You cannot have your cake and eat it, too. It is a tale as old as time. But apparently, with its latest “Most Favored Nation” executive order on drug pricing, the Trump administration has stumbled upon a solution to this conundrum.
Or so they would have you believe.
The entire phenomenon centers around the hotly contested Affordable Care Act (ACA), or Obamacare. On one hand, the Trump administration is litigating before the Supreme Court in favor of the entire law being struck down as unconstitutional. On the other hand, the administration would like to use an obscure provision within the very same law in order to implement its new drug pricing mandate.
Can you see the problem?
Before we can even discuss the merits of price controls and their implications for our healthcare system, simple logic should have dismissed this latest action when it was first proposed. If you believe a law to be unconstitutional and invalid, how can you then use that law to carry out a particular policy agenda? The numbers simply do not lie. And perhaps this is why this particular executive order stayed under lock and key until September 13th—nearly two months between its signing and when it officially went into effect.
If you still are not sold, that is OK. After all, the Supreme Court could very well uphold the ACA as constitutional. If that happens, it would be easy to assume that President Trump’s executive order would then be in the clear. Fortunately, these assumptions are far from accurate and there is plenty of policy and precedent standing in stark opposition to this executive action.
A “most favored nation” pricing model is an extreme form of international price indexing (IPI), where price caps on certain drugs are put in place based on an average price obtained from a select group of other countries. These arbitrary price controls would have devasting effects on our access to groundbreaking drugs. The U.S. would be basing its drug market off of Europe, where socialized, restricted medicine is the norm. And such an approach exceeds the statutory authority of the executive branch. Under basic constitutional separation-of-powers principles, “sweeping” and “very dramatic”—the president’s own words—changes to major federal programs must be authorized by Congress. To date, Congress has flatly rejected any form of international price controls. Period.
The executive branch hopes to carry out its ambitious plan through an obscure clause in the Affordable Care Act, whereby modest authorization for testing “pilot projects” in underserved populations is authorized. According to President Trump, however, this new order contains “the most far-reaching prescription drug reforms ever issued.” But an unprecedented new program that will disrupt the entire healthcare sector is a far cry from a modest “pilot project.”
Simply put, the authority to execute this administration’s latest drug pricing mandate simply is not there. The same administration is fighting to strike down the very law it is using for this order. Congress has already plainly rejected the international pricing model. And the ACA itself does not grant the statutory authority for such a measure in the first place.
Until recently, this administration had a good record on healthcare—fighting to protect American innovation and promoting measures such as rebate reform and price transparency. Why, then, reverse this approach in favor of dangerous and unconstitutional executive actions?
President Trump is at his best when he is fighting for America, and he must return to supporting our pharmaceutical innovators that will get us through the current health crisis. We must stop “global freeloading” off of American innovation and negotiate more favorable deals with foreign governments. We need them to contribute their fair share toward research and development costs for new treatments and vaccines that are changing the world. These are solutions that will lower drug prices.
The president is a dealmaker, and that is exactly what we need during COVID-19. America must leave the cake outside and return to the head of the table.
Taxpayers could have to shell out nearly $23 billion a year to provide Obamacare coverage to illegal immigrants, according to a new analysis being released Thursday that puts a high price tag on one of the Democratic presidential candidates’ top election promises.
Nearly 5 million illegal immigrants have incomes that would qualify them for Obamacare’s subsidies that help pay lower-income Americans’ premiums, and they would average about $4,600 a year, the Center for Immigration Studies calculates.
If all of them signed up, that would total $22.6 billion a year. Even assuming a more realistic enrollment rate of about half, it would cost taxpayers $10.4 billion a year, according to the organization, which advocates for less immigration overall.
Under an alternative plan, in which the lowest-income illegal immigrants are put on Medicaid while others receive Obamacare subsidies, the costs would be similar, the study found.
“Any serious debate on providing health care coverage to those in the country illegally requires a cost estimate,” said Steven Camarota, research director at the organization, who said his findings were a reminder that “tolerating illegal immigration creates a significant burden for taxpayers.”
The group released another report Thursday calculating that immigrants who use Medicaid — legal and illegal — already cost more per family than native-born Americans. The reason, the analysis says, is that they are more likely to be less-educated and have larger families.
It’s become a must-have position for Democratic presidential candidates that illegal immigrants deserve access to government-sponsored health care. At one of the debates, all 10 candidates on stage raised hands when asked if they backed the idea.
But the candidates have different ideas about how to get there.
Sen. Bernard Sanders, father of “Medicare for All,” says he would cover illegal immigrants through his fully government-run system.
