Category

Fact Sheet

FACT SHEET: Consumers Would Save Billions Under the Lower Drug Costs Now Act

H.R. 3 Would Save Individual Patients Thousands Of Dollars On Costly Medications 

Giving Medicare the power to negotiate is the single most effective way to bring down drug prices and reduce costs for patients at the pharmacy counter. In addition to saving taxpayers $500 billion, the Democrats’ proposal would reduce the prices for the costliest medications by as much as 55 percent – saving patients an estimated $158 billion. An analysis from the Center for American Progress found that, in addition to saving patients thousands on expensive treatments for conditions like cancer and multiple sclerosis, H.R. 3 would help lower the cost of insulin for some diabetics by more than $700 annually.

The facts speak for themselves — consumers will benefit from drug price negotiations. It is time to put an end to Big Pharma’s fear mongering once and for all. A recent Committee on Oversight and Reform report found that between 2016 and 2020, 14 drug manufacturers spent a whopping $577 billion on stock buybacks and dividends. This figure is $56 billion more than what was spent on research and development over the same period, proving that high drug prices are funding profits, not innovation. 

KEY POINTS:

  • Drug price negotiations will save Americans billions. Drug price negotiations would drastically lower the cost of prescription drugs for consumers. Analyses confirm empowering the federal government to negotiate would reduce negotiated drug prices for the costliest medications by as much as 55 percent – saving patients an estimated $158 billion
  • Patients are at the whim of Big Pharma. Under our current system, patients are completely at the mercy of pharmaceutical corporations, with nearly one in four Americans taking prescription drugs experiencing difficulty affording their medications.
  • The vast majority of Americans support drug price negotiations. More than eight in ten Americans support the federal government negotiating lower prescription drug prices for Medicare recipients.

Negotiations Are Good For Consumers. The Lower Drug Costs Now Act (H.R. 3), would dramatically reduce the cost of prescription medications by empowering the federal government to negotiate prescription drug prices. Analyses from the nonpartisan Congressional Budget Office and the CMS Office of the Actuary confirmed the bill would reduce negotiated drug prices by as much as 55% – saving patients an estimated $158 billion over the next several years.

Americans Demand Negotiations Now. 79 percent of Americans say the cost of prescription drugs is “unreasonable”, with a recent Harvard-POLITICO poll finding 87 percent of respondents found drug pricing reform to be “extremely important”. When it comes to empowering the federal government to negotiate lower prescription drug prices for Medicare recipients, 86 percent of Americans are in support.

Nearly One In Four Americans Have Difficulty Affording A Prescribed Medication. Nearly one in four Americans taking prescription drugs have difficulty affording their medications, with 29 percent reporting not taking their medicines as prescribed at some point in the past year because of the cost. Those most severely impacted make less than $40,000 a year and have medication costs over $100.

Americans Live In Fear Of Drug Price Increases. Nearly nine in ten Americans feared that drug companies would use the pandemic as an excuse to raise prices. With seemingly endless price increases and drug manufacturers putting profits over people, it’s no wonder three in four Americans don’t trust Big Pharma to do the right thing and set fair prices for prescription drugs. 

High Prescription Drug Prices Perpetuate Racial Disparities. On average, Black, Hispanic, and Latino Medicare beneficiaries without drug coverage use 10 to 40 percent fewer prescription drugs than their white counterparts being treated for the same health issues. Inability to afford needed drugs is likely a critical element in why Black individuals suffer from many chronic illnesses at a greater level of severity. A prescription price increase of just $10 can result in reduced ability to access prescription drugs, often with fatal consequences.

Patient Assistance Programs Are Inaccessible For Those Most In Need. Many pharmaceutical corporations fund independent drug assistance programs. These deceptive programs function under the guise of providing needed medications, but in reality, tend to cover expensive, brand name drugs, even when cost-effective generic alternatives are available. Even more shocking is that 97 percent refused assistance to those who needed it most, individuals without insurance.

NEW REPORT: How High Drug Prices Hurt American Indians and Alaska Natives

Protect Our Care Releases New Report As Part of Lower Rx Summer

Today, Protect Our Care is continuing Week 6 of Lower Rx Summer with a report underscoring how high drug costs hurt American Indians and Alaska Natives. Earlier this week, Protect Our Care published research on the toll that high drug prices take on Black Americans and Hispanic and Latino people. Racial disparities in medication access only demonstrates the urgency for reform to bring down drug prices.

In June, Protect Our Care announced Lower Rx Summer as part of The Campaign to Reduce Drug Prices. Lower Rx Summer consists of themed weeks of action to illustrate the urgent need for legislation to lower drug prices principally by giving Medicare the power to negotiate with drug companies for lower prices for all Americans.

