Trade Agreement Needs to Protect Access to Affordable Drugs

December 18, 2014 at 10:02 am

AARP, the AFL-CIO, Doctors Without Borders, the Generic Pharmaceutical Association, and Oxfam have written President Obama expressing several concerns — which we share — about the Trans-Pacific Partnership (TPP), a trade agreement that the United States and 11 other Pacific Rim countries are negotiating.  The proposed agreement requires changes to avoid reducing access to affordable drugs both in the United States and abroad, they explain.  Here are three excerpts:

  • “[T]he intellectual property (IP) provisions that the U.S. Trade Representative has proposed fail to strike a proper balance between fostering innovation and ensuring expedited access to more affordable generic drugs through increased competition in the pharmaceutical market. . . . [They] would not only require TPP parties to grant very high levels of IP protection that go beyond existing international trade commitments, but would also lock in policies, for example with respect to biologic pharmaceuticals, that would contribute to putting these very expensive drugs and vaccines out of the reach of patients.”
  • “[T]he Annex on Transparency . . . could jeopardize governments’ efforts to contain costs in publicly supported health care programs. . . . [It] puts too much emphasis on the priorities of the originator [that is, pharmaceutical] industry, and does not give equal weight to patients and public health priorities such as drug affordability, safety, efficacy, and cost-effectiveness.  Indeed, this proposed text could have a negative impact on cost containment mechanisms, such as preferred drug lists, rebates, discounts, and formularies in all countries.  For example, it could adversely impact formularies and utilization rules used in U.S. health care programs, including Medicare, Medicaid, the Veterans Health Administration, the TRICARE program, and the 340B Drug Pricing Program.”
  • “Investor State Dispute Settlement proposals in the Investment Chapter could be used to limit competition, by allowing originator pharmaceutical firms to challenge efforts to manage pharmaceutical spending in public programs, including those used by state legislatures, Congress and public agencies here in the U.S. and abroad. For example, a manufacturer could challenge a state’s Medicaid preferred drug list or utilization rules that limit access to a certain drug under specific circumstances.”

We hope that the U.S. Trade Representative will heed these concerns as the TPP negotiations continue.

Further Health Coverage Gains, Especially in Medicaid Expansion States

December 17, 2014 at 2:08 pm

The number of uninsured Americans fell by 6.8 million over the first two quarters of 2014, preliminary data from the Centers for Disease Control and Prevention’s (CDC) National Health Interview Survey show.  These are the most up-to-date government survey data on the early impacts of health reform’s major coverage expansions, which took effect in January.  And they show a widening coverage gap between states that have adopted health reform’s Medicaid expansion and other states.

Superseding earlier CDC estimates, the new figures that the CDC released yesterday include the second quarter of 2014, when enrollment surged in state Medicaid programs and health reform marketplaces. … Read more

Tennessee Proposal Shows Growing Momentum for Medicaid Expansion

December 16, 2014 at 12:44 pm

Contrary to some predictions, November’s election results haven’t stalled momentum among states to adopt health reform’s Medicaid expansion.  Tennessee Governor Bill Haslam yesterday became the sixth governor — and third Republican — in the past two months to announce an expansion plan.  Twenty-seven states and Washington, D.C. have already expanded (see map).

If the federal government and Tennessee’s legislature approve it, Governor Haslam’s “Insure Tennessee” plan would extend coverage to more than 200,000 uninsured Tennesseans through a demonstration project, or “waiver.”  The federal government has approved four states’ expansion waiver proposals, which give them added flexibility over their Medicaid programs.… Read more

Potato Mandate Overrides WIC’s Science-Based Policy

December 15, 2014 at 12:50 pm

In requiring the WIC nutrition program to add white potatoes to the foods it provides, Congress last week pandered to industry lobbyists rather than prioritizing the nutritional needs of low-income women and very young children.

Study after study shows that WIC (the Special Supplemental Nutrition Program for Women, Infants, and Children) improves birth outcomes and participants’ diets.  One reason is that it provides a “prescription food package” of a limited number of nutritionally important foods that participants’ diets tend to lack. … Read more

In Case You Missed It . . .

December 12, 2014 at 2:25 pm

This week on Off the Charts, we focused on the federal budget and taxes, inequality, health reform, and the safety net.

