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Unveiling the flaws in the 340B Drug Pricing Program: Hospitals, medical debt, and consumer struggles

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Sally Greenberg

By Sally Greenberg, Chief Executive Officer

In 1992, Congress created the 340B Drug Pricing Program to help ensure vulnerable patients would be able to access medications they need but may not be able to afford. This program provides steeply discounted drugs to health care providers – mostly hospitals – serving low-income patients with the intent that the providers would pass those discounts along to patients. Unfortunately, that is not what is happening. The National Consumers League (NCL) is increasingly concerned about this program, especially as it relates to hospitals’ abusive and aggressive debt collection practices, and how those practices lead to consumer medical debt. A recent letter from a bipartisan group of Senators underscores hospitals’ role in this growing problem.

We find it particularly troubling that many hospitals benefiting from 340B are not only nonprofit entities but are designated as charity hospitals – supposedly caring for low income and indigent patients. A 2022 report by the Alliance for Integrity and Reform of 340B found that charity care spending for nearly two-thirds of 340B hospitals was less than the national average for similar hospitals. Further, a December 2019 Government Accountability Office (GAO) report found that “some nongovernmental hospitals that do not appear to meet the statutory requirements for program eligibility are participating in the 340B program and receiving discounted prices for drugs for which they may not be eligible.” One report found that 82% of nonprofit hospitals spent less on community programs than the value of their tax exemptions.

Consumers are not benefiting from the 340B program in the way Congress intended. A patient whose income is above 200 percent of the Federal Poverty Level (FPL) is expected to pay full price for a drug they receive at the hospital, even though the care center from which they are “buying” the drug did not pay full price for it. Hospitals participating in the 340B program saved an average of $11.8 million per year, according to a 2019 report from Beckers Hospital Review, and multiple studies have found that a majority of hospitals markup medicines between 200-500 percent. Under the current program, an individual who makes $29,200 per year has to pay that price.

What is even more alarming is the fact that if a patient can’t pay, the hospitals that have benefited enormously from discounted drugs intended for vulnerable patients are aggressively suing these same patients. This illustrates a major disconnect between the intent of the 340B program and the way it is operating today.

While estimates differ, medical debt is believed to cause more than 60 percent of bankruptcies in America. Most consumers facing medical debt did not end up in that situation because of bad decisions or profligate spending. Most have had some kind of injury or unexpected illness and don’t have insurance – or don’t have sufficient insurance – to cover their medical and hospital costs. Patients who need financial assistance should be processed when entering the hospital for medical care. Many are not given the chance to do so and as a result, can be sued for debt after services are rendered. Medical debt collection practices are debilitating for low-income consumers and can destroy their credit ratings, subjecting them to subprime rates and a never-ending spiral of debt.

Even if patients don’t start out poor, because of excessive fees, penalties, and other costs added onto what may or may not be actual medical debt on the part of patients, aggressive debt-collection practices can leave them destitute. Many don’t have funds to hire a lawyer, and if summoned, they often don’t know they need to actually go to court; in fact, sometimes debt collectors advise them not to show up in court. As a result, default judgments are filed against them, leading to garnishments of wages, and liens on homes, cars, and other properties. In 2019, the Journal of the American Medical Association studied the garnishment of wages by hospitals in the state of Virginia and found that 71% of the hospitals were nonprofit and the gross mean annual revenue of hospitals engaged in garnishments was $806 million, with 8,399 patients having wages garnished.

Below are just a few stories illustrating hospitals’ medical debt collection practices playing out in communities throughout the nation.