Remaining Theme Weeks for Lower Rx Summer

Week 6 (July 12): How High Drug Prices Hurt People of Color

Week 7 (July 19): How High Drug Prices Hurt Small Businesses

Week 8 (July 26): How High Drug Prices Hurt Children

Week 9 (August 2): Expanding Medicare Benefits—Hearing, Vision, And Dental

Racial inequity penetrates every corner of the American health care system, and high prescription drug prices are no exception. Nearly 30 percent of individuals taking prescription medications struggle to afford the cost, with the burden most severely impacting those who make less than $40,000 a year and have medication costs over $100. These factors disproportionately impact American Indians and Alaska Natives, who are more likely to require medications for chronic health conditions, while simultaneously earning household median incomes nearly $30,000 less than white counterparts, resulting in reduced ability to pay at the pharmacy counter. In addition, many American Indians and Alaska Natives live in one of the 13 states yet to implement Medicaid expansion, with people of color comprising 60 percent of individuals living in the coverage gap. 

“Structural racism has led to American Indians and Alaska Natives being disproportionately burdened by both high drug prices and wealth inequality in the United States,” said Protect Our Care Chair Leslie Dach. “It is unacceptable that millions of people can’t afford the drugs they need to survive. Bringing down the cost of drugs is an essential step in addressing racial inequities in health care. It’s time to put an end to Big Pharma’s greed and give Medicare the power to negotiate for lower drug prices.”

In 2019, the House of Representatives passed the Lower Drug Costs Now Act (H.R. 3), historic legislation that would lower drug prices for all Americans. H.R. 3 would save patients over $150 billion and reduce the price of the costliest drugs by as much as 55 percent

Not only does giving Medicare the power to negotiate help patients at the pharmacy counter, but it would save the federal government $500 billion, which could be reinvested to strengthen health care. These savings could help lower premiums, expand coverage, and strengthen Medicare benefits to include hearing, vision, and dental. As the nation recovers from the coronavirus pandemic, ensuring access to affordable health care, and specifically prescription drugs, has never been more critical. 

KEY POINTS

  • American Indians and Alaska Natives are disproportionately harmed by income and health inequity. American Indians and Alaska Natives are more likely to have a lower median income compared with their white counterparts. This disparity has profound impacts on health outcomes for American Indians and Alaska Natives that can result in reduced ability to access lifesaving drugs and a decrease in life expectancy.
  • American Indians and Alaska Natives are regularly forced to navigate chronic health conditions with reduced access to needed drugs. Compounding social, economic, and political forces make American Indians and Alaska Natives more likely to suffer from ongoing health issues and be faced with outrageous medication prices. Inequitable drug access due to cost creates additional medical problems that disproportionately impact American Indians and Alaska Natives. 
  • Drug pricing reform is crucial to addressing racial health disparities. American Indians and Alaska Natives are significantly more likely to be uninsured than their white counterparts, pushing up the cost of prescription drugs in a country that is already paying nearly three times what individuals in other countries are spending on the same drugs. Wealth and health disparities perpetuated by systemic racism increase the strain of drug costs for American Indians and Alaska Natives.

Read the new report on how high drug costs hurt American Indians and Alaska Natives here.

NEW REPORT: How High Drug Prices Hurt Hispanic and Latino People In the U.S.

Protect Our Care Releases New Report As Part of Lower Rx Summer

Today, Protect Our Care is releasing a new report as part of Week 6 of Lower Rx Summer underscoring how high drug costs hurt Latinos and Hispanic people. Throughout the week, Protect Our Care will host events and release additional research showing the urgency for reform to bring down drug prices for people of color. 

In June, Protect Our Care announced Lower Rx Summer as part of The Campaign to Reduce Drug Prices. Lower Rx Summer consists of themed weeks of action to demonstrate the urgent need for legislation to lower drug prices principally by giving Medicare the power to negotiate with drug companies for lower prices for all Americans. 

Remaining Theme Weeks for Lower Rx Summer

Week 6 (July 12): How High Drug Prices Hurt People of Color

Week 7 (July 19): How High Drug Prices Hurt Small Businesses

Week 8 (July 26): How High Drug Prices Hurt Children

Week 9 (August 2): Expanding Medicare Benefits—Hearing, Vision, And Dental

Racial inequity is pervasive within the American health care system, and high prescription drug costs are no exception. Nearly 30 percent of individuals taking prescription medication struggle to afford the cost, with the burden most severely impacting those who make less than $40,000 a year and have medication costs over $100. These factors disproportionately impact Hispanic and Latino individuals, who are more likely to require medications for chronic health conditions and earn household median incomes nearly $20,000 less than non-Hispanic white counterparts, resulting in reduced ability to pay at the pharmacy counter. 

“Structural racism has led to Hispanic and Latino people being disproportionately burdened by high drug prices in the United States,” said Protect Our Care Chair Leslie Dach. “It is unconscionable that millions of people can’t afford the drugs they need to survive. Bringing down the cost of drugs is an essential step in addressing racial inequities in health care and helping communities recover from the pandemic. It’s time for lawmakers to put an end to Big Pharma’s greed and give Medicare the power to negotiate for lower drug prices.”

