FYI, Eric
________________________________
From: Barry A. Kaufmann, NYSARA President <president@xxxxxxxxxxxxxxxxxxx>
Sent: Monday, May 2, 2022 7:00 AM
To: ericprussell@xxxxxxxxxxx <ericprussell@xxxxxxxxxxx>
Subject: May 2, 2022 NYSARA Monday Alert Retiree News
[Image]
New York's top court rejects congressional maps drawn by Democrats
April 27, 2022 by the Associated Press
ALBANY, N.Y. — New York's highest court on Wednesday rejected new congressional
maps that had widely been seen as favoring Democrats, largely agreeing with
Republican voters who argued the district boundaries were unconstitutionally
gerrymandered.
The state's Court of Appeals said lawmakers lacked the authority to pass the
congressional and state Senate maps after an independent redistricting
commission failed to reach a consensus.
The judges also said lawmakers gerrymandered the congressional maps to
Democrats' favor, in violation of a 2014 constitutional amendment designed to
rout out political gamesmanship in redistricting.
The Appeals Court said it will "likely be necessary" to move the congressional
and state Senate primary elections from June to August.
The group of Republican voters had said in their lawsuit not only that the maps
were gerrymandered, but also that the Legislature didn't follow proper
procedure in passing them.
A lower-level court had also ruled that the maps were unconstitutional and had
given the Legislature an April 30 deadline to come up with new maps or else
leave the task to a court-appointed expert.
A court will oversee new district maps instead of the state Legislature
The judges in Wednesday's ruling said a special court master will pass new
district maps instead of the Legislature.
Judicial "oversight is required to facilitate the expeditious creation of
constitutionally conforming maps for use in the 2022 election and to safeguard
the constitutionally protected right of New Yorkers to a fair election," the
ruling read.
The ruling didn't specify a deadline for the adoption of new maps. But the
judges said they were sending the matter to a lower state court, which "shall
adopt constitutional maps with all due haste."
The legal fight over New York's redistricting process could be a factor in the
battle between Democrats and Republicans for control of the U.S. House.
New York is set to lose one seat in Congress in 2021. New York's new maps would
give Democrats a strong majority of registered voters in 22 of the state's 26
congressional districts. Right now, Republicans currently hold eight of the
state's 27 seats.
Democrats had been hoping that a redistricting map favorable to their party in
New York might help offset expected losses in other states where Republicans
control state government.
Political district maps across the nation have been redrawn in recent months as
a result of population shifts recorded in the 2020 census.
Under a process passed by voters in 2014, New York's new district maps were
supposed to have been drawn by an independent commission. But that body, made
up of equal numbers of Democrats and Republicans, couldn't agree on one set of
maps. The Democratic-controlled Legislature then stepped in and created its own
maps, quickly signed into law by Gov. Kathy Hochul.
Republicans then sued, seeing to have the maps tossed for violating a provision
in the state constitution barring the redrawing of districts for partisan gain.
Similar legal battles have been playing out in several other states.
The battle has moved quickly through the courts, but not fast enough to quell
uncertainty about the primary, now scheduled for June 28.
In the meantime, candidates have had to begin campaigning in the new districts,
even as they are unsure whether those districts will still exist by the time
voting begins.
NYSARA President and Executive Director Attend Senator Gillibrand's Forum on
Aging Committee
On Thursday, April 28th NYSARA President Barry Kaufmann and Executive Director
Steve Madarasz attended a meeting of Senator Kristen Gillibrand's Forum on
Aging Committee (Formerly The Aging Working Group). During the meeting we
heard from Geri Shapiro, Aging Assistant for the Senator, Brook Gesser, Aging
Assistant for the Senator, Gil Ruiz, National Legislative Director and Monica
Hansen NYS Legislative Director.
We were updated on current priority legislation for Senator Gillibrand. Her
number one priority involved Rx pricing and lowering the cost of prescription
drugs. NYSARA President Kaufmann asked a question about the current status of
unequal funding on behalf of Medicare Advantage programs vs. traditional
Medicare and that inequality impacting the Medicare Trust fund. President
Kaufmann was assured that the Senator was very aware of the problem, wanted to
mitigate or solve it and that the issue is very much on her radar.