  • A woman in Knoxville, Tennessee, was diagnosed with cancer and underwent surgery and chemotherapy. Even though she had health insurance, she was left with almost $10,000 in medical bills that she couldn’t pay. Financial counselors told her she couldn’t schedule cancer checkup appointments with her doctor until she has a plan to pay her bills, according to a December 2022 story by NPR.
  • As reported by the Washington Post in May 2019, an investigation by the Baltimore Sun found that 46 hospitals in Maryland filed more than 132,000 lawsuits for unpaid medical bills from 2003 to 2008 and won at least $100 million in judgments. In some cases, hospitals added annual interest at twice the rate permitted for other types of debts or placed liens against patients’ homes.
  • The Washington Post reported in 2019 that the University of Virginia (UVA) Health System sued former patients more than 36,000 times for over $106 million over a six-year period. During that time, UVA’s Medical Center earned a $554 million profit and held stocks and other investments worth $1 billion. One of the patients the UVA Health System sued was Heather Waldron. Following emergency surgery and other treatment in 2017 to address an intestinal malformation, Waldron received a bill from the University of Virginia Health System for $164,000, more than twice what a commercial insurer would have paid for the care. When she was unable to pay, the UVA Health System pursued her with a lawsuit and a lien on the home she shared with her then-husband and five children. In the fall of 2019, the family lost their home, and the “financial disaster” contributed to Waldron and her husband divorcing earlier that year.

We support the critical role hospitals play in communities across the country and understand many dutifully provide charity care to those who cannot pay. However, we believe that if hospitals are designated charity entities and are receiving 340B discounts, they should be required to prove that those discounts have been passed along to patients. The current situation is unacceptable and merits an in-depth investigation and tightening up of the 340B rules. Charity hospitals should not be able to both claim 340B status and drag the very populations they are pledged to serve into debt collection proceedings, taking their homes, their cars, and their possessions in the process. Changes need to be made to ensure that only eligible hospitals are allowed to participate in the 340B program and that the deep discounts for medicines are passed along to patients, as Congress intended.

National Consumers League response to the Request for Information regarding FDA regulation of CBD

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August 25, 2023

Media contact: National Consumers League – Katie Brown, katie@nclnet.org, 202-823-8442

Washington, D.C. – On August 17, the National Consumers League responded to the Request for Information regarding FDA-Regulation of CBD.

“In 2019, in response to the proliferation of unreviewed and untested CBD products, NCL identified the need for greater education among consumers about CBD and better enforcement of regulations in the CBD marketplace. NCL created Consumers for Safe CBD to address the need, champion the rights of consumers, and call on government and industry to do better – to ensure safety and promote a pathway for new products through clinically tested scientific research. Since then, action has been taken on the state and federal levels to increase access to cannabinoids beyond CBD. In response, NCL expanded our educational campaign and established Cannabis Consumer Watch.” 

The full letter can be found here.

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About the National Consumers League (NCL)
The National Consumers League, founded in 1899, is America’s pioneer consumer organization.  Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad.  For more information, visit nclnet.org.

New insurance schemes to carve out specialty drugs deserve skepticism and scrutiny

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Sally Greenberg

By Sally Greenberg, Chief Executive Officer

Employers seeking to cut healthcare costs should remember this simple rule of thumb: If an offer to save money seems too good to be true, it usually is. That seems to be the case with offers to try “Alternative Funding Programs” or AFPs.  This is a devious but growing cottage industry, which promises to cut employer costs for specialty medicines.

Specialty medicines are used to treat complex, chronic conditions like cancer and rheumatoid arthritis; they are drugs often offered to some of the sickest patients. While they represent a mere 2 percent of prescriptions, they add up to half of the estimated $500 billion spent each year in the U.S. on drugs. Thus, specialty drugs are hefty contributors to self-funded employers’ health plan costs. (Source: optum.com)

One “solution” offered by third party vendors peddling AFPs is to remove coverage of specialty drugs from the employer’s formulary. This immediately renders those employees “uninsured” as far as coverage for their needed drugs goes. The AFP vendor then matches the newly uninsured employee with a patient assistance program offered by drug manufacturers and other charitable foundations. The patient’s co-pay is fully covered by the assistance program, the employer saves money, and the vendor takes a cut of the savings.

We think this so-called solution is underhanded and dangerous for patients.  It is also unethical and possibly illegal.

First, the charitable programs being mined by the AFP vendors are meant for the truly needy—those who are uninsured or underinsured. If these sources of funding are being drained by the AFPs, they won’t be available for patients who really need the assistance.

