Today, the House Oversight Committee is holding an important hearing entitled "The Role of Pharmacy…
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House Hearing Spotlights Pharmacy Benefit Managers (PBMs) as Drivers of Higher Drug Prices

Today, the House Oversight Committee is holding an important hearing entitled "The Role of Pharmacy Benefit Managers in Prescription Drug Markets Part III:  Transparency and Accountability."

For those unfamiliar, Pharmacy Benefit Managers (PBMs) amount to middlemen that control prescription drugs for millions of Americans.  A majority of Americans receive health insurance through employer plans or government programs such as Medicare, which in turn cover prescription drugs through PBMs.  Those PBMs negotiate with drug companies and pay pharmacies, but throughout the process determine the drugs that insured patients may obtain and at what cost.

The problem is that PBMs operate in such an opaque and complex manner that they're able to inflate drug costs while claiming to be working…[more]

July 23, 2024 • 04:57 PM

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ObamaCare’s Biggest Lie Print
By Ashton Ellis
Wednesday, September 25 2013
Up and down the income ladder and across many kinds of employment, implementation of ObamaCare is revealing that the law’s biggest lie is that everyone can keep their doctors and health insurance.

Remember in 2009 when President Barack Obama was campaigning for his health reform law that became ObamaCare?

He told anyone who would listen that despite widespread fear of a government takeover, “[W]e will keep this promise: If you like your doctor, you will be able to keep your doctor. Period. If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away. No matter what.”

With ObamaCare only days away from going online, it turns out that promise just isn’t true for millions of Americans.

Family Glitch – For starters, you can’t keep your current doctor and health insurance if you fall victim to the so-called "family glitch."

For some reason, ObamaCare’s drafters assumed they could dramatically raise the price of health insurance and private employers would simply absorb the costs. Then reality set in.

The choice facing employers is simple, but distasteful: They can either comply with the mandate or pay a fine. And since the price of covering a worker and her family will soon outweigh the amount of the fine, it makes financial sense to cut them loose.

But that makes the federal government responsible for subsidizing expensive health insurance on an ObamaCare exchange. If thousands of employers sever millions of workers, the net result is billions of unanticipated public spending.

Alarmed by the prospect, the IRS swooped in. Without any statutory authority, the agency declared that a worker’s family members do not have to be covered to satisfy the employer mandate. This also makes the employee ineligible for subsidies to cover her family.

The decision saves money for the Feds and employers, but leaves an estimated 3.9 million dependents without the means to afford health insurance.

Self-Employed – You can’t keep your doctor or health insurance if you already pay for either a high-end PPO or a low-cost catastrophic plan. Under ObamaCare, choices in the existing individual health insurance market are dwindling while costs are rising.

In a searing article, Michelle Malkin details how she and other self-employed entrepreneurs are seeing their health plans get eliminated in state after state thanks to ObamaCare. Across the country, private insurance companies are canceling popular individual and family plans, citing compliance with the health law as the main reason.

The regulatory pressures are driving insurance providers to drop both high- and low-end coverage options, transforming the diverse, nationwide individual insurance market of 22 million into a one-size-fits-all pool with less choices and higher costs.

Malkin and her family are losing their PPO doctor network, while people who prefer to buy insurance as a hedge against unanticipated and costly medical bills are being forced to buy more coverage than they can afford.

Working Spouses – You also can’t keep your doctor and health insurance if you have access to insurance at work, but choose coverage under your spouse’s plan.

In August, UPS told employees that it would no longer cover working spouses. The move will shed 15,000 people from the company’s rolls, and in the process change the doctor and insurance provider of those affected. The primary culprit: New expenses associated with ObamaCare.

Look for other large employers to follow suit.

Part-Time Union Workers – Much to their chagrin, unions representing 20 million part-time workers won’t be able to continue offering the same health insurance plan and doctor networks once ObamaCare goes into effect.

Like their competitors, unions operating Taft-Hartley plans must absorb ObamaCare’s compliance costs without the benefit of qualifying for subsidies. It will be cheaper to push workers onto a public health insurance exchange, so the unions and their members are out of luck. The generous benefits negotiated by union leaders will soon be a thing of the past.

Retirees – It looks increasingly likely that you can’t keep your doctor and health insurance if you are one of the millions of retired Americans eligible for Medicare.

Employers in the private and public sectors see legacy costs associated with retiree health care ballooning under ObamaCare, and seem to have found a way to avoid – or get out of – bankruptcy.

Large businesses like IBM, Time Warner and Walgreen Co. are moving hundreds of thousands of retirees to private insurance exchanges like Towers Watson’s Extend Health, “the largest private Medicare exchange” in the country, according to Bloomberg. GE is planning to transfer former workers toward public exchanges created under ObamaCare.

Shifting retirees onto ObamaCare exchanges also seems likely for municipalities reeling from financial mismanagement. Cities like Chicago and Detroit are exploring how to transfer a combined 50,000 retired workers onto their respective states’ ObamaCare exchange.

Up and down the income ladder and across many kinds of employment, implementation of ObamaCare is revealing that the law’s biggest lie is that everyone can keep their doctors and health insurance.

The numbers, and the specific categories, of those who cannot will only grow.

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