National Task Force to Repeal the WEP/GPO Day of Action
The National Task Force to Repeal the Windfall Elimination Provision
(WEP)/Government Pension of Offset (GPO) of the Social Security Act will
hold a Day of Action and rally in Washington, D.C. on Wednesday, May 18, 2022
from 9:30 a.m. to 4 p.m.
Both retired and active, teachers, firefighters, police officers, city, state
municipal, federal employees and others affected by the WEP/GPO will visit
Congressional members, Democratic and Republican, to ask for their support to
repeal the egregious WEP/GPO that penalizes over 9 million retired and future
retirees, the majority of which are women, across the United States who are
being robbed by as much as an 88% a month in their Social Security Benefit.
On May 18th, the Task Force will hold a Rally in Area 7, near the Russell
Senate Building, from 11:30 a.m. to 1 p.m. to educate Congress on the hardships
of retired and active participants on how they can rectify the issue by
supporting legislation that repeals these two appalling parts of the Social
Security Act. There currently are several pieces of Legislation that address
the REPEAL of the WEP/GPO:
H.R. 82, by Representative Rodney Davis (R) (IL)
H.R. 5723 by Representative John Larson (D) (CT)
S. 1302, by Senator Sherrod Brown (D) (OH)
S. 3071, by Senator Richard Blumenthal (D) (CT)
The Task Force will also present Congressional members with a petition signed
by 100,00 people affected by theWEP/GPO.
CMS Announces Proposed Rule Implementing Important Medicare Enrollment Changes
This week, the Centers for Medicare and Medicaid Services released a
much-anticipated proposed
rule<https://nam12.safelinks.protection.outlook.com/?url=https%3A%2F%2Fclick.actionnetwork.org%2Fss%2Fc%2FatcYNHk4Eh2YdGnwBh-YDEybHypJO_UCwq6AvxHgpBuy2HrI663e2waKPq3YNK_STprsPGZsV6J_E538KD8JsTG5jgD1VPbLHXkf-9BMSRlZDyYT0J1Y-0dMyE0qsY_Dr-ojw_WvAGzl1OyMhOcOeoZWW3-hLp8tNwsBEQZlUdZcqIPCSYbvXAM8hOa-YAsjK2JSxqcGjWrDDWnikdEpqf0VumIz6r0Xgc1MLh9Y8TKKeVpIqStXu-gLyjGX9Z7Fy76PP2Eew23YwhdVMC5wmfIjfS9vy4LqR5TF3acZEOwfOxf4msWJjpFDTmoiDA6oGy_x8zGM64bikRw_-3CBJ3Wp_tnpN5lYX74RnsRNe1DO9nPa5Nh7jz67o_TP9UPZEtnW3mXuBK0PuqRqD5Zdus8CoVv_lC5uN1Qkaai32an1db4K6PRSMF7FHWuVXWvjXejPYAnt_96z0qNYfKANiw%2F3lp%2FqfFXtNLzQl6kYJtY4jWoxA%2Fh0%2FocoYp22o6SQYWblddJXtHb0dekrsoyXUMY06RwnZwDg&data=05%7C01%7C%7C23cca0f880bc4b61bcdd08da2c2af3da%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637870860245330249%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=UhDqd2rOPuHwrhuyC57RqN3LAQot%2FUWaPh5%2F9XIEfSI%3D&reserved=0>
implementing important changes implemented by the Beneficiary Enrollment
Notification and Eligibility Simplification (BENES) Act, key provisions of
which were included in the Consolidated Appropriations Act, 2021 (CAA), which
was signed into law on December 27,
2020<https://nam12.safelinks.protection.outlook.com/?url=https%3A%2F%2Fclick.actionnetwork.org%2Fss%2Fc%2FatcYNHk4Eh2YdGnwBh-YDF4XFQ5RBkSodmMvsTyswfRgiMLgVRZm-LqC__b04sNp8i4x5LqIurGmKuWpedxqcge1YLCILB0vV5EX5nFgIf_BU8jaOHy0xa2XJTMYLbEDEYC2KXz0wPnwpyRwoFaQWTN4vJjHoO4ZqvhL7OqEGEiQodP15Teej1TCM2PehxPi4AYaQ1MaW-gILnE6YQEw3eNNucYPfrFICJ4Wx6xoydjEtdwKXSKDBfbFXk5A7w3AUhbLrfLOQDsps28rnomRvo_t-v3f1McCTyntfK-CdRJ7nuCCoqTT8wWDr0jy2BiegKpQzQqhIvnXHpaJjhGoAawWQ6jn4ELiVNz8Qkt-x5XR_yfNWPpdCbWCEopf_tgTtoMjIcOZHnxSygw7_aJ_Xw%2F3lp%2FqfFXtNLzQl6kYJtY4jWoxA%2Fh1%2F1v9KbUp7YCqqMkc2tEmcas73F2yZoa9nBNGY_PTee0A&data=05%7C01%7C%7C23cca0f880bc4b61bcdd08da2c2af3da%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637870860245330249%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=6pFx5pNnFweLELoPCjQMWk7RUZJmTLOcrlRi2i%2Bj8K8%3D&reserved=0>.