In 2019, the House of Representatives passed the Lower Drug Costs Now Act (H.R. 3), historic legislation that would lower drug prices for all Americans. H.R. 3 would save patients over $150 billion and reduce the price of the costliest drugs by as much as 55 percent

Not only does giving Medicare the power to negotiate help patients at the pharmacy counter, but it would save the federal government $500 billion, which could be reinvested to strengthen health care. These savings could help lower premiums, expand coverage, and strengthen Medicare benefits to include hearing, vision, and dental. As the nation recovers from the coronavirus pandemic, ensuring access to affordable health care, and specifically prescription drugs, has never been more critical. 

KEY POINTS

  • Income and health coverage inequity disproportionately harm Hispanic and Latino people. Hispanic and Latino individuals are more likely to have a lower median income and live in a state without Medicaid expansion, compared with their white counterparts. These disparities have profound impacts on health outcomes for Hispanic and Latino people that result in reduced ability to access lifesaving drugs with tragic results.
  • Hispanic and Latino people are regularly forced to navigate chronic health conditions with reduced access to needed drugs. Compounding social, economic, and political forces make Hispanic and Latino individuals more likely to suffer from ongoing health issues and be faced with outrageous medication prices. Inequitable drug access due to cost, creates additional medical problems that disproportionately impact Hispanic and Latino individuals. 
  • Drug pricing reform is crucial in addressing racial health disparities. Hispanic and Latino individuals are significantly more likely to be uninsured than their white counterparts, pushing up the cost of prescription drugs in a country that is already paying nearly three times what individuals in other countries are spending on the same drugs. Wealth and health disparities perpetuated by systemic racism increase the strain of drug costs for Hispanic and Latino people.

Read the new report on how high drug costs hurt Hispanic and Latino people here.

NEW REPORT: How High Drug Prices Hurt Black Americans

Protect Our Care Releases New Report As Part of Lower Rx Summer

Today, Protect Our Care is kicking off Week 6 of Lower Rx Summer with a report underscoring how high drug costs hurt Black Americans. Throughout the week, Protect Our Care will host events and release additional research to demonstrate the urgency for reform to bring down drug prices for people of color. 

In June, Protect Our Care announced Lower Rx Summer as part of The Campaign to Reduce Drug Prices. Lower Rx Summer consists of themed weeks of action to demonstrate the urgent need for legislation to lower drug prices principally by giving Medicare the power to negotiate with drug companies for lower prices for all Americans. 

Remaining Theme Weeks for Lower Rx Summer

Week 6 (July 12): How High Drug Prices Hurt People of Color

Week 7 (July 19): How High Drug Prices Hurt Small Businesses

Week 8 (July 26): How High Drug Prices Hurt Children

Week 9 (August 2): Expanding Medicare Benefits—Hearing, Vision, And Dental

Racial inequity penetrates every corner of the American health care system, and high prescription drug prices are no exception. Nearly 30 percent of individuals taking prescription medication struggle to afford the cost, with the burden most severely impacting those who make less than $40,000 a year and have medication costs over $100. These factors disproportionately impact Black Americans, who are more likely to require medications for chronic health conditions, while simultaneously earning household median incomes nearly $30,000 less than white counterparts, resulting in reduced ability to pay at the pharmacy counter. 

“Structural racism has led to Black Americans being disproportionately burdened by high drug prices in the United States,” said Protect Our Care Chair Leslie Dach. “It is unacceptable that millions of people can’t afford the drugs they need to survive. Bringing down the cost of drugs is an essential step in addressing racial inequities in health care. It’s time to put an end to Big Pharma’s greed and give Medicare the power to negotiate for lower drug prices.”

In 2019, the House of Representatives passed the Lower Drug Costs Now Act (H.R. 3), historic legislation that would lower drug prices for all Americans. H.R. 3 would save patients over $150 billion and reduce the price of the costliest drugs by as much as 55 percent

Not only does giving Medicare the power to negotiate help patients at the pharmacy counter, but it would save the federal government $500 billion, which could be reinvested to strengthen health care. These savings could help lower premiums, expand coverage, and strengthen Medicare benefits to include hearing, vision, and dental. As the nation recovers from the coronavirus pandemic, ensuring access to affordable health care, and specifically prescription drugs, has never been more critical. 

KEY POINTS

  • Black people are disproportionately harmed by income and health coverage inequity. Black Americans are more likely to have a lower median income and live in a state without Medicaid expansion, compared with their white counterparts. These disparities have profound impacts on health outcomes for Black people that result in reduced ability to access lifesaving drugs and a tragic decrease in life expectancy.
  • Black Americans are regularly forced to navigate chronic health conditions with reduced access to needed drugs. Compounding social, economic, and political forces make Black people more likely to suffer from ongoing health issues and be faced with outrageous medication prices. Inequitable drug access due to cost, creates additional medical problems that disproportionately impact Black people. 
  • Drug pricing reform is crucial in addressing racial health disparities. Black Americans are significantly more likely to be uninsured than their white counterparts, pushing up the cost of prescription drugs in a country that is already paying nearly three times what individuals in other countries are spending on the same drugs. Wealth and health disparities perpetuated by systemic racism increase the strain of drug costs for Black people.

Read the new report on how high drug costs hurt Black Americans here.

