It’s challenging to be optimistic about healing and preventative healthcare. Headlines such as “Is curing patients a sustainable business model?” Goldman Sachs analysts ask, and CMS is tweaking Medicare Part D in an effort to reduce drug and plan costs for beneficiaries, or It’s Official! Curing Patients Is Bad for Business- Milton Packer describes the end result of profit-dominated drug development validate skepticism that the medical and mental health worlds are patient-friendly. With this Omnibus spending bill: Congress’s $1.3 trillion spending bill explained headline in recent memory, the skepticism seems validated.
President Trump signed the Omnibus Spending Bill only days before those news items went public. It presents a multifaceted problem to mental health practitioners and their patients. The source of the problem lies with the fact that the success of Trump’s bill relies upon congressional action, a contradiction in terms at many junctures. That leaves too much to chance. Anyone in need of medical or mental health care, and anyone providing them, is left to wonder how much of a remedy that bill’s passage can provide to America’s sick MediCaid and MediCare insurance plans. They’re designed to limit access to health care though they claim to provide it as necessary.
It’s already clear that private insurers are the losers among the alleged health care beneficiaries of those trillions of dollars: their cost-sharing reductions (CSRs) and risk-management insurance, also called “reinsurance,” are not going to be of financial help. CSRs and reinsurance are what keep insurance companies solvent after unusually large claims, such as those for natural disasters which cause exceptional losses, are paid. But the new bill prevents the sharing of fiscal responsibilities though financial concerns drive both the medical/mental health care and insurance industries. Medical and mental health practitioners and insurance industry actuaries remain at odds with each other about the costs of caring for ill people, and the necessity to do so. Meanwhile, people suffering deteriorating mental (and/or medical) health remain in need of solutions.
Drug manufacturers are hurt by the new bill despite its cash reserves, too. Troubled by Medicare Part D rules, they may not ease their financial liabilities via insurers.
The Affordable Care Act, which Trump had intended to repeal, is now crippled by a lack of new grant funding prospects plus by efforts to limit reported data. That indicates a lack of stabilization for the ACA. Though specific omnibus bill funds have been designated for mental health care – including addiction treatment, consumer costs are not being controlled. Many voters already lack sufficient medical insurance to meet their needs. Further harm regarding accessibility to necessary care is far too likely.
In brief, MediCaid and MediCare endanger and complicate patient and practitioner lives more than they protect them. Though the omnibus bill added funds to the mental healthcare industry, it’s no guarantee that the omnibus plan will save many people. It is bloated legalese to be interpreted by an already inefficient body of legislators. The government-funded health insurance programs are controlled by the Centers for Medicare & Medicaid Services (CMS). The following press release indicates why that control can be problematic:
Title CMS lowers the cost of prescription drugs for Medicare beneficiaries
CMS lowers the cost of prescription drugs for Medicare beneficiaries
Today, the Centers for Medicare & Medicaid Services (CMS) finalized polices for Medicare health and drug plans for 2019 that will save Medicare beneficiaries money on prescription drugs while offering additional plan choices.
“The Trump Administration is taking steps for seniors with Medicare to save money on prescription drugs,” said CMS Administrator Seema Verma. “The steps we are taking will drive more competition among plans and pharmacies to meet the needs of seniors and lower costs.”
The final policies announced today further the Trump Administration’s commitment to lowering drug prices. CMS is finalizing a reduction in the maximum amount that low-income beneficiaries pay for certain innovative medicines known as “biosimilars.” Other actions that CMS is finalizing to lower the cost of prescription drugs include:
- Allowing for certain low-cost generic drugs to be substituted onto plan formularies at any point during the year, so beneficiaries immediately benefit and have lower cost sharing.
- Increasing competition among plans by removing the requirement that certain Part D plans have to “meaningfully differ” from each other, making more plan options available.
- Increasing competition among pharmacies by clarifying the “any willing provider” requirement, to increase the number of pharmacy options that beneficiaries have.
There’s more to worry about. The National Association of Science Writers, Health News Review, and ScienceWriters Today editions for March 29, 2018 noted that that even fact-checked reporting is often skewed in favor of personal agendas by announcing that Even if a story carries a “fact-checked” label, that doesn’t mean you should believe it. An indication that “the APA [Ed: American Psychiatric Association] is expecting favorable outcomes for increased spending on mental health care – including attention to the opioid crisis” alerted readers that the voters, aka some people in need of mental health care, are missing necessary educational information. That can prove harmful.
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