Drug Companies Fail to Get Congress to Remove Change that Closes Medicare Drug Plan “Donut Hole” in 2019

Drug companies failed to get Congress to reduce a change in the Medicare drug plan that requires them to pay 70% of drug costs for seniors in the Medicare donut hole in 2019.  They currently pay 50%  but Congress moved to close the coverage gap a year earlier than in current law and raised the drug companies share of the costs in order to pay for the change.   AARP and other senior organizations had lobbied against the drug companies and thwarted them from defeating the change which was in the major appropriations bill passed to fund the government for the rest of the fiscal year.

The donut hole is a coverage gap in the Medicare Part D drug plan.  After reaching a certain level of annual drug costs, $3750 in 2018, beneficiaries have to pay most of the cost of drugs in the gap until they reach $5000 in costs and then receive catastrophic coverage and only pay 5% of drug costs for the remainder of the year.   The Affordable Care Act (ACA) included provisions to gradually reduce and eliminate the donut hole by 2020.   Congress had recently included changes to eliminate the coverage gap in 2019 and the pharmaceutical lobby had launched a vigorous effort to defeat the change.

This was a rare defeat for the drug company lobby which has made extensive campaign contributions to members of Congress and gained the support and allegiance of some powerful members of Congress.


First “Age Justice Rally” Set for Union Square in New York on May 15

A new generation of activism among older persons is dawning and the Radical Age Movement has been formed and is planning the first Age Justice rally on May 15 at 5:00 pm in Union Square in New York City.  The movement is  “a grassroots nationwide effort that challenges traditional notions of aging and introduces new ideas for building co-creative and interdependent communities.”  The movement is focusing on age discrimination in employment, the failure of government to increase funding adequately for senior services as well as marginalization of older people in society.   The movement was founded by Alice Fisher, a former New York legislative employee who worked for Senator Liz Krueger.

Its website it states,

“No age-segregation or pitting generation against generation — we want a society that works for us all.  We can’t leave it to ‘experts’ to tell us how to age ‘well’ or ‘successfully,’ or to an aging industrial complex that sees older adults as a dependent group or growing market of consumers. We need new social visions that will inspire and support people to grow and participate actively throughout their entire lives.

It’s up to us.

This movement brings to mind the early days of StateWide Senior Action Council and the Gray Panthers when a previous generation of activists organized for political action as well as cultural reform to change society’s view of older people.  That work is continuing now as a new larger generation of Baby Boomers becomes seniors.  The Village Movement is another great example of older persons taking the lead in their own self determination to remain living independently.

Here is a link on the web to the Radical Age Movement with more information about it and the rally   www.radicalagemovement.org

Uber, Lyft Teaming with Health Providers to Offer Non-Emergency Medical Rides

Uber and Lyft have announced recently that they are offering a service for  non-emergency health care to provide rides to medical appointments.    Uber Health is similar to the existing Uber service but it works with health providers who can schedule and pay for rides for patients.   Providers can pass the costs onto patients but many are assuming the costs.  Transportation has been identified as a top priority as hospitals are  trying to coordinate care for patients for their non-medical needs when they leave the hospital as well as for other non-emergency trips to providers.  As health systems are trying to reduce emergency room and hospital utilization, they view payments for transportation for routine care as cost effective.

It is estimated that there are 3 million persons who don’t make medical appointments because of a lack of access to affordable transportation.   Uber offers some specific information on its website about the service.  Here is a link to frequently asked questions


Some health care systems in New York’s DSRIP Medicaid transformation program are using transportation platforms to coordinate rides.   Lyft, which is an Uber competitor, is working with a company called Circulation, another online platform for non-emergency medical transportation.   Here’s a link to the press release announcing their collaboration.


Consumer Organizations Urge Public Transparency and Accountability for Acquisition of Fidelis Care; $3.75 Billion in Charitable Health Care Assets at Stake

this is a press release from the following four consumer groups about the proposed sale of Fidelis Health Care to a private company, Centene

Albany, NY – Four leading statewide consumer advocacy groups – Health Care for All New York, Medicaid Matters New York, New Yorkers for Accessible Health Coverage, and Consumers Union – released a joint statement on February 27, expressing concern about the proposed acquisition of the nonprofit Fidelis Care health plan by Centene Corporation, a national for-profit insurance company. Centene has proposed to acquire Fidelis Care’s assets for $3.75 billion, and operate the organization as part of a national for-profit insurance company. Fidelis Care has proposed to convey 100% of the proceeds to a charitable heath care foundation, while New York State is proposing to take up to 90% of the plan’s value as a “public asset” to pay for state health care programs. The advocates call for more specificity from both sides regarding their proposals for what is to be done with the assets, as well as for assurances that quality of care will improve as a result of the transaction.

“There are basically two sides to this transaction,” said Chuck Bell, Programs Director for Consumers Union. “On the one hand, you have a statewide nonprofit health plan that is essentially being privatized, and will in the future operate as part of a national for-profit insurance company under investor control. On the other hand, there is the issue of what happens to the nonprofit Fidelis Care’s charitable assets, which essentially belong to the community, and are held in trust by the Fidelis Care board of directors. We need full public transparency and accountability for both sides of the transaction, so that the public knows what changes in health care are in store, and also the details of what is happening to the $3.75 billion in the proposed asset sale.” “The proposed Centene acquisition of Fidelis Care is not just a technical corporate change that can be quickly rubber stamped,” said Lara Kassel, Coordinator of Medicaid Matters New York. “The asset sale must not be allowed to adversely affect consumers or health care access in New York State, and Fidelis Care’s assets should be protected for the public’s benefit. We urge a thorough review of this application, with public hearings and independent analysis of the impacts on the Medicaid program and the affordability and accessibility of insurance coverage, to ensure that consumer interests are fully protected.”

“New York has been an outlier in the way that it has approached some nonprofit insurance transactions in the past, with massive conversion assets taken by the state in 2002,” said Mark Scherzer, Legislative Counsel to New Yorkers for Accessible Health Coverage. “Other states have placed 100% of the value of their insurance plan assets in charitable foundations, to provide for investment in long-term resources to offset the loss of the nonprofit health plan. New York State needs long-term funding streams for our state health care programs that are robust, renewable and reliable.”

“Fidelis Care’s charitable health care assets should remain dedicated to its mission of expanding quality, affordable health insurance in New York,” said Elisabeth Benjamin of Health Care for All New York. “Consumers would like to see Fidelis and state officials use the assets to: offer coverage to immigrant New Yorkers who are currently ineligible for coverage; develop programs to offer enhanced premium support to shore up the individual market; or other consumer assistance programs designed to help New Yorkers trouble-shoot health coverage and care.”