These programs are having a predictable effect:  drug manufacturers are starting to tighten the eligibility criteria for their charitable programs, limiting them to patients who are truly uninsured. That means the AFPs won’t be able to fulfill their promise to find alternative sources to pay for the medicine. The inevitable will happen:  patients will be forced to go back to their employers’ insurance, causing dangerous delays in treatment and eliminating any savings.

Critically, the AFP process interrupts and delays care for patients. One of the AFP vendors, aptly named SHARx, with a logo shaped like the predatory creature its name invokes, admits the process can take 2 to 6 weeks. While trying to enroll the previously insured patient in an assistance plan, they’ll “do as much as they can” to help a patient access their medicine, sometimes demanding they sign over power-of-attorney to their company. In practice, that means patients can be left in limbo with no coverage for a period of time.

How can an employer ethically expose their employees with serious health conditions to that risk? (Source: sharxplan.com)

There are also ERISA and IRS legal and compliance risks to self-insured employers, too, according to an analysis by Vivio, a Public Benefits Corporation (Source: viviohealth.com)

And by some accounts, the AFP vendors are taking a huge cut of any savings, as much as 25 percent, on top of the administrative costs employers must pay to implement the program. (Source: drugchannels.net)

Nonetheless, according to a 2022 survey, 10 percent of self-insured employers with at least 5,000 U.S. employees are using alternative funding vendors. Some 8 percent said they were planning to use them within two years and 19 percent are considering their use in three to five years. (Source: optum.com)

It is easy to initially discount AFP critics as defenders of unfettered drug pricing. However, even Optum, a subsidiary of leading health plan provider United Health Care, has sounded the alarm. They advise their clients “to look past the short-term sales pitch and consider longer-term financial implications, compliance risk and ethics of alternative funding programs.” (Source: optum.com)

We are raising the voice of consumers in support of efforts in Congress to rein in other dubious co-pay assistance schemes deployed by Pharmacy Benefit Managers such as co-pay maximizers and accumulators.  In this case, employers should take the lead in standing up for their employees’ health by refusing to open the door when third party AFP vendors come calling.

Safety in question: The alarming disparities between cannabis product health claims and research, and the magnified risks for women

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By Health Policy Intern Grace Lassila

July 27, 2023

When I started my National Consumers League (NCL) internship in May 2023, I quickly dove into NCL’s health policy work. NCL is leading on several efforts to protect consumers –one area of focus that stood out to me is their work in the cannabis policy space. NCL is a founding member of Cannabis Consumer Watch (CCW), which educates consumers on cannabinoids, their effects, the risks related to the unregulated marketplace, and the ways policymakers and regulators can help protect consumers. NCL is also a part of the Collaborative for Cannabinoid Science and Safety (CCSS), which also works to educate people about cannabinoids and policy in the interest of public health.

CCW’s “test your cannabis knowledge” quiz was shocking for me. Going into the quiz, I was fairly confident about my knowledge, but as I started getting wrong answer after wrong answer, I realized I had no idea that not only are these products under-researched, but they may pose serious public health risks for consumers. Products can be sold, without having gained FDA approval, making false claims about their medicinal abilities.  And side effects are not adequately researched or revealed to consumers.

One particularly concerning aspect of the cannabis marketplace is that while CBD or Delta-8 or other cannabis products are often marketed to women, there is a concerning lack of research into the safety of these products for women. Historically, misogyny and sex discrimination have made women’s health severely under-researched and underfunded. More research on diseases, disorders, and medication is conducted on men, not women. Women are misdiagnosed far greater than men are, and experience dangerous health outcomes because of it (Greenhalgh). And without sufficient research and data on women’s health, it is incredibly difficult for legislators to write policy (Adams). Overall, for women’s health to improve, more resources need to be devoted to this issue.

