Tuesday, April 23, 2013

Medicare’s Projected Spending Has Dropped $500 Billion Without Lawmakers Cutting A Dime

Medicare will spend $511 billion less between now and 2020 than was predicted two and a half years ago, according to the latest number crunching by the Center On Budget and Policy Priorities. More importantly, this drop occurred completely separate from any changes in government policy — rather, it resulted from an overall slowdown in the growth of health care costs.

The last time the Congress and the President actually altered Medicare policy in order to bring down the program’s spending was when they passed health reform in March of 2010. By comparing the Congressional Budget Office’s projections from August of that year with their projections from earlier this month, and by leaving out the the SGR cuts and the Medicare cuts in sequestration, the CBPP was able to isolate how much Medicare’s spending is anticipated to drop due purely to changes in the health care markets. And the drop is considerably larger than the proactive cuts in Medicare spending the Simpson-Bowles plan was calling for back in December of 2010:

According to the CBO itself, its projections for Medicare and Medicaid spending between now and 2022 dropped 3.5 percent since its previous projection in August of 2012.

Spending on Medicare and Medicaid is the main driver of the country’s long-term debt problem. But because the programs buy health care, larger economic forces in the health care market that drive up costs also drive up their spending, regardless of any specific policy enacted by lawmakers. Conversely, if health costs begin to slow, that will bring spending down — and there’s evidence that’s exactly what’s happened over the last few years.

Between 2009 and 2011, all spending in the health care system, both public and private, grew at 3.9 percent — the lowest annual rates we’ve seen in 52 years. 2012 looks like it will turn out to be similarly sluggish. Some of this is certainly due to the recession and ongoing depression. But an increasing number of economists and experts are convinced a big piece of the slowdown is also a more permanent restructuring of the way health care markets buy, sell, and deliver care.

No small part of that change may be due, in turn, to the passage of Obamacare, which put in place a host of new incentives and reforms to move health care delivery in a more efficient direction. And if Obamacare’s reforms continue pushing the health care system to adapt, then the United State’s fiscal future could continue to improve without lawmakers having to cut a dime.


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Scott Walker Proposes Budget That Cuts Taxes While Reducing Funding For Public Schools

Governor Scott Walker (R-WI) is proposing a budget that would fund a variety of right-wing priorities by slashing support for public services and local communities, according to an outline of the plan given in Walker’s “State of the State” address Wednesday night. Walker, who had already cut taxes significantly in his first term, proposed an additional $630 million in cuts (about half of which come from income taxes):

With this in mind, I am pleased to announce an income tax cut of $343 million. You, the hardworking taxpayers of this state helped to create the budget surplus, so it is only right that we put more money back into your hands. Over the next decade, this will lower income taxes $1.7 billionOverall, our budget includes more than $630 million in tax cuts.

Walker touted the tax cuts as a way to boost Wisconsin’s economy, but they give relatively little money back to middle-class families, limiting their stimulative effect. A four-person family with a total yearly income of $80,000 would only see an extra $8 per month under Walker’s plans. But even tax cuts with limited effects cost the government money — $1.7 billion over the next decade, according to Walker. And while he says it will be paid for a projected surplus, that’s the same thing former President George W. Bush said about his budget busting tax cuts.

Moreover, Walker’s budget proposes several dangerous changes and cuts to critical public services that could hurt the economy. Despite the fact that “a decade of research has shown no academic benefit from sending students to voucher schools,” Walker proposes a significant expansion of voucher funding, which will come at the expense of public schools. He also plans to freeze state financial support for municipal and city level programs. A similar move in Ohio caused problems for localities when it came to funding fire and police departments.

Walker also doubled down on his refusal to accept Obamacare Medicaid support, a move too irresponsible even for Florida’s hard-right Governor Rick Scott. Walker’s proposed budget also contains provisions requiring “non-elderly, able-bodied adults” on food stamps to attend job training programs in order to get food support.


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GOP Rep. Open To Closing Loopholes To Avoid Defense Cuts

Virginia Rep. Scott Rigell (R) would consider raising new revenue through the closure of tax loopholes in order to avoid part of the automatic budget cuts that will take effect March 1, he said Thursday. Rigell was among the Republicans who hinted at support for ending the Bush tax cuts for the wealthy during debate over the so-called “fiscal cliff,” when a last-minute deal raised tax rates on Americans making more than $450,000 but pushed sequestration off until March.