That law, which was championed by the Medicare Rights Center and enjoyed broad
support among beneficiary advocacy organizations, established modernized
timelines for effectuating Part B enrollment and also established authority for
CMS to create Special Enrollment Periods (SEPs) to account for “exceptional
circumstances” that might cause a person to miss or make a mistake around their
Initial or other enrollment period.
The proposed rule updates existing rules to reflect the CAA’s changed timelines
for coverage when people enroll in the later months of their Initial Enrollment
Period (IEP) or during the General Enrollment Period (GEP). Starting in 2023,
Medicare coverage will be effective the month after enrollment for people who
enroll in the last three months of their IEP or during the GEP, reducing or
eliminating gaps in coverage. The rule also proposes several SEPs for people
who meet “exceptional conditions” and missed a Medicare enrollment period
including:
* An SEP for individuals impacted by an emergency or disaster
* An SEP for Health Plan or Employer Error that constitutes “material
misrepresentation” of information related to enrolling in Medicare timely
* An SEP for Formerly Incarcerated Individuals
* An SEP to coordinate with the termination of Medicaid eligibility
* An SEP on a case-by-case basis for other exceptional conditions where
circumstances beyond the individual’s control prevented them from using another
enrollment period.
These absolutely essential enrollment flexibilities will expand Medicare
enrollment opportunities, reduce coverage gaps, and relieve the burden of
lifetime penalties.
The rule also contains provisions that implement another change included in CAA
– the creation of a new limited Medicare coverage for people who have received
a kidney transplant but whose full Medicare coverage as a result of end-stage
renal disease (ESRD) has terminated 36 months after the transplant. The law
establishes a right to continued coverage of immunosuppressant medications for
individuals in this situation who do not have other health insurance coverage.
CMS has named this coverage “the immunosuppressive drug benefit, or the Part
B-ID benefit.” The benefit covers immunosuppressant drugs only and does not
include coverage for any other Part B benefits or services, and people must
attest that they do not have and do not expect to enroll in certain other
coverage. There will be a premium, which will be lower than the standard Part B
premium, and people who are eligible for the Medicare Savings Programs,
including QMB, can access cost sharing.
The rule also makes important, but largely administrative, updates to the
functioning of the Medicare Savings Programs, including limiting the premium
liability of states in situations where a person is awarded retroactive
Medicare enrollment and is eligible for both Medicare and Medicaid.
Read a fact sheet about the proposed rule
here<https://nam12.safelinks.protection.outlook.com/?url=https%3A%2F%2Fclick.actionnetwork.org%2Fss%2Fc%2FatcYNHk4Eh2YdGnwBh-YDEybHypJO_UCwq6AvxHgpBuy2HrI663e2waKPq3YNK_STprsPGZsV6J_E538KD8JsTG5jgD1VPbLHXkf-9BMSRlZDyYT0J1Y-0dMyE0qsY_Dr-ojw_WvAGzl1OyMhOcOeoZWW3-hLp8tNwsBEQZlUdZcqIPCSYbvXAM8hOa-YAsj0S4u_TLF-mHDoGMJ3AtsfWFZMnMDCsqY5KoJzwGnUen2y1RHMvT3Fm0I62LcyobMEWuE05e-ji_qcBwQEb3qqA84GdzwmURx3rvgWTe2ugJOsScSQlQlBb24h6PzuLmEAkNYpUUQrWW_m0gQ0-du95ZWpOz_oUnRIx6Mh7LkaDIJYqpADUrMdd8rNnHAqMFfuHI5yv26hQLnC2OCgdWxQD9ayclSQvvh4jNRI3U9DG6drXJItEz-ytXzcKX2EqjcuMLQ3jrunnTX4-APM0j6MA%2F3lp%2FqfFXtNLzQl6kYJtY4jWoxA%2Fh2%2FqpRtRpM42BU1oC5le4t0Hf1Eo4Otvv6nPdXsy-ttj5U&data=05%7C01%7C%7C23cca0f880bc4b61bcdd08da2c2af3da%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637870860245485752%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=QV%2By%2BaY5X8Mp1yGZd8S%2FVSLcM%2B2ldPYPXtiATXkxsSA%3D&reserved=0>.