Despite cannabis companies’ marketing efforts that claim their products can help with anything from menstrual cycle-related pain to morning sickness, there is little insight into the effects of cannabis or cannabis derivatives on women, pregnant people, nursing parents, and newborns. What we do know is that the risks are very real – a recent study found that THC use during pregnancy was linked to changes in fetal development and several studies have shown that CBD can be transferred to a baby via breast milk. The FDA strongly advises against THC or CBD usage while pregnant or breastfeeding. And, given the evidence currently available, I would caution any women from using these products for medical benefit.

The lack of regulation, as well as research, is very concerning. Because the FDA currently does not regulate these products, consumers have no way of knowing whether the dosage, ingredients, or claims on the label are accurate and no way of knowing whether or not they are contaminated. Though some products may acknowledge they are ‘Not Approved by FDA,’ many consumers may not see this fine print – and assume that anything they can buy at their local grocery store must be safe for consumption. While the risks of an unregulated cannabis marketplace affects all consumers, women who need medical health and relief and turn to cannabis products may be more at risk.

The good news is that in January of this year, the FDA recognized this grey area for regulation – particularly for CBD – and stated that CBD would not be regulated as a food and dietary supplement anymore, because of the unknown safety risks, and requesting that Congress act quickly to protect public health and the consumers involved.

While cannabis products are often marketed as a miracle drug, they are not. While there may be some health benefits, without comprehensive research and regulation of these products, the risks outweigh the potential good. Consumers remain responsible for making their health decisions, and women in particular should be vigilant. The FDA is heading in the right direction but more must be done to protect consumers – and women in particular. I encourage you to learn more about a safe path forward here and help NCL raise awareness of this important issue.

Sources:

Adams, Katie. “Women’s Health Is Suffering Due to Lack of Research and Funding, Experts Say.” MedCity News, 9 Dec. 2022, medcitynews.com/2022/12/womens-health-is-suffering-due-to-lack-of-research-and-funding-experts-say/#:~:text=Women’s%20health%20has%20been%20historically,healthcare%20conference%20in%20Washington%2C%20D.C.

Eversheds Sutherland. “FDA Says ‘No’ to CBD: Now What?” FDA Says “No” to CBD: Now What? – Eversheds Sutherland, us.eversheds-sutherland.com/mobile/NewsCommentary/Legal-Alerts/256713/FDA-says-no-to-CBD-Now-what#:~:text=Since%202018%2C%20the%20FDA%20has,%2Dapproved%20drug%20(Epidiolex). Accessed 6 July 2023.

Greenhalgh, Ally. “Medicine and Misogyny: The Misdiagnosis of Women.” Confluence, 5 Dec. 2022, confluence.gallatin.nyu.edu/sections/research/medicine-and-misogyny-the-misdiagnosis-of-women.

Grinspoon, Peter. “Cannabidiol (CBD): What We Know and What We Don’t.” Harvard Health, 24 Sept. 2021, www.health.harvard.edu/blog/cannabidiol-cbd-what-we-know-and-what-we-dont-2018082414476.

“What You Should Know about Using CBD When Pregnant or Breastfeeding.” U.S. Food and Drug Administration, www.fda.gov/consumers/consumer-updates/what-you-should-know-about-using-cannabis-including-cbd-when-pregnant-or-breastfeeding#:~:text=FDA%20strongly%20advises%20against%20the,during%20pregnancy%20or%20while%20breastfeeding.&text=Cannabis%20and%20Cannabis-derived%20products,products%20appearing%20all%20the%20time. Accessed 6 July 2023.

NCL applauds the FDA for renewing its focus on infant formula

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July 14, 2022

Media contact: National Consumers League – Katie Brown, katie@nclnet.org, (202) 207-2832

Washington, DC— The National Consumers League (NCL) applauds the Food and Drug Administration (FDA) for taking strong steps to assure consumers that infant formula coming from overseas has been properly inspected and is free from contaminants or adulterants and therefore safe for infants.

“Consumers should have confidence that the infant formula that is being imported to the U.S. … involved a thorough review of the information provided by the companies, including details about the product’s nutritional adequacy and safety, microbiological testing results, labeling information, and importantly, details about the manufacturing facility’s food safety production practices and inspection history,” according to a press statement posted on FDA.gov.