Now, Rigell is again calling for talks about revenues to avoid defense cuts that would hit his district, the Wall Street Journal reports:

Rep. Scott Rigell (R., Va.), whose Hampton Roads district is home to the largest naval base in the world and relies heavily on Pentagon spending, said he is reaching the point where he will consider whatever Senate Democrats offer up, even if that includes closing tax loopholes.

“I want our leadership to consider it and not reject it outright,” he said.

With a week to go before the cuts begin, President Obama reached out to Republican leaders to negotiate a replacement for the sequester. Obama has proposed raising revenue through the closure of tax loopholes, a position many Republicans support, but Democrats want to put new revenues toward deficit reduction. Republicans prefer to use revenue gained from loopholes to lower current tax rates.

Other Republicans, including Sens. John McCain (R-AZ) and Lindsey Graham (R-SC), have previously indicated that they would consider raising revenues to avoid defense cuts.


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First Lady Michelle Obama and Big Bird Team Up to Help Get Kids Healthy

The White House

Office of the First Lady

New Let’s Move! Public Service Announcements Filmed in the White House
Encourage Kids to Eat Healthy and Get Active

Washington, D.C. – First Lady Michelle Obama and Sesame Street’s Big Bird teamed up to film two public service announcements encouraging kids to eat healthy and get active. The new PSAs, which can be viewed HERE and HERE, are launched as part of the third anniversary celebration of Let’s Move! – Mrs. Obama’s initiative to ensure that all our children grow up healthy and reach their full potential.

The new PSAs feature Mrs. Obama and Big Bird in the White House showing kids how easy and delicious it is to eat healthy snacks like fruits and vegetables and demonstrating fun ways to get active like dancing and jumping. Sesame Workshop, the nonprofit educational organization behind Sesame Street, will distribute these PSAs to 320 PBS Stations, Sesame Workshop’s partner channels as part of their Healthy Habits for Life Initiative. The PSAs are also posted on the Sesame Street and Let’s Move! websites.

These PSAs are part of the celebration of Let’s Move!’s third anniversary. Next week, the First Lady will kick off a two day nation-wide tour celebrating the anniversary by showcasing progress and announcing new ways the country is coming together around the health of our children.

Mrs. Obama launched Let’s Move! on February 9, 2010 to unite the country around our kids’ health and create real support for families to live healthier lives. Since then parents, business leaders, educators, elected officials, military leaders, chefs, physicians, athletes, childcare providers, community and faith leaders, and kids themselves have stepped up to improve the health of our nation’s children.

Thanks to these efforts, families now have access to more information to make healthier decisions for their children. Young people now have more opportunities for physical activity in their communities. Food in schools has been dramatically improved.  More Americans now have access to healthy, affordable food closer to home. And the national childhood obesity rate has leveled off, and even declined in some cities and states.

More information on three years of healthy changes can be found here: http://www.letsmove.gov/blog/2013/02/08/lets-move-three-years-working-towards-healthier-generation-children

About Sesame Workshop

Sesame Workshop is the nonprofit educational organization that revolutionized children’s television programming with the landmark Sesame Street.  The Workshop produces local Sesame Street programs, seen in over 150 countries, and other acclaimed shows to help bridge the literacy gap including The Electric Company.  Beyond television, the Workshop produces content for multiple media platforms on a wide range of issues including literacy, health and military deployment. Initiatives meet specific needs to help young children and families develop critical skills, acquire healthy habits and build emotional strength to prepare them for lifelong learning.  Learn more at www.sesameworkshop.org.

Extending Middle Class Tax Cuts

A Balanced Plan to Avert the Sequester and Reduce the Deficit

President Obama has already reduced the deficit by over $2.5 trillion, cutting spending by over $1.4 trillion, bringing domestic discretionary spending to its lowest level as a share of the economy since the Eisenhower era.

February 21, 2013 12:53 PM EST

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Young people must establish work ethic early in life

Young people need to learn to work. Their parents must not let them be idle all year for, as they say, idle hands are the devil's workshop.

