Who are the top doctors in Columbus? Search by specialty with Columbus Monthly's 2021 list

Harris Builds On And Differs From Biden Administration's Healthcare Policies

WASHINGTON, DC: U.S. President Joe Biden and Vice President Kamala Harris greet audience members ... [+] during an event promoting lower healthcare costs in the East Room of the White House on August 29, 2023 in Washington, DC. The Biden administration announced a list of the first ten medicines that will soon have lower prices following negotiations with Medicare. (Photo by Win McNamee/Getty Images)

Getty Images

If elected President, presumptive Democratic nominee Kamala Harris looks to expand upon the Administration's efforts to reduce healthcare costs. But Harris will also likely distinguish herself from President Biden in a number of areas, including more vocal support for abortion rights and a possible broadening of the scope of the role of the federal government in the healthcare sector.

On the issue of abortion, Vice President Harris has been a much more outspoken advocate than Biden. Harris has forcefully called on Congress to restore the protections offered by Roe v. Wade with respect to women's reproductive rights. She has made women's autonomy in deciding whether or not to end pregnancies a centerpiece of her campaign.

By contrast, Biden said during a fundraising event in 2023 that he's "not big on abortion," though he opined that Roe v. Wade "got it right."

On the campaign trail, Harris has spoken of the need to expand Medicare—the government health insurance program for seniors and the disabled—to cover dental, vision and hearing benefits. She also trumpets the Biden Administration's record on reducing levels of uninsured to their lowest in history and decreasing Medicare beneficiary out-of-pocket costs for prescription medications through provisions included in the Inflation Reduction Act. The cost of insulin, for example, has been capped at $35 per month for Medicare recipients and the Centers for Medicare and Medicaid Services have begun direct price negotiations on 10 top-selling prescription drugs. Fifteen more drugs will selected for negotiation in February 2025. Moreover, beginning next year Medicare beneficiaries will have a $2,000 annual cap on out-of-pocket costs for outpatient prescription drugs.

Echoing Biden, Harris has expressed the desire to expand Medicare drug cost measures enacted by way of the IRA to the commercial sector where the majority of working Americans purchase their insurance.

But as newly elected Senator in 2017, Harris was to the left of Biden on the issue of how to achieve universal access to healthcare. At the time, she called for a transition to a single-payer system, something Biden did not endorse.

Then, during the presidential campaign in 2019 and 2020, Harris walked back her support for eliminating private health insurance and establishing a single-payer system. Rather, she unveiled a healthcare plan which would involve a gradual expansion of Medicare access to all Americans over a 10-year transition period. The plan would automatically enroll newborns and the uninsured. Employers could choose from federally designated programs. The proposal would allow healthcare providers time to enter and adjust to the new system. Harris's concept preserved a role for private insurers, allowing Americans the choice of Medicare plans offered by private insurers or a so-called public option. A public option is a government-run or regulated health benefit plan that competes with private payers.

Since becoming Vice President, Harris has pivoted to seeking to improve implementation of existing laws, such as the Affordable Care Act, to work towards universal access rather than a wholesale change of the system. Seen in this light, it's probable Harris would want to extend the enhanced subsidies for people purchasing coverage in the Affordable Care Act exchanges. These subsidies can substantially diminish the cost of monthly premiums. Individuals or families are eligible if they would otherwise pay more than 8% of their annual income on ACA coverage. This subsidy stipulation is due to expire at the end of 2025.

And in line with the current Administration, Harris would want to work with Congress and state authorities to try to extend Medicaid coverage in the 10 states that haven't yet expanded it under the ACA.

It's speculative at this point whether Harris would favor a more expansive role for the federal government in curbing prescription drug prices beyond what is entailed by the IRA.

As a presidential candidate in 2019, Harris supported a plan that would authorize the Department of Health and Human Services to set price caps for drugs sold in the U.S. Based on prices charged in other developed countries. In some ways, this international price referencing arrangement is strikingly familiar to what former President Trump envisioned during his first term in office but failed to accomplish. Now that the IRA is being enacted and Medicare is negotiating drug prices, it's not likely that Harris would want to pursue pegging the price of particular drugs to international benchmarks.