Over the past few months NCL, the nation’s oldest consumer advocacy organization, has issued several statements on the infant formula shortage. The shortage was caused primarily by the unconscionable and unsanitary practices at Abbott’s Michigan infant formula facility when it failed to follow safety protocols, falsified documents to the FDA, and then shipped contaminated formula resulting in babies contracting foodborne illnesses and as many as nine infant deaths, according to FDA documents. Abbott’s reckless actions – coupled with the FDA’s slow response to the outbreak – finally lead to both parties issuing a recall of the faulty formula and ultimately triggered a nationwide shortage of powdered infant formula.

As FDA renews its focus on infant formula, NCL applauds the agency’s determined outreach to keep parents informed about how to read food labels from products made abroad. These labels use metric measurements that consumers in the United States may not easily comprehend. Most importantly, FDA has ramped up inspections of the products to ensure good and safe manufacturing processes.

Below are several statements on the infant formula crisis issued by NCL in the past few months, one of which includes our June 16 testimony before a Senate Judiciary Subcommittee.

https://nclnet.org/ncl-applauds-fda-response-formula-shortage/

https://nclnet.org/senate-testimony-consolidation-harms-consumers/

https://nclnet.org/baby-formula-shortage/

 

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About the National Consumers League (NCL) 

The National Consumers League, founded in 1899, is America’s pioneer consumer organization. Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad. For more information, visit www.nclnet.org.

NCL denounces today’s SCOTUS ruling overturning Roe v. Wade

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June 24, 2022

Media contact: National Consumers League – Katie Brown, katie@nclnet.org, (202) 207-2832

Washington, DC— Almost 50 years since the Supreme Court ruling in 1973, Roe v. Wade, which guaranteed a woman’s constitutional right to an abortion, the protections provided by Roe were overturned today by the Supreme Court of the United States (SCOTUS). The ruling is a devastating blow to women, girls, and their families who have long fought for equal access to reproductive health services – health services which includes access to safe abortion, says the National Consumers League (NCL).

“Many women will suffer and will suffer unnecessarily from this egregious ruling by SCOTUS,” says Sally Greenberg, Executive Director of NCL. “This decision is an attack on poor women or low-income woman, who represent 75% of abortion patients,” according to the Guttmacher Institute, a research group that supports abortion rights.

The final opinion is strikingly similar to the draft that was leaked in May of this year and authored by Justice Samuel Alito. In the opinion, Alito writes, “It is time to heed the Constitution and return the issue of abortion to the people’s elected representatives.”

In the wake of this June 24 ruling, 26 states are expected to ban all or nearly all abortions.

Justice Clarence Thomas, in his concurring opinion overturning Roe v. Wade, laid out a vision that fomented fears about what other rights could disappear: the same rationale that the Supreme Court used to declare there was no right to abortion, he said, should also be used to overturn cases establishing rights to contraception, same-sex consensual relations and same-sex marriage.

In their joint dissent, the three liberal justices of the court, argued that the ruling will affect “countless life decisions.” They also noted that, “It says that from the very moment of fertilization, a woman has no rights to speak of.”

“NCL applauds responses from many employers, including JPMorgan Chase, which is clarifying its health care benefits in the wake of the Supreme Court overturning Roe v. Wade on Friday, saying that abortion has long been a covered service for the bank and starting in July will be included under the company’s health care travel benefit,” says Greenberg. “We applaud Levi Strauss & Co — the 169-year-old jean company — stands strongly against restricting access to abortion and said it will continue to protect employees — making sure they have access to the care they need regardless of where they live.

NCL also thanks officials in many states and the District of Columbia that have pledged to provide abortion access and safe havens including New Hampshire, Michigan, New York governors along with New York Attorney General Letitia James and DC Mayor Muriel Bowser.

In his address to the nation today, President Joe Biden expressed his disappointment over the SCOTUS ruling: “This is a sad day for the country in my view, but it doesn’t mean the fight is over.” He also added that his administration will use all its appropriate lawful powers and that “Congress must act.” He went on to say, “with your vote, you can act.”