When I was growing up, it was early to bed, early to rise. My family worked hard, every one of us, starting even before the sun rose. Sure, I wanted to rest many times, but my parents wouldn't let me until our work was done. They needed a rest more than anybody. They taught by example and instilled in us a strong work ethic.

Today, many parents fail to provide that example. Now, I am not saying that young children should be put to work. We do not want a return to a time before child labor laws went into effect. Little children need and deserve their playtime. We should not take away their childhood. 

But once they reach a certain age, they must realize that it is time to accept a certain degree of maturity and responsibility, part of which involves going to work. Whether it is flipping burgers at McDonald's, delivering newspapers, washing cars, cutting lawns, or walking dogs, as long as they are working, they stay out of trouble, they learn better how to interact with adults.

Plus, they get to make a little money. The trouble is, many young people today want something for nothing. They don't want to have to work for anything. They expect to be handed everything, and many parents often give in to their demands. 

What those parents should do instead is to force their sons and daughters to see the value of hard work. Being handed everything diminishes the value of everything. The rewards are much greater when you have to work for them. When you work for something you feel a real sense of worth, both in yourself and in the object or goal you are trying to reach.

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UPDATE 1-Chelsea says FDA allows Northera resubmission with existing data

(Adds details, analyst comments; updates share movement)

Feb 20 (Reuters) - Chelsea Therapeutics International Ltd

plans to repitch its once-rejected hypotension drug Northera in the second quarter after a review by U.S. health regulators determined that the company could use its original data for the resubmission.

Shares of Chelsea were up 93 percent at $1.48 in heavy volume trading on Wednesday on the Nasdaq. The stock traded around the $4 levels before the FDA rejection.

"(Wednesday's news) was surprisingly positive given what the FDA reviewers earlier said," Liana Moussatos of Wedbush Securities said.

The FDA's guidance was in response to a formal appeal by the company to the Director of the Office of New Drugs of the FDA, after the Cardiovascular and Renal Products committee denied approval to the drug last March, asking for another study to show long-term benefit.

This means the FDA believes the data Chelsea had submitted last year for approval can serve as the basis for a resubmission of the marketing application of Northera, analyst Moussatos said.

Northera is being tested for symptomatic neurogenic orthostatic hypotension, or a chronic drop in blood pressure on standing up that is most often associated with Parkinson's disease. The drug has an orphan drug status, or a seven-year marketing exclusivity from the day of approval.

"We now have a regulatory path forward, including the potential for an approval of Northera later this year," said Chelsea's interim Chief Executive Joseph Oliveto.

However, risks still remain as the Cardiovascular and Renal Products committee of the FDA, which rejected the drug last year, will be the one reviewing it after Chelsea resubmits its application, Moussatos added.

Since the first rejection, Chelsea has cut jobs, reduced officer compensation and abandoned the development of a rheumatoid arthritis drug to cut costs and focus on Northera, its most advanced clinical product.

The Charlotte, North Carolina-based company had cash and cash equivalents of about $28.4 million as of Dec. 31. Chelsea said it expects this money would fund its operations into the third quarter of 2014.

"The company will continue to explore options for new capital, including various partnering and financing options," the company added.

Moussatos said British drugmaker Shire Plc and California-based BioMarin Pharmaceuticals Inc could be among companies potentially interested in partnering Chelsea.

"The disease that they are treating is common in Parkinson's patients, so potential partners could be any big pharma or a company that is interested in orphan drugs," Moussatos said.

In August, Chelsea changed the main goal of its earlier study, codenamed 306B, and re-reported results in December.

Chelsea said on Wednesday the FDA guidance suggests data from its 306B study strongly showed short-term clinical benefit, but the regulator could ask for a post-approval study to verify Northera's long-term clinical benefit.

The company said it plans to start a new clinical trial in the fourth quarter to test for long-term benefits.

However, it added that its current cash reserves would not be sufficient to complete the post-approval study, which is likely to run into 2015.