NEW REPORT: Closing the Medicaid Coverage Gap in South Carolina

Report Outlines Urgent Need for Federal Approach to Provide Relief to Millions of People Who Have Been Locked Out of Coverage

Washington, DC — Today, Protect Our Care is releasing a report on the impacts of the Coverage Gap in South Carolina, one of 13 states that refuse to expand Medicaid. Americans with low-incomes should not be forced to go without health coverage simply because they live in a state that has refused Medicaid expansion. According to the report, nearly 325,000 South Carolinians could gain coverage and, even after paying for the cost of expansion, the state would receive an additional $600 million in from the federal government thanks to the American Rescue Plan.

However, South Carolina Governor McMaster continues to stand in the way of expansion, calling the incentives for expansion in the American Rescue Plan a “bribe. In response to Republican inaction, Democrats in Congress are now proposing another approach that would have the federal government close the Medicaid expansion gap this year by creating a federal solution to medicare expansion that would bypass those state governments who refuse to do the right thing.

The report comes after leaders of the Congressional Tri-Caucus, which includes the Congressional Asian Pacific American Caucus (CAPAC), Congressional Black Caucus (CBC), and Congressional Hispanic Caucus (CHC), joined more than 60 of their colleagues on a letter advocating for closing the coverage gap through the American Families Plan.

“South Carolinians are suffering unnecessarily due to the state’s failure to expand Medicaid. Closing the Medicaid gap will not only provide many low-income families with access to health care, it will help rural hospitals remain open, create jobs, and save lives,” said Congressman James E. Clyburn. “This is not an argument about how much it will cost to expand Medicaid, it is about what it will cost us if we don’t.”

“Waiting for the Republican leaders in these states to change course is no longer a viable option,” said Protect Our Care Executive Director Brad Woodhouse. “By refusing to expand Medicaid in their state, South Carolina Republican lawmakers are denying coverage to their most vulnerable populations. Despite the overwhelming benefits of Medicaid expansion, and even with the additional incentives included in the American Rescue Plan, Republicans have put politics over people by continuing to reject the program. Democrats are proposing a bold new approach for the federal government to close the expansion gap, and Congress must take action now to make it a reality. Protect Our Care is grateful for the leadership of Majority Whip James Clyburn on this issue and his continuing commitment to ensure South Carolinians and all Americans have access to the care they need.”

Read the new report on closing the coverage gap in South Carolina.

Read the previous reports on Florida, Georgia, North Carolina, Texas, and Wisconsin.

FACT SHEET: How High Drug Costs Hurt Seniors

Protect Our Care Releases New Fact Sheet As Part of Lower Rx Summer

Today, Protect Our Care is kicking off Week 3 of Lower Rx Summer with a fact sheet underscoring how high drug costs hurt seniors. Throughout the week, Protect Our Care will host events and release additional research to demonstrate the urgency for reform to bring down drug prices for seniors.

Remaining Theme Weeks for Lower Rx Summer

Week 3 (June 21): How High Drug Prices Hurt Seniors

Week 4 (June 28): How High Drug Prices Hurt Women

Week 5 (July 5): How High Drug Prices Hurt People with Disabilities

Week 6 (July 12): How High Drug Prices Hurt People of Color

Week 7 (July 19): How High Drug Prices Hurt Small Businesses

Week 8 (July 26): How High Drug Prices Hurt Children

Seniors are at the center of the drug pricing crisis. Nearly 9 in 10 Americans over the age 65 take prescription medications, with many struggling with serious conditions such as diabetes, arthritis, and cancer. As many as one in four seniors, or more than 10 million seniors nationwide struggle to afford prescription drugs, with higher rates among more vulnerable groups, including low-income seniors, people of color, and those in poor health. It is unconscionable that seniors and older adults in this country are forced to make impossible choices between purchasing essential medicines and buying food or paying rent. 

Yet every day, drug companies profit off of seniors. Drugmakers are raking in record profits and spending millions on lobbying to block reform while continuing to hike the prices of lifesaving medications. A recent analysis from the Kaiser Family Foundation found that half of all drugs covered by Medicare Part D, or 1,646 drugs, had price increases averaging 3.5 times the rate of inflation between 2018 and 2019. This translates to hundreds, if not thousands, in additional out-of-pocket costs for patients — simply unworkable for seniors with fixed incomes. Research shows that even a modest increase in out-of-pocket costs can have deadly consequences for patients, who are forced to skip doses or forgo medications altogether due to rising costs. 

High drug prices demonstrate the urgent need to give Medicare the power to negotiate for lower drug prices. In 2019, the House of Representatives passed the Lower Drug Costs Now Act (H.R. 3), historic legislation that would lower drug prices for all patients, not just those covered under Medicare. H.R. 3 would save patients over $150 billion and reduce the price of the costliest drugs by as much as 55 percent. 

Not only does giving Medicare the power to negotiate help seniors at the pharmacy counter, but it would save the federal government nearly $500 billion, which could be reinvested to strengthen health care for seniors and older adults. These savings could help lower premiums, expand coverage, establish an out-of-pocket cap for drug costs, and strengthen Medicare benefits to include hearing, vision, and dental. As the nation recovers from the coronavirus pandemic, ensuring access to affordable health care, and specifically prescription drugs, has never been more critical. 