NCL believes that women’s reproductive rights is fundamental and must be protected; this radical decision by the Supreme Court is vastly out of step with American public opinion and a disastrous for women’s rights and freedoms.  We will continue to advocate for federal, state and local protections for women across the country, in keeping with NCL’s long history of championing the rights of women and children, especially those among us who are most vulnerable.

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About the National Consumers League (NCL) 

The National Consumers League, founded in 1899, is America’s pioneer consumer organization. Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad. For more information, visit www.nclnet.org.

The failure of the AHCA is a victory for the American people – National Consumers League

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j_johnson92.jpgSpotlight on Health Care Series, Part 2: As America’s health care system is facing uncertainty, NCL staff is exploring the topic in a new weekly blog series.

Ding dong, the bill is dead! Democrats, health advocates, patients, and consumers across the country are rejoicing after the GOP’s first attempt to repeal and replace major pieces of the Affordable Care Act (ACA) crashed and burned. Republicans ultimately could not coalesce around House Speaker Paul Ryan’s (R-WI) American Health Care Act (AHCA) and, in a stunning turn of events, the bill was pulled from the House floor without a vote last Friday.While inability to build a solid block of support for the AHCA in Congress became painfully obvious over time, the American people made their disdain of the bill apparent from the start. In the weeks following its introduction, citizens from every corner of the nation fervently expressed their disgust with the attack being waged on their health care. By the time the would-be vote was to have taken place, the AHCA had a meager 17 percent public approval rating, according to a Quinnipiac poll. Though dismal, this figure is hardly surprising, as the bill did nothing to improve access to care or quality of coverage for a clear majority of Americans – and, in many cases, the bill would have left many worse off than before the ACA.

The AHCA touted several policy changes that would have undoubtedly wreaked havoc on our health care system. Paramount was the spending cap (read: MASSIVE CUT) on Medicaid, the defunding of Planned Parenthood, an exponential premium increase for older Americans, a cost shift from the federal government to states and their citizens, and a general rationing and reduction of care to cover massive tax cuts for the wealthy. Arguably, one of the bill’s most odious aspects was the elimination of the essential health benefits – a measure put on the table in a last-ditch effort to get the unyielding, far-right, so-called “Freedom Caucus” block of the House on board. The essential health benefits are 10 services the ACA requires all plans to cover, including maternity and newborn care, ambulatory services, preventive and wellness services, and substance use treatment that can address issues such as the opioid epidemic ravaging communities across the country. Women of child-bearing age would have experienced significantly higher health care costs due to the elimination of maternity care and contraception from the standard benefits package – and they would either have considerably higher premiums than their male counterparts or be forced to pay for their maternity care or contraceptive methods out-of-pocket.

In addition, the AHCA would have effectively gutted consumer health protections, particularly for patients with pre-existing conditions, by eliminating out-of-pocket caps and reinstating lifetime coverage limits. In the long run, adequate care would be far beyond the reach of many Americans who would be left with bare-bones coverage and a higher cost burden. What is worse, by 2026, 24 million Americans would lose their coverage altogether. Americans heard that message loud and clear and they didn’t like what they heard.

While we can breathe a sigh of relief that the ACA is still the law of the land, NCL is among the many groups that agree that the ACA needs some tweaks to make it work better for all Americans. Now more than ever, a bipartisan approach to bringing affordable care and coverage to ALL Americans is not only desired, but essential. Rather than trying to undermine the ACA, Republicans and Democrats should embrace this opportunity to work together to come up with solutions that address the current insufficiencies in health care and make our system one that works for everyone.

The defeat of the AHCA is a big victory for the American people. The persistence and hard work of everyday Americans who spoke up, who called their members of Congress, who attended rallies, wrote to their local papers, and used social media ultimately made the difference. The National Consumers League, which since our inception in 1899 has spoken up for consumers and supported health insurance for all Americans, is proud to have stood alongside our colleagues in the consumer and public health communities in this battle to defend our care and oppose policies that would send us backward. We will continue to fight to protect the ACA, preserve consumer health protections, and argue that it is good for the economy and good for America’s future if all of us have access to health care coverage.