(Reporting by Zeba Siddiqui and Pallavi Ail in Bangalore; Editing by Roshni Menon)

((zeba.siddiqui@thomsonreuters.com)(within U.S. +1 646 223 8780, outside U.S. +91 80 4135 5800)(Reuters Messaging: zeba.siddiqui.thomsonreuters.com@reuters.net))

Keywords: CHELSEATHERAPEUTICS FDA/


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February 22 News: Likely EPA Nominee Vows More Action on Climate Change

Gina McCarthy. (Photo credit: Alex Brandon/Associated Press)

Gina McCarthy, the current Environmental Protection Agency’s Assistant Administrator for the Office of Air and Radiation and the front-runner to fill the top vacancy at the EPA pledged to push ahead with actions to confront climate change during a speech on Thursday. [The Hill]

McCarthy discussed a list of emissions rules rolled out during Obama’s first term, touting them for their public health benefits and effects on tackling climate change.

Among the rules were stronger fuel economy standards for vehicles, proposed rules for new coal-fired power plants and limits on mercury and other toxic air pollutants. [...]

Republicans have slammed the emissions standards, calling them economically burdensome.

McCarthy said, however, that tackling climate change “hasn’t hurt the economy,” and that “there are tremendous opportunities to address climate change that build the economy, that grow jobs.”

She challenged those in the audience to “be clear on the cost and benefits on all these programs moving forward.”

An analysis of weather station data shows that the coldest American states are warming the fastest, and across the country winter warming since 1970 has been more than four-and-a-half times faster per decade than over the past 100 years. [Climate Central]

The boom in cheap natural gas is undercutting the development of American nuclear power. Since 2010, the amount of electricity generated from U.S. nuclear reactors has fallen about 3 percent. [WaPo]

According to a paper published Thursday in Science, the melting of northern permafrost and consequent release of carbon dioxide could come sooner, and be more widespread, than experts previously believed. [Climate Central]

Time is running out to avert a third summer of drought in much of the High Plains, West and Southwest, unless significant bouts of heavy snow and rain come in the remaining days of winter. [Climate Central]

Affordable solar power is starting to make its way down the income ladder, and a pair of statewide California solar programs show how that’s good news for utility customers and taxpayers, too. [Clean Technia]

A new report by Bloomberg New Energy Finance uncovers a litany of biases in financial regulation that tilt markets in favor of conventional energy, and could potentially hold back the flow of investment into renewable energy technologies. [BusinessGreen]

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President Obama Announces Presidential Delegation to the Republic of Sierra Leone to Attend the Inauguration of His Excellency Ernest Bai Koroma

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For Immediate Release February 20, 2013 President Obama Announces Presidential Delegation to the Republic of Sierra Leone to Attend the Inauguration of His Excellency Ernest Bai Koroma

President Barack Obama today announced the designation of a Presidential Delegation to the Republic of Sierra Leone to attend the Inauguration of His Excellency Ernest Bai Koroma on February 22, 2013.

The Honorable Carrie Hessler-Radelet, Acting-Director of the Peace Corps, will lead the delegation.

Member of the Presidential Delegation:

Ms. Kathleen FitzGibbon, Chargé d'Affaires, United States Embassy to the Republic of Sierra Leone

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Blog posts on this issue February 21, 2013 5:39 PM ESTWest Wing Week: 02/22/13 or “A Single Sacred Word: Citizen” February 21, 2013 1:10 PM ESTA Balanced Plan to Avert the Sequester and Reduce the DeficitA Balanced Plan to Avert the Sequester and Reduce the Deficit

President Obama has already reduced the deficit by over $2.5 trillion, cutting spending by over $1.4 trillion, bringing domestic discretionary spending to its lowest level as a share of the economy since the Eisenhower era.

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From ‘Freaks and Geeks’ To ‘The Big Bang Theory,’ Pop Culture’s Conflation Of Geekiness and Autism

In mid-January, the critic Noel Murray wrote a perceptive and important essay for The AV Club about how much depictions of both nerds and people with autism have improved in popular culture in recent years. He explained that:

Five years ago, when my son turned 6, I wrote an essay for this site called “Rain Man Revisited,” in which I lamented that movies and TV episodes about autism tend to treat the autistic as aliens in our midst, defined only by their family members, who spend their lives waiting for their autists to say “I love you.” The situation has vastly improved since then, even beyond Sheldon Cooper. The HBO movie Temple Grandin did justice to an icon in the autism community, showing Grandin as a complicated person with accomplishments and pleasures as well as limitations. Community, The Middle, and Parenthood have created distinctive ASD characters in the pop-culture-consumed Abed Nadir, the obsessive-compulsive bookworm Brick Heck, and the inadvertently insensitive Max Braverman. And Ryan Cartwright’s performance as the autistic superhero Gary Bell on Alphas has been one of the truest I’ve yet seen, accurate in the autist’s at-times-frustrating inability to control his own quirks while also allowing Gary to be amused and amusing on his own terms.

