Elaine Herscher

By Michael McAuliff | Kaiser Health News

The giant health care, climate, and tax bill expected to pass the House and be sent to the president for his signature won’t be as sweeping as the Democrats who wrote it had hoped, but it would help millions of Americans better afford their prescription drugs and health insurance.

The Inflation Reduction Act is estimated to spend about $485 billion over 10 years on health and alternative energy programs while raising about $790 billion through tax revenue and savings. The difference would be used to help reduce the deficit.

On the health front, the legislation achieves two key goals of congressional Democrats. First, it would give the federal government the ability to negotiate prices of some drugs purchased by Medicare beneficiaries, a tool that has long been opposed by the drug industry. Second, it would extend the enhanced premium subsidies for people who buy insurance on the Affordable Care Act marketplaces that Congress put in place last year to help confront the covid-19 pandemic.

“It’s historic. Never before have we been able to negotiate prescription drug prices. This is something we’ve been fighting for [for] decades,” House Speaker Nancy Pelosi said this week. “I want more, of course — we always want more. But this is a great deal.”

The bill extends the enhanced subsidies, which will expire this year if they are not continued, through 2025. The 2021 covid relief bill boosted subsidies for those people who had already qualified for the aid and provided subsidies to some middle-income people who had found coverage to be too expensive. According to an analysis by KFF, about 13 million people will see their premiums jump by more than half, on average, if the enhanced subsidies are not continued. And people who earn more than four times the poverty level will not be eligible for subsidies anymore, on top of seeing their premiums spike.

The subsidies’ extension is expected to cost about $64 billion.

The bill will also have a major impact on Medicare, including by allowing the program to negotiate prices for some of the most expensive drugs, capping beneficiaries’ out-of-pocket payments for drugs, limiting their insulin cost sharing to $35 a month, and barring drug companies from raising prices faster than inflation.

The drug pricing provision, estimated to save the government nearly $100 billion over 10 years, would require the U.S. Department of Health and Human Services to identify Medicare’s 100 most expensive drugs and then pick 10 for price negotiations starting in 2023. Those prices would take effect in 2026. Another 10 drugs would be added over the next two years, with the savings fully in effect by 2028.

The negotiations would apply first to drugs people get at the pharmacy, but in the later two years, drugs that people get in doctors’ offices could also be covered.

Some of the Medicare changes would kick in next year. One is the cap on price hikes. Under the bill, companies that raise the price of drugs sold to Medicare faster than inflation must pay rebates back to Medicare, generating an estimated $101 billion in savings for the government. The inflation protections will also apply to certain drugs, such as biologicals, that patients get in a doctor’s office.

New vaccine and insulin cost caps would also take effect in 2023. Under the bill, all vaccines recommended by the federal Advisory Committee on Immunization Practices will be fully covered by Medicare, as well as by Medicaid and the Children’s Health Insurance Program. For Medicare beneficiaries who need insulin, out-of-pocket costs would be capped at $35, and starting in 2026, the cap would be $35 or 25% of the negotiated price if that is lower.

Another big saver for Americans enrolled in Medicare would be a $2,000 cap on out-of-pocket drug costs, which would begin in 2025. According to KFF, 1.5 million Medicare beneficiaries paid more than $2,000 for their drugs in 2019. According to an analysis by the Council for Informed Drug Spending Analysis based on data from 2012, about 3.5 million beneficiaries would likely save more than $1,500 a year.

Starting sooner, in 2024, people whose out-of-pocket drug costs reach the “catastrophic” threshold of $7,050 won’t have to pay any additional money on drugs that year. Currently, there is no cap, and people must pay 5% of the cost of extremely expensive drugs after hitting the threshold.

Also starting in 2024, Medicare would extend low-income subsidies to about 500,000 beneficiaries who earn between 135% and 150% of the poverty level ($18,347 to $20,385 for a single person). Premium hikes on drug plans would also be limited in 2024 to 6% for all beneficiaries through 2029.

The bill could have reached far more people, but Democrats’ attempts to slow the increase in drug prices and cap insulin copays outside of Medicare were blocked.