There may, however, be other ways in which Harris could address the prices of certain medicines. As BioPharma Dive reports, Harris has previously endorsed the possible use of "march-in rights" to break the patents on "federally funded inventions" to assist in lowering the price when manufacturers are allegedly engaged in price-gouging. The Biden Administration released a framework in 2023 for when march-in-rights that could be used going forward. But it hasn't yet been implemented and there are no signs this Administration is about to embark on doing so. One of the operational problems relates to how to define and then ascertain what constitutes price-gouging. Another is that only approximately 11% of all new drug approvals have patents that disclose government funding support.

A separate initiative that Vice President Harris has focused on during her time in office pertains to medical bills and debt. According to a study by Commonwealth Fund, 79 million Americans have "medical bill or debt problems." With respect to combating medical debt, Harris supports efforts to use funds from the American Rescue Plan to purchase medical debt from healthcare providers—an initiative that could lead to three million Americans having a total of $7 billion forgiven by 2026. Harris also seeks to prohibit medical bills from being included on individuals' credit reports. Medical debt relief has come up during campaign rallies and may be featured more prominently as a "bread-and-butter" policy matter in the weeks and months ahead, Associated Press reports.

Most of Harris's public pronouncements regarding healthcare policy suggest she would continue on the path forged by the Biden Administration. Yet subtle differences in emphasis appear to be emerging as the Harris presidential campaign gets into full swing.

Social Care Leaders Urge Government To Change Course

More than 30 leaders in the sector have sent a joint open letter to Wes Streeting raising concern with the new government's decision to scrap funding set aside for training and upskilling social care workers.

On Tuesday, the government announced the adult social care training and development fund would not be taken forward, as proposed by the previous Conservative administration. This followed the government's decision on Monday to scrap plans to impose a cap on how much people will have to pay for adult social care.

The letter to the health and social care secretary is signed and endorsed by social care leaders, and people with lived experience, representing organisations and voices from the sector.

It said: 'The last few days have raised alarm bells for those working in adult social care and those drawing on care and support services.

'Significant delays by the previous government left social care vulnerable to cuts because programmes were not nailed down. We urge this government not to continue that pattern.'

It went on to call for 'positive action on social care', urging the government to change its course and help to transform the sector.

Organisations that have signed the letter include National Care Forum, Care England, Care Provider Alliance, National Care Association, The Care Workers' Charity, Independent Care Group, Voluntary Organisations Disability Group, Social Care Institute for Excellence, and the Homecare Association, among others.

Vic Rayner, National Care Forum chief executive, said: 'This letter demonstrates the sector's willingness to work with the government to find creative and feasible solutions to the entrenched issues social care faces.

'It acts as a clarion call to the government to put social care front and centre of its agenda. The decisions made by the government this week will affect the huge number of people drawing on care and support and those working across services. We are committed to working with the new government and want this shared message to ensure that priority and focus is given to social care from the outset of this new administration.'

Addiction Recovery Care Says It's Cooperating With FBI Investigation Into Possible Fraud

Addiction Recovery Care, Kentucky's largest provider of drug and alcohol treatment, has offices and other facilities in Louisa, photographed June 27, 2024. (Kentucky Lantern photo by Matthew Mueller)

Kentucky's largest provider of addiction treatment services, Addiction Recovery Care, or ARC, is the subject of an  FBI investigation into possible health care fraud, according to a July 30 post on a website of the federal agency's Louisville office.

ARC, which is funded almost entirely through Kentucky's Medicaid program, has not been charged with any crime but the agency is asking people with information to fill out an online form "if you believe you were victimized by ARC or have information relevant to this investigation."

ARC, a for-profit company based in Louisa, and whose CEO and affiliates have emerged as prolific political donors in recent years, said in a statement from spokesman Kyle Collier that it is cooperating with the FBI.

"We have recently learned that there is a federal investigation into ARC," the statement said. "As we all know, healthcare is one of the most highly regulated fields in the country, and addiction treatment is among the most highly scrutinized healthcare services. ARC is a trailblazer in the field of addiction services. We are confident in our program and in the services we offer. We, and our legal counsel, are cooperating fully in the investigation."