In the weeks since Murray published his essay, I rewatched Freaks and Geeks, Paul Feig’s genius single-season show about the students at a suburban high school near Detroit, and Undeclared, collaborator Judd Apatow’s show about college freshmen living on the same hall. And while I was struck by any number of things in both shows, part of what stood out for me was the depictions of nerds. There’s no question that the geeks on both shows face any number of social challenges, from bullying, to building friendships with women they find attractive, to communicating sincerity when their default mode is sarcasm, to determining the status of a relationship after you’ve slept with someone once. But they’re decidedly not autistic: in fact, many of their problems stem from a mismatch between the geeks’ strong emotions, sincerity, and desires to connect and the environments in which they operate, which tend to overvalue coolness, detachment, and irony. It was a set of depictions that made me wonder if the depictions of nerds and autists have improved because we’re over-conflating geekiness and the presence of characters somewhere on the autism spectrum, rather than reflecting the range of both nerds and people with autism.

One of the best creations of Freaks and Geeks is Harris Trinsky, a long-haired nerd played by Stephen Lea Sheppard who, incidentally, has his only other acting credit Dudley Heinsbergen, the character in The Royal Tenenbaums who is being studied by Bill Murray’s Raleigh, who describes Dudley as suffering “from a rare disorder combining symptoms of amnesia, dyslexia, and color-blindness, with a highly acute sense of hearing.” Harris unmistakably geeky—the Dungeon Master of his social circle’s Dungeons and Dragons games, a good student, slack-physiqued in a way that suggests he isn’t trying to assimilate by bulking up or going out for sports—yet he’s also something of a sage. He advises Sam Weir, Neal Schweiber, and Bill Haverchuck to fight their bully, Alan White. He has a girlfriend, Judith, who he gets “scented oils and plenty of time with her man,” though they don’t appear to be having sex. Chief Freak Daniel Desario comes to Harris for an assessment on whether or not he’s a loser, and Harris calmly tells him “You’re not a loser ’cause you have sex, but if you weren’t having sex, we could definitely debate the issue.” When Coach Fredericks institutes a requirement that students shower after gym class, Harris is the one of the geeks who reacts with utter calm—he’s not ashamed or anxious of his body. Harris is very, very different from his contemporaries, but he’s not made uncomfortable the ways in which he’s socially out of step. Instead, Harris is comfortably and confidently marching to the beat of his own drummer.

The question for the rest of the geeks—and even for some of the freaks—is whether they’ll end up deciding that the tune Harris identified earlier than the rest of them is a fit, or whether they’ll end up socially assimilating in other ways. Sam, as his friendship and experience dating Cindy Sanders suggests, may have more capacity than Harris does to socially assimilate. The most conventionally handsome of his friends, once Sam hits his growth spurt and develops some fashion sense that doesn’t involve powder-blue jumpsuits, he may face even more intense questions about which social groups he wants to be a part of, rather than finding happiness in the group that will have him. Sensitive Bill may not grow into those options, but his bluntness has its appeal for popular students who are also going through the process of finding out that the social group where they initially landed may not be the one where they’d prefer to end up, as was clear in the episode where he and the other geeks attend a makeout party, and his seven minutes in heaven with a cheerleader turns into something more sincere and extended.