Because the bill is being passed on expedited procedures known as budget reconciliation, all the provisions must have a direct impact on federal spending or revenue. The Senate parliamentarian, who vets such measures, ruled that the insulin and inflation measures targeting the private insurance market were out of bounds. Democrats tried to add back the broader-market insulin cost caps but fell three votes shy of the 60 needed to do so, with only seven Republicans joining them.

Senate Majority Leader Chuck Schumer pledged to hold another vote on expanding the insulin cost cap in the fall.

Still, some analysts see reasons to believe that most Americans not directly affected by the bill will see some benefits, particularly from the limits on drug price increases and the Medicare drug price negotiations.

In a conference call with reporters Thursday, Sean Dickson of the nonprofit West Health Policy Center pointed to the government’s 340B program, in which drug companies are required to provide discounts to certain care providers and in which there are inflation penalties. He estimated that Medicare alone saved $7 billion over five years indirectly because of those inflation restraints.

“There was a spillover effect from the subsection of a government program that had an inflation penalty,” Dickson said. “That resulted in lower costs for everyone who used those drugs and slower price growth.”

The original article from Kaiser Health News appeared here.

Berkeley City College is offering fall classes tuition-free regardless of financial status.

Every student enrolled in a minimum of three units can attend classes for free, including fees. Students must complete an admissions application and apply for financial aid. But they need not qualify for financial aid to receive free tuition. Fall 2022 classes start August 22.

Click here for more information on the program and instructions on how to apply.

We’ve just finished producing a video that highlights the multiple rewards for healthcare providers who come to work at LifeLong.

Enjoy.

If you tuned in to July’s Open Mic Monday, you may have met (virtually) Learning & Development Manager Ann Elkan for the first time.

Since starting at LifeLong four months ago, Ann has been busy, particularly with the Employee Appreciation Committee. On the call, Ann had the enviable task of unveiling the kinds of gifts people can receive for their work anniversaries, but she’s involved in so much more.

“I’ve heard from many people throughout LifeLong that there’s a great need for help, especially for new managers to learn our procedures,” she says.

Ann creates and assigns courses to catch people up on their CPR training , infection control procedures, and HIIPA and other policies. She’s also a part of the Strategic Workforce Planning Committee under the direction of Chief Strategy Officer Julie Sinai. She’s been working on a manager

guide and hopes to create a “manager bootcamp” so people would learn new skills together.

“My hands are in a little bit of everything,” she says. “I’m really excited. We’re going to get a robust training program together to hopefully serve the needs of all these different areas of LifeLong.”

Ann says she was attracted to LifeLong because of a phrase often quoted by CEO David B. Vliet: “We hire from the community to serve the community.”

“It’s really important to me that LifeLong is really centered in different communities and we really care that people are getting the healthcare that they need.”

This isn’t Ann’s first experience in healthcare. She designed courses and trainings for On Lok, based in San Francisco, which provides healthcare for older people. She has a master’s degree in American Culture Studies, and she’s taught courses in gender studies, humanities, and communications at Bowling Green State University, De Anza College, Foothill College, and Berkeley City College.

Ann describes herself as a “big sci-fi nerd and a huge Star Trek fan.”

“Maybe this is one of the reasons I’m attracted to LifeLong,” she says, because in those worlds there is “infinite diversity in infinite combinations. It’s a vision of the future where money is not so much a concern and everybody gets the healthcare that they need.”