Medicaid per-capita caps: A recipe for disaster – National Consumers League

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j_johnson92.jpgSpotlight on Health Care Series, Part 1: As America’s health care system is facing uncertainty, NCL staff is exploring the topic in a new weekly blog series.

No matter how you slice it, the proposed changes to Medicaid in the GOP’s new health care bill are not a spending compromise–but rather a massive cut in funding that will decimate the Medicaid program as we know it.House Republicans recently introduced the American Health Care Act (AHCA) as a first step in fulfilling their promise to repeal and replace the Affordable Care Act (ACA).  The AHCA would cut $880 billion in federal support for state Medicaid programs over the next decade, while dramatically altering the funding structure of Medicaid from a flexible federal entitlement to a rigid per-capita cap. Under the current system, the federal government matches state Medicaid spending as enrollment increases and health care needs change. The new plan proposed by Republicans would cap federal funding solely based on the number of Medicaid enrollees.

This cap would not match the dynamic nature of health care. If Medicaid spending increases–perhaps due to a natural disaster, a sudden disease epidemic, or even a breakthrough drug the state wants to cover–states would be left to foot the bill for any costs over the strict per-person cap. This policy also makes Medicaid particularly susceptible to deeper cuts in the future; if Congress succeeds in divorcing federal support from the actual cost of providing health care, it will have greater liberty to continue to slash funding over time to generate more federal savings.

Republicans assert that the capping approach will slow the growth of Medicaid and expand states’ flexibility to innovate and provide patients with the care they want. The reality is, rather than curtailing spending, the costs will simply shift away from the federal government and onto the backs of state governors–sending state budgets into turmoil and placing millions of Americans at risk. Ultimately, states will be faced with the choice of raising taxes on their residents to meet funding needs, cutting funding from critical programs such as infrastructure or education, or imposing devastating cuts to Medicaid eligibility, benefits, and coverage for millions.

Among those most severely affected by a Medicaid spending cap are rural communities, where at least one-quarter of residents rely on public insurance. Several health crises already plague this population, including the onset of disease in coal workers and the Opioid epidemic. These issues, among many others, have contributed to a spike in the mortality rate of lower and middle class white Americans, and a huge reduction in federal funding would only further limit states’ ability to respond.  Capping will also have negative ramifications for children, who account for approximately 40 percent of the Medicaid population. According to the Center on Budget and Policy Priorities (CBPP), a slash in funding for Medicaid will have devastating consequences for children’s health, educational attainment, and earning potential, leading to long term damage to state economies. In short, this colossal overhaul of Medicaid would jeopardize health care for our country’s most vulnerable populations.

Today, 70 million low-income and disabled Americans rely on Medicaid to fulfill its guarantee to provide coverage for all eligible men, women, and children just as it has done for over 50 years. The GOP proposal reneges on that guarantee. Capping funding for a program that serves as an essential lifeline for so many will not lead to a more efficient health system or healthier Americans–it’s a recipe for disaster.

A threat to public health: Resurfacing of the anti-vaccine movement in Trump presidency – National Consumers League

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clare.jpgGuest blog by Clara Keane, a graduate of Drew University, Madison, NJ.

In the midst of a news avalanche in recent days as the Senate holds hearings for cabinet positions and new information breaks out related to Russian hacking, it is easy to miss what may be the most dangerous development of the incoming Administration: reopening vaccine skepticism and linking vaccinations to autism.On Tuesday, January 10, just ten days before President-elect Trump’s inauguration, Robert F. Kennedy Jr., an anti-vaccine crusader with no medical training who alleges causation between vaccines and autism, said that he accepted the position of chair to a new commission on vaccinations. In a statement from the transition team, spokeswoman Hope Hicks did not confirm Kennedy’s claims, although she did say that Trump is considering creating a commission on autism.