Former Vice President Joseph R. Biden at the debate agreed that illegal immigrants should get coverage — “It’s the humane thing to do,” he said — but later slimmed down that commitment, saying they should be allowed to buy into Obamacare and should be able to get emergency coverage. That latter part is already the law.
Mr. Camarota warned that if illegal immigrants are covered, the next steps could be to offer taxpayer-sponsored health care to guest-workers in the U.S. on temporary visas.
“The high cost of providing healthcare to less-educated workers who earn modest wages is a reminder that tolerating illegal immigration or allowing such workers into the country legally is likely to create a significant burden for taxpayers,” he wrote.
He said he couldn’t calculate how much of an incentive health care could be in enticing people to enter the U.S. illegally.
President Trump is moving in the other direction.
In an executive order last week, he announced a new policy banning entry of immigrants deemed likely to become a drain on the U.S. health care system — chiefly those who show up at emergency rooms, where they can’t be denied care, and then leave the public with the bill.
Whether to extend Obamacare to illegal immigrants was an issue Congress grappled with in 2009 and 2010 as it was debating passage of the Affordable Care Act. The party’s leaders concluded such a step could poison the entire health care effort, since the public seemed opposed to the idea.
It’s not clear much has changed in public attitude.
A CNN poll over the summer found 59% of Americans opposed offering government-sponsored health care to “undocumented immigrants.”
In the absence of federal action, some Democrat-led states have taken steps.
California Gov. Gavin Newsom signed legislation in July to expand state health care assistance to low-income young adult illegal immigrants, granting them coverage under Medicaid. The state had already covered juvenile illegal immigrants and “Dreamers” who had status under the Obama-era DACA program, but the new law expands coverage to any illegal immigrant up to age 25.
The state estimated roughly 90,000 people will get coverage, at an additional cost of nearly $100 million a year.
Ordinarily, being ranked as the worst modern president of the United States would be considered unfortunate. For you Mr. President, that’s the good news.
As painful as it is to note, your presidency has not yet hit bottom. You’ve got a long way to go in your descent.
Everywhere you walk, Mr. President, the world unravels. Americans are whispering that each political missile you fire seems to hit not its target but our own house.
You have undone the core idea you’ve advanced, that a larger public sector can save us. You are becoming the one-man Keystone Cops of an experiment in weakness and incompetent government. Continue reading
The weird, misleading propaganda behind the federal health care law
It might seem odd that Joanna Coles, editor in chief of Cosmopolitan, was invited to the White House for lunch. After all, why would the most powerful person in the world bother meeting with the editor of a publication that specializes in hot summer sex tricks and the year’s most dangerous diet? Particularly on May 2, 2014, when just about every important political journalist was in town for the White House Correspondents Dinner, the annual gala where pols and press rub shoulders and bond over bottomless booze.
But Coles had a big favor coming to her. In 2013, she publicly pledged her magazine’s ad space and editorial content to help promote the Patient Protection and Affordable Care Act, better known as Obamacare. There are now more than 100 references to Obamacare on Cosmo’s website, almost all of them glowing. Continue reading
Those who want to leave ObamaCare as it is are outnumbered more than 5 to 1 by those who want to repeal or change it.
President Obama keeps insisting the debate over ObamaCare is “over.” That declaration, wish, exhortation or command does not correspond with reality. A new Politico poll of voters in “hotly contested areas”–states and congressional districts thought to have competitive Senate or House contests–finds that 60% “say they believe the debate over the law is not over,” whereas only 39% “echo the president’s position” that the “debate has effectively concluded.”
The areas sampled are probably a bit more Republican than the nation as a whole: Of the 16 states chosen on the Senate side, Obama carried only seven in 2012. (On the other hand, they include Minnesota, Oregon and Virginia, which most handicappers currently list as “likely” Democratic holds.) Obama’s approval rating among the Politico respondents is 40%; RealClearPolitics had his nationwide average at 44% as of yesterday.
“At the same time that the health care law is plainly a political anchor for Democrats,” Politico’s Alexander Burns argues, “the poll signals that fully killing the ACA”–that’s the abbreviation for the law’s euphemistic formal name, Patient Protection and Affordable Care Act–“may not be a slam-dunk as a political proposition”:
Among voters who had an opinion of the ACA, the electorate was almost exactly split between those who want to repeal the law entirely and those who favor either leaving it alone or keeping it in place with modifications.
Forty-eight percent of respondents endorsed repeal, versus 35 percent who wanted to modify the law without repealing it and just 16 percent who said it should be left unchanged. Continue reading