Read more about the BENES
Act<https://nam12.safelinks.protection.outlook.com/?url=https%3A%2F%2Fclick.actionnetwork.org%2Fss%2Fc%2FatcYNHk4Eh2YdGnwBh-YDF4XFQ5RBkSodmMvsTyswfSekbd9HeTw3AKBLVW8jrwOsBa6QYYrOhKq5NY1lrOasKJZUkSpZ-GRo4R8F2hz6WyTdRpdN7g8B1QrBze4ICxJsuWQSEJHnvPo0OUXmt4RBExEOn_xY2nFLrg0zVtkurZzxd95BZPZGgOE7g2hJ3D03Zcz7_hJWhEvWgat8NFUnUMHK-fvhzMiCDTA9koRx08MSg01Ts_8HJit2iwJxF3nhMtmc5t62zkdaBCt2WnxcTEh8AjtTsNCeC7v1RPxalKKGUcqHfGCjSXcRw9h2xeR3po2FKVTsNJa57ElKI2wJ6nAOHpwxbvvXLX6wIfAOsHPBgZjXee7ZGHfKnY_SVbpjuAjPb2CU3G0EAAHiHSg0JJR0J_fZ5RxLyJ2yQEatcMd3hjeAJHu3_8Oc1FEBV9F%2F3lp%2FqfFXtNLzQl6kYJtY4jWoxA%2Fh3%2Ft4510nfIAMiF90i3qTz_PF7Kdw3ojBl8inELwB7t_ys&data=05%7C01%7C%7C23cca0f880bc4b61bcdd08da2c2af3da%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637870860245485752%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=0XAzwtnc5S0UwuNtMpU1GLjRCnSNV4%2FX66L00qySShM%3D&reserved=0>.
Read about the BENES 2.0 Act which would further simplify Medicare
enrollment<https://nam12.safelinks.protection.outlook.com/?url=https%3A%2F%2Fclick.actionnetwork.org%2Fss%2Fc%2FatcYNHk4Eh2YdGnwBh-YDF4XFQ5RBkSodmMvsTyswfRgiMLgVRZm-LqC__b04sNpFgVi5_Nf1w2Fy51-lPmB9dG-6YqMccVVtRxVyFYTdiXdEbXdjmWHRm_hJnXwJ4k-yqLpnf0P3uW-QjQOpuk0-G9mWmNucd9VpGpZylzljAn7rujyoUNdSbw9HJnPqlIa3A1H8e4OW_2EdnLwIuTbUAMHfm1O2fHehXKeTKo_Y5ED3fA7dQ0SP5YrBPxzFmMWAjzZAOWX_j-LPpO46lQV_Y531u1jf_9SH4z7U8EJ-Zi0UrDmyp6304J7F2vrhJB4kvVrYqdlGIUtEVPwA4SD1a_eQrljDbRCBHaqsShYJlXYwczWv6f6Tzxnm5yNyqKliQxvpiVsfANaEz-nqaetNzgkOKYhJVvKR-x7t0oBCbAhZZdXM40WI3RBUOcB120ic1QirThCQOxVKCDlB7beqQ%2F3lp%2FqfFXtNLzQl6kYJtY4jWoxA%2Fh4%2FmQAmG56JhLI_inDqJodww95LDW0Zc_7dMiezQzSl99w&data=05%7C01%7C%7C23cca0f880bc4b61bcdd08da2c2af3da%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637870860245485752%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=efOBHCoy1sn1rY49OADSGa99lXlPMFzgTeNp06P3fnA%3D&reserved=0>.
izMay is Older Americans Month!