President-elect Trump has spoken out against vaccines multiple times in the past, although it was not discussed in great detail on the campaign trail. As is the case for determining Mr. Trump’s beliefs on many issues, Twitter provides some insight. In a tweet from 2012, Mr. Trump wrote: “I’m not against vaccinations for your children, I’m against them in 1 massive dose. Spread them out over a period of time & autism will drop!” Mr. Trump shows an alarming disregard to the facts, both in scientific research and in current medical practices.

The only study ever published that connected vaccinations to autism appeared in a 1998 issue of the Lancet and has since been completely discredited as a fraud. The study, which included only 12 handpicked cases, now serves as a textbook example of the danger of poorly executed experiments and the importance of sample size and representation in scientific studies. Returning to the warnings of a “massive dose,” a quick look at the CDC’s childhood vaccine schedule reveals that vaccines are administered in precise intervals from birth through age six.

Sadly, President-elect Trump is not alone questioning solid science. According to a national survey conducted by the National Consumers League in 2013, while most survey respondents (87 percent) say they support mandatory vaccination of school-aged children in theory, 64 percent of adults say parents should have the final say about whether or not to vaccinate. In addition, 33 percent think there’s a link between vaccines and autism.

How did we get to the point where vaccines—one of the greatest public health achievements of the 20th Century that have, among other things, eradicated smallpox globally and polio in the U.S.—are being considered by some as unnecessary or even damaging to their children’s wellbeing? Two equally dangerous contributing factors at play are the distance that vaccination success has granted us from the cruel reality of these diseases and the continued stream of false claims linking vaccines with autism.

It is easy to take for granted the security we enjoy from devastating diseases like polio, which was declared eradicated in the U.S. in 1979. However, it is important to remember that in the 1950’s, polio outbreaks caused more than 15,000 cases of paralysis each year in the United States. Parents during these dark times witnessed their children becoming paralyzed and were told there was nothing doctors could do to help. We are fortunate not to have these worries today. But in order to maintain the luxury of a polio-free nation, we must continue to have full participation in vaccinations. The Disneyland California measles outbreak of 2014 is but a small example of what can happen when people choose to stop vaccinating their children. According to a CDC report, among the 110 California patients, 45 percent were completely unvaccinated and only one percent had the full three doses that are recommended.

The reason for opting out of vaccinations may have felt safe for parents because those children had been protected by the surrounding children who were fully vaccinated. This concept is known as “herd immunity.” However, when large numbers of people stop vaccinating, disease breaks into the herd, as was the case in California. Indeed, the California outbreak led pediatrician and California state Senator Dr. Richard Pan, who was honored by NCL at our 2016 Trumpeter Awards Dinner, to sponsor legislation in California doing away with the “personal exemption” option for parents who don’t want to vaccinate their children.

The CDC lists some individuals who should forego vaccination, such as people with cancer and those with compromised immune systems. Because these people have no choice but to rely on herd immunity, members of the herd who are not vaccinated because of personal choice are causing an even bigger public health risk to those who are advised not to be vaccinated.

We must not take for granted the privilege of living in a society where parents no longer have to worry about a child’s death or disability from polio, whooping cough, diphtheria, hepatitis, measles, mumps, chicken pox, or influenza. It is remarkable that we have access to enough vaccines for the entire population and at no cost to parents. We cannot sacrifice this security. For this reason, we reject the messages of those fanning the flames of false information and promote fear of these life-saving vaccines.

So what might the new Administration mean for vaccine laws? Stat News provides a useful guide to what the President-elect can and can’t do. Of course, he will not be able to control vaccination schedules, but he may appoint agency officials who raise questions about vaccine safety. This should trouble all Americans because it puts our children and all immune-compromised Americans at risk of illness and even death. NCL plans to speak out in support of mandatory vaccinations and against false connections between vaccines and autism. We will continue to remind Americans how lucky we are in 2016 not to have to worry that any of us—but especially our children—will become sick, crippled or die of diseases. We have very safe and very effective vaccines to thank for that reality.