  • On the federal budget and taxes, Robert Greenstein explained that IRS funding cuts for 2015 will likely lead to more tax-credit errors. Paul Van de Water noted a New York Times editorial on the flaws of using “dynamic scoring” in budget estimates.
  • On inequality, we highlighted our updated paper showing that income gaps have widened significantly since the 1970s.
  • On health reform, Jesse Cross-Call pointed to new figures showing that the law’s Medicaid expansion isn’t hurting state budgets.
Read more

Why Re-Enrolling in Federal Marketplace Makes Sense

December 12, 2014 at 12:02 pm

As of December 5, only about 720,000 customers had returned to the federally run health insurance marketplace to re-enroll or switch plans for 2015, the New York Times reports. Our recent paper explains why people who bought private health insurance last year through the marketplace could pay more than they should next year unless they return to the marketplace to renew coverage.  Next Monday is the deadline for enrolling in coverage to start January 1.

As our paper points out:

People in 34 states who enrolled in health coverage for 2014 through the Federally Facilitated Marketplace (FFM) will be automatically re-enrolled in the same plan in 2015 unless they choose a new plan through the FFM during the open enrollment season, which began November 15 (see map). 

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IRS Funding Cuts Likely Mean More Tax-Credit Errors

December 11, 2014 at 11:00 am

Even as the Treasury Department’s Inspector General noted a significant overpayment rate in the refundable part of the Child Tax Credit (CTC) this week, lawmakers chose — in the pending 2015 government funding agreement — to weaken the IRS’s ability to reduce errors in this credit and other parts of the tax code by once again cutting IRS funding to enforce and ensure compliance with the tax rules.  And, while lawmakers such as Senator Orrin Hatch (R-UT), the Senate Finance Committee’s top Republican, assailed the IRS for failing to address the errors, the Treasury and IRS have recommended a series of measures to Congress to reduce errors in the tax credits and other parts of the tax code — and Congress has failed to act on them (except for one very small measure included in the 2015 funding agreement).… Read more

Our Big-Picture Look at Inequality

December 10, 2014 at 11:58 am

“The broad facts of income inequality over the past six decades are easily summarized,” our newly updated Guide to Statistics on Historical Trends in Income Inequality explains:

  • The years from the end of World War II into the 1970s were ones of substantial economic growth and broadly shared prosperity.
    • Incomes grew rapidly and at roughly the same rate up and down the income ladder, roughly doubling in inflation-adjusted terms between the late 1940s and early 1970s.
    • The income gap between those high up the income ladder and those on the middle and lower rungs — while substantial — did not change much during this period.
Read more

High-Poverty Schools Using New Tool to Streamline Meal Programs

December 9, 2014 at 3:53 pm

Half of the high-poverty schools eligible for the Community Eligibility Provision, which became available nationally this year, adopted it to streamline their meal programs and free up resources for other education priorities, the Agriculture Department (USDA) announced today.

For decades, USDA has offered options to allow high-poverty schools to serve meals to all students at no charge.  Community eligibility, which has phased in over the last four years, further simplifies the meal programs by eliminating the need for schools to process applications or track individual students’ eligibility.… Read more

Medicaid Expansion Isn’t Hurting State Budgets

December 9, 2014 at 10:59 am

State Medicaid spending rose just 2.7 percent in state fiscal year 2014, when health reform’s Medicaid expansion took effect in more than half of the states, a new report from the National Association of State Budget Officers (NASBO) estimates.  Along with Kaiser Family Foundation projections that state Medicaid spending in fiscal year 2015 (which began July 1 in most states) will grow more slowly in states that have expanded Medicaid than in the others, the NASBO report provides evidence that the Medicaid expansion isn’t hurting state budgets.… Read more

New York Times Warns Against “Dynamic Scoring”

December 8, 2014 at 12:06 pm

A New York Times editorial this weekend raised several red flags about so-called “dynamic scoring” — that is, including estimates of the macroeconomic effects of policy changes in official cost estimates for tax and spending legislation.  We strongly agree.  Our recent paper making the case against dynamic scoring, and a short summary we released today, explain that:

  • Current budget estimates aren’t “static.” The Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) incorporate in their cost estimates many changes in individuals’ and companies’ behavior in response to proposed changes in tax rates and other policies.
Read more

In Case You Missed It…

December 5, 2014 at 3:30 pm

This week on Off the Charts, we focused on state budgets and taxes, the federal budget and taxes, the safety net, health reform, and jobs.

  • On state budgets and taxes, Michael Mitchell mapped the large growth in state prison populations in recent decades. Nicholas Johnson presented a video highlighting the State Priorities Partnership, a network of 41 independent organizations working to improve state budget policies.
  • On the federal budget and taxes, Chye-Ching Huang pointed out that a reported congressional “tax extender” package included costly expansions of tax cuts.
Read more