Undeclared, which examines the same kind of students four years down the line as they enter college. Steven Karp, Ron Garner, Marshall Nesbitt and Perry all have better social skills than than Bill, Sam, and Neal did, but the challenges they face are also more significant, mostly because having sex is an actual possibility for them in the way it wouldn’t have been for their younger counterparts. But once again, the things that make them awkward may also be the things that are going to make them wonderful, open-hearted men once they get the kinks out. Steven gets overly attached to Lizzie Exley, a pretty girl on his hallway, after they have sex their first day on campus, but once they find a way to be together, he wants nothing more to be solicitous and attentive to her needs, even if he’s not always clear on what they are. Marshall is, to a certain extent, a prototypical Nice Guy, yearning after Rachel, even to the point of letting her do alternative medicine experiments on him, without ever making a definitive move on her. Fortunately, though, he never acts as if he’s entitled to sex with her simply because they’ve been friends for a long time. And his desire for her, and his failure to act on it, is part of Marshall’s larger efforts to act on his own behalf, including deciding to study music rather than business. His instincts are good, he just has to learn to follow that he has a right to follow them. And then there’s Perry, who we meet when he uses his obsessions with hip-hop and Brit-pop to find a place for himself DJing campus parties. The things that might have made Perry weird in high school give him a role on campus. And it’s true with girls as well as guys. In the final episode of Undeclared‘s lone season, Perry’s expertise in dying hair, gained from the fact that he’s gone prematurely gray, gives him the skills to save Lizzie from bad highlights.

All of these kinds of stories about coming to terms with your difference, finding strength in it, embracing your openness and emotionality even if they don’t conform to the expectations for your gender, sharing your powers of perception and observation with people who have more social capital than you, and moving beyond the first social group you fell into are wonderful, important stories. There are scenarios in this class that people—and characters—with autism experience, but they’re not necessarily inextricably linked to the autism spectrum. Conflating geekiness and autism may help render people with autism more recognizable to audiences who aren’t on the spectrum, and may grant them access to social capital that wasn’t previously available to characters like Raymond Babbit. But that conflation also cuts us off from stories about social confident and competent geeks who are powerful bridges between social groups, rather than struggling to learn social norms, and from stories about people on the autism spectrum who have geeky interests, but whose behaviors are less comprehensible to people who don’t have much experience with people with autism than Sheldon Cooper’s might be (Alphas did an exceptionally good job of bringing out Anna, a character on the autism spectrum who invented her own language). As useful as combining these kinds of traits may have been over the past half-decade, I wonder if it’s time for us to start separating them out again, and start telling stories that both recognize the social capital many geeks possess today, and expanding pop culture’s exploration of the humanity of people whose main symptoms of autism aren’t defined by obsessive interest.


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New Jersey Legislators Will Vote To Override Chris Christie’s Marriage Equality Veto

In early 2012, lawmakers in New Jersey successfully passed marriage equality bill, but Gov. Chris Christie (R) vetoed it, claiming same-sex marriage was not an issue of “gay rights.” The legislature has until January 2014 to attempt to override that veto, and Democratic leaders in both chambers announced this week that they will attempt to do just that.

The bill originally passed the Senate with a 24-16 vote, so only three more votes are needed to reach a two-thirds majority for the override. In the Assembly, however, the bill only passed 42-33, so 12 more votes are needed. Lawmakers will likely wait until after the June elections to hold the vote so that Republicans are more willing to consider a controversial vote. LGBT activists have been lobbying for more support for an override since the bill’s passage last year, primarily because they are opposed to a referendum.

Openly gay Assemblyman Reed Gusciora (D) actually wants to allow for a vote, because he believes “the worst thing that can happen is the status quo.” However, Senate President Steve Sweeney also opposes a referendum, and for good reasons. As Garden State Equality pointed out last year, ballot initiatives are “a contest of which side can raise more millions” that offers “a community’s civil rights up for sale to the highest bidder.” Not only is a referendum incredible expensive, but it can have harsh consequences for the mental health of the entire LGBT community.

Arguably, a majority of New Jersey voters do support marriage equality, with polls showing as many as 53 percent, if not 57 percent, support. That, however, should be motivation for lawmakers to simply do their job and represent the interests of their constituents. Marriage equality is what’s best for New Jersey’s economy and the well-being of its citizens, in addition to just being the right thing to do.


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COLUMN-Medicare drug costs to fall in 2014, but donut hole widens

(The writer is a Reuters columnist. The opinions expressed are his own. For more from Mark Miller, see )

By Mark Miller

CHICAGO, Feb 21 (Reuters) - There will be good and bad news next year for seniors using Medicare's prescription drug program.