Hello LifeLong Team: it has been awhile since our last “In the Loop” publication, here is the latest:   Fiscal Year 2023 Budget is Approved Special Note from the CFO, Brent Copen, MPA: A big thank you to all of you who participated in the budget process this budget season!  I am pleased to say that the LifeLong Board of Directors has formally approved the current Fiscal Year (FY) 23 budget.  I am also pleased to announce that all budget holders will have access to your respective budgets and budget details in our software platform, Adaptive Insights.  Additionally, as we close the books for each month, budget holders will also have access to your “budget-to-actual” results.  This is a big step forward for LifeLong, and I want to thank you all for your patience with a budget process that I know has been different from what you have seen in the past.  Given the narrow margin for this year’s budget, the collective bargaining process with our two Unions, and some underlying business model vulnerabilities resulting partly from the wind-down of one time funding (COVID-related) we are maintaining status quo and placing a current hold on all growth-related positions that are not grant funded.     The Bottom Line: The budget process for this fiscal year, 2022-2023 is complete, approved by the Board of Directors, and with new technology, there will be greater accessibility to data to help meet budgeted goals.   COUPA: Adding Greater Efficiencies to our Payment Processes Coupa, a market leading “procurement-to-payment” and expense system will be launching this fall.  Coupa is a web-based system for creating purchase requisitions, initiating approvals, creating purchase orders to suppliers, receiving invoices from suppliers for payment, and submitting expense reports.  Here are some key advantages for using Coupa: •     Easy to use interface for employees and suppliers. •     Greater visibility into relevant information for buyers and employees submitting expense reports. •     Detailed reporting, dashboards, customizable approval “flows”. •     Improved customer support and the ability for Coupa administrators (admins) to make quick changes based on employee feedback.  Stay tuned for more information on training dates and our launch, currently planned for late September.      The Bottom Line: We want to improve efficiency so you have what you need, when you need it.   Hybrid Work Environment: Updating Our Telecommute Policy We are updating our Telecommute Policy as we offer the long-term opportunity for a hybrid work environment. COVID forced many of us into working from home and many of our staff reflect a mix of folks who work full-time on site, full-time remote and/or hybrid with both on-site and remote.  The new policy will clarify when and how a supervisor and employee determine the appropriate in-person and/or remote work environment.  As more employees in administrative roles work with their supervisors to return to the office at least part time, specifically those located at the 6th Street, 7th Street, Adeline and Herrick sites, we are working to optimize our office space utilization through the adoption of workspace sharing system. Employees who work on-site for 4 full-time days or more will have a dedicated office space.  Other workspaces will be structured through a new platform designed to help space sharing.  More to come….   The Bottom Line: The pandemic changed the way the world “works” including LifeLong, and we’re updating our policies to reflect those changes.   MonkeyPox – Update from the CMO Monkeypox is caused by a virus similar to the virus that causes smallpox although monkeypox causes milder symptoms than smallpox and is rarely fatal.  The virus was named monkeypox because it was first discovered among colonies of monkeys that were kept for research in 1958, however the source of the disease in humans (which was first identified in 1970) is unknown.  The WHO has announced that they will change the name of the monkeypox virus due to concerns about stigma and discrimination. The virus spreads most commonly from person-to-person through direct contact with the monkeypox rash, however, it also can be spread by respiratory secretions during prolonged intimate contact and touching items (such as clothing or linens) that previously touched the infectious rash. Monkeypox can spread from the time symptoms start until the rash has fully healed and a fresh layer of skin has formed. The illness typically lasts 2-4 weeks. While this current outbreak happens to be concentrated among men who have sex with men, the spread of the virus has nothing to do with sexual orientation.  Sexual transmission is a risk simply because that is one form of close contact.  As the virus becomes more widespread, the groups of people at risk is likely to expand. There are two vaccines available for preventing monkeypox infection, JYNNEOS (also called Imvamune or Imvanex) and ACAM2000.  The vaccine being made available currently is the JYNNEOS vaccine, which is a 2-dose vaccine (4 weeks apart).  The current priority is to vaccinate people who have been exposed and people who are higher risk of being exposed to monkeypox with the first dose of the JYNNEOS vaccine.  This has been particularly challenging due to limited supplies of the vaccine, although supplies are expected to increase over the coming months. Information on how to evaluate patients with symptoms of monkeypox, including how to collect and submit samples for testing, have been sent to providers at LifeLong.  A LifeLong specific protocol has also been developed based on learnings from our initial experiences evaluating suspected cases of monkeypox in our clinics.  This will be posted and accessible to all early next week after final review. ~ M. Stacey, MD, MPH, Chief Medical Officer   The Bottom Line: We want to keep you updated on this virus and will provide ongoing updates as needed to help keep our staff and communities informed and safe. Our hope is to greatly improve communication about what is happening behind the scenes at LifeLong so we can keep you “In the Loop”! Thank you for reading! Sincerely, The Senior Leadership Team       Volume 1, Issue 9