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for-profit healthcare system
Trump Reportedly Picks Medicare Advantage Lobbyist for Top Health Budget Role
Don Dempsey would join Centers for Medicare and Medicaid Services nominee Mehmet Oz and other supporters of privatized Medicare Advantage plans in the new administration.
Jan 23, 2025
U.S. President Donald Trump is reportedly set to appoint a lobbyist for the for-profit health insurance industry for a top White House budget job, a move likely to heighten concerns about the new administration's expected push to bolster Medicare Advantage plans that deny necessary care and dramatically overbill the federal government.
The Financial Times reported Wednesday that Trump is "poised to appoint" Don Dempsey as associate director of the Office of Management and Budget's health programs. The appointment would give Dempsey "sweeping power over the $1.8 trillion U.S. healthcare budget and responsibilities of the 13 divisions and agencies," the newspaper noted.
Dempsey is currently the vice president of policy and research at the Better Medicare Alliance, a lobbying organization that describes itself as "the nation's leading research and advocacy organization supporting Medicare Advantage." FT observed that the group is "funded by insurance companies including UnitedHealth Group and Humana"—the two largest Medicare Advantage insurers in the United States.
Trump's reported choice represents another potential boon for Medicare Advantage, a program run by private insurers and funded by the federal government. As STAT reported last month, "Medicare Advantage insurers thrived under the first Trump administration, and it's expected to happen again now that Trump is returning to the White House and Republicans are taking control of Congress."
The president has nominated Mehmet Oz, who has previously expressed support for a plan dubbed "Medicare Advantage for All," to lead the Centers for Medicare and Medicaid Services (CMS), a move that one watchdog warned would kick Medicare privatization efforts "into overdrive."
Since his inauguration earlier this week, Trump has taken a number of steps that have alarmed healthcare advocates, including rescinding Biden-era executive orders aimed at lowering prescription drug prices and strengthening Medicaid and the Affordable Care Act.
"On one hand, what we see coming from the executive orders by Trump is important because it shows us the direction they are going with policy changes," Sarah Lueck, vice president for health policy at the Center on Budget and Policy Priorities, told KFF Health News. "But the other track is that on the Hill, there are active conversations about what goes into budget legislation. They are considering some pretty huge cuts to Medicaid."
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US Drug Prices Still Far Higher Than Other Nations' Even After Medicare Talks
The U.S. "has always accepted that we are the country that overpays relative to the rest of the world," said one health policy expert.
Sep 03, 2024
The Biden administration's Medicare drug price negotiations yielded lowered costs for 10 commonly used drugs, and the White House said last month that Americans would save an estimated $1.5 billion in out-of-pocket expenses thanks to the talks—but an analysis out Tuesday found that the U.S. will still be paying far more than other wealthy countries.
Reuters reviewed the maximum prices that Australia, Japan, Canada, and Sweden have agreed to pay for nine of the 10 drugs for which Medicare negotiated prices this year, and found that the U.S. will still be paying more than double the amount for the medications on average.
The new prices are set to go into effect on January 1, 2026, but two of the highest prices the U.S. will still pay are for Imbruvica, for blood cancers, and Stelara, for conditions including Crohn's disease and psoriasis.
Medicare will be charged $9,319 for a 30-day supply of the latter drug, compared to $4,607 in Sweden. For Stelara, the U.S. will pay $4,695 under the negotiated prices—more than four times the amount it costs in Sweden, Australia, and Canada.
For Enbrel, which treats conditions including arthritis, Medicare will pay $2,355 per month—far less than the list price of $7,106, but still more than $1,000 over what Sweden is charged: $709. Australia pays $573, while Canada pays $704, and Japan pays just over $300 for the drug.
"The government negotiations are especially significant for drugs where market forces were most limited and therefore had the least impact on producing price concessions."
Stacie Dusetzina, a professor of health policy at Vanderbilt University, told Reuters that the U.S. has "always accepted that we are the country that overpays relative to the rest of the world."
The analysis comes two weeks after the Brookings Institution published a review of the impact of the United States' first federal negotiations of prescription drug prices, finding that just three of the drugs which had little competition in the market accounted for more than half of the $6 billion the U.S. is expected to save in 2026.
"The government negotiations are especially significant for drugs where market forces were most limited and therefore had the least impact on producing price concessions," said Brookings.
Reuters noted that in other countries, prices generally come down over time, but U.S. drugmakers are able to raise prices annually and often extend patents by making small changes to medications, stopping less expensive generic versions from hitting the market and saving patients money.
Unlike in other wealthy countries, Johns Hopkins Bloomberg School of Public Health scientist Mariana Socal told Reuters, "the longer a drug is in the U.S. market, the more we pay."
With previous list prices well into the hundreds and thousands for the 10 drugs included in negotiations so far, Medicare agreed to pay close to $200 for a 30-day supply for drugs including Xarelto, Jardiance, and Farxiga—medications for which other governments examined by Reuters pay $78 or less, thanks to their longstanding negotiations.