KEY POINTS

    • Millions of seniors are struggling to afford medications as drug companies are raking in major profits. 89 percent of Americans over 65 take prescription medications, with one in four struggling to afford drug costs. Meanwhile, pharmaceutical companies are experiencing record profits and breaking records for the money they are spending on K Street lobbyists to block legislation to lower prices for seniors. Research shows Big Pharma could lose $1 trillion in sales and still be the most profitable industry. 
    • Despite record profit, drug manufacturers continue to exploit a broken system by hiking prices at the expense of our seniors. In January 2021, drugmakers hiked the price of nearly 1,000 drugs. Between 2018 and 2019, 1,646 drugs covered by Medicare Part D experienced price increases averaging 3.5 times the rate of inflation. These surging drug costs are particularly difficult for the 50 percent of Medicare beneficiaries living on annual incomes below $29,650
  • Growing out-of-pocket drug costs put the lives of seniors at risk. Medicare has no cap on out-of-pocket prescription drug costs. A 2021 study found that increasing out-of-pocket drug costs by only $10 created a 33 percent increase in mortality, due to a decrease in medication accessibility. Biogen’s debut of Aduhelm, a new Alzheimer’s treatment slated to cost $56,000 per year with over $10,000 in out-of-pocket costs to patients, demonstrates the reckless greed of the pharmaceutical industry. 
  • Americans don’t trust Big Pharma to play fair. Nearly 75 percent of Americans do not trust drug manufacturers to set fair pricing for prescription drugs and nine in ten believe the federal government should have the power to negotiate with drug companies to lower the price of prescription drugs for Medicare recipients. 

Rising Prescription Drug Costs Disproportionately Impact Seniors

Nearly Nine In Ten Seniors Currently Take Prescription Medication, With Millions Struggling To Afford The Cost. One in four adults over 65 report difficulty affording their prescription drugs. Seniors most likely to experience difficulty are: in poor health, have an annual household income under $30,000, and/or take four or more prescription medications. 

Prescription Drug Prices Continue To Outpace Inflation. Between 2018 and 2019, 1,646 drugs covered by Medicare Part D experienced price increases averaging 3.5 times the rate of inflation.

The Most Essential Medications Are Often The Most Expensive. With the high cost of specialty medications, it should come as no surprise that 80 percent of prescriptions that seniors report struggling to afford are for the treatment of ‘somewhat serious’ or ‘very serious’ health conditions. One million Medicare Part D beneficiaries spend more than Part D’s catastrophic coverage threshold, paying an annual out-of-pocket average of $3,200. Patients taking prescription drugs for treatment of cancer, hepatitis C, multiple sclerosis, and rheumatoid arthritis face some of the most extreme costs. The average out-of-pocket cost for 11 oral prescription cancer drugs was $10,470 in 2019. 

Most Medicare Beneficiaries Live On A Fixed Income. In 2019, 50 percent of Medicare recipients had incomes under $29,650. With average out-of-pocket costs for specialty medications surpassing $8,000, many seniors are faced with the impossible decision of filling their prescriptions or paying for other basic needs. 

Growing Out-Of-Pocket Prescription Costs Limit Medicare Beneficiaries’ Access To Drugs

Medicare Has No Out-Of-Pocket Limit For Prescription Drugs. Individuals on Medicare are the only insured Americans to have no cap for out-of-pocket medication costs. Once Medicare beneficiaries are out of the coverage gap and have obtained catastrophic coverage, they are still responsible for coinsurance and copayments costs.

Out-of-Pocket Costs For Specialty Medications Are Skyrocketing. Even with catastrophic coverage, Medicare Part D enrollees can face thousands of dollars in out-of pocket expenses for specialty drugs. Kaiser Family Foundation anticipated the average 2019 out-of-pocket cost for specialty drugs to be $8,109

High Out-of-Pocket Costs Force Seniors To Forgo Medications. One in five seniors report not taking their medications as prescribed due to cost. A 2021 study found that increasing out-of-pocket costs by only $10 created a 23 percent decrease in Medicare beneficiaries taking prescription drugs as instructed, as well as a 33 percent increase in mortality. 

Seniors Are Forced To Put Off Retirement To Access Needed Drugs. Without a limit on out-of-pocket costs for prescriptions, many older Americans continue working to retain access to employer insurance plans which offer additional coverage. Postponing the transition to Medicare also allows for the continuation of financial assistance from pharmaceutical manufacturers, not available to Medicare beneficiaries.

Americans Don’t Trust Big Pharma And Support Efforts To Bring Down Drug Prices 

Americans Hold Big Pharma Responsible For High Costs. 80 percent of Americans believe the profits of drug manufacturers are a leading contributor to the unreasonably high price of prescription medication. As a result, nearly 75 percent of Americans do not trust pharmaceutical corporations to set a fair price for their prescription drugs. 

Seniors Want Action From Congress. 82 percent of seniors support the federal government negotiating lower prescription drug prices for Medicare recipients and nearly 70 percent favor an annual cap on out-of-pocket drug costs for those on Medicare.

