The National Consumers League (NCL) was honored to welcome Special Guest Speaker Dr. Wendell Primus, Senior Health Policy and Budget Advisor to Democratic Leader Nancy Pelosi, at its December 3, 2018 Health Advisory Council Meeting and Holiday Reception. Below is a summary of Dr. Primus’ remarks:
Dr. Primus reflected on the historic results of the 2018 Midterm election and offered great insights into the Democratic Party’s upcoming healthcare priorities. He discussed the changing dynamics that we should anticipate within the 116th Congress and its potential impact on the healthcare legislative landscape, as he aptly framed “a difficult terrain.” Despite the split Congress, Primus predicted there would be many opportunities for bipartisan collaboration on health issues.
Primus mentioned the following issues as some of the highest priorities for the Democratic Party going forward:
- Prescription drug pricing
- Lowering healthcare costs
- Moving towards universal coverage
- Strengthening the ACA
- Improving Medicare and Medicaid
- Addressing the opioid epidemic
Prescription drug pricing
With regard to high prescription drug prices, Dr. Primus said that very little can be achieved without legislation. Areas of focus include fostering competition; providing the HHS Secretary with the authority to negotiate drug prices; and establishing an out-of-pocket limit in Medicare Part D. Primus noted the prominent role that Senator Chuck Grassley (R-IA) is expected to play as the Chairman of the Senate Finance Committee.
Lowering healthcare costs
Dr. Primus urged consumer and patient advocates to join together to advocate for reducing wasteful healthcare spending, such as unnecessary breast re-excisions, two-day procedures that should have been conducted simultaneously, and other low or no value healthcare.
Moving towards universal coverage
While there is agreement in the Democratic caucus on the importance of universal coverage, Dr. Primus stated that the most cost-effective path towards universal coverage is improving the Affordable Care Act (ACA). Primus noted that Medicare for All faces several challenges, including cost ($30 trillion over 10 years); stakeholder opposition; creating a system where there would be winners and losers; and implementation challenges.
Strengthening the ACA
Dr. Primus discussed factors that threaten to compromise the ACA going forward. Primus noted that ACA enrollment is down by 9-10%, as a result of a combination of the following:
- Individual mandate repeal
- Cuts to outreach/marketing/enrollment assistance
- Discontinuation of the cost-sharing reduction payments
- Introduction of Short-Term Limited Duration Insurance Plans and Association Health Plans
- Shortened open enrollment period
- 1332 Waivers
States can act to protect the Marketplace by:
- Restoring the individual mandate
- Improving affordability
- Limiting substandard plans
- Safeguarding health benefits
- Increasing enrollment
Improving Medicare and Medicaid
With good news for coverage, Dr. Primus noted that Nebraska, Idaho, and Utah all voted to expand Medicaid in the 2018 Midterm elections. However, Medicaid work requirements threaten to take away people’s health insurance. Primus expressed concern that the U.S. is not preparing for the baby boomer retirement, which is expected to have enormous implications on the federal and state budgets. Primus mentioned several improvements that should be considered for Medicare, including establishing an out-of-pocket limit, improving benefits, slowing healthcare cost growth, and improving the Part D program.
Addressing the opioid epidemic
Dr. Primus stated that the opioid epidemic remains a top priority for Congress. As a result of the opioid epidemic, the average life expectancy in the U.S. has dropped for the third consecutive year. In 2017, there were 72,000 drug-related deaths, and 42,200 of 63,600 drug-related overdose deaths in 2016 were attributed to opioids. The highest overdose rates reported in 2016 were in West Virginia, Ohio, New Hampshire, DC, and Pennsylvania.
To address the opioid crisis, the Bipartisan Budget Act of 2018 appropriates $3 billion/year towards opioid efforts over the next two years. The SUPPORT for Patients and Communities Act which was passed in late October will bolster access to treatment and other interventions to mitigate opioid-related deaths. In addition, Medicaid expansion has reduced opioid-related deaths due to increased access to treatment.