What is Changing in Health Care Now?!

As we are all aware of, another change to health care has come with the recent Inflation Reduction Act. The new law is set to affect some, but not all Americans. We all have heard a lot of praise about the bill, but what will it actually change about the way you receive your health care? 

If you want the short answer, Democrats finally followed through with their long term promise to reduce prescription drug cost, but as with all things that come out of congress it comes with a few stipulations.

To start with, the new law only applies to Medicaid and Medicare recipients only, and not the privately insured. It also will not be taking effect until 2026, and with only 10 selected drugs. Of which have yet to be determined. Momentarily it is only these selected drugs which are directly being considered for price reduction. The next big change will not come until 2029, when the number of Prescription drugs being capped will rise to 20. Even though changes will come in 4 years, when the time does come, the law will accomplish capping insulin to $35, and only for Medicare and Medicaid members, and not with the privately insured. This provision for capping drugs across the board was in the bill originally, but was struck out by Republicans refusing to overrule the Parliamentarian to allow that provision, once again leaving millions of Americans to still pay inflated pricing for life saving drugs, like insulin. 

Lobbyists have been battling the capping of drugs all along the way, claiming that capping the cost of drugs would reduce expenditure on research and development of new drugs. In the past 12 months, PhRMA and closely allied groups spent at least $57 million — $19 million of it since July, on ads opposing price negotiations, and in the last year unleashed 1500 lobbyists on capitol hill at the tune of over $100 million. Although they claim it would reduce research, it is a fact that big pharma has consistently spent more on marketing and lobbyists than it has on research, and not by a small margin, but by billions over the years.   

In the past few years 14.5 million people signed up for the Affordable Care Act (ACA) due to more subsidies than ever before. Florida leads the nation with a record 2.7 million of those signing up. These subsidies allowed millions to have access to care, during the Corona Virus outbreak that we have all been living with recently. In this new law, those same people will still qualify for recent subsidies, which were set to expire this year, but now will continue until 2025.

Now let's go back to the lowering of prescription drugs. Within the bill the highest costing drugs will face negotiations from Medicare in 2026, and on top of that, all Medicare out of pocket cost will be capped at $2,000. A move that will benefit 63 million of some of our most vulnerable members of our society. One of the downsides was that the bill originally sought to cap the increase of drug prices as a ratio of inflation, but that did not make it through the Senate to the final writing of the law. With that being said, 330 million Americans will continue to struggle with high healthcare costs.

Here are some other changes to look out for in the new law:

• Low income Part D subsidies expansion- The bill expands who can qualify for the Low-Income Subsidy Program. This is the section of Part D that helps meet cost sharing burdens like deductibles. The current program allows a beneficiary to qualify for the program if they earn 135% of the federal poverty level, and a partial benefit if they earn 135% to 150% of the level. The new rule would allow full benefits to those who earn 135%-150% according to an analysis from the Kaiser Family Foundation.
• The new law will also eliminate cost sharing for adult vaccines for Medicare Part D, requiring states to cover all vaccines for Medicaid and Children's Health Insurance Program beneficiaries. This section of Plan D will be limited to vaccines that are cleared by the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices.
• There would also be a delay in the controversial Trump-era safe harbor Part D rebate rule. The rule was passed at the tail end of Trump's term, but has never gone into effect , and now will be delayed until 2032.
• And finally the new law limits the premium growth of Medicare Part D to no more than 6 percent between 2024 and 2029. This is where the $2,000 out-of-pocket cost cap on Part D drugs comes in, and will require the spreading of cost out in installments for the member over a calendar year. Part D will also have to start picking up more of the cost in the catastrophic coverage phase, which a member reaches when their drug cost attains a certain level of cost. 

As you have read these changes are still a few years off, and if one thing is clear when it comes to healthcare in America, today's rule is tomorrow's exception. Which is why we will be your experts in keeping track of all the new laws and changes to healthcare. At Benefits Management Team we will be your experts, advocates, and most importantly we will be there to answer the phone when you call. The only thing we ask of you is for the opportunity to earn your business, and to show you how to shop smarter for healthcare.

Do not go it alone when shopping for your own healthcare, please have a BMT expert help to make you a consumer of your healthcare, and not a victim.