There Is Strong Support For Drug Price Negotiation. Nine in ten Americans agree the federal government should have the power to negotiate with drug companies to lower the price of prescription drugs for Medicare recipients. 

Seniors Support Basing Drug Prices On Amounts Paid In Other Countries. 60 percent of older Americans favor tying what Medicare pays for prescription drugs to the amounts paid by other countries. The CommonWealth Fund found that H.R. 3 would create a maximum price for any negotiated drug by tying it to the cost in other countries and penalizing manufacturers who fail to agree to prices set by HHS.

How The American Rescue Plan Strengthens Medicaid Coverage

April is Medicaid Awareness Month. On March 11, President Biden signed the American Rescue Plan into law, historic legislation that includes the most significant health care expansion in a decade. After four long years of Republican efforts to sabotage the Affordable Care Act (ACA) and Medicaid, President Biden and Democrats in Congress are now working to expand coverage, lower costs, and reduce racial disparities in health care. 

In addition to providing affordable coverage options for millions of uninsured Americans through the ACA, the American Rescue Plan provides robust financial incentives for the 14 states that have not yet implemented Medicaid expansion. The legislation also includes important measures to strengthen Medicaid coverage and benefits. Medicaid has served as a critical safety net as millions have lost jobs and their employer-based health insurance during the pandemic. Unsurprisingly, Medicaid enrollment has grown to an all-time high of 77 million Americans. Between February and November 2020, states that expanded their programs saw a 22 percent increase in Medicaid enrollment. 

The American Rescue Plan: 

Incentivizes Medicaid Expansion. The American Rescue Plan includes an offer too good for Republican holdout states to turn down: In addition to covering 90 percent of the costs for the expansion population, the federal government would chip in an extra 5 percent for the traditional Medicaid population for two years. This translates to billions in additional dollars for the states — more than enough to cover the cost of expansion itself. Research confirms that Medicaid expansion increases access to care, improves financial security, and leads to better health outcomes. 

  • Four million uninsured adults could gain coverage if remaining holdout states expand Medicaid. The Urban Institute estimates that more than 6 million people could enroll in Medicaid coverage if the remaining states implemented expansion. This includes at least 2.4 million people of color, 500,000 people with disabilities, and almost a million older Americans who are currently uninsured. Additionally, research shows that Medicaid expansion helps increase coverage rates for children. 
  • Even after paying the cost of Medicaid expansion, these states would receive an additional $9.6 billion in new federal funding that they could use to offset spending in other state programs or budget shortfalls. According to estimates from the Kaiser Family Foundation, the 14 states that have not yet implemented Medicaid expansion would receive $16.4 billion thanks to the enhanced federal match rate under the American Rescue plan, while the total cost of Medicaid expansion in these states would only be $6.8 billion.

Expands Medicaid Coverage To New Mothers One Year Postpartum. Women in the United States are more likely to die during childbirth than in peer nations, and Black women are three to four times more likely to die of complications related to pregnancy and childbirth compared to white women. A recent study from the Urban Institute found that 20 percent of uninsured new mothers skipped care because of cost, and half worried about not being able to afford medical bills. The American Rescue Plan works to address the maternal mortality crisis by enabling states to expand Medicaid coverage to new mothers 12 months postpartum. This is particularly important in non-expansion states, where many new mothers fall into the coverage gap. 

Includes Funding To Ensure Medicaid Patients Can Get COVID-19 Treatment & Vaccinates For Free. The American Rescue Plan includes federal funding to provide COVID-19 treatment and vaccines at no cost to Medicaid recipients. The ARP also gives 100 percent federal match funding to states that choose to provide vaccines and treatment to the uninsured without cost sharing. Efforts to increase vaccination will be especially beneficial in communities of color and hard to reach populations.

Invests In Medicaid Home- And Community-Based Services (HCBS). HCBS help seniors and people with disabilities live and age independently at home and in their communities. Under the American Rescue Plan, states will receive a 10 percentage point increase in federal matching funds through March 2022 to strengthen Medicaid HCBS. The American Rescue Plan also includes additional funding for Medicaid-certified nursing facilities experiencing COVID-19 outbreaks. 

Invests $8.5 Billion In Relief Payments For Rural Medicaid Providers. Rural hospitals have taken a serious financial hit during the pandemic. Per the Kaiser Family Foundation, “These funds are available to compensate for health care related expenses and lost revenues attributable to the pandemic for rural providers who diagnose, test, or care for individuals with possible or actual COVID-19.” 

Provides Additional Funds For Community-Based Mobile Crisis Intervention Services. The American Rescue Plan gives states the option to provide community-based mobile crisis intervention services with 85 percent federal matching funds for three years. These services help people experiencing issues with mental health and substance use disorder. 

Lifts The Medicaid Drug Rebate Cap. Eliminating the cap on prescription drug rebates that manufacturers pay to state Medicaid programs would bring significant savings to state budgets as they recover from the economic toll of the pandemic. 