Every May is Older Americans Month and this year’s theme, Age My
Way<https://nam12.safelinks.protection.outlook.com/?url=https%3A%2F%2Fclick.actionnetwork.org%2Fss%2Fc%2FP8Elou2Rvc0qoMPEUZrMXbCCe1ma5X_eWqRUvMOVX2gfxsurT0HL9ofCTNIG_3Ih9cJP3zOqvd0sIZ_apznhiEsI3Pox3cTMcchFW5oePwKNv47Gwx8ZqYs9WTrbTZWlO5iCkMvG_gWgAfOIkh6QbjF74zOXAvxey0XTLkbUqGZt0Eq874owpWwfDHiQ4bNQq8kN2xI5hKaKxeGsV1U5AomewIuApDD25xSyOy2Hk32IUy5uGub7JCxIPhgSxm-BCOGWQO2XacGc4BgOBxkIFjGsxaSgfN96rTaT4Crubn_k-QBpPmK4De9Qd1xpqBf-IYoO9pzqQERfKrltZJ9oHg%2F3lp%2FqfFXtNLzQl6kYJtY4jWoxA%2Fh5%2FyuCQssIGsWxBggxlv6b4TBgiSc4aFreQemXDRXR2aRo&data=05%7C01%7C%7C23cca0f880bc4b61bcdd08da2c2af3da%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637870860245485752%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=imzJsAmLZBxaEW%2Bhurl5cAYF55tKpNxZ1mxeEWSk5cg%3D&reserved=0>,
provides an opportunity to explore the many ways older adults can remain safe
and involved with their communities.
[https://s3.amazonaws.com/can2-unlayer/1651253344480-image+(13).png]
The Alliance encourages everyone to make themselves aware of the work of the
Administration for Community Living (ACL), part of the United States Department
of Health and Human Services (HHS), which focuses on how older adults can plan
to stay in their homes and live independently in their communities as long as
possible.
Planning, participation, accessibility, and making connections all play a role
in aging in place. The National Institute on Aging, also part of HHS, has a web
page<https://nam12.safelinks.protection.outlook.com/?url=https%3A%2F%2Fclick.actionnetwork.org%2Fss%2Fc%2FatcYNHk4Eh2YdGnwBh-YDJ55sJfaZ7E0ac-JjoCAnzt625uj0EgF5OS2L7N2xcunDbw7GFwG_dKXwLUk-2XnJSDGqmD3gNdC8GHSuXVFGwzb_S377Cq9df6xniuLKtbxDJK2yjDOCe7fH7iDuktFRTBZH5_PuWQpgKaUeaSyRnRa5QBPDJBUcO93FNTn2ui--46Z1Mjh6dwXETCw_gSjrgd-gY0nZne96PY7PDUe0L6AmXLbNgGF3a2xllkIWRBXfK8fTV9lLTlowkCqD58h7VAYQ2GYS_Z4JIjcXM0-9ShAVBQl_rLhGSF6V2Rx5b_iVbmXTqnXu8Ws0UK2J6dw_svvKeHvScNPh4XSP-xEnk8%2F3lp%2FqfFXtNLzQl6kYJtY4jWoxA%2Fh6%2FB3EH_HdKG_-35rcXUBj5jK6nEkrZXvp0AMBcDAssBUI&data=05%7C01%7C%7C23cca0f880bc4b61bcdd08da2c2af3da%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637870860245485752%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=%2FcUg4NITVm%2BDYY2Q0bXvSdmS83Y7FP0imhgLiTsTSQk%3D&reserved=0>
which gives advice on how to plan to age in place if that is your preference.
"It is important to remember that every senior's needs and preferences are
unique, but wanting to age in place remains a goal for the majority of older
Americans," said Robert Roach, Jr., President of the Alliance. “However, aging
in place can carry risks and challenges, from falls to transportation issues.
Planning ahead is important to prevent health problems and ensure that older
people can enjoy the benefits of staying in their homes and communities.”