The RAND Corporation found in a study in February that before the Medicare negotiations were included in the Inflation Reduction Act, U.S. health plans paid more than three times as much as other countries for brand-name drugs, even after discounts.
"A contributor to higher U.S. per capita drug spending is faster uptake of new and more expensive prescription drugs in the United States relative to other countries," wrote researchers at the London School of Economics in a study in 2013. "In contrast, the other OECD countries employed mechanisms such as health technology assessment and restrictions on patients' eligibility for new prescription drugs, and they required strict evidence of the value of new drugs."
The researchers suggested pharmaceutical companies in the U.S., like in other countries, should be required "to provide more evidence about the value of new drugs in relation to the cost" and negotiate prices accordingly.
As Merith Basey, executive director of Patients for Affordable Drugs, said in August after the results of the first round of negotiations were announced, advocates are still pushing for far more savings in upcoming talks between Medicare and drug manufacturers, which are expected to start next year.
"We remain committed to expanding the Medicare negotiation program to more drugs," said Basey last month, "and fighting for additional reforms to lower drug prices for all patients who need relief."
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UnitedHealth Reports $7.9 Billion in Q2 Profits After Protesters Arrested
"Health insurance coverage has expanded in America, but we are finding it is private health insurance corporations themselves that are often the largest barrier for people," said one organizer.
Jul 16, 2024
A day after 150 people assembled outside the headquarters of UnitedHealth Group to demand the for-profit health insurance giant stop its "systemic" denial of coverage, the company announced Tuesday the huge profits it raked in over the second quarter of 2024: $7.9 billion.
The sum, said one organizer, exemplifies why the demonstrators were willing to risk arrest to speak out against the firm's practices.
"UnitedHealth Group's $7.9 billion quarterly profit announcement is the result of a business model built on pocketing premiums and billions of dollars in public funds, then profiting by refusing to authorize or pay for care," said Aija Nemer-Aanerud, Health Care for All campaign director for People's Action Institute. "People should not have to turn to public petitions or direct actions to get UnitedHealthcare to pay for the care they need to live. That makes no sense, unless you're a shareholder or executive eyeing your next big luxury purchase."
Eleven people were detained by police at Monday's demonstration, where they blocked the street in front of UnitedHealth's headquarters in Minnetonka, Minnesota, displaying signs that read, "United (Denies) Healthcare" and "The Price Is Wrong."
The demonstration was organized by the Care Over Cost campaign at People's Action Institute, which has worked to help people across the country overturn care denials by UnitedHealth and other for-profit insurance giants.
Gina Morin of Auburn, Maine spoke at the event about having her mental health treatment denied by her Medicare Advantage plan administered by UnitedHealth.
"Two years ago my therapist was denied payment for seven of my mental health sessions she provided," she said. "I tried to pay her even though I'm on a limited income and she wouldn't take the money. If my provider, in her professional opinion, believed I needed those therapy sessions, who is UnitedHealth to deny coverage?"
As Common Dreams reported last month, UnitedHealth was named in a letter written by 52 members of the Democratic caucus in Congress as one of the healthcare companies that use artificial intelligence to decide via algorithm that coverage should be provided or denied to patients who have Medicare Advantage plans, which are billed as offering coverage that traditional Medicare doesn't include.
ProPublica reported last year on Christopher Naughton, a man with ulcerative colitis whose treatment cost $2 million per year, leading UnitedHealth to flag his account as "high dollar." The company contracted with a doctor to review Naughton's case, and the doctor found the treatment for symptoms including arthritis, debilitating diarrhea, and blood clots was "not medically necessary."
After suing the company, Naughton's family found UnitedHealth had lied about what Naughton's personal physician told the contractor in order to come to their conclusion and end coverage.
"Health insurance coverage has expanded in America, but we are finding it is private health insurance corporations themselves that are often the largest barrier for people to receive the care they and their doctor agree they need," Nemer-Aanerud told CBS News Monday.
In April, People's Action sent a letter to UnitedHealth noting that its CEO was paid nearly $10 million in 2022 while the CEO of its parent company "extracted over $90 million in executive and board pay for himself" over four years.
The company took $22.4 billion in profits in 2023 and sent $14.8 billion to shareholders through stock buybacks and dividends—yet continues to deny necessary healthcare coverage to its members.
The group called on UnitedHealth to:
- Stop denying claims and overturn any existing denials for treatments recommended by medical professionals;
- Immediately cease the practice of using artificial intelligence and algorithms to initiate claims denials in bulk; and
- Execute a publicly shared audit and reimburse federal and state governments for the public money diverted by claim and prior-authorization denials within Medicaid (Managed Care), and Medicare (Medicare Advantage), among other demands.
"We will never stop fighting for a world where everyone gets the care they need, no matter their race, gender, or background," said People's Action. "When greedy corporations deny our care, we organize."
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