ACA At 11: Protections For People With Pre-Existing Conditions

Protect Our Care Is Marking the 11th Anniversary of the Affordable Care Act With 11 Days Celebrating the Success of the Health Care Law

Eleven years ago, the Affordable Care Act (ACA) became the law of the land and millions of people gained coverage and critical protections as a result. Because of the ACA, insurers in the individual market can no longer drop or deny coverage, or charge people more because of a pre-existing condition. More than 135 million Americans have a pre-existing health condition, such as asthma, diabetes, or cancer. 

After four long years of Republican efforts to repeal and sabotage the law, President Biden and Democrats in Congress are now working to build on the strong foundation of the ACA to expand coverage, lower costs, and reduce racial disparities in health care. On March 11, President Biden signed the American Rescue Plan into law, historic legislation that includes the most significant health care expansion in a decade. Solidifying and expanding the ACA is especially important as millions of Americans have contracted the COVID-19; without the health law’s protections, survivors of COVID-19 would likely be deemed as having a pre-existing condition and be at the mercy of their insurance companies who could refuse to pay for needed care. 

At the same time, millions have lost their jobs and their employer-sponsored coverage during the pandemic, and experts say an overwhelming majority have been able to get covered under the ACA — through the marketplaces or through Medicaid expansion. Every single one of these individuals now relies on the ACA’s protections for pre-existing conditions. 

The ACA Includes Four Key Provisions That Protect People With Pre-Existing Conditions: 

  • COVERAGE GUARANTEE: Rule that forbids insurance companies from denying coverage to people with pre-existing conditions. 
  • COST: Rule that prevents insurers from charging people with pre-existing conditions more. 
  • ESSENTIAL HEALTH BENEFITS: Requirements that insurance companies cover essential health benefits, such as prescription drugs and maternity care.
  • LIFETIME CAPS: Ban on insurance companies having lifetime caps on coverage.

The ACA Prevents Insurance Companies From Charging Americans With A Pre-Existing Condition More, Or Denying Them Coverage Altogether. Prior to the ACA, insurance companies were allowed to charge people more or deny coverage simply because they had a pre-existing condition. The ACA banned this practice, requiring that insurance companies offer people coverage regardless of their health status. Without the ACA, premium surcharges could once again be in the six figures for some conditions. 

The ACA Guarantees Comprehensive Coverage. Because of the ACA, insurers have to cover what are known as “essential health benefits,” such as maternity care, prescription drugs, and substance and mental health. Importantly, ACA-compliant plans must cover COVID-19 testing, treatment, and hospitalization. Before the ACA, individual market plans often failed to cover these basic health services.  

The ACA Ended Annual And Lifetime Limits, Including For People With Employer-Based Coverage. Because of the ACA, insurers can no longer put annual or lifetime limits on the care you receive. At the time the ACA was passed, 91 million Americans had health care through their employers that imposed lifetime limits. Many such plans capped benefits at $1 million, functionally locking people with complex medical needs out of coverage. 

A Closer Look At Who Has Pre-Existing Conditions In The U.S.

Before the Affordable Care Act, insurance companies routinely denied people coverage because of a pre-existing condition or canceled coverage when a person got sick. According to an analysis by the Center for American Progress, roughly half of nonelderly Americans, or as many as 135 million people, have a pre-existing condition. This includes:

  • 44 million people who have high blood pressure
  • 45 million people who have behavioral health disorders
  • 44 million people who have high cholesterol
  • 34 million people who have asthma and chronic lung disease
  • 34 million people who have osteoarthritis and other joint disorders

More than 17 million children, 68 million women, and 32 million people aged 55-64 have a pre-existing condition.

The Kaiser Family Foundation estimates that 54 million people, or 27 percent of adults aged 18 to 64, have a condition that would have been grounds for coverage denial in the pre-ACA marketplace. Recent survey data found that six in 10 say they or someone in their household suffers from a pre-existing condition, such as asthma, diabetes, or high blood pressure. 

ACA At 11: Women’s Coverage

Protect Our Care Is Marking the 11th Anniversary of the Affordable Care Act With 11 Days Celebrating the Success of the Health Care Law

Eleven years ago, the Affordable Care Act (ACA) became the law of the land and millions of women gained coverage and critical protections as a result. Among the many benefits of the ACA, the health care law ensures that women cannot be charged more than men for the same coverage. Additionally, 68 million women with pre-existing conditions like diabetes and asthma are protected from discrimination, and they are no longer subject to annual or lifetime limits. The ACA also guarantees free preventive care, such as mammograms, Pap smears, and other important screenings, in addition to providing birth control with no out-of-pocket fees. These benefits, along with creation of the ACA Marketplace and expansion of Medicaid, have improved the health of women across the country. 

After four long years of Republican efforts to repeal and sabotage the law, President Biden and Democrats in Congress are now working to build on the strong foundation of the ACA to expand coverage, lower costs, and reduce racial disparities in health care. On March 11, President Biden signed the American Rescue Plan into law, historic legislation that includes the most significant health care expansion in a decade. Making coverage more affordable and accessible is essential as millions of women have lost their jobs and their health insurance during the COVID-19 pandemic. Protect Our Care recently released a report detailing the impact of the American Rescue Plan on women’s lives. 