HHS Investigation Finds Many Medicare Advantage Enrollees are Denied Necessary
Care
Medicare Advantage (MA) plans have grown in popularity, with enrollment more
than doubling over the last decade. However, an investigation conducted
<https://nam12.safelinks.protection.outlook.com/?url=https%3A%2F%2Fclick.actionnetwork.org%2Fss%2Fc%2FBqA3LhzOFl92KwaVoz69Nwd4cDe1TV7YkueOjLGkV_98SyJ8n6GcKtb2XBuJjtdzKuhp1uM9LtlydafAZL4ScAtVCcZBY8myk4G90I_DSNE6LZHTvi3fCjaeYbmphSJF7cZdqbHp_L1wVtv97qqBL0scDdGdkyswrfrqm9WL7pqHMJ0CeD7HcRh58JNYXH38TYK8FtYiixA3-q2BzoCF4G3Rp-gNgFgklFyBT8PyPxzsOYV7XukjhC6Ly5RewmpnVWnSdguDV0JwIWdlDi1BFPHOmf7O0pMju2DDYLNZmtk--3c1GmF4R2mmlxWpv9LCoiLAmYbJ_4Wq60scLdwd4w%2F3lp%2FqfFXtNLzQl6kYJtY4jWoxA%2Fh7%2Fhh_sMcb9QoyMzavcppTvk9PGBBtirLKiJlsIyXZIIK4&data=05%7C01%7C%7C23cca0f880bc4b61bcdd08da2c2af3da%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637870860245485752%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=Kfs1ihJwyGScLO7bAGs73lxP7cQ1Hzak7ShAR46L6zw%3D&reserved=0>
by the HHS Inspector General found that tens of thousands of enrollees are
denied care that should be covered under the program.
Advantage plans offer a privatized version of traditional Medicare coverage,
and they sometimes offer less expensive options or a wider array of benefits.
However, the price can be delays or
denial<https://nam12.safelinks.protection.outlook.com/?url=https%3A%2F%2Fclick.actionnetwork.org%2Fss%2Fc%2FatcYNHk4Eh2YdGnwBh-YDGlyFEPfIQqTPhAJ7ICxnKHC5GclHIcwZZdx5jEm-yLpAboPhQHRZaQng-11gSaNLY2PLHgNxHerpQZSl8H1wk8MtYTxuveH7th-7AyMsgm4khsyIJU0Ar7iLP-3eVvWAqXopYGk6dqicgQgQ5H69GjoxsfEuNAxPvI0MlVqza5yzS4eEAZfpi4OJOz8AuC6RylcsH3Qfuq9PnmpFPr410NvNWhpD7PpaVTIufTqBZdBblB0ZYKsiXSDiK6F4d6xWoAZz_Pp8zAR7EsiSr7G8ox8glJxumUVir7jgwNKLLUgrzDE6Cjkn9PnwYxw8Jme9UPsnfvslLWJSapfV0IxJKk3cGeEF7NA98KSh84qBiuV%2F3lp%2FqfFXtNLzQl6kYJtY4jWoxA%2Fh8%2FfsVIeKewO4zqB6zF2sRd0FZzMDTecCcT-eC6NUD2CW8&data=05%7C01%7C%7C23cca0f880bc4b61bcdd08da2c2af3da%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637870860245485752%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=Ut58BNqIZuldWuZN5rDWU3p3kl9UMR8m7r0z4lMG5Zo%3D&reserved=0>
of needed medical care which Medicare requires MA plans to cover.
Tens of millions of denials are issued each year for both authorization and
reimbursements by the MA private insurers, and the report found “widespread and
persistent problems related to inappropriate denials of services and payment.”
Hospitals and doctors complained about the insurance company tactics for years,
and Congress is considering legislation to address those concerns.
“Medicare Advantage plans too often give insurance companies too much power to
make medical decisions,” said Joseph Peters, Jr., Secretary-Treasurer of the
Alliance. “MA plans are contractually obligated to follow all of Medicare’s
required coverage rules, and in many cases they are not. HHS needs to hold all
MA plans accountable and ensure they deliver the health care benefits patients
need when they need it.”
Sen. Warren, Experts Highlight Executive Actions to Lower Drug Prices
In a
letter<https://nam12.safelinks.protection.outlook.com/?url=https%3A%2F%2Fclick.actionnetwork.org%2Fss%2Fc%2FatcYNHk4Eh2YdGnwBh-YDL0195r-gNaKL0NXw0E6jsZuKl1avBTLb2IeCccY6Ve48SEsHwiG77ejdiuLh57mUKOx-qt1EHWJqjMQa0FAxUbL-gd3Oj6P5GqbCaIxyf0NB4cRg6y7brrH9w6pcIfcc4vpbUwKAsJ3BVlR2aXUtfiEto7s4-uGykf3c5-4SjN8JIiiE2UNFCKkfoCDDdzNGU8GkB82Hci1MMZVpgVN-0mmwsaRjUatwo806kWxqpMR0wn0Vq_xpX2F-UmxCNxvfb7JVVE3UwCXSsrI1i4I49aQmAKWIA_sjiYRGw-IfZIA3-8P8kIAJmmYuKx4cXcMUXuRws-jGJf4dnhXTaWKINA%2F3lp%2FqfFXtNLzQl6kYJtY4jWoxA%2Fh9%2Fc4ORvMKjf-ipNZrqBm1st1BO_5SZXEc3O14IMjbkdQ0&data=05%7C01%7C%7C23cca0f880bc4b61bcdd08da2c2af3da%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637870860245485752%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=hhCsmR%2FgjXncI2%2FQZxVWePKzUPBuFiXH9asfIhJkCPA%3D&reserved=0>
to HHS Secretary Xavier Becerra, Senator Elizabeth Warren (MA) outlined a
number of executive actions that the Biden administration could take to lower
the cost of prescription drugs.