Overall, enrollees can expect a year of flat or decreasing Medicare prescription drug costs, according to data released last week by the federal government. The government said Medicare's per-beneficiary drug costs fell 4 percent last year. As a result, some of the most important numbers in the program's 2014 Part D will drop by roughly the same amounts.

The number that will matter most to seniors is the standard annual plan deductible. The federal Centers for Medicare & Medicaid Services (CMS), which administers Medicare, said last week that it will be $310, down from $325 this year (the numbers are proposed, and still could be revised).

And insurance plan premiums - which won't be known until this fall - could reflect the decline in drug prices. Although some Part D premiums jumped sharply in 2013, average rates have been flat for several years, ranging from $37 to $40, according to Jack Hoadley, research professor at the Health Policy Institute of Georgetown University.

"Premiums are driven by insurance plan estimates of what their average cost will be to treat a patient, so it's fair to say we're likely to see relatively flat premium growth next year," he says.

WHY COSTS ARE GOING DOWN

The moderation in drug costs is in sync with a broader slowdown in healthcare expenditures. The Congressional Budget Office said earlier this month that Medicare per-beneficiary spending rose only 0.4 percent in fiscal 2012, and overall Medicare spending was up just 3 percent.

The lower spending on prescription medicines results mainly from the expiration of patents on some of the most widely used drugs, such as Lipitor, made by Pfizer Inc .

"There's been a major shift to much less expensive generics," Hoadley says. "It's not just the drugs that went off patent, but also competing drugs that are still on patent, but where the patient can switch to a generic."

The exception, he notes, has been new biologic drugs used to treat conditions such as cancer, rheumatoid arthritis and multiple sclerosis. Those drugs remain relatively expensive, but may save healthcare dollars in other areas. "Biologics could put upward pressure on drug costs in the years ahead, but that could still be a good thing if it leads to better treatment and outcomes."

THE BAD NEWS

The wrinkle in the outlook is that because of the lower prices, for the first time in the Part D program's history, beneficiaries will enter the infamous "donut hole" more quickly than before. And that will likely cause confusion and consternation among the 19 percent of seniors affected by it.

Seniors fall into the "donut hole" when spending on drugs (the combination of what the individual and the insurance company spend) reaches a predetermined threshold. This year, the number is $2,970; after that point, the senior pays 50 percent (a new change this year from the Affordable Care Act) of brand-name drug costs, until individual spending exceeds $4,750.

But for 2014, the CMS has proposed that beneficiaries enter the hole when combined spending reaches $2,850 - $120 less than in 2013. That means seniors would start paying more out-of-pocket at a lower level of spending. That will surprise seniors, since one of the key touted benefits of President Barack Obama's healthcare reform law is the gradual closing of the donut hole entirely between now and 2020.

What is going on here?

The donut hole entry point isn't related to the ACA at all. It is determined by a formula tied to per-capita total Part D drug expenses - that 4 percent decline. Meanwhile, the out-of-pocket maximum is determined by the ACA and it also will be smaller next year - $4,550, down $200. Overall, the size of the donut hole shrinks by $80.

With me so far? Good - because the big thing going on with the donut hole under health reform is the reduction in the share of drug costs borne by seniors who enter the gap.

Before passage of the ACA, seniors in the gap paid 100 percent of all drug costs. Now, they pay 50 percent out-of-pocket for brand-name drugs, with the rest made up by insurers and discounts from pharmaceutical manufacturers. For generics, they pay 79 percent. Enrollees' out-of-pocket burden for brand-name and generic drugs will gradually fall to 25 percent by 2020 - the same percentage applied for standard coverage.

"More people could reach the coverage gap next year, but there will be better coverage in the gap once you get there," says Tricia Neuman, vice president of Kaiser and director of the foundation's Medicare policy work.

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Editing by Beth Pinsker and Dale Hudson)

((beth.pinsker@thomsonreuters.com)(1 646 223 7289)(Reuters Messaging: beth.pinsker.thomsonreuters.com@reuters.net))

Keywords: COLUMN MILLER/MEDICARE


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