Thanks To The ACA: 

  • 68 Million Women With Pre-Existing Conditions Cannot Be Charged More Or Denied Coverage. Prior to the ACA, conditions like asthma, diabetes, and even pregnancy were grounds for insurance companies to charge more or deny coverage altogether. Additionally, insurance companies could impose annual and lifetime limits on coverage, which further eroded access to care for the sickest patients. 
  • Women Cannot Be Charged More Than Men For The Same Coverage. Before the ACA, women were often charged premiums on the nongroup market of up to 50 percent higher than men for the same coverage, and 1 in 5 women reported postponing or going without preventive care due to cost. Thanks to the ACA, insurers cannot charge women more than men for the same coverage, and women gained access to important preventive care services with no out-of-pocket costs. 
  • More Than 60 million People Have Access To Birth Control With No Out-Of-Pocket Fees. The ACA guarantees that private health plans cover 18 methods of contraception and make them available to 62.4 million patients with no out-of-pocket costs. More than 99 percent of sexually-active women have used contraceptives at some point in their lifetimes, and approximately 60 percent of women of reproductive age currently use at least one birth control method. In addition to increasing access to this essential treatment, this ACA provision has saved money for women and their families: women saved $1.4 billion on birth control pills alone in 2013.
  • Women Can No Longer Face Discrimination In Health Care Settings. Section 1557 of the ACA prohibits discrimination the basis of race, color, national origin, sex, age, or disability by any health program or activity receiving federal assistance. It also prohibits these types of discrimination in health programs and activities administered by HHS as well as the ACA marketplaces. 
  • Nursing Parents Gained Breastfeeding Support And Critical Workplace Protections. The Affordable Care Act requires insurance companies to cover breastfeeding support and counseling as well as breast pumps without cost-sharing for pregnant and nursing women. 

A Closer Look At How The Affordable Care Act Is Working For Women Across The Country:

The Number Of Uninsured Women In The U.S. Fell By Nearly Half Between 2010 And 2016. The number of women lacking health insurance had fallen by almost half between 2010 and 2016, from 19 million to 11 million. The uninsured rate for women with low incomes fell from 34 percent to 18 percent over the same period. 

The ACA Improved Women’s Access To Care. Studies have shown that women with insurance are far more likely to receive preventive care, including mammograms. According to the Commonwealth Fund, the percentage of women skipping needed care, including filling a prescription, going to the doctor, or receiving recommended care, dropped from 48 percent in 2010 to 38 percent in 2016. Additionally, the number of women reporting problems with medical bills declined after the implementation of the ACA. The Center for American Progress found that, by 2014, Black women were already more likely to receive care because of the ACA. 

The ACA’s Medicaid Expansion Improved Maternal Health. Research from the Georgetown Center for Children and Families found that Medicaid expansion has helped fill gaps in maternal health coverage, leading to healthier mothers and babies. It also helps new mothers maintain access to coverage and important postpartum care after giving birth. Multiple studies draw the connection between Medicaid expansion and reduced infant and maternal mortality rates. One study found that reductions in maternal mortality in expansion states were concentrated among Black mothers, “suggesting that expansion could be contributing to decreasing racial disparities in maternal mortality.” Medicaid expansion has also been tied to improving access to birth control and family planning. 

As Health Care Takes Center Stage, Protect Our Care Releases Agenda to Lower Costs, Improve Care and Reduce Inequities

Protect Our Care Says Key Health Care Measures Must Be Included As Congress Considers COVID Relief and Budget Reconciliation 

Read the Agenda Here

Washington, DC — Today, Protect Our Care released a health care agenda detailing steps President Biden and the Democratic-controlled Congress should take to improve Americans’ health care. The agenda lays out both administrative and legislative actions to expand coverage, lower costs, strengthen protections and address inequities in care. The agenda comes as the Biden administration prepares to sign executive orders related to health care, presses forward with the American Rescue Plan, which includes key health care affordability provisions, and Congress prepares to move forward on budget reconciliation if Republicans fail to agree to the rescue plan America needs.   

“Protect Our Care’s health care agenda lays out common sense measures in line with what Democrats, including President Biden, have run and won on when it comes to health care. These provisions will increase coverage and lower costs, and they are even more important as Americans battle the pandemic. President Biden has put health care front and center since taking office by prioritizing critical executive orders that make sure more Americans can get covered and remove barriers to enrolling in Medicaid. We look forward to working with President Biden and Democratic leaders in Congress to move our common agenda forward,” said Protect Our Care Executive Director Brad Woodhouse

“President Biden’s American Rescue Plan includes strong provisions to reduce the cost of health insurance for millions of Americans and get millions more covered. Polling shows that large majorities of Republican voters support these provisions, and Republican members of Congress should support them too. And if Republicans refuse, any COVID relief budget reconciliation plan should include them. That’s what Americans want and expect. Americans cannot afford to wait any longer,” said Protect Our Care Chair Leslie Dach.