such a public option would increase the federal deficit by $800 billion in the first ten years, while raising taxes for American families by more than $2,500 per year.  The new analysis considers the impact that a future recession would have on those figures and estimates that the long-term cost of the public option could balloon by an additional $1.4 trillion.

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