Backed by legal and medical experts from Yale Law School, Harvard Medical
School and Columbia Law School, the Senator provided an extensive list of
options<https://nam12.safelinks.protection.outlook.com/?url=https%3A%2F%2Fclick.actionnetwork.org%2Fss%2Fc%2FZsYp6Jc2ATNP3MkVzvte6IX7LXmCC1H1bxMzsGmXS2hCPq7CD9RL2eVbMH1ZVZwdKUqvJI7mQMd-WOXqRN_NZIr644YMVBtrB_jZ0u3c6_TwS7hQmoeOAWyDHIi-kkyeCtmKTJGKs5OFaV9rF0xxlwIldz4gJXK2qZLSq0j0AuyXQhMz6MVs6joRYzr-yfUtyEFYiXABtrFHrcDLk78ftwtNwu7EffLiWT5QA86PCljgCICYZ9geBFABOI5Uml13s0z7W_AxzO7CqWlclKCA2hLIx5mUUhDqktKfxSBNYQTKrfXBAIknTm0mdCDEqrbbh-CvT6yoeFZr78MEzglCeERHBVpJWoxEaYWrzqflT7XLCZvKZXrk2SqS2jBHp0Gpg90vQitBfzUL9iS2NVeQgETa8nSTLwXE49rX2OwPJ3AxeCZoyLdQd5SMV-E-VC2f%2F3lp%2FqfFXtNLzQl6kYJtY4jWoxA%2Fh10%2FCoJiyaJDH7ENdT5mBHAh2LYhB_Zy4ZcvH0BzKd64f5I&data=05%7C01%7C%7C23cca0f880bc4b61bcdd08da2c2af3da%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637870860245485752%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=ltbjo25DpwU4g7JfVNlAXhwPuwxFwyk1npaGX8mpqlI%3D&reserved=0>
for lowering drug prices without additional Congressional intervention.
Sen. Warren mentions ‘government patent use power,’ as one action the Executive
branch could take. This option formalizes the government’s ability to use any
“invention described in and covered by a patent of the United States” without a
license, provided that the use is “by or for the United States” and the patent
holder is afforded “reasonable and entire compensation.” As recently as the
1960s and 1970s, federal agencies used government patent use power to procure
low-cost versions of patented medicines.
Other possible actions come by way of the Bayh-Dole Act’s “royalty-free
license” and “march-in rights.” Adopted in 1980, the Bayh-Dole Act was intended
to ensure that the public would not be deprived of the benefits of inventions
that it had effectively sponsored through government-funded research.
Royalty-free licenses to covered patents permit the government to manufacture
drugs for its own use or license production on the government’s behalf. Sen.
Warren writes that the plain text and statutory purpose of the Bayh-Dole Act
make a strong case that this option encompasses production of drugs for use by
government programs such as Medicare and Medicaid.
March-in licenses can be authorized if a patent holder has not taken “effective
steps” to “achieve practical application” of a drug or if “action is necessary
to alleviate health or safety needs which are not reasonably satisfied” by the
patent holder. Sen. Warren writes that excessive pricing alone should provide
sufficient grounds for exercising march-in rights.
“As important as these Administrative actions are, these recommendations are
not a substitute for strong Congressional action. Congress must put the needs
of patients first, and pass legislation curbing the pharmaceutical industry’s
monopoly power and allowing Medicare to negotiate lower prescription drug
prices. A cap on the price of insulin is also important,” said Richard Fiesta,
Executive Director of the Alliance. “Americans continue to pay the highest
prices in the world for prescription drugs, and comprehensive action is needed.”
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