Steve Anderson, in his ”Brief History of Medicare in America,” writes that it took 20 years before some form of national health insurance, what we know as Medicare for Americans 65 and older would become a reality.
President Lyndon Johnson made Medicare law on July 30, 1965, and President Harry S Truman was issued the very first Medicare card during the ceremony. The budget that year for Medicare was about $10 billion and 19 million Americans signed up for Medicare during its first year.
Discussion about a national health insurance system that now covers 58.5 million Americans goes all the way back to the days of President Teddy Roosevelt, whose platform included health insurance when he ran for president in 1912.
Truman on Nov. 19, 1945, was seven months into his presidency, when he called for the creation of a national health insurance fund open to all Americans. This plan would provide health coverage to individuals, paying for such typical expenses as doctor visits, hospital visits, laboratory services, dental care and nursing services.
Trump has proposed to bring transparency to the system, end the status quo of kickbacks from drug companies to middlemen and plans known in the industry as “rebates,” and deliver those savings straight to patients and their pocketbooks.
John O’Brien, the senior advisor to the new secretary for drug pricing reform, issued a release summarizing it as the single-biggest change to how drugs are priced at the pharmacy counter.
When Medicare’s coverage took effect in 1966, Americans age 65 and older were enrolled in Part A and millions of other seniors signed up for Part B. In 1972, President Richard Nixon signed into law the first major change to Medicare. The legislation expanded coverage to include individuals under the age of 65 with long-term disabilities and individuals with end-stage renal disease known more commonly as ESRD.
The Omnibus Reconciliation Act of 1980 expanded home health services, and brought Medigap or Medicare Supplement insurance under federal oversight. In 1982, hospice services for the terminally ill were added to a growing list of Medicare benefits. Anderson writes that in 1988, Congress passed the Medicare Catastrophic Coverage Act, adding a true total to out-of-pocket expenses for Part A and Part B, along with a limited prescription drug benefit. Opposition from senior groups over the program’s higher premiums had this program repealed, and to this day there is no cap on out of pocket costs for Medicare A and B.
There have been many changes to the program in the 1990s and the 2000s, and in 2010, the Patient Protection and Affordable Care Acts were passed, which included a long list of reform provisions intended to contain Medicare costs, while increasing revenue, improving and streamlining its delivery systems, and even increasing services to the program
In early 2015, after years of trying to accomplish reforms, Congress passed the Medicare and CHIP Reauthorization ACT, or MACRA, which served as a catalyst through 2016 and beyond for the Centers for Medicare and Medicaid, CMS, to push changes as to how Medicare pays doctors for care, moving to pay for more value and quality over just how many serviced doctors provide Medicare beneficiaries.
Most plans for Medicare prescription drug coverage Part D have a coverage gap called a “donut hole.” This means that after you and your drug plan have spent a certain amount of money for covered drugs, you have to pay all costs out-of-pocket for your prescription drugs. Currently, all states offer outpatient prescription drug coverage and there are limits on how much the state can make the patient pay for prescription drug coverage by healthcare benefits.
The donut hole has continued to close as a result of the Affordable Care Act and will be fully eliminated by 2020. At that point, enrollees will pay 25 percent of the cost of their drugs until they reach the catastrophic coverage limit, as opposed to paying the full costs of the drugs while in the donut hole, which had been the case before the ACA started to close the donut hole in 2010/2011.
Trump through his Health and Human Services department, if he gets his way, will eliminate the kickbacks and the patient will get the discount right at the prescription counter in the pharmacy. The middlemen will tell you that the money they are skimming off the price of a drug goes back to the patient in the form of lower premiums. Some will say that getting rid of the kickbacks will cause premiums to rise.
Neither is true. Even with the most liberal estimate projections, premiums will rise by just a few dollars, but for most seniors, the savings in premiums will not exceed the costs at the pharmacy counter.
Higher rebates mean higher drug prices, and by correcting this issue we will be able to lower prescription drug prices. Part D prescription plans will do their best to keep the costs of premiums down as they will be in a more competitive marketplace for the customers dollars.
The pharmacist will also have a more accurate picture of what drugs will cost the customer and there will be a more honest picture of what he or she is getting paid when the prescription is dispensed.
To bring about the changes in the system requires the cooperation of both parties. This is an opportunity to really change the way Medicare, Medicaid and probably many employer- sponsored prescription programs will cover the cost drugs they have to pay for.
Bertram Drachtman
Great Neck
