Dozens of seniors turned out at the Edward A. Myerberg Center for a recent health care town hall hosted by U.S. Sen. Benjamin L. Cardin and District 41 Dels. Sandy Rosenberg and Angela C. Gibson. While seniors were looking for answers on drug costs and universal health care, the conversation often focused on what the current administration is or isn’t doing to mitigate what some call a health care crisis.
A February 2018 report by the U.S. Centers for Medicare and Medicaid Services estimates that health spending in 2018 will rise 5.3 percent partly due to higher prescription drug costs. The agency also expects Medicaid spending to rise to 6.9 percent in 2018 from 2.9 percent in 2017, mostly from faster growth in Medicaid’s health insurance costs.
Rosenberg introduced the forum by saying that health care for all is a federal and personal obligation. “The heart of the Affordable Care Act is that everyone should have insurance, and that we share the burden of providing health care costs, for providing governmental assistance and for providing health care at an affordable rate for all citizens.”
He said Maryland has been able to mitigate some of the federal pressure on health insurance with its 40-year-old model “all-payer” hospital rate regulation system (the only one in the nation), which ensures equitable rates for hospital services.
Cardin said many administrations have tried to advance health care, including the Obama administration’s ACA, which he supports because it endeavors to get everyone into the health care system.
“I regret that President Trump has done many things to undermine the Affordable Care Act,” Cardin said, noting it’s made it difficult for people without employee health care coverage to get health insurance. “The state of Maryland is trying to do something about that now.”
Cardin said seniors should be concerned, because “part of the effort of unwinding the Affordable Care Act is the direct attack on care for our seniors,” he said. “The Trump administration would like to get the federal government out of the Medicaid system. Medicaid is the safety net that helps working families, as well as our seniors, on long-term care.”
He said he and colleagues in Washington are making progress to protect and expand the Medicare system, to eliminate the prescription drug “doughnut hole,” to ensure catastrophic coverage and reduce deductibles and copays.
“But make no mistake about it, there is a hostile environment in Washington today,” he said, adding that he works with legislators in Annapolis to keep Marylanders protected. “Maryland has a unique health care system that has served the community well.”
Rosenberg pointed to bipartisan legislation passed this year to help Maryland provide a “reinsurance system” so that people covered by the ACA can still get coverage and assistance with health care costs.
Del. Gibson related the story of a 93-year-old constituent whose 90-day supply of diabetes medication jumped from $90 in November to $176. Without his medical card, Gibson noted, it would cost him $3,500. Gibson cosponsored a bill to create a prescription drug costs commission to study costs and affordability. The bill did not pass, but Gibson said it would be revisited next year.
“We’re going to work with Sen. Cardin about getting these pharmaceutical companies to come down on the costs of drugs for seniors, as well as for everyone,” she said, adding she is collecting anecdotal information to build a case about high prescription drug costs.
Attendee Dr. Donald Dembo was concerned that life expectancy in the U.S. has dropped and that his 90-day supply of maintenance drugs has risen from $40 four years ago to $250 today. “This is from the same drug company,” he said, asking why the price is so high.
Cardin called current prescription drug costs “scandalous,” and cited the pharmaceutical manufacturing group PhRMA for “preventing us from using our market forces to bring down costs.”
He said the system as a whole needs to be more efficient in coordinating and delivering health care, including new initiatives such as telemedicine. He said a reformed health care system, better care delivery and lower costs would improve care and lower physician burnout rates.
Meanwhile, a man in attendance asked panelists if they supported “single-payer, government-controlled national health insurance.”
The panelists said they supported the idea, but were not sure how such a national program would be funded adequately and consistently.
“If you happen to elect someone like Donald Trump and you have a Republican-controlled House and Senate and all your eggs are in the federal appropriation bucket and it’s not mandatory spending, I worry about whether we’ll maintain health care for the people of this country,” Cardin said.
A retiree who worked for the state of Maryland for 50 years said he received a letter that state Medicare-eligible retirees won’t receive prescription drug coverage in 2019. “I wonder if any of you have a suggestion of how to go about correcting this problem,” he asked.
Cardin said the state will require Medicare-eligible retirees to sign up for Medicare Part D, the prescription drug benefit, in order to save money. Rosenberg said he would look into the policy and make sure his coverage would continue.
Another woman was concerned about doctors turning to so-called “concierge medicine” and its high cost for people on fixed incomes.
Cardin said current Republican leadership would not address concierge medicine because they don’t consider it within the balanced billing restrictions of Medicare, “so it’s permissible for primary care doctors and others to do that.” He said some doctors are turning to concierge systems because of frustration with reimbursement structures.
After the event, Cardin addressed how the health care system will handle increasing demand and pressure from the aging baby boom generation.
“Moving forward, we think Medicare is a more challenging cost figure for the federal government, certainly Medicare and Medicaid, than Social Security long-term,” he said. “So, there is a sense of urgency of getting health care costs under control. It’s not so much getting Medicare under control. It’s getting health care costs under control.”