Collier directed further inquiries to ARC's chief legal officer, Jessica Burke, who provided a similar statement.

ARC has developed a reputation for aggressive expansion since it was launched by Tim Robinson, a Lawrence County lawyer who founded the company with a single halfway house for alcohol treatment in 2010. Fueled by the availability of new Medicaid funds for substance use disorder treatment since 2014 under the Affordable Care Act, ARC operates some 1,800 treatment beds in 24 counties and reaches hundreds more clients through outpatient services, the Kentucky Lantern reported in July.

Last year, ARC took in $130 million in Medicaid funds, the government health plan which gets most of its money from the federal government, making it by far the state's largest provider of substance use services.

Robinson and  his wife, Lelia, own ARC and some related entities which provide them with an annual income of $533,400, according to a 2022 tax filing of a related non-profit company, Odyssey Inc.

The company has been singled out for praise by politicians including Kentucky Gov. Andy Beshear, who spoke at an ARC ribbon cutting for a new ARC facility in March.

"With the help of organizations like ARC, we are working to build a safer, healthier commonwealth for our people," Beshear said.

He also praised Robinson, ARC's founder, in his State of the Commonwealth speech in January.

"With us today," Beshear said, "is Tim Robinson, founder and CEO of ARC, an essential partner in our fight against addiction. … I'm proud to say we now have more treatment beds per capita than any other state in the country."

From mid-2021 through the end of 2023 Robinson, his corporations and employees gave at least $252,500 to political committees supporting Beshear, according to reporter Tom Loftus' analysis in the Kentucky Lantern of campaign finance records. 

The donations to Democrat Beshear were a shift in the giving pattern for Robinson, a lifelong and loyal Republican. He also gave big to Beshear's opponent in the 2019 governor's race, Republican incumbent Gov. Matt Bevin.

The Lantern's analysis shows that — including money contributed to Beshear committees — Robinson, his corporations and employees have made at least $570,000 in political contributions over the past decade as his for-profit company grew.

He also has donated to Kentucky Republican lawmakers including some who wrote recent letters on ARC's behalf, asking that rate cuts proposed to ARC and other addiction providers be suspended until further study.

The rate cuts of 15% to20% proposed by three of the six private insurance companies that process state Medicaid claims became public this week at a legislative hearing. ARC and another provider told lawmakers that such cuts would devastate Kentucky's efforts to turn the tide of addiction to drugs and alcohol.

"Kentucky has made significant strides in access to treatment," Matt Brown, chief administrative officer for Addiction Recovery Care, or ARC, told a legislative committee Tuesday. "With these cuts, it could completely set back addiction treatment in our state 20 years."

Six national insurance companies known as managed care organizations, or MCOs, handle the majority of the state's $16 billion a year Medicaid business. Under contracts with the state, they are paid a fixed rate per member to cover the cost of care.

Brown, the ARC official, told lawmakers this is no time to cut payments for addiction services, citing some indicators of success.

Brown noted that overdose deaths in Kentucky have declined for the past two years after years of rising. Kentucky also has the most treatment beds per resident, most of them through ARC, he said.

The state's latest annual overdose report, released in June, shows a decrease in deaths to 1,984 from 2,200 the year before, a decline of 9.8%.

In a statement released after the hearing on the cuts, the Kentucky Association of Health Plans, which represents the MCOs, said its members "are proud to work collaboratively with quality, trustworthy providers of behavioral health and substance use disorder treatment" and access to those services is "top of mind" to ensure those in need receive care.

"Health plans strive for the best networks possible and are encouraged by the state to prioritize plan member outcomes and value-based care," it said.

The FBI posting on the website seeking information on ARC does not provide further information about the nature of the investigation,

A spokeswoman did not immediately respond to a request for comment.

A questionnaire people are asked to fill out includes several questions including whether they have been or are a patient at ARC and if so, what services were received. It also asks whether the person responding has ever made a complaint before about ARC and if so, to whom.

GET THE MORNING HEADLINES DELIVERED TO YOUR INBOX

SUBSCRIBE

View comments

---